In a series of opinion pieces, Health Mandate’s team of expert health policy consultants look at some of the big issues that will shape the political and the NHS landscape in the next parliament. Today’s piece sees our team of consultants examine the health challenges facing David Cameron.
As the end of the 2005-2010 Parliament approaches, and the political classes gear themselves up for the general election, each of the political parties’ health teams will be looking to prove that they have the big ideas to take the NHS forward in a period of tight public finance but escalating public expectation.
New government, new problems: What health challenges will face David Cameron?
It has become almost axiomatic to say that there are no dividing lines between Labour and the Conservatives on health, and that the same challenges which face Labour today are those selfsame ones that will face David Cameron tomorrow. This belief is misguided, however: the apparent similarities between the parties occurs only because securing support as the most trusted party on the NHS remains a vital determinant of a political party’s success. After all, and despite the economic crisis, both parties’ internal polling demonstrates that healthcare remains the number one issue amongst the 20- and 30- something female voters who will decide the outcome of the next election.
It is this importance that has seen the Conservative Party ditch long-cherished policies on healthcare in its quest for key swing votes, including tax relief on Private Medical Insurance and its ideological successor, the Patients’ Passport – and in the process decisively move itself closer to Labour. People should not be fooled however, scratch the surface and there are many radical and controversial ideas which expose deep ideological differences. Chief among them a rapid return to GP fundholding, free price competition between NHS and non-NHS providers, and the scrapping of NHS targets. Every single one presents a potential challenge for David Cameron.
Strengths or weaknesses?
Many of the challenges facing Cameron are those which should be strengths: the commitment to real-terms protection of the NHS budget, together with the statement of support for the NHS frontline, imply that the first 18 months of a Cameron administration should be relatively trouble-free. But these apparent strengths hide great weaknesses:
The funding crisis and the need for efficiencies will put downward pressure on staff pay at a time when pay in the private sector will start to bounce back after the recession. The Conservatives’ ‘Any Willing Provider’ policy, designed to stimulate competition in healthcare provision, will demand wholesale changes to, and even the closure of, the NHS pension scheme. Finally, Shadow Health Secretary Andrew Lansley has pledged to renegotiate the GP contract and rip up GPs’ beloved performance-related ‘Quality and Outcomes Framework’. The British Medical Association has proved a thorn in the side of dozens of health secretaries in the past: will a new Conservative Health Secretary fare any better?
Potential pitfalls and problems
One doesn’t have to delve very deeply into Conservative Party health policy to identify radical differences between it and Labour – differences which, however technical they appear now, signal trouble in the months and years to come.
This policy (NHS-watchers will recognise elements in it of the ‘Total Purchasing’ pioneered in the dying days of the last Conservative Government) amounts to one of the most fundamental realignments of NHS power in its history. And yet the Conservatives have failed to plug some of the obvious gaps in the policy. What if GPs do not have the specialist expertise to do the job they are asked to do? What if GPs use up their budget before the end of the financial year? What if the services GPs choose to invest in happen to be owned by those selfsame GPs?
All of these gaps need to be plugged, but coupled to this is the fact that inherent in the policy itself is that GPs will have to do much more work for the same amount of money. A stand-off early on in a Cameron administration is inevitable.
There remains some confusion as to what the Tories actually intend the NHS Board to do – confusion stemming from the failure of many Conservatives to understand precisely how the Board fits into the complicated tripartite policy framework (based on quality regulation, market oversight and consumer ‘voice’) announced by Andrew Lansley in September 2005. Some commentators argue that the Conservatives want the NHS Board to ‘run’ the NHS, though these commentators are misguided: the Board itself will ultimately performance-manage GPs (although only in their role as the NHS’s budget-holders, not in their clinical capacity), whereas the ‘providers’ who actually deliver care will be independent of the independent NHS Board itself. Confused? Probably – though thankfully for Cameron, in the frenzy of a general election campaign, voters will only need to hear that the Conservatives will establish an independent board ‘to take the politics out of the NHS’, leaving the Byzantine technicalities to the civil servants working out how to pass the system into law.
The policy itself might be admirable – discuss – but the practicalities of it are debatable. All Labour’s attempts to give operational independence to the NHS have floundered on the rock of political necessity. Labour’s flirtation with free-standing foundation hospitals rapidly came to an end with last year’s Stafford Hospital scandal, which resulted in the Government grabbing back many of the powers it had devolved so willingly six years before. In the face of similar scandals, potentially rising waiting times and public protest, will a Cameron government hold firm to its pre-announced course or, like so many politicians before, end the professed aim of NHS independence it has espoused for years?
The greatest challenge
Huge swathes of Conservative Party health policy pose questions that need to be answered. Whilst the Conservatives can, quite legitimately, claim that they cannot possibly answer them all while in opposition, this rather misses the point. Conservative Party health policy is so broad in its scope and so deep in its reach that it might have overstretched itself.
Cameron’s greatest challenge will be finding answers to the questions asked by his policies before the pressures of government bursts them asunder. Put simply – for an NHS notoriously resistant to change – the Conservatives may find they have too many questions to find answers to, and not enough time to find them.