Tory health pledges seek to neutralise NHS as an election issue
Incisive Health's analysis of how the Conservative manifesto suggest little change from the Party’s core political strategy on the NHS: keep it quiet.
Since 2003, the core political strategy for the Conservatives on the NHS has been a simple one: keep it quiet.There is little in the health section of today’s manifesto to suggest a departure from this strategy any time soon.
Yes, there is the new commitment to extra funding, but this should be viewed only as a component of this overarching strategy. Without such a commitment, the Conservatives would have been seeking to last an entire election campaign promising to cut the NHS in the next financial year. Even in these abnormal political times, such an approach would make even the most hard-headed politicians wince. The promise of additional capital funding is reiterated, but the NHS will need to wait for the autumn Budget to find out when, and how much.
Today’s manifesto continues to align, like its predecessor, with the Five Year Forward View. Promises on cancer and diabetes are reiterated and there is a pledge to back local reconfiguration plans, providing they are “clinically led and locally supported” (which is debatable in some cases). As a trick to take the political heat out of a policy area it will work for the election: if a party is happy to outsource policy almost entirely to NHS England, then there are precious few punches that can be landed on the politicians. Until either or both of the opposition parties completely disown the Five Year Forward View – which they show no signs of doing – this approach is likely to be effective for the Conservatives.
But all this will only work so far. The command-and-control model now being formalised in the NHS’s Sustainability and Transformation Partnerships (STPs) will surely test existing health legislation – which assumes that NHS providers are autonomous and competing – to destruction. The manifesto’s pledge to consider legislative change is surely an acceptance that the need for changes to underpin STPs is a question of when, and not if. The pledge to review the internal market “which can fail to act in the interests of patients and creates costly bureaucracy” is not a statement that could be imagined in any previous Conservative manifesto.
Following bruising battles over the junior doctor contract, there are pledges to proceed with reforms to the consultant contract, introduce a new GP contract and make changes to enable pharmacists and dentists to play a bigger role.
Jeremy Hunt’s personal interest in patient safety is reflected in the commitments to an independent safety investigations body, as well as to proceed with reforms to professional regulation. The declared intent to rewrite mental health laws which has emanated from Number 10 (or is it the Home Office?) is repeated.
On Brexit, there are warm words for NHS workers from overseas, but no guarantees. In a nod to those former UKIP voters who the polls say will now vote Conservative, there is a pledge to increase the Immigration Health Surcharge and restrict access to NHS numbers until eligibility is checked.
There are some encouraging words for the life sciences industry with a (long-expected) commitment to implement the Accelerated Access Review to make sure that “patients get new drugs and treatments faster while the NHS gets best value for money.” There are also commitments on end of life care and autism, both of which will be welcomed by campaigners.
As a means to avoid losing any votes on the NHS, it does the job. But the NHS faces big challenges even beyond the short-term financial crisis – and simply borrowing answers from the Five Year Forward View will not cut it (we are half-way through and it has yet to deliver, frankly, anything). How are we going to make better use of data, when patient confidentiality is so important? How can the NHS make better use of new technologies? And (whisper it) what is the role of competition? On these questions the manifesto hints, but we will have to wait for more definitive answers. And the impossible policy conundrum – how do we tackle the burning injustices of health inequalities without the nanny state? – is sidestepped almost entirely. Sugar taxes and school sport are not even half an answer. Tobacco does not get a single mention in the manifesto.
The health section of the manifesto will do the job of buying the Conservatives more time. And eventually, that time will run out and difficult decisions will have to be confronted. But perhaps we should not be too surprised that this is how the manifesto reads. It is, after all, the 2017 General Election in a nutshell.
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