The NHS wasn’t a major issue in the 2010 general election, so what role will it play in 2015? While public satisfaction with the NHS remains high, there is unprecedented pressure on NHS finances, particularly in 2015/16. Professor Chris Ham, Chief Executive of The King’s Fund, considers the political landscape a year before we hit the polls.
The government’s record on the NHS will be at the heart of the election debate. The good news for the coalition is that the unprecedented slowdown in NHS funding since 2010 has not yet had a serious, adverse impact on patient care.
The King’s Fund have recently published the results of a new survey; health questions from NatCen’s British Social Attitudes Survey 2013, which show that public satisfaction with the NHS remains high. The bad news is that a significant amount of capital was expended on the reforms enshrined in the Health and Social Care Act 2012, at a time when the last thing the NHS needed was a destabilising, top-down reorganisation.
As we argued at the time, Andrew Lansley’s reforms led to precious time and resources being wasted on changes that could have been made gradually, working with the grain of what was already happening rather than turning everything upside down. It is hoped that this lesson is not lost on those writing election manifestos. The policy review led by Sir John Oldham for the Labour party has certainly taken this message on board, making the case for whole-person care while urging that this should be done through evolution not revolution.
Debate about the role of competition and the private sector is certain to loom large in the campaign. Labour spokespersons have argued that Part 3 of the 2012 Act should be repealed to limit the role of competition regulators and reduce the threat of legal action if commissioners decide to place contracts with NHS providers instead of testing the market.
For its part, the coalition has maintained that the provisions of the Act reflect EU law that would apply whether or not Part 3 remains on the statute book, although Norman Lamb broke ranks when he called for the role of the Office of Fair Trading in NHS mergers to be scrapped. The involvement of the National Health Action Party in a general election for the first time will also add spice to this debate.
In the Fund’s view, the principal challenge for politicians is to be honest about the pressures facing health and social care, and be willing to argue for additional resources notwithstanding continuing pressures on the public finances.
Our recent analysis of progress in improving NHS productivity supported by our quarterly reports on performance paint a picture of a service experiencing growing financial distress. This has already been felt in the difficulty in meeting the four-hour A&E waiting time target and is beginning to manifest itself in lengthening waiting lists for hospital treatment.
It is not an exaggeration to suggest that a major crisis will occur if the NHS is not given more time, more support and more funding to deal with these pressures. It is for this reason that we have argued for the creation of a transformation fund to invest in the new models of care needed to meet the challenges facing the NHS.
Every health economy should have access to the fund and its use should be conditional on demonstrating that the investments it supports will release cash from existing services. Additional financial support will also be needed to keep necessary services going while new models of care are developed.
We have also challenged politicians to face up to the need for a new health and social care settlement, building on the work of the Commission on the Future of Health and Social Care in England, whose interim report made the case for a single ring-fenced budget for health and social care in which entitlements to care are more closely aligned.
Hard choices on how to fund health and social care must be confronted in working towards a new settlement, including what should be paid for by the state and what by individuals. The complexity of the issues involved means that debate should start before the election rather than after. The final report of the commission will be published in September to stimulate discussion at the party conferences.
Narrow agenda focus
Sadly, the prospect of a serious and informed discussion about these issues seems unlikely when the leaders of all the main political parties seem focused on a narrow agenda centred on the economy and public finances. The unwillingness of politicians to engage in a fundamental debate about the future of health and social care is a sign of the failure of a political process in which argument and dispute are the oxygen of life.
Collective denial in the political class not only risks undermining the NHS, which is often cited as an example of what makes people feel proud to be British but also misses an opportunity to attract support in what promises to be a closely fought campaign.
Professor Chris Ham is Chief Executive of the King’s Fund. This article originally appeared on the King’s Fund website and has been reprinted with the kind permission of the author and the King’s Fund.