My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

…and today – the Conservative Manifesto

Filed Under (Conservative party, Health Policy, Manifestos) by Paul on 13-04-2010

The politics of the Conservative electoral strategy on health is not to have it as an issue during the election.

At the moment when the public are asked to choose who has the policy that they approve of the most, a larger number of people choose the Labour Party than the Conservative Party. Therefore, politics would tell us that if the entire campaign was fought about health policy, people would see the most important issue – health policy – as one where they think Labour are better than the Conservatives. After a campaign such as that more people would vote Labour.

Therefore it is in the Conservatives interest that, in the next three weeks, there is very little political controversy at a national level about the NHS. One of the best ways of doing this would be to construct a health manifesto where most of the main levers of change are the same as the Government’s. And unsurprisingly that is what we have.

  • Both Labour and Conservative develop payment for performance around quality thereby using the incentive of payment as  a main lever of change
  • Both pledge that NHS providers will be set free and that they will all become Foundation Trusts
  • Both extend patient choice with additional information for the public on all providers
  • Both give every patient the right to choose between any provider including independent voluntary and community provision
  • Both pledge expansions of opening times for all GPs during the week and at weekends
  • Both make pledges about choice for mothers-to-be
  • Both extend access to cancer care significantly
  • Both pledge to increase talking therapies

The politics of these agreements are clear for the Conservative Party. They don’t want a row about the NHS and it makes it harder for the Labour Party to make the NHS an election issue.

But what is different?

There are a number of significant differences.

The first and most consistent of Conservative policies is to stop targets on waiting. Whilst this has a lot less resonance with professionals than it used to – since they are now being met much more routinely – their abolition will be met with relief by the leadership of most NHS institutions since they make their lives harder. (In fact of course saying that everybody can access a GP in their area seven days a week for 12 hours a day as this manifesto does looks a lot like a target but let’s not be semantic.) Politically, if the Conservatives were to form a Government, this policy is their greatest risk. If six months into their Government opposition MPs could start to point to their constituents waiting that long for an operation, their pledge to be the “Party of the NHS” would begin to look a lot more like same old Tories with long waits for operations.

The second consistent and different Conservative policy is putting GPs in charge of the commissioning of local health services. Given that some GPs do not want to do this, how they do it will be worth looking at, but if this pledge happens it will mean that public money for a public service will be disbursed not through a publicly accountable body but through private sector small businesses called GP practices. (I am not sure in the middle of a financial crisis that Her Majesty’s Treasury will look kindly on giving £100 billion to hundreds of small businesses as a method of public expenditure control, but let’s wait and see)

Thirdly, whilst there is less emphasis than before, the pledge to set up an independent NHS board to allocate the resources to commissioners and provide commissioning guidelines will mean a radical change in what the DH as a Department of State does. Alongside this the Department will become the Department for Public Health which will provide separate funding aimed at health improvement to ‘local communities’ – probably local government.

Fourthly there is an important pledge to create single budgets for health and social care funding for people with long term conditions.  

What is not in the Manifesto but has been in previous Conservative Policy documents?

Interestingly ever major Conservative Policy document for the last three years has had a cast iron pledge that there would be no more NHS reorganisations. This does not appear in this manifesto (but it does in the Labour one). Given what the Conservatives pledge on putting GPs in charge of commissioning local health services, and given the pledge to remove extensive layers of bureaucracy and save one third of NHS administrative resources, this does not bode well for the future of PCTs and SHAs.  It will take a while but in their present form they will not survive a five year Conservative term.

Most of the previous policy documents have pledged to ‘take the politics out of NHS decision making’ and this has sat uneasily with a pledge to politically interfere with decisions made by clinicians to close A and E and other wards. The manifesto is silent on this and would therefore expect a Conservative Secretary of State to interfere in these decisions to keep hospitals open for political reasons.

Previous policy documents have talked about an enlarged role for Monitor as an economic regulator taking a lot of the work from the Department. The manifesto is silent on this.      

I would say “let battle commence”, but I suspect that if the Conservatives have their way there will be very little battle about health policy in the next three weeks.

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