Two organisations published reports last week calling for a cross-party consensus in health and social care policy. Both should be prepared for disappointment, as Kevin Barron, who chairs the House of Commons Health Select Committee, conceded on Friday’s Today programme. Mr Barron’s committee had just released its report on social care, which notes that there is in fact a reasonable degree of agreement around the Government’s proposals, published in a green paper last July, for a “national care service”. All we have to do, argued Mr Barron, is to agree on how to pay for it. This is a little like saying that everyone is agreed on the wisdom of flying to the moon, and all we have to do is build a space rocket. When Andy Burnham, the health secretary, put forward three options for funding the national care service earlier in the week, his Tory oppo Andrew Lansley dismissed them out of hand. “There is now a clear dividing line between the parties”, said Mr Lansley, while re-heating the slogan “death taxes” to describe his opponents’ policies. In British general elections it tends to be dividing lines, not consensus, that win the day.
So Mr Barron was on a certain bet saying that there was “nil” chance of consensus on funding social care before the election is decided; optimist that he is, however, he says that conditions could be set for harmony once a new government is in place. We shall see. If that government is Conservative, still more one with but a small majority, or no majority at all, then the temptation for Labour to torture the old enemy’s Achilles heel – the NHS – may be too great to resist. A coalition government, meanwhile, while by definition involving some co-operation between parties, would leave one of the big two out in the cold and perhaps in no mood to be all sweetness and light.
All of which is bad news for the NHS Confederation, whose report published on 10 March, Rising to the Challenge, spells out with admirable clarity the pressures about to be faced by the NHS and calls upon all the political parties to live up to their responsibilities in helping get it through. There is also a high level of overlap with the health select committee on social care because both organisations stress the need for a much more tightly integrated health and social care regime. There should be joint commissioning of health and social care, say the Confed, in order not just to improve care, but to realise big savings in an area where plenty of money is wasted through the failure of different agencies to align. So say most commentators. So say, indeed, the six health secretaries we’ve had since 1997, and who knows how many policy papers over the same period. But the dividing lines between health and social care were laid down in the post-war settlement that created the NHS, and have remained frustratingly resilient ever since.
The Conservatives will be pleased to see the NHS Confederation giving weight to the importance of improved prevention, as this has emerged as a major theme in Tory policy. They will also note the swipes at targetism and support for competition and contestability (though not, interestingly, for the independent sector per se) and contrast that with Labour policy. Tory enthusiasm for payment by results, however, should be tempered by the Confederation’s sensible observation that the current PBR system only really works for planned surgery and diagnostics, and that in the much more money-swallowing areas of primary care and chronic disease management it can actually create “perverse incentives”. A review of NHS payment systems and incentives is “long-overdue” say the Confederation.
The Confed is even less enamored of the current system of NHS regulation, which, it says is “burdensome”, “bewildering” and (that word again) lacking in consensus about what it is for. Diplomatically, no doubt, the report declines to point the finger at any particular corner of the regulatory leviathan and it will be a brave secretary of state who plunges in after the election. The important point though is that policy will need to be a lot more sophisticated than bureaucrat-bashing or quango-culling, superficially attractive though that may be in pursuit of instant savings. There are fundamental questions to be asked and answered about the regulation of the NHS: why, what, who, how?
The main theme running through the Rising to the Challenge is that the easy things won’t be enough. More integrated care, improved management of chronic conditions, reducing variations in outcomes and effectiveness, joint health and social care planning, better regulation: these are all first-order issues, the scale of which dwarfs the relatively modest NHS reforms of the last decade. Nor is the Confederation reticient in contemplating some really tough stuff: cutting the NHS pay bill; re-negotiating the GP contract; moving to an era when the district general hospital is an “outdated concept”. The party in power is proposing to freeze nurses’ pay, squeeze the family doctor, shut the local hospital. You’re the opposition. Consensus? What would you do?
