Anyone who has had the “pleasure” of attending party conferences will know they are largely political theatre. While serious discussion does happen, spiky debates mostly take place in the lively fringe sessions. However the main conference speeches this year have offered some clues as to the agenda for the next parliament.
Healthcare, not surprisingly, is a significant feature. There are three important things in the background that will help to put the headlines from the Conservative and Labour conferences into context.
Three important points
First is the money. The NHS is facing the biggest challenge since its formation because of a funding crunch which has seen real-terms growth of 0.8% since 2009-10, compared with the long run historic average of between 3-4%. The NHS has also faced rapid increases in demand, due in part to an ageing population, cuts to social care, and new drugs and technology.
In the past, the main option used to balance budgets was to cut staffing numbers. But after the the Francis report into the scandalous care at Mid-Staffordshire hospital, this is not an option hospitals want to consider. Indeed, many have been increasing the number of nurses they employ. But the latest figures show that more than two-thirds of hospitals are now in deficit. At this rate the service is heading for a £2bn hole in its finances by the end of 2015-16.
Second is productivity. Speed of progress is key. The trend over the last decade has been to devolve power to the front-line and not run everything from Whitehall. The main reasoning for this approach is to: give some hospitals more freedom over their affairs; encourage fresh thinking from new entrant providers of NHS-funded care; foster (to a limited extent) competition among providers within a system of nationally set prices; boost commissioners of care to be more effective; and to further develop the system of regulation.
Third is quality of care. While the poor care at Mid-Staffordshire NHS Trust has galvanised necessary changes, perhaps the bigger picture has two elements: first, care is so often disintegrated rather than integrated as patients receive care from separate specialisms inside hospitals, with cracks emerging when, for example, patients move from hospital to community to social care; and second, much care is paternalistic and not person-centred.
Red and blue party lines
So with this in mind, what have the Conservative and Labour parties said about the NHS over the past couple of weeks?
There were two main promises from Labour. The first was the allocation of an extra £2.5bn per year as a “Time to Care” fund to help pay for 3,000 extra midwives, 5,000 care workers, 8,000 GPs and 20,000 nurses, with the extra funding to come from closing tax loopholes, proceeds from a mansion tax on homes above £2m and increasing tobacco tax. The second promise was to repeal the Health and Social Care Act 2012.
While extra funds are clearly welcome, it was not clear what the £2.5bn would be additional to, over what period and whether the funds would be earmarked for the NHS or the wider care system, including social care.
The Health and Social Care Act 2012 resulted in the most profound set of changes in the NHS’s history. Labour has condemned the reforms, but has not given details as to how they would structure the NHS in the future.
In his speech, shadow health secretary Andy Burnham underlined the need for more integrated care, on which there is considerable consensus among the political class and in the NHS, but if he continues to see the NHS as the preferred provider of service, what does he see as the role of other providers?
The central message from the Conservatives, like Labour, was that the NHS is safe in their hands. Like Labour, this message was underlined by pledges of increased spending. While this is a time-honoured tradition, in the current fiscal environment the promises take on extra significance. Here the promise by the prime minister was that NHS spending would be ring-fenced and “not a penny cut”. How this would translate into actual real terms increases was not forthcoming, but the coalition’s current pledge is to maintain real-terms growth in NHS spending.
On increasing productivity, little was said. Health secretary Jeremy Hunt was quick to point out the value of using independent sector and charities to provide NHS-funded services, suggesting that this policy direction will be maintained at least. But most of Hunt’s comments were about the quality of care. He, like Burnham, stressed the need for integrated health and social care, pointing out initiatives such as the Better Care Fund, which was set up with £3.8bn to drive this agenda.
Improved access to care also featured the promise of GPs providing “8am-to-8pm care” seven days a week by the end of the next parliament. Such a promise is fine in theory, but with not nearly enough money to deliver this, and health chiefs arguing the system is already at breaking point, what will the potential increase in demand cause and how will it look in practice?
Omissions tell us something too
So while the speeches contained crowd-pleasers and clues as to thinking, they were more notable for what they did not say than for what they did. And we have yet to see whether or what the Liberal Democrats propose for the NHS when their party conference kicks off on Saturday.
As argued in our recent report More than money: closing the NHS quality gap, any move to increase funding above and beyond inflation is certainly part of the mix for securing the future of the NHS. But there also needs to be a new transformation fund to support changes in the way that care is delivered.
But money alone is not enough – supporting capability for healthcare providers to deliver integrated care is also needed. Such support might include building skills in basic management, change management, and improving skills and analysis, all with the objective of improving quality and efficiency. Further to this, there needs to be a candid dialogue between politicians, the public and the NHS about the challenges the services is facing, and why significant change is needed now.