Heart of the matter

It is clear that the NHS will change in the next five years. Although both main parties have committed to real-terms increases in frontline NHS spending for at least two years after the current spending period ends in 2011, these are unlikely to come anywhere near the unprecedented year-on-year increases of the last decade. Sir David Nicholson, NHS chief executive, meanwhile says that health services will need to find £20bn of savings over the next five years to maintain the current level of service provision. This financial challenge, and the forthcoming General Election, puts healthcare firmly at the heart of the political battle. A further challenge will be ensuring that the NHS remains a political priority after the election when other demands, such as cutting the deficit, will be jostling to take precedence.

Current polls suggest that the next General Election will be won by the Conservative Party. The national press has taken sides in the political battle and commentary is focused not on who will win the next election, but by how much. Conservative policy on health, a key election issue, has already been laid out but the policy document raises as many questions as it answers.

Policy after policy
Although no General Election has yet been called (as this publication goes to print), the pundits are still betting on a May 6 date. The national stage is already primed with all three major political parties setting out their health pledges in an attempt to do it first and to do it right; the Conservative Party launched its draft manifesto with a first chapter on health on January 4. In early February, Gordon Brown announced the Cancer Guarantee, pledging that all cancer tests will be completed and results given in one week and a dedicated nursing service for all cancer patients. These announcements are just the start of a flurry of activity, pledges and 'new' policy announcements. In the current economic climate, the difficulty for any incoming government will be to manage the expectations this creates. Any new government will be held to account and forced to look at its pledges after the election. It will also have to take a careful look at its plans, and mark those that are realistic.

Healthcare is an emotive issue; public perceptions of the NHS often serve as a barometer of the mood of the nation, so this process is a delicate balancing act. Any government overseeing this review has a tough job on its hands.

A new parliament
The NHS is changing and Parliament is also set to change dramatically. We know already that 140 current MPs will not be contesting their seat at the next election and it is predicted that over half of all MPs will be new to the House of Commons. This is a major overhaul bringing threats and opportunities. Threats for the NHS as the Health Select Committee is overhauled, the number of MPs who are healthcare professionals potentially reduced and new cost-cutting measures ready to be implemented. There are also benefits as a new Parliament brings in fresh perspectives and forces legislators to re-evaluate how best to cope with limited budgets, ultimately for the benefit of patients.

Health is firmly on the political agenda at the moment but as government finds the situation tricky or difficult to manage, the challenge will be to keep health at the top of the agenda and ensure the changes made are the ones that are required. Whatever the make-up of a new Parliament, the squeeze on budgets means that it will be difficult to maintain the current level of service while keeping up with the latest technological advances and medicines.

The burden of cutting costs
The Conservative Party has positioned itself as the 'party of the NHS' and health is one of only two areas (the other being overseas aid) where the Conservatives guarantee they will not make cuts to the overall budget. Policy-wise, this means pledging to axe top-down bureaucracy, getting rid of targets and giving 'real' choice to patients. However, cutting costs comes with its own burden; one that will become apparent only when civil servants start looking seriously at policy pledges to make the promise of change a reality.

The Conservative patient choice, and the associated localism agenda, has the potential to create bureaucracies of its own and the extent of these may be difficult to control. Previous rhetoric from Cameron's Conservative Party proposed an 'independent' NHS but this idea has fallen by the wayside. The burden of cost-cutting could stifle policy ideas they have already had, and eventually, cost them politically.

Missing details
The Conservative draft manifesto, with a first chapter on health, and the Conservative public health Green Paper make it clear that the party's health policy pledges are not radical. The basic premise of Conservative public health policy is a focus on preventative measures by promoting social and behavioural change and incentivising localism. Beyond cutting central costs by reducing bureaucracy, the basics of Conservative policy are much more uncertain. The proposed overhaul is unlikely to rival the one implemented by Tony Blair or indeed by the Conservatives when they established the internal market in the early 1990s. Essentially, the system looks to be the same.

But, beyond public health, the details are missing and this is causing some concern. A highly contentious issue, which lacks detail, is the Conservative proposal to introduce value-based pricing when the current PPRS comes to an end in December 2012.

This commitment was confirmed by David Cameron at one of his weekly press conferences on January 25, when the decision by NICE to reject the use of a rheumatoid arthritis treatment on the NHS on the grounds that it was too expensive was questioned. At the time Cameron said that reform was required to ensure that more people could receive more drugs quickly.

Value-based pricing is highly contentious and if the Conservatives form the next government then there will be more tough questions to answer.

If the UK deficit is to be reduced then innovation and R&D-based industries need to be encouraged. The Conservatives may well find that the lengthy  and involved process of value-based pricing, and all its associated bureaucracies, may backfire as an efficiency measure if it discourages companies from investing in the UK economy at a time when such investment is sorely needed. The Conservative policy to ring-fence funding for local authorities to enable "local communities" to tackle public health issues also lacks detail and the role this will play in the overall budget plans, or what might need to be cut elsewhere to pay for it, remains unclear. 

Winning votes
The NHS is a key election issue. It has the ability to stimulate debate due to people's personal experiences and perceptions of the service they are offered or have received. This is due partly to the disconnect between how people perceive the health service versus their actual experience of it. When speaking generally, a person will vow that the NHS is failing while a personal experience often reveals a high level of service and patient satisfaction.

However, it is not for nothing that the NHS has been placed on the political agenda – the postcode lottery, end-of-life care and clean hospitals are all emotive issues likely to make it on to the front pages. If Conservative plans to streamline the service are deemed ineffective there will be a backlash against the cost-cutting, and hence job losses, which have had to be endured to help the deficit recover. There is an added danger that the Conservative localism agenda could be seen as a way of devolving responsibility from central government, to unaccountable, local health authorities. Could the Conservative lack of experience, and desire to strip away bureaucracy, trip them up?

If the Conservatives form the next government they are unlikely to make dramatic changes to the way in which the NHS is run. The current Conservative approach is considerably more statist than previous manifestos and the economic situation means that they will be looking for a steady hand to guide them through the next spending review with minimal damage.

The difficulty for the NHS will be maintaining a high level of service with restricted funds while the politicians hammer out their plans. The difficulty for the Conservatives will be to ensure that they are flexible enough in their approach to make their policy a reality.

The Author
Amna Ahmad is a senior account executive, Healthcare Public Affairs at Fleishman Hillard

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