Comment / Health warning

The promises made around political campaigns – in general and maybe even those particularly relating to health – should be taken with a pinch of salt. Remember 2010’s coalition government pledge to ‘stop the top-down reorganisations of the NHS’? This may have been post-election, but it was a strange way to warm up for the upheaval involved with 2012’s Health and Social Care Act.campaigns – in general and maybe even those particularly relating to health – should be taken with a pinch of salt. Remember 2010’s coalition government pledge to ‘stop the top-down reorganisations of the NHS’? This may have been post-election, but it was a strange way to warm up for the upheaval involved with 2012’s Health and Social Care Act.

Perhaps a more obvious example was last year’s bus-delivered claim by the Leave campaign that it could take the £350m spent on the European Union and redirect it to the NHS. Even leading Brexiteers found that amusing… at least once the vote was in the bag.

Elsewhere, we’ve seen the new leader of the free world’s promise to ‘quickly’ repeal Obamacare meet the harsh reality of the political real world of government – to say nothing about his wall.

We need to read everything, but be careful what we believe. However, there are early signs that the general election campaign could actually provide a platform to get the public thinking about key issues relating to health and social care. 

Okay, perhaps I’m being naïve, but when the snap election was announced in April, there was a feeling that the election would be a one-issue debate: Europe. This time it would not be about if we leave but how we leave, and who we want in charge of the all-important negotiations. Some suggested the election was effectively all over bar the shouting, given the Conservatives’ apparent domination of polls and the media’s portrayal of a divided main opposition party.

But as the month drew to a close, there were signs that the Brexit debate might need to give up a little air time for other important issues. And the NHS is without a doubt at the top of the ‘other issues’ list.

The HFMA and others have long called for a debate about the challenges facing the NHS. Yes, we need to transform services and redesign pathways so that patients are treated in the most clinically and cost-effective way. But if this doesn’t enable the service to close the famous £22bn efficiency gap, we need to look at other options – more funding (which can only come from taxation or unpopular co-payment approaches) or restricting the services offered.

It really is wishful thinking that any of the parties might actively address different funding options or service rationing as part of an election campaign – other than accusing their opponents of such unthinkable ideas. But just getting the NHS on the stage alongside Brexit would be a good start.

Labour’s opening gambit – ending the pay cap, safe staffing legislation and reinstating nursing student bursaries – is interesting. On safe staffing, the suggestion is that the National Institute for Health and Care Excellence would restart its guidance initiative. It is not clear what difference a legislative approach would make. The NICE guidance published for acute adult wards did not set minimum staffing ratios, but required trusts to use a structured approach to setting establishments and monitoring actual staffing levels day to day.

But while having high-level public appeal, it should force all parties to address some of the detail of current issues – with pressure groups and thinktanks able to then keep the discussion going. And, of course, in setting out or questioning how these measures would be funded, it puts the overarching NHS funding question front and centre. 

Depending on who you choose to believe, these policies were uncosted or would be funded by other simple and populist changes. But at least the NHS funding question is up and running. And with manifestos due shortly, May should prove an interesting month.