Comment / NHS in pole position?

According to legend – at least that described in the book and radio series the Hitchhiker’s guide to the galaxy  - the Babel fish was a small leech-like creature that, once placed inside the ear, would
enable the ‘wearer’ to understand any language. How NHS staff, patients and voters could do with such a translation aid in the run-up to the general election.

We are long used to the NHS featuring prominently in general elections. In 2015, this appears set to be even more the case. Politicians will line up to tell us how more joined-up, patient-centred or frontline-focused they will make healthcare. Something that turns high-level rhetoric into a simple description of the real implications for health services would be invaluable.

Not that these high aims aren’t worthy of pursuing. Clearly, they are – as identified by numerous stakeholders and claimed as goals by current and former governments. But it is the detail about how this will happen that will be important – and provide the real opportunity to differentiate the parties.

Perhaps the current challenges facing the NHS – and facing many health systems across the globe – open greater potential for politicians to delve beneath the surface this time around, rather than trading in truisms and sentiment.

There is often a fear around general elections that incumbent governments won’t make decisions for fear of generating poll-damaging headlines. But the NHS is already splashed all over the headlines. And we’ve seen a change in the past year – helped to a great extent by the multi-agency Five-year forward view – in how the challenges facing the NHS are openly discussed.

The severe emergency activity pressures over winter have served to underline that these pressures are happening right now.

We need to see this greater openness translated into how the political parties set out their plans for the NHS. For while transformation may be the agreed solution, getting there will be challenging and will require the right policies, incentives and funding.

Labour set the ball rolling with its 10-year plan. There are examples of traditional pre-election promises – more staff, savings from reducing bureaucracy and releasing surplus assets – but also thoughtful ideas on integration and mental health. The next few months should provide a chance to get beneath these headlines, as well as promises made to voters by other parties.

The funding flow mechanism will continue to evolve whichever party or parties form the next government. Labour talks about year of care tariffs for frail elderly as an incentive to avoid hospital care. We need to understand what the parties would do differently to accelerate this type of development. Such systems can’t be brought in overnight.

Most of all we need to understand how all the parties will fund the service. The FYFV gives us the best estimate of what the service will need over the next parliament – an extra £8bn a year by the end of the period.

It may be too much to expect all parties to agree to match this at this stage – involving more detailed decisions across all public spending and a better idea of future economic performance. But discussions of plans and approaches must at least consider the financial implications.

There are three aspects to funding needs. How will governments make up the shortfall in meeting the costs of existing service provision? How will they support the costs of moving to new models of working, including any double-running costs? And if they insist on making new commitments as part of manifestos, how will these additional costs be met?

The old call of ‘it’s in the baseline’ is unlikely to wash anymore.