Comment / Words left unsaid

Does it matter for the NHS which of the main parties is successful in the general election at the beginning of May? OK, yes it does. I’m not so cynical to think otherwise. But looking at the different manifestos and specific health pledges, it is hard to base that decision on much more than gut feel.

Even just focusing on the three main parties (despite a growing feeling that come 7 May, smaller parties may have a controlling influence), everyone wants to integrate services in some form. The Liberal Democrats and Conservatives back the Five-year forward view, and Labour supports it in principle. And there have been the usual commitments to increase frontline staff – GPs from the Conservatives; GPs, nurses and care workers from Labour.

But the superficial nature of political campaigning – not just in health – leaves me with a suspicion that it is what parties don’t say in their manifestos that will have the most impact on the health service’s ability to transform itself and deliver sustainable services into the future.

Funding is the standout issue. The Conservatives and Liberal Democrats have both promised to meet the £8bn identified as necessary by 2020/21 in the FYFV. Labour has made a lot of the fact that its promised £2.5bn ‘time to care’ fund (to pay for those doctors and nurses) is fully funded.

But again it is difficult to read too much into these commitments. On the one hand, you couldn’t expect politicians to stump up more money than the service itself has deemed required. On the other, there has been precious little discussion about whether the £22bn efficiency savings needed alongside this £8bn are at all achievable – or what achieving them might do to services.

To an extent, the £8bn figure has acted as a bit of a distraction from the real financial challenges the service is facing right now, let alone at the end of the next parliament. It is as if a commitment to find this money will solve the service’s immediate financial challenges.

All the parties talk at a high level about how they will drive integrated care across health and social care. But there is no real mention of what broader transformation might entail.

Immediate problems are clearly with achieving the right number and quality of staff – perhaps hospital nursing staff in particular. But if the NHS can change its model, support patients earlier and in the community, it could need fewer beds.

Better care – not just more cost-effective – might mean smaller hospitals or not all hospitals delivering a full range of services.

But there is clearly a gulf between the reality of now and the transformation theory. If transformation is the answer – and most agree it is – then how do we get there? What are the obstacles? How quickly can we achieve it? What double-running costs might we face? 

It was probably unrealistic to expect politicians to grapple with this in the run-up to the election. They recognise that subtleties tend to get lost in translation when delivered through the medium of newspaper headlines and TV soundbites. So we’ve had the more typical arguments about who will prioritise the frontline more.

Whichever flavour of government we get, the key for the NHS will be in how it understands the challenges facing the service. It will need to get the funding right. Not just the global amounts, but ensuring the payment system (working with Monitor and NHS England) is aligned with new ways of working. It will need to be careful about imposing new spending commitments on services. And above all, it will need to strike the right balance between supporting and challenging the service to deliver the necessary changes.