Summit’s up: issues for the 2015 election

Just over a year to go to the next election and we are all in for a prolonged bout of campaigning. Come next March we will probably all be bored, waiting for it to be over having made up our minds. So now is the best time to get a sense of what will be coming – and our annual Health Policy Summit next week will offer some clues.

Call me a wonk if you like, but I’m looking forward to Philip Collins reviewing the political scene and Jeremy Hunt and Andy Burnham strutting their stuff, along with further debate from Rt Hon Stephen Dorrell MP, Lord Phillip Hunt and Polly Toynbee (and hopefully a Lib Dem as well!), Lord Gus O’Donnell and others.

There is a narrative emerging about the record on the NHS from the coalition – or is that really a Conservative narrative? The story is of an NHS that has been better than ‘safe in our hands’. Problems of lack of compassion and care exemplified by Mid-Staffs (and allegedly in part created or at least not dealt with by Labour) are being rooted out.

The story is of an NHS that has been better than ‘safe in our hands’

The emphasis is on better quality. And if you want a comparator, look no further than Wales. David Cameron himself has unfavourably compared performance in Labour governed Wales with that in England. Jeremy Hunt has called for a public enquiry on the subject. Our forthcoming report comparing the performance of the four UK health systems will add some much needed facts to the conjecture.

So far as the record is concerned, the Lansley reforms are being brushed under the carpet, c*********n is a word that dare not be used and any financial problems are covered by the single rebuttal that NHS funding has been protected in real terms (again contrast that with Wales).

Labour’s narrative of the past four years isn’t yet so clear, although there are strong themes of an expensive and unnecessary reorganisation, rising waiting times, struggling A&Es and progress for patients stymied by little understood, and inappropriate, rules on competition. What they say about the future in part depends on the John Oldham led ‘Whole Person Care’ Commission.

One can’t help thinking that the election issue will be ‘the economy stupid’ and whether we are all beginning to feel better off. Health will probably be below immigration in the public’s pecking order.

But there is a critical issue that all parties need to address. How are we going to ensure that health and social care are adequately funded over the next five to 10 years?

Technocratic answers about integrated care, and soaring rhetoric about transformational change just won’t translate into high quality services for all on the ground. After five years of such statements the service doesn’t look to be capable of making the changes on anything like the scale and pace needed. Nor has it so far found a way of engaging with the public to get support for radical change.

These issues are covered at the Summit and I hope implementable ideas will come forward as a result. But on current form, the experience likely to be faced by many increasingly older and frailer people and their families is one of poorer services and higher personal costs.

There are steps that could be taken – such as ring fencing social care spending as recommended by The Health Select Committee in their report on public expenditure and finding a formula that enables health and social care spending at least to rise in line with GDP in real terms so that the rest of public spending doesn’t get scythed as a consequence.

Events may of course overtake us all. It seems probable that the NHS will stagger financially through the next year, leaving a major unanswered question over what will happen in 2015/16. And, objectively the quality of service is being at least maintained or improved where it is measured as our QualityWatch programme with the Health Foundation demonstrates.

But one wouldn’t bet against an A&E crisis. Belfast has recently suffered one. Like the floods it would become all-consuming for the media and politicians. But, unlike the floods, it wouldn’t be possible to claim it is the result of extreme conditions caused either by an act of God or by global climate change, depending on one’s point of view. This would be home-grown and there would be no hiding place.