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Health policy emerges from the shadows


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Friday, 14 May 2010

Health policy emerges from the shadows

Andrew Lansley has hardly got his feet under the desk but we are starting to find out what he’s thinking.

You might think we would already have known – he has been shadow health secretary for seven years – but politicians in opposition tend to deal in policy muesli, designed to create a vague sense of being good for you without being particularly tasty or satisfying.

Now he’s doing the job for real and the broad sweep of the Conservative health manifesto is already starting to acquire detail.

Let’s start with the boring but important bit: what is the health secretary’s take on NHS finances?

As promised, there will be real growth in NHS funding, possibly at the expense of other areas of the public sector, but this will nevertheless be lower than in previous years. Average annual growth of the NHS budget over its 61 year history is around 4% and in the past decade was closer to 7%. Mr Lansley has a lower figure than either of these in mind for the future. So “real terms growth” is technically correct, but it will feel like a reduction.

We also know that the productivity gain sought from the NHS will be at least as high as the bar set by David Nicholson last June. The £20 billion improvement in the financial position was to have been achieved by an approximately 3.5% annual productivity gain over each of the three years from 2011.

On Radio 4 this week, Mr Lansley hinted that this might not be enough to meet the still growing pressures on the system. So anyone who dreamt that a new government might somehow wave the financial crisis away needs to pull the duvet further over their head.

The new health secretary has also made it clear that whatever investment is made in the NHS will go to improve services not to protect jobs. Big reductions can be expected in the payroll of the NHS and the Department of Health. Again, this is no surprise. Cutting top heavy management, reducing bureaucracy and targets, moving commissioning from back office to frontline – all of these were clearly flagged in the Conservative manifesto. But rather like a patient who has felt unwell for a long time, the diagnosis when it comes is still a shock.

The NHS is to have greater autonomy. There are whispers of a Department of Public Health, a radically slimmed down DH that will take fewer management decisions, and will defer to a more independent NHS board.

There will be a new emphasis on the needs of the patient and renewed focus on quality. The health secretary is not going to measure health outcomes against our own narrow standards but against a broader canvas. Regional and local comparisons may be important, but global comparisons will also come into play.

The swirling mists are also clearing around social care. The new health secretary is keen on better funded social care for the pragmatic reasons that it could not only reduce acute sector costs but deliver better services to patients. The end of the care pathway does not have to be a hospital. Successful healthcare systems are not defined by the number of people in hospitals but the number that are kept out of them.

NHS Networks will open its first general discussion forum since the re-launch of the service in February. Use it to tell the new secretary of state for health what we think of his ideas and where you think we should be heading.