With the main political party conferences completed for another year, all attention now turns to Westminster and where the health debate will go next.
In many ways this conference season did not change the health agenda significantly, even though some personnel changes are expected imminently. Norman Lamb called for cross-party talks on the future of funding; Andy Burnham continued to lead his Party’s charge against competition in the NHS; while Jeremy Hunt tried to position himself once again as the ‘Secretary of State for Patients’.
Integration, integrated care or coordination (or the lack of these things) is still at the centre of the current debate, funding remains tight, transparency is seen as essential in driving up care standards, and Labour remains, in the eyes of the polls, the party of the NHS. However, there are a number of issues likely to dominate the headlines in the coming months ahead.
Open all (or some) hours
The headline voter-friendly announcement of the conference season was the Conservative announcement that patients (in certain regions on a trial basis) will be able to get GP appointments between 8am-8pm seven days a week. While Labour immediately cried foul saying that this was an old policy of theirs re-launched, there is no doubt that Jeremy Hunt sees improved access to primary care as a major opportunity to provide the public with tangible evidence that the Conservatives are changing the health service for the better. If Mr Hunt can make these pilots work and extend them, while at the same time painting Labour as being obstructive and on the side of the old, top-down system he may well start to see an improvement in Tory NHS poll numbers. The GP contract negotiations due to begin shortly, also provide an opportunity for Mr Hunt to back-up his rhetoric around Labour’s failure to get GPs to do more with something of substance. However, with little money to hang as a carrot and given the track record of such negotiations in the past, this will be no easy task.
Sir Mike’s army goes into battle
Earlier this summer, Professor Sir Mike Richards’ began recruitment for his ‘small army’ of hospital inspectors to lift the lid on poor care in the NHS. Since then the first wave of inspections has already got underway and the ‘whistleblower-in-chief’ is earning his reputation as one of the most respected forces in the NHS.
Behind the rhetoric, the new hospital inspection plans have been widely welcomed as a move away from a regime built around ‘tick-boxes’ to a regime built around the experience of patients and healthcare professionals. However, the task facing Professor Sir Mike and the CQC is mammoth. It is expected to take two and a half years to inspect all acute hospitals in England and, during this time, the media will be not shy away from shining its own spotlight on hospitals at risk of becoming the next Mid-Staffordshire.
For Hunt and Cameron, this means increased political pressure to demonstrate that they are rooting out poor care across the system. For the CQC, it will be about getting to grips with it new freedom and responsibilities and demonstrating that it is up to the job. A challenge for both sides.
Pioneers vs Innovators vs Leaders
The language of integration is everywhere. Everyone on the conference fringe was talking about it and many were eulogising about its potential to transform the health and care system. But it’s not always clear what people really mean when they use the term or whether it is a fig leaf for something else.
The three main political parties are all fighting over this ground. In the yellow corner, Norman Lamb is set to shortly announce the 15 integrated care pioneers, in the red corner Andy Burnham has already announced 26 whole person care innovation councils (including interestingly, one Conservative council) and in the blue corner Jeremy Hunt is driving the development of a lead clinician for older people (basically stolen by Labour in Burnham’s conference speech).
How these different programmes progress in the coming months will be important in shaping the policy detail that sits beneath the integration narrative. The integration pioneers are seen as particularly important for the Lib Dems and their well respected Health Minister, who has invested significant capital in getting them up and running. However, there remains a real concern that once the detail on integration emerges that any consensus of its benefits is lost amongst rows over funding and responsibilities for its execution. At a local level the development of local integrated care plans to oversee health to social care funding flows over the next six months will be a key test of this brave new world.
A Bill that will protect patient care?
After the long summer, Parliament returns this week and so does the Care Bill. To date, the Bill’s passage has been relatively smooth for the Coalition when you compare it with the Equal Marriage Bill, Welfare Benefit Up-Rating Bill, and especially compared with the Health and Social Care Bill. Its relative absence from the conference halls of Glasgow, Brighton and Manchester are perhaps a symptom of this.
Hunt’s surprise decision to make the CQC ‘independent’ was, politically, shrewd and spoken about in a way that would resonate beyond readers of this piece: “never again will care failings be covered-up by managers dancing to their political masters’ tune”. And yet, the announcement will mean the Care Bill returns to a renewed focus on the strength of the proposed regulatory regime. A number of questions have yet to be answered: why has the Government chosen to split inspection and enforcement between CQC and Monitor? Will the CQC be adequately funded to carry out its new functions? What happens when a provider fails and what happens to the guarantees for service users?
As we have said on this blog before, in the campaign towards the next general election, Labour need to move the debate onto Jeremy Hunt’s record in office rather than the focus being on theirs. Scrutinising the extent to which the Care Bill will protect patients would be a good start.
On the fence
“We will cut the deficit, not the NHS” was one of the most defining parts of the 2010 General Election. For David Cameron it was a symbolic statement of the Conservative Party’s move towards the centre ground and an opportunity to create a dividing line with the traditional party of the NHS, Labour. Throughout this Parliament the Government has faced criticisms over the extent to which it has met this promise and expect the Labour leadership to continue to scrutinise this further.
And yet, outside of the Westminster debate, health and care services in England face significant long-term financial challenges. Norman Lamb was right to call for a “national debate” on this issue, but it also needs to be a sensible debate – one that learns from the difficult cross-party care funding talks of 2010.
Funding treatments
Once again the Conservatives chose the NHS as their issue to lead their party conference announcements. Last year it was a technology fund to support nurses this year it was the Cancer Drugs Fund. The news that the Fund is to be extended, was recognition of the ongoing struggle to develop an effective system that can properly assess the value of treatments for cancer patients, including both those that are already on the market and those to be launched in the future.
Throughout conference both Hunt and Cameron reminded voters of the number of patients who have benefited from the fund and laid down the gauntlet to the Labour administration in Wales to introduce a similar Fund there (Labour for its part does not seem to have a CDF policy position as yet). More of such comparisons are expected in the coming months as the Tories look to secure the Fund as a major vote-winner at the ballot box next time around.
Health’s G8
Perhaps surprisingly one of the topics missing from Jeremy Hunt’s speech last week was dementia. The financial, social and economic challenge of dementia makes it a political challenge too, and the launch of David Cameron’s ‘dementia challenge’ last year is a clear signal of this.
The G8 summit on dementia research in December will be an important test for the Prime Minister’s dementia challenge. To date the challenge’s work has focused on making communities safer (or friendlier) for dementia sufferers and fixing some of the barriers to funding reform. While these seek to address some of the short-to-medium term threats of the growing dementia generation, improving the availability of effective treatments for the disease will be an important longer-term goal, and something December’s summit will seek to respond to.
Dementia is a disease that affects millions of people across the country, be they patients, carers or the children of people suffering from the disease. Making December’s summit something that matters to the public, therefore, could reap political rewards.
The danger of a cold snap
The Secretary of State will certainly have his fingers crossed that this winter, and the accompanying flu season, is a mild one. Stories of A&E departments unable to cope are not unexpected in November and December, but they are not expected in July. The £500 million to support struggling A&E departments was a short term (political and operational) sticking plaster. While welcoming the funding, provider representatives have been warning for a while of the pressures they are under. It is therefore no coincidence that the Government has this year released the annual winter pressures funding earlier, to assist trusts in planning how best to deploy it. The Secretary of State will hope that trusts have used this additional time to plan ahead effectively and manage increasing demand. However, as with any Minister, Mr Hunt will need a bit of luck to ride out the trickiest season for someone running the health service.
So, where does health go next?
An analysis by social media monitoring and engagement agency Synthesio at Conservative conference revealed health as the number one policy area discussed and debated, once again demonstrating its importance as a political issue. For politicians, getting health right matters, how they respond to these issues in the coming months will determine who goes into the next election with momentum on the issue.