There are barely six weeks until the election. Polls show the NHS to be the issue the public cares most about and everyone – voters, staff and its leadership – now accepts that it must undergo big changes to survive the tough years of 2015-2020. In the circumstances, the three main political parties should already have policies in place on the NHS that are not just detailed but also credible, well thought through and, necessarily, bold; that are commensurate with the daunting task facing the nation’s most cherished public service, to modernise completely or risk collapse. But sadly, and worryingly, they don’t.
Labour’s launch last week of its first poster of this campaign – an X-ray of a broken leg with “next time, they’ll cut to the bone” above it – saw Ed Balls and Andy Burnham warn that a Conservative government could shave £7bn off the NHS’s budget. Health may not be one of David Cameron’s six priorities for the runup to 7 May, and it is hard to disagree with Labour’s description of that as “a staggering omission”. But the Tories have promised to ringfence the NHS budget and give it real-terms funding increases, as the coalition has done, albeit those annual uplifts have been tiny. Labour’s scaremongering followed Balls’s equally dubious claim that the Tories would introduce charges for NHS services. I fear these early skirmishes are an ominous sign of the quality of the debate during the campaign – knockabout, when it should be deadly serious.
It is inescapable that unless social care is fixed, the NHS will not cope and cannot improve. So where are the Labour, Tory and Lib Dem plans to rescue social care, which the NHS Confederation chief executive, Rob Webster, last week said was “on its knees”? Even Ukip have pledged £1bn extra a year. Labour’s signature pledge of full integration of health and social care into one service involves admirably fresh thinking but, without cash, fails Simon Stevens’s “how do you avoid simply bringing together two leaky buckets” test. Similarly, on preventing illness – identified as vital in the NHS Five Year Forward View to reduce the unsustainable demand for care – where are the big parties’ big thoughts on the game-changing public health measures needed? On reformulation of unhealthy food, for example, Labour is proposing legal limits on fat, salt and sugar in products marketed at children. That’s a start. The others have nothing to say.
The NHS-wide staff shortage, already serious, will become even more problematic in the years ahead, as stress, overwork and pay damage recruitment and retention. Labour is promising £2.5bn a year (though only from 2017) to pay for more nurses, GPs etc. The Tories have pledged 5,000 more family doctors. But this problem – the real shortfalls in more and more specialties (GPs, radiologists, nurses, A&E staff etc), the growing reluctance to work as staff for the NHS, and the huge agency and locum bills that NHS trusts face – is so acute that much more imaginative thinking is needed.
Labour and the Tories’ refusal to commit to finding the extra £8bn a year for the NHS that Stevens has said will be needed by 2020 – the Lib Dems have pledged it – is very worrying. So they accept Stevens’s blueprint – no one has a plan B – but won’t commit to doing their bit. What does that tell us? When delivering the unprecedented transformation envisaged in the Forward View becomes controversial – when a local hospital faces being downgraded because services are to be moved elsewhere, hospital doctors prove sticky about working much more in the community or the £8bn proves inadequate – will the political will be there to err on the side of necessary but unpopular change?
Jeremy Hunt, Andy Burnham and Norman Lamb acknowledge the unsustainable state the NHS is now in. But their parties’ prescriptions thus far are too cautious for the scale and urgency of the task that will face the next government. The manifestos, many debates and endless arguments between now and 7 May could change all that, of course. But there is no room for any failure to rise honestly to the challenge.
