The general election comes as every part of the NHS in England is in flux and social care waits for a reform plan.
The two main parties are promising a monsoon of extra funding for the health service. But while Conservative commitments lack credibility, Labour’s ideological tinkering risks getting in the way of service delivery.
The Tories trumpet their mythical 40 new hospitals, of which only six are funded while the remainder include 12 community hospitals in Dorset. Throwing cash at desperately needed projects such as rebuilding Whipps Cross hospital in London is better than nothing, but the Conservatives’ “famine then feast” approach to capital spending ramps up maintenance costs and harms patients by depriving the NHS of investment in vital technology such as scanners.
The Tories’ promise to enshrine NHS England’s long term plan in legislation matters because it includes legal changes to help NHS organisations collaborate on priorities such as improving population health, scrapping many rules around competition and procurement. Unlike Labour’s approach, this clears the worst of the wreckage of the current system out of the way without risking even more reorganisation.
Voters face bamboozling funding figures that give an impression of endless largesse, glossing over how money has been diverted from capital spending, clinical education and training and public health services such as sexual health clinics to keep day-to-day services afloat.
But the money is no longer the biggest problem. It is a measure of how the NHS workforce crisis – notably in general practice – is worrying voters that the manifesto gives extensive space to plans for more staff such as 50,000 additional nurses and 6,000 GPs. But they lack credibility. As health secretary, Jeremy Hunt promised an extra 5,000 GPs and numbers went backwards. A lot will depend on the post-Brexit deal and wider immigration policy.
A commitment to sort out the doctors’ pension problem, which is causing a haemorrhage of top talent, means little after months of failure to grip the issue.
There is not a syllable worth reading on solving the social care crisis.
The big flaw in Labour’s plan is the prospect of triggering yet more turmoil in NHS structures by repealing the Health and Social Care Act. Everyone knows the mayhem Andrew Lansley’s reforms created and the damage caused by the obsession with competition, but repealing the act is not the answer.
The ingrained behaviours of almost 30 years of competition are beginning to give way to collaboration. Local services are beginning a long journey towards thinking and working as integrated care systems managing population health instead of just fixing illnesses. Hospitals are increasingly coming together in groups with shared management. GPs are being brought together into primary care networks.
Yet more important than all this, almost one in 10 clinical posts lie unfilled. In the face of such extraordinary turbulence, yet another top-down reorganisation would be an unforgivable and costly distraction from integrating services and tackling the workforce crisis.
Labour’s determination to rapidly “end and reverse privatisation” prioritises the ideological over the practical. With escalating waiting lists this is not the time to cut off capacity.
Other commitments risk putting politics before pragmatism. Promising to “halt the fire sale of NHS land and assets” must not morph into preventing the sale of outdated buildings to finance new developments. Of course the government should commit to ensuring NHS data is not “exploited” by international technology and pharmaceutical companies, as long as that does not mean blocking collaboration that benefits patients and brings a good return to the health service’s massive investment in securely collecting data.
Labour’s best commitments are tackling health inequalities and developing a national care service for England built on the principle of independent living. These pragmatic policies would change lives.
The NHS will be a financial winner whoever forms the government. But the top priority has to be the workforce.
• Richard Vize is a public policy commentator and analyst