Health policy in a well-run country should be boring. It should be the precise and prosaic matter of examining data on health and care demand; looking at issues of performance, outcomes and safety; and making systems run in such ways that every taxpayer’s pound buys as much as possible of what we citizens and taxpayers need.
As we stare down the barrel of our third general election in four years, it’s sobering to realise that for the past decade, health policy has not been boring at all.
We had the 2010 general election with accusations from the Conservatives that Labour proposals to fund universal free social care through a compulsory contribution amounted to a “death tax”. This accusation was symmetrically played back on the Conservatives in 2017’s general election campaign.
We had Andrew Lansley’s controversial 2012 Health and Social Care Act, aiming to let patient choice, provider competition and clinical commissioning drive the NHS – none of which, in reality, has happened. And the political skills of Simon Stevens, who became the boss of NHS England in 2014, ensured that health and social care funding have never been far from view – and drove former prime minister Theresa May’s 2018 announcement of £20bn extra NHS funding. And now Boris Johnson has pledged even more extra money for the NHS – though some of his figures don’t add up.
This week’s NHS spending promises from Labour and the Conservatives, with the former pledging £5.5bn more than the Tories’ £20.5bn over the next parliament, guarantees that the NHS will play a key role in the coming weeks of campaigning. Yet this may not be great news for the NHS – or for us taxpayers, voters and service users.
Johnson’s self-identified chief strategist, Dominic Cummings, notoriously helped to swing the Brexit referendum with his claim, on the side of a bus, that “We send the EU £350m a week – let’s fund our NHS instead”. Now the Conservatives are trying to rebrand themselves as “the party of the NHS”, and, after nine years of marginal increases, believe the NHS needs a lot more money. Other than that, they don’t really have a health policy or even any ideas, having outsourced all that to Stevens.
Labour knows it is widely regarded as the party of the NHS, given that the party created it in 1948 and, under the Blair/Brown administration, gave the health service its biggest funding increase ever, of 6% real-terms cash growth every year between 2000 and 2010. As a result, Labour has looked at the Tories’ pledges, and responded: “Anything you can promise to spend, we can promise to spend more.” Labour also has the additional rhetoric about halting NHS privatisation, which seems likely to appeal mainly to already confirmed Labour voters.
So which party can voters trust? Labour faces political credibility problems, given that its front bench is light on government experience. Interestingly, for all the party’s “anti-privatisation” talk, shadow health secretary Jon Ashworth told Health Service Journal he would be “pragmatic” about using private sector capacity to treat NHS patients in the early years of a Labour government.
But the Conservatives face the “you broke it: you own it” dilemma. Conservative-led governments have been in charge of the NHS for almost a decade now, and its performance is objectively deteriorating, as independent academic research and official data on performance from a range of credible sources show.
With the recent announcements of further deficits and record waiting times, the experience of those needing healthcare will not help the Conservatives. Earlier this year, the British Social Attitudes survey found that public satisfaction with the NHS was at its lowest level since 2007.
These issues are the direct consequences of years of highly constrained NHS funding; the near collapse of social care; and, more recently, the huge impact of the “taper tax”, which has driven many consultants to refuse the extra work that will be vital in bringing down waiting lists.
Labour, as in 2010, is offering a universal, free-at-point-of-use national adult personal social care service. There is no clarity yet about how it will fund this, though detail is promised in its manifesto.
The NHS should be Labour’s brand, and voters may break its way if enough are angry at the Tories’ stewardship. But more broadly, this election campaign has the air of one that could easily be decided or derailed by a big event.
We seem to be living through a game of party political poker over the NHS. Labour is, in effect, daring the Tories to raise their NHS funding bet. It will be interesting to find out which side blinks first here, but it’s not a wildly mature way to run a national health and care service.
• Andy Cowper is editor of Health Policy Insight and a columnist for the British Medical Journal
