The NHS and the Election – Parties Ignore the Big Issue

We looked at the major party manifestos earlier this week from a procurement perspective but it is worth looking at the NHS specifically and what might happen after the election. The Conservatives and Liberal Democrats have promised to fund the Five Year Forward View (FYFV) with the £8 billion over and above inflation that is required according to Simon Stevens et al in the FYFV. Labour has not made that promise, offering instead a targeted £2.5 billion and various changes to the service, including to the current commercial NHS regime.

“We will repeal the Government’s Health and Social Care Act, scrapping the competition regime and restoring proper democratic accountability for the NHS. We will establish a sensible commissioning framework, based on the principle of an NHS preferred provider, to stop the drive towards privatisation and make sure that NHS services are not destabilised by competition and fragmentation. Where private companies are involved in providing clinical services, we will impose a cap on any profits they can make from the NHS, to ensure that the needs of patients are always put first.”

Labour also want to exclude health from EU procurement regulations – good luck with that, guys. But none of the parties really highlight any procurement issues, unfortunately, either from the perspective of opportunity or threat (see comments on temporary staff below).

However Labour present their ideas, they would mean yet another major reorganisation of the NHS, with all the disruption and indeed cost that this always implies. And in terms of this profit cap, we commented here on the dubious nature of this idea. I guess if you are philosophically against competition, the Labour proposals may look attractive.

But the biggest issue for all the parties, which they are conveniently ignoring, is that the FYFV is NOT a “plan”. It is a vision, with little detail on how to achieve that vision. It also assumes the NHS can make efficiencies of 2% to 3% a year to effectively “save” £22 billion by 2020. But not only is this a higher rate of efficiency increase than has ever been achieved before, the starting point is that productivity has actually declined in the last two years, as we reported here. That has meant many hospitals falling into severe financial difficulties.

David Nicholson spoke up last week on this.

“Sir David Nicholson, who retired last year, told the BBC the NHS in England was accruing large deficits which would become "crystal clear" later this year. But he said instead of talking about how to address these, politicians were focusing on expanding services.

He said the situation caused him "very great concern". In an interview for BBC Radio 4's Today programme, Sir David - who ran the NHS in England for eight years - said that because there was an election period, the NHS was unable to publish the latest report on its financial position.

But he said it was "pretty clear in the NHS that there is a substantial financial problem, particularly in the hospital sector" which would become "crystal clear" in the autumn.”

We are also seeing a vicious spiral developing in terms of the use of temporary staff. As wages for staff have been frozen for several years, and shortages grow because of poor resource planning, it becomes more and more attractive for permanent staff to become “temps.” That reduces the permanent workforce further, pushes up temp fees, attracting more people to move into that type of work .. . and so on. That may be part of what is happening now, and it’s hard to see how we are going to break out of it quickly.

So, make your choice. Another major re-organisation from Labour, and the end of any competitive pressure on providers (which you may consider a good or a bad thing). Or a “throw some money at the NHS, and hope for the best” approach from the coalition parties.

Whoever wins, here is our prediction. By this time next year we will be into a full-scale, headline news, “NHS crisis.”

 

 

 

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