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Public concern on NHS may tempt parties to undermine its future

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In the general election next year, health could play strongly in the many marginal constituencies, especially where reform is under way. That is why Health Service Journal has taken the unusual step to poll the public on their views on health policy


The 2015 general election is going to be close. Indeed, there might even be two elections next year – if, for example, Labour secure the most seats but the Conservatives take a greater share of the popular vote.

It is unlikely that any of the main parties will propose detailed radical healthcare policies in their manifestos.

‘All parties are likely to promise “more money” and “more doctors and nurses”, without being very specific’

All, in various ways, are likely to promise “more money” for the NHS and “more doctors and nurses”, without being very specific about numbers or timing. Other healthcare manifesto commitments will also be mood music - leaving significant wriggle room.

However, the parties all know the future of the NHS will play a significant part in the vote. As an issue which people think is both important and are concerned about - the key measures of whether a subject influences voting - health trails only the economy and immigration. Most notably, health could play strongly in the many marginal constituencies, especially where reform is underway.

It is for this reason that HSJ has taken the unusual step of working with partners FTI Consulting to poll the public on their views of health policy. It is an exercise we will repeat to plot trends and to drill into specific policy areas.

Post-election planning

The public’s attitude to issues such as service reconfiguration and the role of the private sector will colour the stance of the parties and their behind the scenes post-election planning. As HSJ commented last month, intense electioneering can find politicians committing to things they would prefer not to.

‘Black and white positions are damaging to the development of effective health policy’

For example, our polling shows significant levels of concern over NHS “privatisation” that outstrips the current reality. Faced with such a strong public bias it would be a brave, or perhaps foolhardy, Labour politician who did not stoke that fire – and potentially paint the next health secretary into a corner.

Equally, politicians of all parties would look at the 74 per cent describing themselves as “very concerned” about A&E closures and be tempted to give reassurances that could bind an incoming government.

More than ever, black and white positions are damaging to the development of effective health policy. As incoming NHS England chief executive Simon Stevens noted, there is now a lot more that unites health policymakers from the various schools than divides them.

The integrated care debate

Last week Andy Burnham was due to speak at the Commissioning Show on the subject of health and social care integration but had to cancel at short notice. The recently retired Commons health committee chair Stephen Dorrell was also speaking in the session and Mr Burnham’s office let it be known they were happy for the former Tory health secretary to reflect their view on the issue.

On the same day, Jeremy Hunt spoke of clinical commissioning groups becoming “accountable care organisations” responsible for improving the health of a population rather than simply managing its healthcare. The creation of ACOs within the NHS was first linked to Mr Burnham’s developing ideas by HSJ 18 months ago.

‘Even the supposed great divide on the use of competition is largely a technical one’

It would also be remiss not to mention that the Liberal Democrats have made much of the running in the integrated care debate.

There are differences of course. Mr Hunt sees ACOs as commissioners, Mr Burnham as providers – and “preferred NHS providers” at that. But these are differences in tactics, not strategy. Even the supposed great divide on the use of competition is largely a technical one over the guidance given to commissioners about the most effective methods of selecting providers.

Care integration, reducing reliance on hospitals, improved transparency, better use of technology – a suite of ideas whose time has come is coalescing. The HSJ/FTI poll shows the potential for public concern to derail this hard won consensus and responsible politicians should do all they can to avoid that outcome.

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