Opinion: Conservative health policies are short on detail

What have the Conservatives said on health so far? Their manifesto makes big promises – but is vague on detail.

NHS England’s Five Year Forward View called for £8 billion more annually by 2020 (alongside £22 billion efficiency savings) to maintain NHS standards.

Liberal Democrats were the first to sign up to this – and we set out clearly how to fund it. The Conservatives matched this – but give no details on funding this other than the ‘recovering economy’.

Lamb also called for a (much-needed!) cross-party Review of NHS & Social Care funding.

David Cameron yesterday proposed 7-day hospital services and 7-day extended hours GP access, offering 5,000 extra GP’s.

GP access is a vital problem that matters for many of us. The Liberal Democrats called for more telemedicine. Co-locating GP’s in A&E – so you go to one place out-of-hours (both ideas backed by NHS England’s CEO). £2.5 billion more to keep people out of hospital.

True seven-day hospital services may generate some efficiency of scale savings – but you still need more people working who would not otherwise be there, be they extra pathologists or porters. Where does the funding come from?

The King’s Fund added: “A seven-day NHS is the right ambition but delivering it by 2020 will be a tall order…and it will cost money” The £8 billion mentioned earlier “will not pay for new initiatives such as seven-day working.”

At the same time, the Conservatives are planning tough anti-strike laws – while we promised inflation-linked pay rises.

The NHS Confederation set out five challenges for an incoming Government – including to:
a) prioritise “reducing preventable illness and maintaining wellbeing across all public services” 
b) deliver “supported self-management and personalised care” and 
c) create “a simplified outcomes framework which aligns [health and social care]”.

We gave considerable detail on how we would meet this, such as “[by combining] the public health, adult social care and health outcome frameworks to ensure [public bodies work] towards common goals”.

The Conservatives? Yet again, excruciatingly silent on how they would meet these challenges.

Lastly, on carers and mental health Conservative policies are again vague.

The King’s Fund noted “with social care services under huge pressure […] the [Conservative] manifesto is silent about the unprecedented challenges facing [them]”.

For mental health, they talk about “enforcing access standards” and increasing funding. That’s it. Compare that with our Mental Health Mini-Manifesto, precisely detailing how we would have built on our record.

With the Conservatives’ health policy, our NHS is taking a leap into the dark. We still do not know how they will deliver their promises.

* Dr Mohsin Khan is an NHS psychiatrist. He is Vice-Chair of both Oxford East Liberal Democrats and Liberal Democrat Mental Health Association. He sits on the Sex Work Working Group and is South Central’s Regional Policy Chair. He is co-founder of NHS Survival. He has commented on healthcare for BBC Breakfast, ITV Good Morning Britain, Sky News, and London Live.

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  • Simon Gilbert 22nd May '15 - 12:00am

    Disatisfaction with the main access point to the NHS, GPs, will never end whilst there is no facility to co pay or top up. Whilst this bottleneck persists the working poor will suffer the most.
    Consider an airline flight – those in economy will get there as safely as those in business class, and the higher paying customers subsidise the cost of economy seats. If the rest of Europe can make a mixed system work so can we!

  • @Simon Gilbert

    I don’t see how paying extra to sit in a comfier seat on a flight is in any way comparable to linking access to or quality of healthcare to ability to pay.

  • David Rogers 22nd May '15 - 8:23am

    Mohsin, thanks for this, especially your points about co-location, joining up of outcomes frameworks ( a point I repeatedly made on behalf of the LGA when I had that role a few years ago), and about building on Norman Lamb’s sterling work on parity of esteem for mental health. The ongoing debate about the future of health and social care needs more details such as these, in order to make progress which is both realistic and achievable. I am often frustrated by those amongst us who seem to have a rose-tinted view of “our NHS”, monolithic and untouchable – or who are easily distracted by specious arguments about TTIP or some other latest thing!

  • Simon Gilbert 22nd May '15 - 9:58am

    @Greg Smyth I apologise for arguing by analogy, although I don’t think it is necessarily always invalid. In much commentary on healthcare access there is false binary thinking, that a condition is either same day urgent or else can wait for some weeks. In reality there is a large space in between, where earlier access is important but the patient might not expect to stop the rest of their life until they are seen.
    Unfortunately the current primary care system, where 90% of consultations occur, has no way to draw in extra funds to cope with demand, and is working at over 100% capacity (working as a GP I now sympathise with the premier league manager’s ‘110%’ descriptions a little more!). In such a system there are usually appointments, but little choice as to when that will be. Thus when a self employed plasterer has shoulder problems they have to negotiate the cost of staying off work to try to get an urgent appointment with the risk of the problem getting worse if they continue to work whilst undiagnosed.
    The NHS doesn’t have an £8 billion deficit, it has a £30 billion deficit just to provide the current service, and I see no evidence of £22billion pounds of waste that no one has managed to notice until now and can be cut to provide efficiency savings. In a health service there are natural peaks and troughs in demand, so it is not possible to equate some mid summer spare capacity with efficiencies to be cut without increasing the inherent risks in a stressed system.
    My views are not Tory ones – I believe they are more interested in giving NHS money to large commercial providers, despite the lack of evidence they will be better than the current independent GP providers, but I don’t think they are inconsistent with Liberalism.
    For if the evidence is that no government will create the capacity needed in the NHS, and there is no mechanism to draw in extra funds from elsewhere when cuts are made, the whole service itself will collapse, harming everyone. My views are by no means mainstream on this in the UK, but are the uncontroversial accepted norm in the rest of Europe.

  • Katerina Porter 22nd May '15 - 12:12pm

    The discussion of NHS costs we are having has not included what are not strictly medical costs – PFI and the 2012 bill. We all know about PFI and that some hospitals have found it worth paying off PFI contractors in spite of the cost of doing so as costs then fell enough to make it worthwhile. There is another. There is a video on YOUTUBE made by Professor Allyson Pollock whose subject has been the NHS for 25 years and who has drafted an NHS reinstatement bill. Two particular points she made are that the Act removes what was the first item in 1946. This stated that the Secretary of State has the duty of ensuring that everyone in the country has access to health care. This is no longer there. One has to be on a GP list so the homeless, refugees, and old ladies with expensive complicated medical problems will not necessarily get this. Another is the administrative costs of competition and contracts. Until the internal market came in administrative costs ran at 3/4%, and now they are running at 30/40%. And there is much more, so that any extra money found for the NHS will in part be committed to these costs. Anybody interested might find it worth checking https://www.youtube.com/watch?v=Cz5dl9fhj7o. Virgin is bidding for a contract at one billion for mental health.

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