2017 will mark the 5th anniversary of the passing of Andrew Lansley’s Health and Social Care Act. Its Royal Assent signalled a period of great change and new ambitions. Some things didn’t change however. There was no new money, and demand continued to grow.
Lansley’s reforms did impose limitations on political interference in the daily running of the NHS. Indeed, in 2016 Jeremy Hunt succeeded where his predecessor failed. He managed to keep a relatively low profile, the junior doctors strike perhaps the exception rather than the rule, leaving the really tricky stuff for Simon Stevens and NHS England to deal with. In keeping the harsh realities of the NHS front-line at arm’s length, Hunt protected himself and his seat at Cabinet.
2017 and the continuing affordability agenda will likely put this strategy to the test.
“Affordability” is relatively new to the NHS lexicon. While it injects a dose of pragmatism to health policy-making – something NHS England and its partners are keen to establish – the pain of the cuts it conceals will be felt by many. Moreover, it has the potential to force Hunt’s hand, triggering renewed political intervention than we’ve not seen much of in recent years.
The Sustainability and Transformation Plans are already reported as a “Trojan Horse”, primarily to help NHS England and NHS Improvement achieve substantial savings on the front-line. Local health leaders have been forced to make, and own, tough decisions on A&E closures, job losses and mergers.
The joint NHS England and NICE consultation on affordability markers for new technologies, and the Montgomery Review in Scotland, both look set to strengthen central control of budgets and access decisions, diminishing the once independent NICE and SMC to advisory status only.
De-commissioning has been mentioned in various NHS England consultation documents, and yet little has been said as to how it will be put into practice. How will NHS England take products and services out of circulation? How will they decide what stays and what goes?
With such significant moves being led out of NHS England, with little scrutiny or accountability, it is hard to see how the Department of Health and the Secretary of State can remain at a distance.
December’s panic plug to social care funding showed once again that Government have few new ideas of how to respond to health and social care crises, delivering only a short-term funding fix, but still no lasting solution. And as one hand gives, the other takes away, with a 12 per cent cut to community pharmacies triggering legal challenges from the sector, and yet more pressure on the front-line of care.
These recurring issues are already starting to register on parliamentary radars. Recent calls for a cross-party commission to address the future of our health system have landed better than past attempts, and may yet gain momentum as the cuts start to bite close to home.
So how will Hunt and his Whitehall colleagues respond? And how long can the new Prime Minster take a back-seat on health?
For some, Brexit signals a new era of opportunity. Government officials have offered warm words about the role of the UK life sciences sector, expressing a desire to put the sector at the heart of its so-called industrial strategy. This was most recently evidenced by Hunt’s visit to the Far East, attempting to court major pharmaceutical players in the region. Welcomed by most in industry, but perhaps too little, too late for some.
Those working within the sector know only too well the untapped potential within our NHS and the wider healthcare sector. The use of data still raises more questions and answers, but undoubtedly holds the key to a truly personalised and responsive national health service.
We should also expect a new focus on combinatorial innovation– no longer innovating in isolation but in step with the system, within a pathway of care.
And where is the patient within all of this? It has been some time since a Minister or official uttered the phrase “no decision about me, without me”. But a vision for truly patient-centred care must not be abandoned. A system for the future must say goodbye to the paternal approach of old, no longer treating the disease, but treating the individual instead.
The affordability question remains the greatest barrier to achieving this vision. Limited resource will limit patient choice. But if people are told “no” more often than they hear “yes”, Hunt and his Whitehall and Westminster colleagues may start to feel the heat in a year of unhealthy discontent.
Measurement and evaluation