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  • We already have a radical manifesto for the NHS: it was written by the NHS

    Just two of the three political parties whose ideas could shape the NHS in England over the next Parliament have published their manifestos. But we don’t need to wait for the Conservatives to reveal their ideas later this week to conclude that the most radical health policies have already been revealed…10 months ago… by the NHS.

    If you’re looking for a really radical read, look no further than the Long Term Plan (LTP) for the NHS in England.

    It is against the backdrop of the NHS LTP’s implementation that political electioneering and party promises for the health service feel a little flat.

    Without a doubt there are eye-catching commitments in the manifestos we’ve seen so far. The Liberal Democrat’s promise to increase the urgency with which mental health services reach patients is significant. Plans for large capital investment in the NHS estate including new equipment are also notable and both policies make clear where the Party feels the NHS has been left unloved.

    Proposals to move drugs policy to the Department of Health & Social Care also seeks to change the focus on combatting the burden of drug use from law and order, to care and rehabilitation. Yet this speaks to a Party looking to stay ‘on brand and on message’ and these are not unexpected positions for a Party – with a membership that directs policy – to take.

    Equally, The Labour Party’s commitment to introduce a ‘Future Generations Wellbeing Act’ focussed on narrowing inequalities, demonstrates the progressive qualities the Party seeks to espouse. The health of a child’s life can be defined even before they begin their first day at primary school, and this Act (much like Sure Start centres did for New Labour) makes a clear statement of investing in the future.

    But even this Labour Party, confidently positioning itself as the radical party of change – is recycling as much as it is reforming. Establishing a nationalised generic drug company, though disruptive to the market, is not much more than extension of an ideology that runs as a thread through proposed nationalisation of rail, water, broadband and more.

    Indeed, Labour’s health policy feels like reverse-gear – repealing legislation, removing the NHS from any exposure to market forces and returning universal free prescriptions and dental care (that only ever lasted three years between the establishment of the NHS in 1948 and Aneurin Bevan’s resignation as Health Minister in 1951).

    The Conservative Party manifesto will be published in the next few days. One can only speculate, but we will likely see more detail on issues that have been covered already: money for new hospitals and equipment; money for primary care services and doctors; and an expectation that a ‘prevention better than cure’ focus will translate into more money for public health services.

    The reason all this sounds quite underwhelming, backward-looking and like more ‘magic money’ (and ‘magic doctor’) trees is that all Parties have been beaten to the punch.

    NHS England was established in large part to put an end to the NHS being used as a political football. As one of the most skilled political operatives in the country, Simon Stevens has used his position as Chief Executive of the organisation to keep the ball firmly at his feet.

    And with the NHS LTP Stevens’ intensified a comprehensive programme of reforms that began when he took charge of the NHS in 2014 and that he has continued to shepherd since.

    There is a reason that since taking the helm in 2014, Stevens has not fallen from his position as the most influential person in health – leaving Prime Ministers and Secretaries of State looking upward.

    From that position the LTP, its development personally overseen by Stevens, introduced a properly radical programme. It set-out a complete overhaul of primary care services that has seen the establishment of 1,300 new primary and community care organisations across the country. It committed to a comprehensive NHS workforce implementation plan – that has become the NHS ‘People Plan’ – and that will define the issue that the current Health Secretary made his first priority just two weeks into the role. And the LTP also paved the way for a full review of NHS Access Standards that have dogged politicians month-in-month out for years. These three are to name but a few.

    Engraved on the tombstone of Karl Marx, in London’s Highgate Cemetery, are the words:

    The philosophers have only interpreted the world in various ways. The point however is to change it

    The influence of NHS England has grown to such a point that politicians of all stripes are left to interpret the health system in many different ways and deal in the theory of how the NHS should work.

    But the truth is that the way that patients will experience care and treatment will be decided by the change NHS England will oversee – and the levers that only Simon Stevens knows how to pull.

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