How hard will it be for the Tories and Lib Dems to agree on a health policy?

BMJ 2010; 340 doi: (Published 12 May 2010) Cite this as: BMJ 2010;340:c2571
  1. Nicholas Timmins
  1. 1Financial Times

    During five days of tense negotiations to try to form a new government for the United Kingdom, the NHS was barely mentioned.

    “Not a deal breaker,” said senior Conservatives and Liberal Democrats as the two parties finally came to agree on the really big issues: how to cut the deficit; when to start cutting the deficit; defence; education; and, critically for the Liberal Democrats, political and electoral reform.

    And on one level it is easy to see why this is the case. On the basis that it is money that makes the world go round, there is precious little difference between the Conservatives and the Liberal Democrats on NHS finances, despite some divergent rhetoric during the campaign. So what does the future hold for the NHS now that the Conservatives and Liberal Democrats have formed a coalition government?

    The Tories have pledged to real terms rises in NHS spending throughout a parliament, although no one believes that any increase will be anything other than absolutely minimal in real terms.

    While Labour promised to protect frontline services for at least two years—95% of the health department’s budget, the party said—the Liberal Democrats were the only party not to promise to protect health, arguing that no department should be fully protected from the tornado of spending cuts to come.

    In practice, however, the Liberal Democrats, like Labour and the Conservatives, promised more or less credible cuts to management costs but declared that “we do not plan to make net cuts in spending on frontline services.” So the difference is smaller than it appears.

    The Liberal Democrats, like the Tories, are pretty happy with the idea of any willing provider—private or voluntary as well as public—being able to offer NHS care. Both parties sound more robust on the issue than Labour did, with its policy of “preferred provider,” whereby NHS organisations got a first and second chance to improve before services were tendered to outside suppliers, and its manifesto promise of an “active role” for the independent sector, which it qualified by saying, “particularly where they can bring innovation.”

    There is much else the Conservatives and Liberal Democrats have in common—putting more money into health deprived areas, widening choice of GP (common to all parties), and publishing more data on quality—and where their health policies differ the issues are not likely to be contentious.

    But one huge structural divide exists. The Tories want to create an independent board to commission care and to radically revamp the regulatory system, turning Monitor into a fully independent regulator that would oversee not just foundation trusts—its current role—but also manage market entry and exit, possibly set the NHS tariff, and take over the role of the Cooperation and Competition Panel for NHS-Funded Services. The Liberal Democrats, by contrast, want to turn primary care trusts into elected local health boards to commission care, hoping in time to give them revenue raising powers.

    During the election campaign Norman Lamb, the Liberal Democrats’ health spokesman, attacked the Tory idea of an independent board as “crazy” and “a nonsense.”

    Mr Lamb declared that “to have an independent, non-elected quango responsible for £100bn of public money is simply incredible.” Decisions will have to be made on closing hospitals and restructuring services, he said; and if those decisions are made by “an unelected quango, it will become the Child Support Agency of the NHS.”

    The board, he said, “will be a deeply hated organisation, and just because it is independent of ministers will not make it popular. I think it is a nonsense. It will lack any democratic accountability.”

    Equally, while the Tories have been promoting themselves as localists, they are none too keen on elected local health boards. How far either party remains wedded to these opposing ideas remains to be seen.


    Cite this as: BMJ 2010;340:c2571


    • Nicholas Timmins is public policy editor at the Financial Times.

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