As spring turns to summer, most people’s thoughts will turn away from the election and its aftermath to the weather, summer holidays, the weather, the World Cup and the weather. Inside the air conditioned offices of Whitehall, civil servants and policy wonks will be working hard on delivering the coalition’s health policies.
Almost a month after they received their ministerial portfolios, the coalition health team will be pretty confident they know what they are doing – especially as many of them had the health brief in opposition. In Simon Burns’ case he was a health minister in the Major government. But what about the rest of us?
In terms of funding and the impact of the new government’s efficiency programme, we know there are two important dates. First, George Osborne’s first Budget on 22 June, and second, the comprehensive spending review (CSR), which is likely to report in the autumn, possibly at the same time as the pre-Budget report. The CSR will likely set out health spending for the next three to five years and, as health secretary Andrew Lansley has hinted, whether the NHS in England will be required to generate efficiency savings greater than the £15bn to £20bn that has already been targeted. In the meantime, the coalition has committed to real terms increases in health spending for each year of the Parliament and to cut administration costs by a third.
Policy-wise, we know that reconfiguration plans are on hold, Strategic health authorities are likely to be downgraded and primary care trusts may get directly-elected representatives on their boards. GP commissioners could be offered hard budgets rather than the current indicative sums – a move that could increase management costs.
Like all new governments the Conservative – Lib Dem coalition is going over Labour’s policy documents with a fine tooth comb. This includes the current year’s operating framework, policy on payment by results (PBR), management costs, programme budgeting and costing. (It should be said that all statutory regulations and guidance remain in force while the ‘update’ is taking place.) But given the wafer thin differences between the Conservatives, the Lib Dems and Labour on PBR, for example, how much will really change when the government’s own tariff policy documents and guidance begin to appear?
Some interesting embellishments of the coalition’s health policy have emerged. The proposal to make Monitor an economic regulator with some influence over price setting, for instance, is an attention grabber, particularly as there will be an independent board set up to (among other things) allocate resources to commissioners. Will the Department of Health sit in the middle squaring the circle between funding and prices? There are even unconfirmed reports about wholesale changes to the GP contract – scrapping PMS and GMS in favour of a new contract held centrally by the new NHS board.
The new regime at the Department is also keen to be seen as transparent. That is how it explained why it published on 2 June the McKinsey report into the fiscal future of the NHS. Why now, one might ask? The report is the best part of a year old and Mr Lansley has rejected its recommendations because they set a top-down agenda. The previous government, which commissioned the report, had also binned the consultants’ proposals.
Is the health secretary saying, ‘Here are examples of things I don’t want you to do’. Or, a cynic might ask, does Mr Lansley want local health economies to take the ideas, toss them around for a bit and then make them appear to be their own?
Either way, the NHS would appreciate some clarification and the end of this nudge-wink style of management.