The Seven Month Forward View?
This weekend brought news that Labour’s transition chief, Lord Falconer, has confirmed that five pieces of draft legislation have been prepared to smooth the party's transition into government if so required. Unsurprisingly, a bill repealing the Health and Social Care Act is among them. With this bill comes the confirmation that a Labour-led first 100 days is being planned to include primary legislation that at least tinkers with the rules and, at most, explores the future of existing NHS structures, leadership and priorities.
Andy Burnham has been questioned on numerous occasions on how his proposed changes to the Health and Social Care Act do not amount to a top-down reorganisation. His assurances that the party will ‘work through the structures we inherit’ come after five years immersed in a health community that has told him that there is little desire from clinicians, commissioners or patients for further structural upheaval.
The draft bill being prepared by the Labour Party therefore needs to be modest in size and scope. There would be considerable risk in kick-starting a new term in office with a broad health bill that could drain political capital, snarl up the parliamentary timetable and create untold confusion and frustration to those trying to plan and manage NHS services across the country.
But even the best laid plans could go awry, particularly when the majority of polls point to a hung Parliament in which Labour will need to join with a coalition of the left to secure a workable majority. How far would Labour’s coalition partners – whoever they may be – allow a health bill to stick within such narrow parameters?
Nicola Sturgeon in particular has a bold agenda for the NHS that reaches far beyond the Scottish borders. Her promises to protect the NHS in Scotland from privatisation by helping to roll back the market in the English NHS could push Labour far deeper than they really want to go (whatever Andy Burnham’s rhetoric suggests). Bringing the myriad of providers who are currently delivering services - across clinical delivery, mental health services, social care and beyond - back into the NHS-fold may be beyond the scope of a Labour bill, but their new partners in Government may have other ideas.
For the NHS England leadership, who have enjoyed considerable political support and autonomy under the current Coalition, the new uncertainty created by a Labour-led coalition of the left may have major consequences. Indeed a coalition deal between any combination of partners will likely require the foot being eased off the Five Year Forward View pedal, at least while coalition agreements are thrashed out.
Coalition negotiations can easily lead to compromises that have unintended consequences (just look at the chain of events unleashed by the commitment to have greater democratic involvement in health commissioning in 2010). Even parties supposedly committed to stability can end up bargaining their way into extensive upheaval.
So, in spite of everyone’s recognition that a period of stability is what is needed in the NHS, we cannot be certain that Simon Stevens' defining strategic plan for the future of health services shouldn’t have been called the Seven Month Forward View instead.
Image 1: 1, 2 Ipsos Mori (20 April 2015), 3 YouGov (16 April 2015), 4 GP Magazine survey of 460 GPs (17 April 2015)