While time marches forward, there are some things that will never change. The NHS will remain an area of potential political danger for the Conservatives, and the health service in England will continue to face financial constraint despite the extra funding promised in the 2015 spending review. In addition to these perennial pressures, it appears that social care will come increasingly to the front of the political agenda. The policies set out by the government after the 2015 election will move towards implementation. Ministers can expect a bumpy ride, as changes impact right across the service.
Devolution of health powers will continue apace. While in most cases there may not be immediate impact, the tectonic plates will begin to shift. Devolution to Greater Manchester is progressing. George Osborne announced in December 2015 that devolution of health to London would begin with pilots in five areas of the city. Among others, Cornwall, Gloucestershire and Liverpool have also applied for devolved health powers. In the long term, this will mean a new way of approaching health public affairs. Local government health decision makers will face different pressures and this may be seen in the shape of the health system in each devolved area. A watching brief on how these local deals will affect private sector suppliers of services will be essential in 2016.
In tandem with local devolution, the 50 NHS ‘vanguard’ sites will continue their work. The sites will be crucial to the future development of the NHS and are a lynchpin of delivery of its Five Year Forward View. These sites are tasked with meeting efficiency targets by 2017/18. How they do this will be important. Not least because there is growing scepticism that the NHS can meet the £22bn in efficiencies it committed to in the Five Year Forward View. Some key figures now feel a significant percentage of these savings can be made but achieving the £22bn total will be difficult.
This is a good example of how local devolution can clash with a health service that will remain ‘national’. Although the overall funding envelope is set nationally the implementation of efficiencies will happen increasingly at a local level. The balance between the centre and periphery will become more interesting and of greater concern to businesses supplying the NHS. For example, to what extent will the Carter review into operational productivity be implemented with a heavy hand from the centre or left up to local areas to put into practice? In this climate controversy will continue over how best to incentivise and adopt innovative medicines and technologies into the health service.
Whilst policy making power is increasingly shifting towards a local level, the national focus will remain pre-eminent in 2016. One policy of particular interest to NHS staff will be proposals leading towards more parts of the NHS functioning seven days a week. It is a policy that has caused much controversy already and will continue to do so as it moves towards reality. This will be as much for the disruption caused to the workforce practices as the price tag the cash strapped service will face.
One area that is unlikely to escape the attention of Parliament this year is social care funding. There was some recognition of this in the recent announcement of a social care precept allowing councils to raise extra funding for social care provision. But expect social care strains to persist. The introduction of the national living wage from April and limited increase in fee rates will add to the pressure on providers. Indeed, it is far from guaranteed that every local authority will adopt the social care precept. There is also the potential for a gap to widen in social care between the ‘have’ and ‘have not’ councils. This could cause difficulties for the government’s one nation and northern powerhouse messaging and provide the opposition a stick with which to beat the government.
2016 looks to be a year of transition for health and social care in England. To paraphrase Antonio Gramsci, the old is dying and the new is not yet born. It will be a year for businesses to shape what is emerging and to prepare for what may be coming down the road.