Three weeks in politics when three letters were the talk of the town | Matthew Macnair-Smith


A revealling look at the health news and views that emerged over party conference season.

The poet WH Auden once opined that his “deepest feeling about politicians is that they are dangerous lunatics to be avoided when possible and carefully humoured; people, above all, to whom one must never tell the truth.” 

Ignoring this advice, the NHS Confederation headed to all three major political party conferences this year where, far from avoiding politicians, we sought them out in an effort to amplify some important ‘truths’ about the challenges currently facing health and care.

The Labour and Conservative conferences were platforms for a newly re-elected Jeremy Corbyn and a new Prime Minister, Theresa May, along with her new-look Cabinet. But all was not change, as Jeremy Hunt returned to the stage to give his usual polished performance as Secretary of State for Health – for the fourth year running. 

His speech included announcements of up to 1,500 more medical training places a year from 2018/19, so the NHS can be “self-sufficient” in doctors by 2025, and proposals for newly trained doctors to work for the NHS for four years after training, to recoupe the £200k training cost.

We are not clear what these policy announcements will do in the immediate term to address the workforce shortages we know the NHS is facing. Indeed, better workforce planning was a theme at several roundtable and fringe events we attended, including the Royal College of General Practitioners roundtable at Tory conference. There, a discussion about multi-morbidities quickly became an agreement on the need to find an immediate plan of action to facilitate a change to the way health and care systems are designed. This, it was argued, would help meet the changing needs of a population increasingly living with multiple conditions. 

The urgent need for action was also a key part of the Liberal Democrats’ conference. At the Royal Pharmaceutical Society/2020Health fringe session, former health minister Norman Lamb was forthright in his views about the health and care system facing an ‘existential crisis’ and said that without ‘radical action’ it faces a crash. 

The solutions the Lib Dems have alighted on include a promise to give more money to the NHS – even if that means raising taxes. Other solutions garnered more cross-party consensus, and at all three conferences, there was clear recognition of the parlous state social care is in and agreement that it needs a sustainable funding settlement. 

The Labour Party promised parity of esteem for social care while the Lib Dems proposed the creation of a national health and care service, with joined-up budgets for health and social care. We also heard politicians make further calls for a ‘national conversation’ or an ‘open and honest debate with the public’ about what we are prepared to pay for and what the consequences are for not paying for it. 

In her speech, Corbyn’s then shadow health secretary, Diane Abbott, repeated her pledge to ‘reverse the tide of privatisation’ by repealing the Health and Social Care Act.

She also announced that she would address the crisis facing social care by giving it parity of esteem with health. Her conference address committed a Labour government to rolling out a ban on the NHS taking out PFI contracts and the establishment of a PFI monitoring unit. We will see where the newly appointed shadow health secretary, Jon Ashworth, stands on these pledges as we seek to meet with him and other newly appointed shadow health ministers in the coming weeks.

Within Abbot’s speech was a call to arms against sustainability and transformation plans (STPs), which have been labelled a ‘Tory cuts programme’. A succession of speakers also highlighted closures and reconfigurations they believed were being planned. Negativity around STPs stalked all three party conferences, with MPs and councillors alike highlighting the concerns emerging about the STP process being too secretive, with insufficient local patient/population, political and clinical engagement. 

At the fringe events we held with the Optical Confederation, Royal Pharmaceutical Society and 2020Health, councillors said they didn’t feel fully involved in the development of STPs and criticised the plans as being overly concentrated on stabilising NHS finances and the acute hospital sector in particular, rather than transforming services for local populations.

We launched our joint paper, Understanding sustainability and transformation plans, in Birmingham and discussed its main thread with MPs from all three parties. We highlighted our view that the principle behind STPs and the progress being made towards planning services across a local place, led by local public service leaders, was a positive step forward, but that more support, more time and more meaningful local engagement are needed to give STPs a fighting chance.

Churchill once said that politicians have the ability to foretell what’s going to happen tomorrow, next week, next month, and next year – and have the ability afterward to explain why it didn't happen… We’ll wait to see whether politicians’ actions live up to their rhetoric over party conference season. 

Matthew Macnair-Smith is a policy and research manager at the NHS Confederation. Follow the organisation on Twitter @nhsconfed

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