Filed Under (Election campaign, Health Policy, Secretary of State) by Paul on 11-05-2010
After an election a Secretary of State for Health exists in a vortex of three major pressures.
The relative power of each of these three determines outputs.
They are the policy; the politics, and the public finances, and to understand what is going to happen we need to understand the relative power of these three forces. In May 2010 these clearly have different strengths.
• Policy Any new Secretary of State will have been developing their policy for some time and will have a great deal of faith in it as it has been honed with their advisers and stakeholders. But the new Secretary of State will not have a resounding mandate for that policy- they did not gain a majority for it. It is possible that those parts of the Manifesto that appear in two manifestos (in health terms – a lot) and which does not need legislation and a Parliamentary majority will have a very good chance of implementation. So it is very likely that the access targets so dismissed by the Conservatives for so long will be stopped. However- see below- a Secretary of State that was worried about an early election might announce the policy now but wait for the new operating framework in April 2011 to implement it
• Politics Most people expect another election to take place within a year or so. This means that the new Secretary of State is fighting the next election from day 1. Their boss the PM will expect that the political impact of each decision on that election will be thought about carefully. The NHS started the last election as the second most important issue. The new PM will not want a lot of headlines about problems in the next year especially if they can be traced to new policy. David Cameron promised a moratorium on closures of A and E and maternity units. In specific seats he has promised the reopening of closed units and wards. So all of this will have to be implemented irrespective of cost as political interventions. The money will have to be found to open redundant plant. Do not expect the new Secretary of State for Health to continue the policy of their two predecessors and pledge to implement all independent reconfiguration panel proposals. This is a pre election year and they will overrule everything except in safe Labour areas. And the policy of stopping targets will probably come under political control. It will be a bold Secretary of State who stops targets from May 2010. Such a quick decision could lead during the election in a year’s time to the Labour Party finding one patient in each marginal constituency who had been waiting a year for their operation. If this were to happen the politics of the next election is already set for May 2011. The slogan “long waiting times with the same old Tories” will be ringing round the country. So expect all policy to be implemented through the strong filter of politics.
• Public finance This dominated the election, the discussion about the coalition and will dominate the next few years of our lives. Its fairly clear that this will be more significant than all the other forces in new developments Does the new Secretary of State have the money to carry out their policy and their politics? Each Secretary of State for Health expects to get more money (less cuts) than their cabinet colleagues. But even if, as is likely, the NHS finances are on steady state then the money will dominate everything. What we know is that unless there is a sudden input of 5-6% a year above inflation for the NHS, then the NHS will feel that it has less money. If it is opening hospital wards that it cannot pay for then in some parts of the country it will have a lot less money. One would expect that the new Government will set up a star chamber which will review all policies in line with what makes sense for public finances.
Over the next few weeks all of this will become much much clearer, but expect a year long election campaign and a tumble into deficits to dominate everything.