HSMC were grateful to honorary member of staff Sir David Nicholson for his recent seminar for staff, students and local partners on the implications of the forthcoming general election.

David Nicholson

Reviewing experience of the 1997 and 2010 elections, Sir David explored the way in which the civil service might respond to the outcome of the election. In 1997, New Labour won a landslide victory but arguably did not have a fully formulated health policy, and therefore lost valuable time before implementing a longer-term reform strategy. In contrast, the Coalition of 2010 had a ready-made plan, but many commentators would argue that they implemented this too quickly (rolling out at pace and repenting at leisure).  Depending on the outcome in May 2015, it will be interesting to see what approach is adopted this time round, and whether any lessons have been learned from previous experience.

In practice, the main three political parties seem to have accepted the arguments of the NHS England Five Year Forward View, albeit there remain differences around the level and sources of funding promised, the emphasis of Labour on a potentially more radical integration of health and social care and the championing of mental health by the Liberal Democrats. There also seems to be a difference in tactics, with Labour keen to focus on the NHS as a key election topic and the Conservatives apparently eager to debate other issues (such as public finances, ongoing welfare reform and immigration).

Irrespective of the outcome of the election, there are likely to be a number of key priorities (all of which are also dilemmas in most other developed countries), including:

  • Finding ways to support and encourage people to take more control of their own health (particularly in an era of long-term conditions and with a series of future pressures likely to be caused by unhealthy lifestyles)
  • The need for new models of primary care, able to play an increasing role and to operate at scale
  • Overcoming traditional divisions between secondary and primary care, and between health and social care
  • Reforming urgent and emergency care
  • Learning from international good practice in terms of reducing the cost and improving the efficiency of elective care
  • Developing new models of specialist services, with potentially significant consolidation of existing centres

Against this background, an optimist would take significant comfort from recent debates about the Five Year Forward View, the extra investment that has been promised and work that is already underway around each of these future challenges. Equally, a pessimist would be concerned about our ability as a system to implement the potentially radically and politically unpopular actions that might be required.  Perhaps a key role for current and future NHS leaders is therefore a more pragmatic approach which tries to do the best we can against each of these priorities and to make the former, more optimistic scenario more likely than the latter, more pessimistic assessment...