At HM Treasury, I worked two floors up from Winston.
Under my desk at 1 Horse Guards Road, with the same floorplan – albeit with lower ceilings and thicker walls – sat the Cabinet War Rooms. It’s here that 76 years ago, Churchill walked in and declared “This is the room from which I will direct the war.”
My job as a Treasury minion was about adult social care spending, a very different national challenge to that of the basement’s previous occupants. Funding shortfalls meant public money was being focused on a smaller group of sicker people. We were concerned that if something drastic didn’t happen soon the system would collapse. Talk of social care crisis had been ongoing for some time. We discussed with the Chief Secretary whether they wanted to use their upcoming November statement to act on a recent review into funding options.
I want to introduce you to three people. Stanley is a US Navy general. He’s 49, jogging in Iraq’s searing heat. Jean-François is a French industrialist. He’s just climbed out of his boss’s helicopter to be announced as the new Chief Executive of a brass foundry. Jos is a Dutch community nurse. He’s just quit his job. So has his wife. They have savings (small) and children (five).
Together, these three can help save our health services.
Health policy goes round in circles. In the words of ex-health secretary Stephen Dorrell, “there is nothing new under the sun in terms of the issues which health secretaries have to deal with.” That we are on such a policy hamster wheel may seem futile and depressing. But the silver lining is that such circularity provides a rich tapestry for politicians and policymakers to learn from when seeking to solve current NHS problems
When Andrew Lansley proudly published Liberating the NHS on 9 July 2010, he had many reasons to be cheerful. It was sunny. The NHS plans he’d long talked about were moving towards reality. Being in a coalition government hadn’t derailed his strategy too much. He had also set a new record: taking a mere 62 days since the election to publish a health white paper.
With Jeremy Hunt now back at the Department of Health, let’s look at what will be happening behind the scenes to turn post-election ideas into government policy…
Right. Let me level with you: I started writing this blog – about what the election result has told us about the shape of future health policy – prior to the polls closing. I’ve since deleted every word I wrote.
From 10pm on Thursday night it was clear that we were likely to get a completely different outcome to what earlier opinion polls had predicted. It’s going to take a while to fully comprehend what the BBC’s Robert Peston has already described as the 'most significant election of my life'.
However there are already some clear implications for health policy – here’s my take and please do give your views in the comments below.
I used to play squash. I largely played with my family, and I thought I was pretty good. Three days into university, I happily agreed to a game with a fellow fresher. After 30 minutes of forlornly chasing shots I couldn’t reach, I gave up and went home realising I wasn’t good, I wasn’t even average – I was bad. Very bad.
Picture it: Andy Burnham, George Osborne and Norman Lamb get stuck in a lift. What do they talk about? Going by their recent speeches, integration of health and care might be a good place to start. It’s the focus of Andy Burnham’s ‘whole person care’ policy, George Osborne’s £6bn ‘Devo-Manc’ devolution, and Norman Lamb’s desire to merge the national budget for health and care. So what’s the prospect of these words becoming reality
The NHS is no stranger to five or ten year plans. Today’s publication of the Five year forward view takes its place in a lineage which includes 2009’s NHS 2010-2015: from good to great and 2000’s NHS Plan, among a library full of other titles with similar echoes of communist tractor production.
Its importance is being talked up, with Simon Stevens (NHS England’s Chief Executive) describing it as the most significant document for the NHS since 1948. However, how different is it really from plans gone by? It’s a similar length (30+ pages), contains the prerequisite homage to the NHS ('may be the proudest achievement of our modern society'), and the usual welter of statistics about how the NHS is simultaneously great and in need of drastic change.
What does the future hold for quality in the NHS? We’ve certainly become accustomed to the quality of health care rising steadily in England. As recently as 2007, only half of those waiting for elective treatment were seen within 18 weeks, compared to over 90% today. In those seven years, MRSA infections have reduced by 79%. However, given the financial challenge the NHS is facing, whether quality is even able to stand still is now being called into question.
Like many others working in health policy, I’m a big fan of a well chosen metaphor. My favourite at the moment is the so-called ‘iron triangle’ – that all health care systems are always looking to achieve quality, access and affordability (the three points of the triangle), but can only deliver two at best.
So why I am obsessing about triangles? It’s all about the signals currently being sent to the NHS, and whether they’re capable of being delivered.