After weeks of party infighting, the prospect of crunch time Brexit negotiations ahead and haunted by the nightmare of last year’s conference shambles, the pressure on the prime minister to deliver a strong speech last week was immense. With a bit of self-deprecation and help from Dancing Queen, by most accounts she pulled through. The prime minister who once was thought might last fewer days in office than Sir Douglas-Home showed again her staying power.
But those hoping for a glimmer of a domestic agenda or more clarity on the future relationship with the EU were to be disappointed. In Liverpool the week before, the Labour leader Jeremy Corbyn –having also proved resilient in the run up to the party conferences – presided over a confused debate on Brexit. What was the Labour party’s line, and how did this differ between members of the front bench (notably John McDonnell and Keir Starmer) or the position agreed at the TUC conference only a few weeks previously?
Lack of direction on Brexit by both leaders created space for a return to values and well-worn rhetoric, including the much-loved (and sure-fire vote winner), the National Health Service. Theresa May celebrated her Conservative government’s robust response to the NHS funding crisis, with the promise of an extra £20.5bn per year. Jeremy Corbyn stressed that the additional money may not be enough for frontline services.
Hosting fringe events on the future of the NHS at both conferences, the Centre for Progressive Policy (CPP) examined how we should think about health and social care over the next 70 years, how any changes would affect the NHS workforce and the huge, unresolved issue of funding and delivering social care. Speakers and attendees included: (Conservative party conference) Sarah Wollaston MP, chair of the Health Select Committee, Dame Julie Moore, Professor of Health Systems, Warwick University and Ian Hudspeth, Leader of Oxfordshire County Council; (Labour party conference) Andy Burnham, Mayor of Greater Manchester, Dr Chaand Nagpaul, chair of the British Medical Association, Maureen Dalziel, former chair, Barking, Havering and Redbridge University Hospitals NHS Trust, Greg Parston, Executive Director, Centre for Health Policy, Imperial College and Lord Victor Adebowale, CBE, Chief Executive of Turning Point and non-executive board member, NHS England.
Central to our debates were three key questions:
Key takeaways from sessions at both the Labour and Conservative conferences were:
- The challenge of good health is bigger than the NHS: speakers and participants in both conferences agreed that we must look beyond improving front line NHS services if we are to take health more seriously. The increase in life expectancy in the UK – previously a trend that had almost come to be assumed – has plateaued. There are also signs that some regions are falling behind more rapidly than others. The causes of this are yet unclear but CPP’s ‘Diagnosis Critical’ report (June 2018) identified population inequalities across the country remain a major concern for improving health outcomes overall. Despite the seminal work of Sir Michael Marmot in his 2011 Review, policymakers and the public seem unable to integrate health into wider economic and social policy. For the NHS to survive it needs to think outside its own institutional walls.
- Plugging the holes in the system is not enough: Speakers emphasised the need for political deliberation as to how to place the NHS on a sustainable funding model whilst delivering world-class care. It was suggested that the anticipated £20.5bn annual funding boost by 2022/23 will help to lift morale within the NHS and potentially improve services but it cannot be a silver bullet for solving the underlying structural pressures on the NHS, such as demographic change and a shortage of sufficient, suitably trained workforce. Health and social care require a radical whole-system overhaul in combination with a long-term financial plan. This financial plan will also have to address the rebound effect of the underfunded social care sector. Without this, it is very likely that we will be back at square one in a few years.
- Moving to deep-place integration of health and social care: A whole–system approach acknowledges that the NHS is not based on hospital treatment alone and the importance of largely place-based, social and economic determinants of good health over the life cycle. Tackling health inequalities will demand coherent national and local governance and accountability, and appropriate financial incentives that foster collaborative, dynamic and integrated economic and social policy. Joint primary, secondary health and social care services must put patients first through the lens of population health management and prevention. At present there are too many perverse financial and regulatory incentives that act against the health ‘system’ working effectively or efficiently in the interests of the people it serves.
We heard that Greater Manchester is already committed to tackling the root causes of health inequalities by moving from a medical to a social model of health, which takes into account – and seeks to build into institutional policy, practice and financial flows – the environmental, working and cultural circumstances of a person, alongside (or as part of) their health condition. But whether and how central government allows the city-region to go further and enables other places to do similarly within a national health service setting remains a question of debate. Finally, the issue of integration must apply between different health providers, enabling closer working practices and facilitating exchange of information through better communication and improved technology (e.g. Bromley-by-Bow Centre or Sandwell Integrated Primary Care Mental Health and Wellbeing Service).
Speakers and participants acknowledged that a key issue is how to raise awareness about the social and economic determinants of health, which are deeply rooted in our communities. This is a tricky task on the local level where health is still mainly perceived as a responsibility of the national government and the fixing of potholes, for example, a more appropriate priority for local authorities.
Ultimately there is a steep hill to climb for local and national politicians, through the media, in communicating the risk that NHS, the crown jewel of the UK welfare state, may not survive another 70 years if the circle between a long-term strategy and sustainable funding cannot be squared. Deliberative research by CPP shows that the public do not currently grasp the scale of the problem and are expecting additional money to raise the quality of services, not just fill an abstract financial gap. The nation’s health depends on more ambitious, more fundamental change.