Ensuring the NHS Five Year Forward View had the right political impact was always going to be a difficult balancing act
To meet its aims the publication needed to win support for the NHS’s own priorities, and for the necessary funding growth, from all major political parties, not only those currently in government.
‘The aim of the forward view was overtly political’
However, despite it being independently developed, the forward view had to be something the sitting Conservative led administration could work with and broadly endorse.
Its originator Simon Stevens has worked closely with prime minister David Cameron, health secretary Jeremy Hunt and chancellor George Osborne – the latter a particularly important relationship as illustrated by the autumn statement and the devo Manc proposals.
Wary of the forward view
Following on from this, both the Conservatives and Liberal Democrats appear squarely lined up behind the forward view as their agenda for the NHS in the next Parliament.
The same is not clear in the case of Labour, the party which according to current polling is most likely to lead the next government.
‘Stevens’ close work with the current government may rankle with Burnham’
Mr Stevens’ plan is not mentioned in Labour’s health manifesto. Health shadow Andy Burnham tells HSJ today that he supports the principles of the Stevens vision but that it “leaves many big questions unanswered” and “doesn’t amount to a detailed plan for the NHS”.
There are several plausible reasons for his wariness about the forward view. Mr Stevens’ close work with the current government may rankle with Mr Burnham, as may the NHS England chief executive’s Blairite background and approach.
There is also the realpolitik difficulty of backing a document published under the current government, the twists and turns of an election campaign, and the fact Mr Burnham has his own very deeply held views on health and social care.
It may simply be that Labour’s perceived vulnerability on the economy has led it to reject making an “unfunded” commitment to the £8bn real terms growth in health spending required by the forward view, and as a consequence it has shied away from any reference to the document.
The upshot, though, is a worry that a Labour led administration in May could move away from the implementation of the forward view as the health service’s central direction and main priority.
This would be a problem. It is vital the stability, focus, local flexibility and (in many areas) energy the forward view provides are maintained. The health service would be severely damaged by having two competing visions for its future.
HSJ has praised Labour’s plans for health and care, as set out in its ten year plan earlier this year, as brave, not least focusing on important but unglamorous issues such as home support, mental health and prevention.
‘Labour would be wise to acknowledge sooner rather than later that £8bn will be required’
These threads remain in the party’s policy, and its emphasis on integration, prevention and personalisation chime with the Stevens vision.
Labour’s desire to hold back the private sector and markets in the NHS, while not 100 per cent in tune with some paragraphs of the forward view, would not throw it off course if pursued in the right way.
Political interventions in the NHS should, however, run with the grain of the service’s own plans and add political momentum to them.
Mr Burnham argues that Labour’s further and faster approach to integration – to a “fully integrated… single service” – would change the parameters underlying the forward view, potentially meaning the NHS requires less than £8bn real terms funding growth.
This is extremely unlikely and, although there are genuine questions to be asked about how the Conservatives would fund their £8bn commitment, Labour would be wise to acknowledge sooner rather than later that it is at least this sum which will be required.
Other arguments for substantial amendments or diversions from the Stevens vision should be explained so the service can consider and adjust if necessary. Politics and personality can’t be allowed to get in the way.
The leadership of the NHS, having staked all on the forward view as the blueprint for the next five years, will be hoping Labour’s downplaying of the document is purely an artefact of the election campaign. If it runs deeper, they will hope they have the bargaining power to bring a would-be government back on side.
Exclusive: Forward view leaves ‘big questions unanswered’, says Burnham
- Currently reading
Neither politics nor personality should throw the NHS's plan off course