NHS managers, who would have to deal with the consequences of underfunding and messy policy commitments, need MPs to make clear promises, rather than averting attention from the funding question, writes Dave West

We are only days into the election campaign proper but have already counted the prime minister using the “bureaucrat” pejorative for NHS managers three times in public.

Dave West

Dave West

David Cameron, as well as using disrespectful language, has been deploying the incorrect assumption that reducing the number of managers is wise.

Politicians of all colours have a tendency to broadcast such myths at election time, so HSJ has debunked the most commonly repeated of these as we launch the second phase of our Respect for NHS Managers campaign.

‘Politicians of all colours have a tendency to broadcast myths at election time’

Yesterday Mr Cameron made clear that the Conservatives’ line of defence for their widely disliked NHS reforms would be to link those reforms with cuts in the number of managers (few of which were directly linked to the Lansley reforms), and recent increases in hospital nurses (in fact a response to the Francis inquiry report).

Many senior Conservatives familiar with the NHS know the reforms set in train by former health secretary Andrew Lansley in reality left behind more “bureaucracy”, not less - a dense jungle of competing and conflicting organisations and committees, fragmentation in decision making, and some unnecessary and ill understood rules.

Pot shot fall back

Several experienced NHS leaders who have made major changes to services in the past, breaking down traditional divisions or rationalising across large areas, have observed that in this post-2013 environment they would not have taken the risk of trying them.

Yet this is exactly what will be needed to make the dramatic productivity increases now required to maintain access and quality despite severely restricted funding.

‘Ed Miliband has also sought to divert attention to a side issue’

Mr Cameron falling back on pot shots at NHS managers serves only as an attempt to distract from this challenge, and from the issue of future funding of health and care, which should be central to scrutiny of competing parties’ health policies.

Similarly, Labour leader Ed Miliband has sought to divert attention to a side issue – while giving a nod to his party’s core support – by launching his election campaign with the announcement of a “profit cap” for private providers of NHS services.

The “cap” would have fairly extensive and potentially thorny exceptions, including non-clinical services, work covered by tariff, and social enterprise, mutual, and GP practice providers. But numerous grey areas remain.

Commissioners would be allowed to vary the cap from the default 5 per cent of contract value, if they justified it with reference, for example, to the level of risk or innovation involved.

Make the commitment

Judging providers’ profits from a given contract, and preventing them artificially reducing it, is another difficult issue which Labour believes it could deal with by requiring open book accounting - a welcome sign of support for transparency in this area.

On the face of it the policy could mean some procurements became more complex for commissioners, requiring more expertise in this area rather than less – although they may be dealing with these issues less often under Labour’s proposed “NHS preferred provider framework”.

The party should be wary of exacerbating complexity instead of fixing it, and of accidentally sending out the message that the NHS does not want to hear of genuinely useful proposals which the independent sector might offer.

‘NHS managers will no doubt study the wording of commitments carefully’

But the main concern is that Mr Miliband, like the prime minister, is averting attention from the funding question.

So far the Conservatives have said they are “confident we can deliver the Stevens plan” through a combination of efficiency savings, but will not “get tied down” to spending increases, such as the £8bn annual increase which national NHS leaders identified as the gap which would need to be filled incrementally by 2021.

Labour have committed to £2.5bn additional annual funding, although it is unclear which year this would become available, but failed to answer questions about the need for increases beyond this.

For a party to demonstrate it will meet the requirements of the NHS Five Year Forward View, its manifesto must clearly state: “We will give the NHS at least 1.5 per cent real terms growth per year, as well as the upfront funds needed to accelerate service transformation.”

NHS managers, who would have to deal with the consequences of underfunding and messy policy commitments, will no doubt study the wording of commitments carefully.