The NHS section of the Tory Manifesto begins with a statement which could have happily been penned by Jeremy Corbyn.
“Our national health service is the essence of solidarity in our United Kingdom” it begins, continuing that the party “believes in the founding principles of the NHS.”
Later in the document it lambasts the “NHS’s own internal market” for its “costly bureaucracy”. There is no mention of choice, competition or the role of non-NHS providers – nothing even on the need for an “efficiency drive”.
But make no mistake - the ideas set out in prime minister Theresa May’s first manifesto do not signal the Conservative Party wanting to give the NHS an easy ride.
For a start the money promised effectively extends the period of NHS funding austerity to 2022.
Yes, there will be a little extra money next year, an “ambitious” capital programme is promised, the revenue pledge is a “minimum”, and – as HSJ predicted – Ms May has given herself more wriggle room on increasing public expenditure. However, the service can still expect the next two years to feel the tougher than any they have experienced for a generation.
Then there is the mood music around “accountability”. The manifesto declares “It is NHS England that determines how best to organise and deliver care” and adds, “we will hold NHS England’s leaders to account for delivering”. This is very different from the “we’re all in it together” tone in the 2015 Tory manifesto.
Here – and in the call for new consultant and dentistry contracts – the hand of Ben Gummer can be clearly seen. The cabinet officer minister, formerly of the Department of Health, has staged a series of robust interventions on NHS issues recently. He was heavily involved in dealing with the NHS cyber-attacks over the last weekend, for example. Many believe he is being lined up replace Jeremy Hunt, although the latter’s influence is notable in a range of other manifesto commitments.
The possible arrival of an even more interventionist health secretary is supported by the caveats that sustainability and transformation plans will get the government’s backing “providing they are clinically led and locally supported”.
This shorter leash for the NHS and its leaders could be felt in the legislation the manifesto permits, to provide “clear national or local accountability”.
This – and the other healthcare legislation mentioned in the manifesto – could be wrapped up in a substantial “omnibus bill”. Something of that magnitude would have to wait until after the Brexit negotiations.
An alternative would be a relatively streamlined piece of legislation which could be enacted sooner. This might tidy up the car crash of responsibilities shared by NHS England and NHS Improvement and, possibly, give some statutory backing to emerging accountable care structures. But the quid pro quo might be a tightening of the financial accountability of NHS organisations to resemble something closer to that governing local authorities.
The Labour Party’s attempt to derail the Tory takeover of their traditional turf is undermined by the size of their funding pledge, which is only a little higher than the Conservative offer at best - and about half what most commentators think is needed.
Its manifesto, realised earlier in the week is full of policies which would be welcomed by most in the NHS. This all things to all people approach does strain its credibility, especially given the funding commitments. One of the brightest ideas is making assaulting NHS staff a specific criminal offence, an idea already put into action in Scotland with positive results. Theresa May has shown an appetite for borrowing ideas raised by rival parties, and the Conservatives could embrace this as part of their pledge to “take vigorous action against those who abuse or attack” NHS staff.