In January 1988 Margaret Thatcher appeared on Panorama to announce the review of the NHS that led to the internal market reforms. Almost exactly 12 years later Tony Blair chose Breakfast with Frost to declare NHS funding should be increased to match the EU healthcare spending average.
Time will tell if Theresa May’s appearance in front of the Commons liaison committee yesterday, in which she announced a “sustainable long-term plan” for the NHS backed by a “multi-year funding settlement”, will take a similar place in the service’s history.
What unites all three interventions without question is that they were all made with the aim of binding in wavering cabinet colleagues to the stated objective. Mr Hammond and the Treasury now have no choice but to back the idea.
Quite how generous they will feel when it comes to providing the necessary funding is another matter - and an absolutely critical one.
The prime minister has come to realise that delaying an NHS funding increase until after Brexit risked having to pay more and receive less credit. The consistent lobbying by the NHS England chief executive Simon Stevens and health secretary Jeremy Hunt has convinced her to make the NHS’s 70th birthday a crystallising moment for the service. The two are now a very effective double act, an astonishing turn of affairs given they where barely on speaking terms just a few months ago.
The announcement received little coverage relative to its importance. Huffington Post political editor Paul Waugh does the best of job of explaining the apparent lack of media interest and why, despite that, the PM’s intervention still constituted a “huge a political moment”.
The next three months will be ones of intense activity to shape the offer. The final plan is likely to have two elements. There is no desire to restart the thinking on the Five Year Forward View, so the plan will focus on how it can be better delivered now the funding (hopefully) matches the ask. The second element will take the big service priorities such as mental health and cancer and set out a vision of what they should look like by the middle of the next decade.
How directly it will tackle social care is perhaps the most significant issue. Without a meaningful plan to address the crisis in that sector the ability for the NHS to deliver, as the Forward View made clear, will continue to severely constrained.
The new plan will echo the forward view in being presented as a compact between the taxpayer and the NHS, setting out what the public can expect to get in terms of improved service and what the NHS will be asked to deliver.
However, it will be much more of a delivery plan and there will be a conscious effort to learn the lessons of the last few years and previous NHS reforms, especially those of the last decade.
As a result there will be a greater concentration on workforce, more realism about ability to contain rising demand, productivity (particularly the use of new technology), and the length of time it takes capital investment to begin impacting on service delivery. The Treasury will be particularly keen that most of the money it hands over goes into service delivery and not, as it believes was the case a decade ago, that too much is spent on significant increases in staff pay.
We should expect to see some more flesh on the bones before the NHS’s 70th birthday in July, but this year’s autumn budget is the effective deadline for a meaningful and long-term increase in NHS funding.