NHS fortunes will rely on Tory and Lib Dem harmony as Andrew Lansley steps into the role of health secretary

Andrew Lansley had been promised the position as the new health secretary and despite the unforeseen coalition circumstances, that promise was kept. He comes to the role with an unprecedented level of knowledge and established relationships, as this is the job for which he has been in “shadow” training for the past six years. “Relief” must be an understatement of his feelings when he finally sat at that Richmond House desk.

The NHS has been spoilt and efficiency took a back seat while practice variation remained unchecked

His new team constitutes a rich seam among the new departmental line-ups. Paul Burstow for the Lib Dems has been given the sensitive issue of social care, with 20 years of campaigning on health issues as wide-ranging as disability, elderly care, public health and MS under his belt. They are joined by three more health experts: Anne Milton served the NHS for 25 years as a nurse; Simon Burns returns to health having served in the shadow team under both Liam Fox and Mr Lansley; and Earl Howe in the Lords, who after 10 years of health in opposition is highly respected by professionals. Together they will have to dig deep to meet the challenges of finding savings and combining policy priorities.

There was only a single line on 12 May in the first seven- page Coalition Negotiation Agreement on the subject of health, stating that NHS funding should increase in real terms each year. That is the good news; but as everyone in the service knows, closing the productivity gap and finding £20bn in savings so the NHS can cope with increased demand is the coal-face reality.

The savings that need to be found are attributed to the rising costs of an ageing population and the cost of technology and the medicines bill. As the number of people living longer increases and both medical and surgical interventions increase, of course the bill rises.

But this does not account for much of the huge increase in spend over the past decade. The NHS has been spoilt and efficiency took a back seat while practice variation remained unchecked. Contracts were poorly negotiated and evaluation was neglected, leading to vastly higher costs than anticipated, with no improvement in productivity.

Power remained in the acute sector, thwarting more care in the community and integration of care pathways. Pensions remained excessive and unreformed. Demand was also fuelled by self care, responsibility and first aid becoming unfashionable in a dependency culture. Unravelling this profligacy is no mean task but has to be done.

Differences in approach

But added to the task are the differences in approach between the Conservatives and the Lib Dems. Mr Lansley had promised no reorganisational upheavals while the Lib Dems wanted to scrap strategic health authorities and introduce local health boards. My impression is that this was not a fully formed vision from the Lib Dems, so this might not be a sticking point, helped by the fact that both parties want to see the role of the GP - through practice-based commissioning and/or through improved accountability - beefed up and taking on more responsibility.

There was commonality between the manifestos in the emphasis on a move to “local”. They both wanted tougher consequences for hospital acquired infections and a move to more autonomy (presumably with greater accountability too) for hospital trusts. Likewise they have emphasised public health, though Mr Lansley has been much bolder in his call for this being embodied through changing the department’s name. Scrapping the NHS IT programme was in the Lib Dems’ manifesto but the Tories have become more measured in their approach.

The biggest differences from the manifestos were on social care and the creation of an independent NHS board. Ironically, before the general election, Mr Lansley had instigated private discussions between the three main parties on the future of social care to see if a consensus could be reached. He was slapped down for taking this initiative and the talks were derailed. So maybe now consensus is in fashion, he can pick up where he left off, as most commentators agree that the Conservatives’ idea of an £8,000 insurance premium at retirement to cover end of life care is not going to comprehensively solve the social care problem.

The aim of the independent NHS board super-quango would be to set strategic objectives for the NHS and to remove politicians from day to day responsibilities, but still be accountable to them.

This creation would represent a radical shift in power and it will be shaped significantly by the first board executives. The idea resonates with the commonly held overall Conservative-Lib Dem philosophy that more power should be given to professionals and that ministers are held accountable for outcomes rather than process. In that they are united. Improved health may rely on their remaining so.