The focus and measures of success of both the government and the healthcare system are becoming ever more intertwined, points out Michael Wood
Health has played a central role in the 2019 general election campaign, with various, and often vague, promises being made about tackling the long-standing issues around workforce, capital and of course, social care. While our sector waits to see what the new Conservative government will do to address these common problem children, it is worth leaders in the NHS taking a moment to ponder what 2020 might bring in other important and linked areas.
The economy will, as ever, be the main focus of our incumbent government. While we often view the success or otherwise of the UK economy through a national prism, it is the regional imbalances in productivity that give most cause for concern and do most to explain the size of Boris Johnson’s majority.
The new administration will, if it wants to maintain the political support of these areas in the midlands and north in particular, have to address the long-standing structural imbalances in these economies which has led to a dearth of “good work”, the rise of low pay and in-work poverty and no sustained replacement for those industries decimated in the 1980s.
Expect, for example, significant infrastructure investment to be thrown at these communities, particularly focused on transport and developing new and highly skilled industrial bases, which should strongly align with any capital, skills and innovation plans NHS leaders are developing to maximise local impact. Strategically, this will also have subsequent, long-term implications for how the Treasury makes future investment decisions which our regional leaders should support.
Inequalities matter for the economy, and vice versa
These stubborn inequalities that we see in many communities are increasingly being commonly understood as both economic and health challenges. While the Local Industrial Strategies currently being drafted will all have touched on this issue expect them to revisit how to develop local economies that spread wealth much more evenly, specifically prioritising initiatives that target those populations furthest from the labour market and who often rely heavily on local public services.
The government’s flagship multi-billion pound post-EU funding programme, the UK Shared Prosperity Fund, will finally be consulted on and ICS population health leads should be prepared to lobby publicly to ensure it fully addresses the needs of their communities.
This takes us on to devolution
Devolution has in many ways been on pause for a few years, yet we should expect it to be much more prominent in policy thinking. The Conservative Party has already promised a white paper outlining a new devolution framework during 2020. This approach will be two-fold: with a focus on progressing a range of new deals with areas yet to commit (roughly half the country); and one which sets out to “level up” the current deals.
In my view it’s highly doubtful whether levelling up includes granting existing Combined Authorities more health and care powers, a la Greater Manchester, but the possibility of this in future is certainly an intriguing thought. Whether sitting in a Devo area or not, now is surely the time for health leaders to understand and engage with the strategic local planning that will be underway.
And what of finance?
For the past nine years the government has been focused on stimulating local economies to effectively become self-sufficient, whether through the early localisation of fiscal policy (such as business rate retention) or through allowing increased local authority borrowing to invest.
In many ways the biggest immediate threat to the funding of social care was the sudden decision in November 2019 to raise the Public Works Loan Board interest rate by a percentage point, which directed millions away from front-line services to refinance council investment portfolios. While the new government has committed to increased public spending and to finding, and presumably funding, a solution for social care, our local government colleagues will be finally hoping for a conclusion to the Fair funding Review, which has been attempting to set out how local authority funding is allocated and redistributed since 2016. Any decisions on social care funding surely cannot be made in isolation from this review.
Playing our part
While we may not yet expect the Conservative Party to publicly champion wellbeing as a key metric for the economy, rather than simply GDP, in the same way as both Labour and the Liberal Democrats promised, this is an argument that will grow stronger as the focus, and measures of success, of both the government and the health and care system become ever more intertwined.
As always, both the health policy sphere and the NHS leadership community will be busy making sense of the ensuing government’s new sectoral focus, but it needs to be much more attuned to the wider plans and developments. There is much in the coming year that the NHS should be closely involved in given the critical importance of health inequalities to the long-term plan.