The government's bid to get reform out of standstill

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The next stages of health and social care reform come with major political hurdles, writes Richard Sloggett.

The irony of the standstill in central London for the pageantry and pomp of the Queen’s Speech yesterday will not have been lost on those who feel this was merely a pre-election exercise.

It became, effectively, a broadcast to show what more could be done if only government and parliamentarians could finally break the Brexit standstill.

It is clear from the prominence of the NHS in the speech, and the slew of health commitments and bills, that nearly 100 days into his tenure, the NHS is the prime minister’s number one domestic priority.

Yet with the current divided politics, and a general election looming, the chances of the speech being implemented are small.

And the issue for health and social care leaders pushing for reform is, if not now, then when will it become reality?

The answer hinges on the political reactions to the details – or lack of them – in yesterday’s plans.

The detailed plan

It is no surprise that NHS England’s long-term plan legislation proposals are to be brought forward.

This enables the government to once again relentlessly reference the increased investment going in to support it, including the recently announced “health infrastructure plan” on capital.

The exact reform proposals have been assiduously cultivated by the NHS leadership.

First included in January’s long-term plan, then opened up to the cross party Commons health committee, thousands of public consultation responses, and ultimately supported by an open letter from stakeholders (and don’t forget the engagement with the NHS Assembly too).

Until now ministers and politicians have been kept at arms length. But as the agenda moves into Westminster, this is where things will get much harder.

The introduction of any new health legislation will be the subject of huge debate and inevitable disagreement (it is well worth a look at the arguments in the last session over the mental health capacity bill if you don’t believe me).

And with cross party relations at something of a nadir, it’s highly unlikely the proposals will get an easy ride.

Anticipating this, the government has made it clear that it will hold a firm line on any attempts to significantly amend or alter the legislation during passage. It will pull the bill if major amendments are inserted that run counter to the NHS proposals.

This “detail first” strategy is designed to create a major headache for the Labour opposition and push the reform through.

Labour’s dilemma is simple. Attack the proposals (which they appear to be all set to do) and see the legislation the NHS wants withdrawn.

Or agree with the proposals and lose a political attack on the government’s NHS plans in the run up to an election.

The shadow health secretary has very limited room for manoeuvre and will need to find a way to square off his pro-NHS credentials with being anti-NHS backed health reform.

How he approaches this difficult challenge will be key to the progress (if any) the bill makes.

The plan with no detail

The reference to adult social care in the Queen’s Speech will disappoint many campaigners, providers and activists. They will likely feel deep frustration at the lack of detail, particularly two years on from a promised and yet to appear green paper, and that after plenty of previous false starts and dawns.

But the experiences of 2010 and 2017 leave a political scar on politicians who look to bring in social care reform during an election (see Andy Burnham’s recent HSJ interview for more).

Given we are now in a pre-election tussle, it is no surprise that a cautious approach is being taken.

Perhaps more positively, the speech comes at a time of an emerging political consensus on the need for a state backed solution, and the agenda gaining much wider prominence.

In setting the social care reform work up in this way the government is looking to take the political heat out of the topic at election time, seeing this as the best way to ultimately deliver commitment Boris Johnson made to fix the system immediately after becoming prime minister.

The main challenge will be whether this vacuum of detail can hold up to the scrutiny that surrounds an election campaign and the understandable clamouring from the sector for urgent action.