The Commissioner: The NHS's Daily Mail moment

Yesterday’s Daily Mail splash will have received plenty of attention in Downing Street. Not only was there a banner headline and half page pic focusing on the legs of the prime minister and Nicola Sturgeon, the Mail is already the guiding media light for Number 10.

It has been said – with only a little exaggeration – that the day the Mail’s editors accept the NHS needs more cash will be the day the money arrives.

So far this year, the paper’s leader columns have wondered “how can we ever reform the 1940s behemoth of the NHS if we simply go on feeding it cash, without focusing on what we get in return?” And recommended “serious discussion about alternative systems in other countries which combine state funding with social insurance”.

Views like this and its enthusiastic coverage of the NHS’s problems feed the resolve of many in the service who regard the paper as its ideological swarn enemy. 

In this context, the paper yesterday had its first interview with Simon Stevens in his three years in post, the NHS England chief having visited Mail HQ to give an exclusive preview of his landmark Five Year Forward View two years in update.

While it was risky, you can understand the case for the charm offensive and the interview has delivered its first positive front page for the NHS leadership I can remember.

You might dispute “positive”, but the NHS is at least presented as battling hard with its spending problem, and the headline proclaiming there is a “blueprint to save the NHS” won’t go amiss.

Unfortunately it is overblown given the meat of the interview, which gives little away about the imminent new delivery plan (you’ll have to see hsj.co.uk on Friday morning for full coverage of that) and certainly doesn’t solve the funding problem.

Instead it is a comprehensive gallop through the NHS’s current policies that lend themselves to the Mail’s populist/right wing outlook: the NHS needs to get its house in order on spending; patients need to reach into their own pockets for specialist products and over the counter drugs; Europeans will pay for care; parents must take responsibility and feed their children vegetables; and unpaid care by families is very important (though insufficient for the social care challenge).

Presumably the clear message that NHS England wanted to convey to the government and the rest of the Mail audience (the largest of any paper if you include its website) is that the health service is being ruthless about making savings, and isn’t squeamish about personal responsibility or shifting justified costs onto private individuals.

Lots of NHS staff will find the thrust of the interview hard to stomach but the service has been calling for help sending out the message that under current funding it can’t do everything demanded of it, and for air cover for controversial decisions like blocking prescriptions.

Clinical commissioning groups have asked for support with prescribing specifically, while a growing number have been tripping over in recent months as they seek to cut costs by restricting operations, sometimes blocked by NHS England. Of the potential prescribing savings outlined yesterday, most are “barn door obvious”, as Graham Jackson says, though some are more contentious and verge into potential risks for disadvantaged patients.

For most CCGs, their finances are so dire that if they haven’t already banked some of these savings, going after them should be unavoidable. While every little helps, the main problem is that the sums aren’t big enough.

As a footnote, the Mail interview is a prompt to consider what a right wing/populist agenda might, given the chance, mean for the service. The usual favourites include migrant charges; punishing patients for being unhealthy and misbehaviour with restrictions and charges; rolling back some prevention measures; relying on families for social care needs; attacks on management; and abandoning taxation funding.

The current funding settlement has gone largely unchanged for a very long time but we’re in a strange place: public finances are still under a cloud a decade after the crash; the social care question may reopen big funding questions; the Labour party is, err, weak; and this is probably the most right wing government since the one that introduced the purchaser/provider split (an old Michael White column reminds us it was Liam Fox, now in the cabinet, who as shadow health secretary proposed changing the funding mix).

Amid growing calls for wide ranging reviews of NHS funding (likely alongside social care), the King’s Fund has been moved to publish work this month pouring cold water on the idea of a major change to the funding mix.

So are we heading for punishment charges, receding the NHS offer, and a move to social insurance funding?

It is highly unlikely. No one thinks Mr Stevens will stand for more of this - he was, unsurprisingly, careful to draw the line with the Mail, arguing that the focus must be on making improvements and savings to the NHS we have rather than revisiting the settlement.

There is no reason to think the government wants to go down this road either, and it has more than enough big ugly problems on its plate already. So it is probably, hopefully, only a fleeting Daily Mail moment for the NHS.