Better jokes but worse hair. We know some of the consequences of a Boris Johnson led government for sure. But what can we say about what the new government means for independent sector healthcare providers asks IHPN’s Policy Director, David Furness.
The fundamentals haven’t shifted
Brexit will make or break this government’s domestic agenda. Theresa May’s domestic ambitions were ultimately broken on the wheel of Brexit. Parliamentary arithmetic means that legislation across government has effectively ground to a halt – nothing can get through. And in a less immediately tangible sense Brexit continues to hog all the government bandwidth. There simply isn’t sufficient capacity within number 10 or individual departments to drive an ambitious domestic programme of domestic policy reform. Brexit is the teenager downloading HD movies on your home broadband – patchy coverage for everything else. Our analysis remains that unless and until Brexit is resolved, government policy on health is likely to remain largely consistent with the past few years – a case of muddling through with delivery largely outsourced to NHS England on a day to day basis.
But PM Johnson has already shifted the dial on health
Whatever your view of PM Johnson he will certainly be a break from the past, even if the future is still unclear. And if politics is the language of priorities, he has set his out – NHS waiting times. Johnson used his first appearance in the House of Commons to say that he has asked for proposals on how to ‘drastically reduce [NHS] waiting times’. While it is far too soon to say if and how this will manifest as a shift of policy, this is an important marker for the new government to lay down. It’s fair to say that NHS performance may well move up the agenda of the (sort of) new Secretary of State for Health
Hancock stays in post, but the challenges have changed
Matt Hancock’s tenure as Secretary of State for Health and Social Care under Theresa May was characterised by a relentless focus on three themes – supporting the NHS workforce, digital technology, and prevention. He returns to the role with the same set of personal passions but with a political context that means the challenges he needs to face have changed.
The political challenge is now to manage the NHS towards a potential election in 2022 and this means getting a grip on worsening performance standards that have attracted surprisingly little political attention in recent years, with the Labour opposition focusing on the bogus issue of NHS privatisation. Boris Johnson’s early intervention on waiting times indicates clearly that they feel this is an issue of both political vulnerability and opportunity. Matt Hancock’s task will now be to deliver improved performance alongside the transformation of care promised by the NHS Long Term Plan.
A spending review is likely and could mean more spending on health
We believe it is likely that the new government will want to set out spending priorities that will either see it through 2020/21 or that can form the basis of a manifesto if an early election takes place. The Conservative leadership context has shifted the political debate over ‘austerity’ meaning that deficit funded spending commitments will be more politically acceptable. This could mean more for NHS capital expenditure (not included in current NHS funding increases) and potentially a big increase in medical and nursing training places (partly to reduce our reliance on overseas clinical staff).
We think that there remains a risk that IPT could be targeted as a source of government income, and we will be working closely to identify the risks of a potential rise, and to make the case for retaining the current level.
The legislative programme will have to wait until after October 31
The process of developing proposals for NHS legislation continues, but there is still no clear route to a Bill arriving before Parliament. MPs break for the summer recess soon and the months of September and October will inevitably be filled with Brexit related parliamentary activity. So there is little prospect of a Health Bill emerging soon.
But nature abhors a vacuum, and there is a risk that in the absence of proper government and parliamentary input the proposals in development will end up reflecting largely the views of NHS England and not those of the broader NHS or elected representatives. Again, we will be working closely to ensure that the views of the sector are fully represented.
Will we see a return to traditional Tory championing of the private sector?
As Zhou Enlai famously said in the early 1970s of the significance of the French Revolution “It’s too early to say”. The Johnson administration is packed with free-market Conservatives who have traditionally championed policies friendly to independent sector healthcare, including a mixed economy of provision in the NHS and even encouragement for individuals to look after their health in the private sector. But it is too soon to say whether these views will cohere into a government programme that changes the political environment for the independent sector. And with the challenges facing the government and the country, we may be in for a bumpy ride.
What are we doing about all this?
We are building on our established relationships with policymakers and forging new connections with key policy advisers to the Johnson administration. We also have a programme of work planned to highlight the issue of NHS access standards and the role the independent sector can play in improving care for NHS patients. And alongside this we will continue to remind those in the corridors of power about the immense contribution of independent providers to the broader health and care system.