Telegram Cam: Conservative leader's unambiguous signal of new Tory health policy

by Andy Cowper, editor, Health Policy Insight

Sunday is a 'good-bad' day for newspapers. The main political parties are all keen to use the Sundays to set the week's policy and political agenda.

This leads to a lot of heat and hype, but not always to great enlightenment. As a result, relatively little attention seems to have been paid to comments David Cameron made on the Conservative party's health policy in a wide-ranging interview in the Sunday Telegraph

'Cameron admits that the party is "not there yet" on health'

According to the article, Cameron admits that the party is “not there yet” on health. ST political editor Patrick Hennesey notes that this comment 'will not be music to the ears of Andrew Lansley, the shadow health secretary'.

Hennesey's understatement here is vintage. Boy, will it ever not be music to Lansley's ears. This is a man who has been shadowing the health brief for over two years, during a period when it was still a Labour issue and who is probably un-trippable on matters of detail.

Lansley is going to be pissed off.

Clear Conservative policy proposals
Whether you agree with them or not, there is no possibility of accusing the Conservatives of vagueness over their health policy proposals.

They have proposed the clearest opposition health policy for a generation - independence for the NHS - accountable to a board; Monitor to become chief regulator; patient choice of GP and of commissioner; the health brief in government (and the Department) to become focused on public health; and the abolition of all central target-setting.

There are some worthy aspects in among this lot.

But it was always going to be a tall ask in media-driven politics to keep telling the same set story for a number of years, and this looks like the first glimpse of change.

Lansley undoubtedly seems like a clever man. He will not be unaware that just as he has become a master manipulator of the news media, with carefully-placed leaks about his policy team's active FOI inquiries into the DH and NHS, there is a bitter irony that his carefully-formulated policy agenda looks set to be - at least - thoroughly reviewed.

Chilly economic winds
The article notes that Cameron 'stresses that he would retain NHS care “free at the point of use”, but says the shape of the health service will “depend on choice made by GPs and their patients in an open, choice-based flexible system'.

The meaning of this is unclear, to put it mildly.

If the Conservative Party are serious about letting go, focusing on outcomes and public health, then the shape of the health service will be nothing to do with government. If that is the way forwards, then the government role is to raise the required taxes; oversee the good functioning of the independent board; and take care of the monumentally hard-to-shift area of public health.

In that version of the future, the 'shape of the system' will be, frankly, none of a Conservative government's business.

Hypothetically (and I'm not advocating this), if one PCT were able to meet its population's health needs by not renewing the GP practice contracts, putting all primary care into nurse-led expert patient-supported teams or local clinics and the rest into polyclinics - and by so doing within the available budget, could produce satisfactory outcomes, that would be real devolution.