Page last updated at 07:24 GMT, Thursday, 13 May 2010 08:24 UK

How the Tories and Lib Dems could change the NHS

ANALYSIS
By Nick Triggle
Health reporter, BBC News

Hospital ward
The NHS has been told to make savings

A fortnight ago, then Conservative health spokesman Andrew Lansley addressed hundreds of nurses at the annual conference in Bournemouth.

He said his only remaining ambition in politics was to "serve the NHS to the best of my ability".

He now has the chance in England as the new health secretary - but with the added complication of being part of a coalition government.

While the differences in health policy between the Tories and Lib Dems - and for that matter Labour - are not what they were a decade or so ago, there still look to be a number of tricky hurdles for Mr Lansley and his yet-to-be appointed team of ministers.

In the short-term much of the reform programme will be put on the backburner.

Instead, it is likely the only issues that future ministers will spend time hammering out in the next few months will be those that affect the budget.

Coalition policies
Conservative pledge of real term increases in spending on the NHS every year maintained - but expected to be little above inflation
No mention made of how to pay for future care of the elderly

The NHS has already received its allocation for this financial year - it has got a rise in excess of 5% bringing the budget over the £100bn mark.

But the fact remains the health service is responsible for nearly a fifth of government spending - and so cuts and savings will have to be made in coming years to help the wider economy.

The Conservatives were actually the only party to promise to increase the NHS budget above inflation after 2011.

However, in reality any increase would be small.

Indeed, none of the parties have disagreed with the head of the NHS, Sir David Nicholson, who has asked the service to make up to £20bn of savings by 2014 to help keep pace with the rising demands from new drugs, the ageing population and lifestyle changes such as obesity.

That is about 5% of the yearly budget - quite a challenge for a service that has seen productivity fall each year over the past decade.

Michael Sobanja, chief executive of the NHS Alliance, which represents NHS staff who work outside hospitals, says money - or rather the lack of it - is the over-riding challenge.

"The most significant area that affects this is staff - headcount, pay and pensions. There is no getting away from it."

But if the coalition does continue in the longer-term - the two parties have said they want to serve a full five years - the scope for joint policy formation does expand.

Potential conflicts

A quick glance at their current positions however does not throw up too many possibilities.

Areas of conflict
Public health - Disagreement over alcohol minimum pricing
GPs - Shared vision of giving people greater choice but the Tories, unlike the Lib Dems, want to give family doctors a much greater role in commissioning local services
Targets - Tories want to scrap so-called process targets, but Lib Dems share Labour's desire to see them remain
Social care - Tories want a voluntary system, but the Lib Dems favour contributions from everyone

The Tories wanted to create an independent NHS board to run the health service and change the Department of Health into the Department of Public Health.

But that is at odds with the Lib Dem vision of putting the power into the hands of local people through directly-elected health boards.

Meanwhile, the Lib Dems have supported minimum pricing for alcohol. The Tories are, however, implacably opposed.

On targets, there is disagreement too. The Lib Dems, like Labour, back the idea of creating patient guarantees for cancer treatment and hospital operations.

Andrew Lansley, now health secretary, spent much of the election campaign criticising them as "damaging and perverse" and promising to abolish them.

Social care

Perhaps the biggest casualty - and probably most far-reaching - will be social care. Lib Dem health spokesman Norman Lamb has worked hard in recent months to try to build consensus over the issue of funding.

His team indicated he had been willing to support the Labour plan for a compulsory levy to create a National Care Service.

But the Tories have made it clear, particularly in recent weeks, that they were opposed.

They want to see a voluntary insurance scheme despite Lib Dem insistences that such models never get high enough take-up to work.

The result could be that the status-quo - the means-tested system - remains in place.

Jeremy Taylor, of National Voices, a coalition of charities and patient groups, says that would be a disastrous situation for some of the most vulnerable people in society.

"The system is unfair and chaotic. People can't get access. But it is a difficult, expensive and politically sensitive issue and the danger now is that the momentum gets lost."

Nonetheless, others are hopeful that once the government settles in changes may happen.

Professor Alan Maryon Davis, president of the UK Faculty of Public Health, says: "Both parties have talked a lot about public health and I think in time we could see something happening."

Professor John Appleby, chief economist at the King's Fund health think tank, agrees.

"There are very few policies that are the same at the moment, but you can see some areas where they could find common ground. You could imagine something being done to stop below cost pricing for example rather than a minimum price. We will have to see."

But he says the big unknown, events, as Harold McMillan famously said, could end up determining the actual areas of agreement.

"You never know what will happen and it could be that new issues which crop up will be where they find themselves really working together."



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SEE ALSO
Clashes over hospital cuts
22 Apr 10 |  Health
Tories rule out forced closures
13 Apr 10 |  Health
Labour pledge on NHS reforms
13 Apr 10 |  Health
Lib Dem plan to cut NHS red tape
14 Apr 10 |  Health
Hospitals 'to feel funding pinch'
10 Dec 09 |  Health
NHS finances 'must not be raided'
29 Jun 09 |  Health

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