Many of the ideas and policy proposals in the Conservative's draft health manifesto are already current government policy – patient choice of hospitals including the independent sector, more foundation trusts, paying GPs based on outcomes, and publishing quality data – although the suggestion is that they want to go further with these ideas than the current government have. There were a few ideas which distinguish the Conservative Party approach to the NHS and public health from that of Labour.
Firstly they reiterated their commitment to create an independent board and to create a separate Department of Public Health. Secondly they propose to change the way drugs are approved and funded, introducing ‘value’ based pricing. Thirdly they propose to put real budgets in the hands of GPs. But more detail is needed before the impact of these policies can be properly understood.
One of the major new announcements was Conservative plans to allocate ring-fenced public health budgets to local authorities in an effort to reduce persistent inequalities in health. Currently the majority of health spending is allocated to areas based on deprivation as well as clinical need. More significant then is what they didn’t say about the basis on which they plan to allocate the lion’s share of the health budget to PCTs. It is not clear whether this signals a move away from the existing allocation formula or not.
They also made announcements about maternity services including a commitment to choice for women over where to have their baby and the creation of maternity networks. The option of a home birth or care in a home-like environment is important for mothers-to-be, but the provision of choice has to be balanced with concerns for safety and quality of services. There is a clear need to improve co-ordination and communication between all those involved in the care of mothers, babies and their families throughout the period of pregnancy, birth and early years. More information is needed on how the proposed maternity networks would achieve this and how new providers would be encouraged into the system.
Finally there is one area on which the Conservative’s were strangely silent - productivity. Even if current spending is protected, demand continues to rise. There is little doubt that whichever party forms a government after the next election, they will inherit an NHS facing the toughest financial challenge in its history. It is not clear from today’s proposals how the Conservative Party proposes to ensure that every pound spent on the NHS is well spent.
Anna Dixon is acting chief executive of The King’s Fund
