Health policy debate
22 May 2006
Political ructions forcing a debate on how reform should proceed
Over the last few weeks health policy has been a red-hot political topic. As the heat dies down, for the moment at least, now is a good time to make sense of how recent political eruptions have affected health policy and its implementation.
The local elections were a turning point because of a better than expected result for the Conservatives whose leader previously faced questions about whether he was able to translate personal popularity into votes [go to note 1]. The government now face an opposition with a lead in the polls [go to note 2]. However, given the broad similarities between party policies, it could be argued that a shift in the balance between the political parties does not greatly change the direction of health policy.
Blair has perhaps faced more intensive pressure from within his own party over if, when and how he should make way for Gordon Brown [go to notes 3 and 4]. Again, although the political impact of the rift was high, power shifts within the Labour Party may have little impact on the broad direction of health policy. While some commentators suggest Brown would approach public service reform differently, many believe policy differences are minimal. Rather than a clash of visions, the political battles are more akin to ‘backstabbing court politics in a Shakespearean drama’ [go to note 5].
In an interview with the Daily Telegraph, Harriet Harman – talked of as a potential deputy to Gordon Brown – told the boys to stop squabbling. She remembers the turmoil from the 1980s and how destructive it was. ‘The difference between then and now is that there is no huge political divide. “We must all make absolutely sure that people don’t get the impression that there is”. She thinks women voters in particular have had enough. “We have to look outwards or else we won’t have spoils to divide up” [go to note 6].
Although there is little difference on the general direction of reform, there is a lot of disagreement on how it is taken forward. Health minister Jane Kennedy resigned because of disagreements about the process of implementation. She said she had struggled with the “uncomfortable question” about why PbR was being implemented before hospitals were ready [go to note 7]. The Economist is amongst those who believe the chances of health reform are being ‘imperilled by poor execution [go to note 8]. Labour MP and GP, Howard Stoate is critical of how reform is being put together. He doesn’t think that the plan to give more autonomy to acute providers sits well with plans to strengthen commissioning and focus on long-term conditions [go to note 9].
The outcome of the political turmoil of the last few weeks is likely to be a more open debate on the direction of reform, which is an opportunity to influence how the next stage of reform is developed. Tony Blair has said he will lead a series of conferences on public sector reform in the run up to the party conference in October.