The areas of concern are well trodden territory. The NHS is in a precarious financial state, social care more so, and there is no sign of any new money. Brexit economics could make matters worse, and Brexit processes will divert government time and attention from health and other domestic matters. Jeremy Hunt’s reappointment as Secretary of State can be read as a sign that No. 10 sees no need for new thinking on health, or that Theresa May relishes facing down the junior doctors rather as she faced down the Police Federation when Home Secretary. That is before we get into any of the substantive issues concerning health, care and NHS reform. So far, so familiar.
But there are reasons to be more positive and to expect the new Government to take an active and constructive interest in health and care issues.
- First, a lack of new thinking is no bad thing. Governments can intervene too much. The Cameron regime backed the Five Year Forward View but overlaid it with 7 day services, devolution and other initiatives in ways that were not necessarily coherent. There is a lot to be said for continuity and sticking with the programme. In that light, Jeremy Hunt’s reappointment is welcome, as is Sir Malcolm Grant’s assurance at today’s NHS England board meeting that the Five Year Forward View remains the basis of discussions between NHS England and the Government.
- Second, the Government has just given itself more wriggle room on public spending. With so much going on in recent weeks it would be easy to have missed the announcement that George Osborne’s target of achieving budgetary surplus by 2020 has been shelved. It would be premature to hail the end of austerity but this is a significant shift in economic policy, which makes it easier to put more money into health and social care. Meanwhile the Government might feel a political imperative to do just that, in order to deliver on the promises of a Brexit dividend for the NHS. Simon Stevens has already been on their case in that regard.
- Third, Theresa May has made social justice a key theme of her new administration and she seems to mean it. It makes sense politically, since social justice is likely to play well with the electorate, to provide a basis for uniting the different wings of the Conservative Party and for stealing Labour’s clothes. I am reliably informed by a Conservative insider that the May camp thinks the Cameroons were all talk on social justice, whereas she plans to deliver.
- Finally, don’t assume that there won’t be some fresh thinking on health and care issues. With an almost complete clear-out of the Cameron cabinet, mirrored by the mass sacking of all the former No 10 special advisors – including health advisor Nick Seddon - the May administration in many ways has the character of a freshly elected government. My Conservative informant tells me that the new No. 10 team are a competent bunch and better-regarded than their predecessors. Of course, going back to my first point, fresh thinking could be a mixed blessing, but health almost certainly deserves something more than benign neglect from the Prime Minister.
All in all, some reasons to be hopeful as we head into August. Happy holidays, if you are lucky enough to be enjoying them!