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What will the election result mean for healthcare? New Labour, Conservative or Liberal Democrat, is there really any difference in health policy? In reverse order, the answer to those questions is not a great deal and a great deal. The current trajectory of the NHS was set in 1991, with a purchaser–provider split and private delivery of publicly-funded healthcare, and the main argument is over the speed and the finer points of change.
Alan Maynard attempts to disentangle the main policies of the Conservative Party, which seemed like a decent idea until Nick Clegg won the first pre-election debate and put a Conservative victory in doubt (JRSM 2010;103:168–72). Not that the JRSM is aligned to any party, but it is happy to play the prediction game. Indeed, the lead times of monthly medical journals mean that predicting the month ahead is an occupational hazard unlike the adrenaline rush of a weekly medical journal. Richard Horton, The Lancet's editor, offers a fascinating insight into his working day, which goes a long way to explaining why in an alternative life he would be smoking kif in Tangier (JRSM 2010;103:207–8).
For what it may be worth after 6 May, Maynard has cleverly identified three strands of Conservative health policy: an ‘independent’ board to set strategy, more information, and more competition. Whoever wins the election, however, it is potentially bad news for health professionals. The twin demons of the financial crisis and the post-election political rush for action will mean that health reform will be rapid and potentially brutal. Capacity will be cut, there will be skill-mix changes, and challenges to wage and employment levels. ‘Radical reform in the way the NHS delivers healthcare is unavoidable given the macroeconomic problems of the UK and the need to control public spending more efficiently,’ concludes Maynard.
Most commentators believe that hospital closures are inevitable, as mergers create super-hospitals apparently better equipped to manage workload more efficiently. Whether these happen or are less severe than predicted is to be seen since hospital closure has historically been one of the most powerful rallying cries for political dissent. The end result, inevitably, will be to unsettle staff struggling to cope with endless, often purposeless, change. Indeed, Maynard argues that the central rational for competition in healthcare is to create uncertainty among organizations and employees so that they innovate more speedily and efficiently.
In which case, I want to argue for us to press pause, my equivalent of smoking kif in Tangier. This is a simple plea, might we deliver better healthcare if professionals were allowed to adjust to their new environment rather than being bombarded with new initiatives? Do we fail patients because health professionals are too disillusioned and bemused by health reform to deliver the best care that is possible in the system? As the minor differences on health between our political parties demonstrate, there is general consensus on the direction of travel but most long and difficult journeys have a watering hole. Sadly, the agenda for change in the NHS is a bottomless pit.