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News archive - March 2015
Party Politics: The general election and future spending on healthcare infrastructure
In the very long run up to the 2015 General Election, all three main parties strive to establish their NHS credentials, each proclaiming the value of this national treasure and confirming their support for it. But how do the spending plans of the parties differ and how will these plans translate into infrastructure spending?
Each party has made spending commitments, but they all have different views on how to support the NHS while containing its growing demands. The big Conservative idea was NHS re-organisation manifested in the Health and Social Care Act 2012, with re-structuring being seen as the key to better management. One of the more-radical aspects of this re-organisation was to put a significant part of the primary care estate into the hands of specialist NHS-owned companies. This would enable a greater focus on estate management and renewal, leaving commissioners to commission and provider bodies to provide core health services. However, with spending severely squeezed, there has been little opportunity for new build beyond legacy projects from the old Primary Care Trust days.
Following continuing industry discussions, and influenced by the Department of Health’s Five Year Forward View, a new pot of £1billion has been made available to fund improvements to GP premises over a four-year period. Bids for this resource will be aimed at increasing capacity – and in the first year NHS England has indicated that the extra funding will help to speed up improvements in the pipeline, rather than support new projects. An annual bidding process for funding new projects will then be implemented in the succeeding years.
This extra budget links into the need to increase capacity in primary and community care and relieve some of the pressures facing A&E departments, which always hit the headlines over the winter months. It is an initial move towards empowering GPs to create an environment that will allow more services to be brought into a community setting.
This comes at a time when GP priorities may be focused on containing their existing workload, and there may not be much appetite to expand into other areas of care. It remains to be seen how this new money will be allocated.
There seems to be a pent-up demand for improvement grants for GP premises. A BMA poll in 2014 revealed that 40% of practices think their premises are inadequate, and 70% consider their premises too small to deliver additional services. The speed with which the aforementioned bidding process is to be conducted suggests an appetite to get the first tranche of funding spent quickly.
In relation to this, the 2014 Dalton Review envisioned a change in the provision of health and social care that would see a variety of new models emerge, which would need support to achieve transformational change.
The Conservative Government pledged £200m to support changes that could see multi-site NHS trusts, hospital ‘chains’, and vertically-integrated care with acute hospitals providing primary care services. GP practices could also provide treatments more often seen in hospitals. Dalton stressed that a top-down, one-size-fits-all managerial approach would not work.
Labour also has a vision of more-integrated health and social care provision, as at least a partial solution to ever-increasing spending on the NHS. Bed blocking, or the long-term occupation of hospital beds, has been back in the news, as well as the disconnect between the demand for GP services out of hours and actual provision. In general, Labour proposes a more-preventative approach to reducing demand. Better funding for social care could mean fewer admissions and speedier discharges. Greater regulation of sugar, fat and salt in food targeted at children, and more information for adults, sits alongside increased spending on health through the annual £2.5billion ‘time to care’ fund and a £100m annual investment in improving GP premises.
The Liberal Democrats have promised greater spending to match the requirements of the NHS England Five Year Forward View. However, rather than offering any individual vision, it suggests a cross-party commission to undertake a fundamental review of NHS and social care spending.
The future for investment in NHS infrastructure should see a trend towards the approval of more projects by NHS England. This would support some limited restructuring of who delivers what where, which could demonstrate new efficiencies to trigger further investment if new models emerge from this.
Any change in government is likely to stall investment to some degree while new priorities are considered and any necessary legislative change takes place; Labour, for example, has stated that it will repeal the 2012 Health and Social Care Act. A hung parliament would clearly mean that policy could shift and party commitments will not necessarily hold good. While financial constraints are likely to remain tight, all parties seem to agree that further change will be necessary.
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