Prof Chris Ham -CEO Kings Fund,comments
Today’s coalition agreement is welcome evidence that the parties have been able to reach agreement on a wide range of issues, and the confirmation that the health budget will increase in real terms in each year of the new parliament is good news for the NHS.
‘Nevertheless, the NHS still faces a £21 billion productivity gap if it is to maintain quality and avoid cutting services. Ministers and NHS leaders will need to take very difficult decisions in the months and years ahead, and it will be critical that they maintain an honest dialogue with the public, both about the scope for cutting administrative costs and the implications for local services.
‘While the pledge to end top down reorganisations suggests a welcome period of structural stability, it is also clear that the next few years will bring significant changes across the NHS. In setting up the independent NHS board, careful thought will need to be given to the relationship between its responsibilities and those of ministers, who will remain accountable to parliament for NHS expenditure.
‘We welcome the acknowledgement of the critical role played by GPs within the NHS and the clear signal that changes are needed to improve the quality of general practice. More clarity is needed about the implications for commissioning – the agreement does not confirm whether GPs will be given ‘hard’ budgets for commissioning care, as proposed in the Conservative manifesto.
‘The commitment to elect local people to primary care trust boards may strengthen the link between PCTs and the communities they serve. The desire to increase democratic accountability will need to be reconciled with the powers of the Secretary of State and statutory bodies to appoint other board members, including the chief executive.
‘We hope the coalition government will prioritise public health, as indicated in both parties’ manifestos, and look forward to more detailed plans in this area. Whether or not it is able to tackle the economic and social determinants of poor health and reduce health inequalities will be a test of whether it can work effectively across departmental boundaries – something that eluded its predecessors