The dividing line between Conservative and Labour is on policy preference. They are in line for now on the broad themes of the NHS backlog, coronavirus, health inequalities, and the need to do something about social care. Neither is yet to define what that something is.
The Conservatives and Labour are also in absolute lockstep in their tendency towards long-grassing it. For example, Labour has plans to draw up a strategy on child health and wellbeing, and is keeping schtum on its social care plan until the next election. The Conservatives, meanwhile, have five-point and 10-point plans, strategies, working groups, ambition committees, three planks and numerous pillars. The answers to the big questions of who pays how much and when; and of who provides what, where and how, remain up for grabs. Here’s what DeHavilland’s David Murray (Conservative) and Holly Sloan (Labour) learned covering this year’s conferences.
Both parties discussed health inequalities. Labour emphasised prevention and early intervention, particularly for children, as a means to tackle inequalities. The Conservatives, however, talked mostly about the role that stakeholders should play, particularly citing the establishment of Office for Health Improvement and Disparities and the role that health tech providers play in inequalities.
On the relationship between the private sector and public sector, Labour’s shadow Health and Social Care Secretary Jon Ashworth repeatedly warned that the privatisation of services could lead to a two-tier system. Sajid Javid, the Health and Social Care Secretary, hailed the vaccination programme as a beacon of public and private sector cooperation, but he and other Ministers avoided talking about the competition implications of the Health and Care Bill, which you could say is right and proper given that the Public Bill Committee has not yet concluded its line-by-line consideration of the Bill. The Conservatives repeatedly praised the vital role that the UK life sciences private sector plays in both the delivery of high-quality care and the national economy, which few touted at the Labour conference.
Social care was discussed in the main halls and especially around the fringes of the conferences, but there is no great detail to report. The Labour leadership did not reveal a social care action plan, to some disappointment in the party – some factions, and not necessarily those on the left, continue to flirt with the idea of providing a social care system free at the point of use.
The Conservatives talked action on social care, but strayed from providing further details about upcoming reform, instead focusing on recent announcements of a cap on care costs and the national insurance tax hike.
All in all, it’s fair to say that the Conservatives skirted around the big questions of further privatisation and social care. Meanwhile, Labour talked a big game but provided little detail as to how they would deliver on their pledges. Something tells me we may have to wait for both respective election manifestos before more light is shed. There are some difficult choices ahead with the NHS still under extreme pressure and the basketcase that is social care provision. From what we heard and didn’t hear at the conferences, we’re looking at crisis management rather than crisis avoidance for the foreseeable.
Conservatives – NHS reform
The overarching structure of NHS reform outlined by the Health Secretary during the conference consisted of the three planks of digitalisation, leadership, and integration of health and care.
On digitalisation, he said the NHS could do more to utilise robotics and other innovations to improve quality and productivity.
On leadership, he wanted to identify best practice and share that across the country.
On integration, he said that health and social care need to be closer but gave no details on how that may be achieved.
Very little detail and few specific actions were outlined on how those broad elements would translate into practical change. Given the Health Secretary is just over 100 days into the role, and dealing with a pandemic still, we can expect policy detail to be revealed at a glacial pace.
Conservatives – Life sciences and health tech
Newly re-minted Minister for Science George Freeman spoke at a number of conference events about the role the NHS could play as a research base for drug development, specifically championing its role in clinical trials and supporting pharmaceutical and medical device developers and manufacturers.
Tech Minister Chris Philp had focused on converting successful, innovative UK tech businesses from start-ups to larger multinational organisations. He identified a lack of UK capital going into such companies, which leads them to search abroad in America, China and Japan. In an effort to resolve the drought of capital investment, Mr Philp suggested that pension funds should invest more. He also said that institutions with large capital reserves should be re-educated to encourage them to move capital investments into tech-led healthcare businesses. Another ticking off for British business.
The Health Secretary highlighted racially-biased health tech. Using the example of oximeters that do not work properly on people with dark skin, he made the point that health tech companies need to make equipment that works for people of all ethnicities.
Conservatives – Public health and prevention
Public health and prevention was not talked about at length or in any detail at the Conservative conference. It was brought up in passing or addressed in general – health inequalities exist, are bad and need to be addressed. Fringe audiences are quite handy at identifying the things that politicians do not want to talk about and asking awkward questions, but politicians, especially Ministers, are equally if not more adept at answering such questions while saying not much. The Health Secretary spoke about public health and prevention mainly in conjunction with health inequalities. Blackpool was the comparator du jour for bad health outcomes, while places such as Richmond upon Thames and Ribble Valley were used as shorthand for superior health outcomes.
Conservatives – Health inequalities
The Health Secretary spoke at length on health inequalities. He particularly referenced the fact he recently set up the Office for Health Improvement and Disparities, which is mandated with exploring the drivers behind health inequalities and providing recommendations on how to address them.
Conservatives – social care reform
Mr Javid skirted with controversy and even ridicule when he said that people should not look to the state as the default option when it comes to social care. That bawdy commentary was slightly unfair given that families can and do provide a lot of the care that our ageing and infirm population needs, and given that Mr Javid also said clearly that the state has a role in care provision.
Gillian Keegan, the new Care Minister, spoke at an event on social care in which she outlined her general view and experiences of social care. Without much professional experience, Ms Keegan relied on personal anecdotes and her family’s experience of the social care system.
She championed the skills of the workforce, which she believes have been unrecognised for too long. To correct that, Ms Keegan said care workers should have recognised qualifications similar to nursing qualifications. Depending on who you listen to, workforce issues are a big lacuna in the Health and Care Bill, currently in Committee in the Commons. It’s entirely conceivable both that the Government will and will not introduce amendments to that legislation to bolster the workforce provisions.
Ms Keegan also called attention to the fact that the social care debate often focuses on older people when there is a significant cohort of younger people with learning disabilities who needed access to social care, and who should be included in the debate.
During the conference there was a great deal of discussion about the poor state of social care, the grim winter that lies ahead, and many ideas about how to fix it. None of these fixes is quick enough for the winter ahead, or the one after that, or the one after that.
Labour – NHS reforms
“Fighting to halt the Tory NHS Bill, fighting to bring services back in house, fighting to reinstate a universal public NHS” – the three priorities outlined by shadow Secretary of State for Health and Social Care Jonathan Ashworth during his keynote speech, as he painted Labour as the party of the NHS.
The shadow Secretary of State used his time in the main hall to pledge adequate training, recruitment, wellbeing support, and a fair pay rise for both NHS and care workers, following countless warnings from industry experts across a range of fringe events that no meaningful reform could be executed without confronting workforce issues.
Labour – Public Health and prevention
Prevention and early intervention formed the backbone of Labour’s messaging on health and wellbeing. Mr Ashworth and his team reiterated Labour’s intentions to drive up health checks and reinstate services such as smoking cessation and addiction in an attempt to tackle the root causes of the most impactful long-term chronic conditions plaguing the UK.
Further devolution was batted as the key to improving wider health resilience, with panellists such as Brigid Jones, Deputy Leader of Birmingham Council, demanding increased power over funding decisions for local and regional authorities.
Labour – Health inequalities (particularly child health inequality)
Shadow Health and Social Care Secretary Jonathan Ashworth reiterated Labour’s plan to address inequalities. He spoke of the threat of increasing NHS privatisation and warned of an emerging “two-tier system” in which treatment can be accessed only by those who can afford to bypass lengthy waiting lists.
Echoing Sir Keir Starmer’s pledge to give every child the best start in life, Mr Ashworth emphasised his plans to draw up a children’s health and wellbeing strategy. This includes eradicating child hunger, increasing access to child mental health support, and ensuring that a child born into poverty would not be “condemned to a life of ill health.”
Mr Ashworth also highlighted equitable global access to vaccines and medicines, but there was little elaboration on how Labour would achieve that.
Labour – social care reform
In light of the Conservative’s freshly revealed plan for social care, the “new frontier of the welfare state” was a key topic of discussion at the Labour party conference.
Labour’s top health team, including shadow Secretary of State Jonathan Ashworth and shadow Social Care Minister Liz Kendall, were prodded on several occasions on whether Labour would pledge free universal access to social care for all, and whether further taxation entered into their plans. While Mr Ashworth remained coy, Ms Kendall confirmed the party does not intend to reveal its plan for social care until it publishes its next election manifesto.
That revelation was met by disappointment by some party members, not least Andy Burnham, Mayor of Greater Manchester (and the last Labour Health Secretary) who told the BBC’s Laura Kuenssberg that he felt the party could be stronger on the Government's proposed health and care levy. Mr Burnham, who is almost certainly on leadership manoeuvres, outlined his vision for a time-limited 10% asset and wealth tax on older people at a fringe event on social care the following day.