Lib Dems aware of tough decisions ahead

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Norman Lamb kicked off the first of The King's Fund's election breakfast debates yesterday with a lively discussion of some key health policy issues the Liberal Democrats will be putting to voters.

While there is significant agreement between the three main parties on the NHS – more patient choice and personalised care, fewer targets and improved quality of care – Norman Lamb was keen to point out the distinctive focus of the Lib Dem's approach.

He restated their commitment to localism and creating locally elected boards to govern primary care trusts. As he set out in a policy paper published last week, this would mean abolishing strategic health authorities.

A strong sense of accountability to the local community could make local health services more responsive to local need and improve the public's faith in NHS decision-makers. However, polling data presented by Jonathan Nicholls of MORI suggested that while the public claim they want to have a greater say in local services, very few actually get involved when given the opportunity to do so. And, as members of the audience pointed out, this creates a danger that devolving power to locally elected representatives could make reconfiguration of services more, not less, difficult.

Norman Lamb enthused about the idea of mutualism and sees great potential in NHS organisations being run along the lines of the 'John Lewis' model, where staff are empowered and given more of a stake in the management and success of their organisation. Steve Field, Chair of the Royal College of General Practitioners, was positive about the idea of developing integrated organisations but admitted there was likely to be mixed feelings among GPs about sharing the leadership of organisations and partnering with a wider range of professionals.

Norman Lamb also argued that tough decisions about reconfiguration – deciding the future of under-used A&E departments and inefficient wards, for example – need to be made with the full engagement of clinicians and the public. As we have seen, national politicians with an eye on their Commons majority have often stood in the way of local change.

Jonathan Nicholls also pointed out that the public don't yet appear to have fully grasped the impact that the spending squeeze is going to have on NHS services. So whoever ends up having to make difficult decisions about which services to prioritise; the real challenge will be keeping the public on side.

The bottom line is this: if the NHS is going to make the productivity improvements that are essential to survive the cold economic climate, politicians will need to ensure that decisions are made with the long-term interests of patients and the NHS at heart.