What conclusions can we draw from this year’s party conferences about the political and policy landscape for health and social care? At this stage in the political cycle, with the next general election three years away (barring a coalition crisis), we shouldn’t read too much into pronouncements aimed primarily at rallying the party faithful. Even the well-trailed speeches of the parties’ leaders register only fleetingly in public consciousness. But all parties are anxious to create the right mood music that will play well with public perceptions.
For the Conservatives that meant David Cameron emphasising his party's commitment to the values of the NHS and highlighting the coalition's pledge to protect its budget. But otherwise the NHS had a relatively low profile in the main conference proceedings. The new Secretary of State’s speech was overshadowed by the controversy that preceded it provoked by his comments about abortion time limits.
Labour's pledge to repeal the Health and Social Care Act went down well with the party faithful, as did the strong commitment by Shadow Secretary of State Andy Burnham to introduce a completely integrated system of care. But he claims his vision is to be achieved without further structural reorganisation; how these circles can be squared will fall to a new policy review to be led by Shadow Minister Liz Kendall.
Andy Burnham is not the only one voicing his commitment to a more integrated care system. Care Services Minister for the Liberal Democrats, Norman Lamb, restated his long standing vision of integration across health and social care and the Secretary of State said that in future, integration is going to be as important as competition in the system. So although it is impossible to insert a cigarette paper between any of the three major parties on the rhetoric of integration, none of the party conferences have left us clearer about what it would mean in practice or what specific new policies would achieve the success that has eluded previous governments.
Finally what about Dilnot and the continuing saga of social care reform? While there is universal agreement that something must be done, this is still not reflected in cross-party agreement about what, how and when. Fringe events confirm there is still strong consensus across the sector that Dilnot is the right starting point for wider system reform, but there is a growing nervousness amongst NHS colleagues that their budget could be raided to be paid for it. It was clear from the Liberal Democrat conference that Norman Lamb is very focused on finding a way through the thickets of controversy that spring up when options for finding the money are debated.
Despite speculation of a government U-turn over the summer, Jeremy Hunt restated their commitment to implementing Dilnot ‘if’ a way can be found of funding it – voluntary options are still on the table. Dilnotologists looking to Labour may not be satisfied with Andy Burnham’s concern that Dilnot would not ‘solve’ social care funding. The party’s pre-election idea of national care services funded through a compulsory single or staged payment (don’t call it a death tax) seems likely to remain their preferred option.
Two very significant policy signals were made over the conference season. The first reports a further £10billion cut in welfare benefits as an extension to the current spending review period. This will make it easier for the coalition to extend its pledge to maintain real terms spending on the NHS (though benefit cuts are likely to add to its pressures). The second was the slipped-out announcement that the council tax freeze is to be extended for a third year, at a cumulative cost of nearly £2billion (compared to the £1.7billion price tag for Dilnot – so no hand wringing about ‘hard choices’ here). This will only add to the woes of local councils as they struggle to manage the widening gap between social care needs and resources.
So as the season of mists and party conferences fades into a winter of almost certain discontent, the next key milestone will be the Chancellor’s autumn statement on December 5th that will set the scene for next year’s Spending Review. So it is economic prospects, not conference speeches, that will be more decisive in shaping future policy.