Ahead of the general election on 8 June, we examine whether the government met their 2015 pledges on health and social care.
What did the Conservative party pledge in 2015?
In its 2015 manifesto, the Conservative Party pledged to ‘ensure you can see a GP and receive the hospital care you need, 7 days a week by 2020’. This commitment was confirmed by Prime Minister David Cameron in his first speech after winning the general election.
What progress has been made?
The manifesto pledge followed publication of studies suggesting that the mortality rate is higher among patients admitted to hospital at weekends compared with those admitted during the week, and calls for better service models in hospitals at the weekend from professional bodies. However, implementation of the commitment has proven controversial.
- The evidence underpinning the case for the policy has been disputed.
- The Healthcare Financial Management Association reviewed the financial implications of implementing seven-day services for urgent and emergency care. It concluded that although there may be potential savings from seven-day services through reducing lengths of stay in hospital, implementing the policy would add to overall hospital costs by 1.5–2 per cent as additional consultants would be needed to deliver these services. Many, including The King's Fund, have questioned whether this is affordable in the current context.
- The policy was initially unclear, with confusion as to whether its scope was limited to unplanned acute care or included elective and outpatient care. Following discussions with the Academy of Medical Royal Colleges, it was agreed that the policy requires compliance with four priority clinical standards focused on improving patient outcomes and reducing avoidable mortality.
- The policy also raises workforce issues, with concerns about whether there are enough consultants and other staff to implement it, while changes to contracts designed to deliver seven-day services played a part in the industrial action taken by junior doctors in 2016.
The government's mandate to NHS England for 2017-18 sets out milestones on how to ensure that the four priority clinical standards are met seven days a week for the whole population by March 2020.
NHS England monitors progress against the delivery of the four standards by hospitals via a self-assessment tool. However, the results are not in the public domain.
Soon after the 2015 election, Health Secretary, Jeremy Hunt launched a ‘New deal for general practice’ which promised additional workforce capacity and infrastructure funding in exchange for ‘better access, 7 days a week, for everyone’. The policy followed pilots established during the previous parliament which sought to improve access and encourage innovative provision. However, as with hospitals, implementation of this policy has proven controversial.
- In a speech, Jeremy Hunt suggested that seven-day access to primary care would reduce emergency admissions to hospital. Some, including the Royal College of General Practitioners dispute this.
- The Royal College of General Practitioners has also questioned the capacity of general practice to deliver seven-day services, given current workforce and resourcing pressures, arguing that the priority should be improving services within core hours rather than extending access beyond them.
- After a national evaluation found that more than half of the pilots reported very low utilisation on Sundays, others have queried to what extent patients actually want the full range of extended access offered by the policy.
The General practice forward view states that the policy does not require every individual practice to be open seven days a week, rather that practices should collaborate through networks, federations and ‘multispecialty community providers’ to provide alternative ways of working and achieve wider economies of scale. It says decisions about the level of access provided on different days of the week should be determined by local commissioners, based on patient demand.
In the recently published Next steps on the NHS five year forward view, NHS England appears optimistic about its ability to deliver the pledge, bringing forward the deadline set out in the 2015 manifesto by a year and committing to full delivery of the pledge by March 2019.
NHS England measures progress on this policy via a twice-yearly online survey of GP practices. The latest results show that 23.6 per cent of practices (serving 12.88 million registered patients) are already offering ‘full’ extended access.
The King’s Fund view
The commitment to give the public seven-day access to hospitals and GPs was a signature pledge of the 2015 Conservative manifesto but has been plagued by controversy.
In relation to hospitals, although the policy has been clarified, progress so far is unclear due to a lack of publicly available data and we continue to question whether it can be delivered within current financial constraints.
With regard to general practice, the policy does not require every practice to be open seven days a week, rather that practices can meet it by collaborating across an area to offer extended access. By taking this approach, NHS England has already made some progress and has chosen to bring forward the deadline for delivery by a year.