The PM’s first policy speech in this Parliament was devoted to the NHS and marked a big shift in tone compared to the election. The campaign message was somewhat defensive, majoring on the extra spending that the Conservatives would provide (and leading some to ask where the extra £8 billion a year was coming from). 11 days after the election, the message was very different. 'The NHS must step up,' said Cameron. His key phrase was 'There is no choice between efficiency savings and quality of care'. That was an unsubtle rejoinder to the health leaders who had been arguing, even during the election campaign itself, that much more money and staff must come.
Since then ministers have kept up the momentum. Last week the Labour peer Patrick Carter, supporting the government, set out the waste in NHS equipment budgets. Simon Stevens, the head of NHS England, has taken over three NHS areas to make change happen faster. Jeremy Hunt will implement another review which means big changes for hospitals. The autumn Spending Review is another opportunity to push on.
Ministers are learning the lessons of the first term when their NHS plans had to be abandoned. They have a good plan this time, they are making the case early and they have an idea – the seven day NHS – which is a much better sell than the creation of 'Clinical Commissioning Groups' as promised in 2010.
Ministers are right that good care costs less. An NHS that thinks harder about treating patients better will deliver a more joined up service with less duplication and confusion. It will prevent ill health in the first place, as far as it can, with benefits all round.
They face a major battle with the NHS establishment nonetheless. If the NHS becomes much more efficient, its workforce will shrink as has happened in the rest of the public sector. Since 2010 NHS staff numbers have fallen by only 1 per cent. That compares to a fall of around 20 per cent for the rest of government. That is a good proxy for the fact that NHS efforts on productivity are a long way behind services such as policing or defence.
Many NHS leaders would like to stick to a labour-intensive model. Others think that a consumer revolution will drive through healthcare in the same way as it has in other industries, putting much more emphasis on technology. As Tony Blair said just after the election, no one would build the same health (or education) service if they were starting today, if only because of new technology. Simon Stevens has said that young people will prefer to get initial health advice over their smartphones rather than in traditional GP consultations. The next confrontation over the future of the NHS workforce is only a matter of time.
Health matters for the wellbeing not only of people but also the nation. The new ONS citizen surveys show that people in very good health are more satisfied with their lives. The Office for Budget Responsibility has shown that a more productive NHS is one of the key ways to prevent the public finances spiralling out of control in the medium term. So far ministers are on the front foot.
Andrew Haldenby is director of the independent think tank Reform which today publishes ‘How to run a country: Health and social care policy’.