May must ensure that increases in NHS spending are tied to outcomes

It’s a politically sensitive subject and the Government has a lot on its plate, but the Treasury is right to be concerned with ensuring value for money.

Today’s Financial Times reports that a new row is brewing between numbers Ten and Eleven Downing Street over Theresa May’s plans for extra NHS spending.

According to the paper, the Treasury is worried that the Prime Minister is pushing ahead with a £20 billion ‘reform’ plan which doesn’t actually secure adequate commitments to deliver savings and value for money.

Others have accused May of ‘displacement activity’, or needlessly dividing the Government’s focus in the crucial weeks before Britain’s departure from the European Union. But the Treasury complaint deserves scrutiny, because it illustrates the unhappy state of the will to healthcare reform in today’s Conservative Party.

Thanks in no small part to Dominic Cummings, who made NHS spending a central focus of the Leave campaign, there is now a consensus in favour of more of it which spans the Tories from the traditionally pro-NHS left to the usually reform-minded, but currently Brexit-focused, right.

By contrast, there is nobody talking seriously about major reforms to how the Health Service operates. Even Liz Truss, busily staking her claim to the mantle of the Cabinet’s most enthusiastic free-market reformer, hasn’t unveiled a plan for the NHS.

Perhaps this ought not to surprise us. Enthusiasm for healthcare reform historically comes in cycles, with the likes of Ken Clarke, Alan Milburn, and Andrew Lansley interspersed amongst Secretaries of State who take a more managerial approach. Jeremy Hunt, despite is high-profile clash with the doctors’ union, was one of the latter.

There are several reasons good reasons why Conservatives might be cautious of any ambitious programme for the NHS. Taking a bold stance on social care, which is subject to very similar pressures, arguably cost the Party its first comfortable majority in thirty years. Likewise the ill-fated Lansley reforms are still fresh in the memory and scarcely likely to motivate people to dip their toe in that particular pool.

Another factor, in light of a looming leadership election and the prospect of an election before 2022, is that Conservative members and voters alike are older than the average citizen, and likely to be unenthusiastic about disruption to health or social care.

Despite this, however, the Treasury’s concerns still need answering. ‘Spending more money’ is not an adequate substitute for an actual policy agenda, at least on the right, and passing the buck for serious reform to the next political generation will only make that reform much more difficult – and possibly painful – when its time comes.