Health warning: Why the Tory leadership contest needs a health check

The battle for Downing Street

The race to be our next Prime Minister is on. The starting pistol was fired after Boris Johnson’s somewhat reluctant resignation statement outside 10 Downing Street on July 7^th. The Conservative Party is now searching for their fourth leader in six years, who will ultimately become our next Prime Minister.  

The leadership candidates have now been whittled down to the final two; the former Chancellor of the Exchequer Rishi Sunak and Foreign Secretary Liz Truss. The Tory psychodrama has dominated our screens for weeks, with bad-tempered exchanges in TV leadership debates overshadowing the contest. As the rival candidates set out their competing visions for the country, the debate has thus far focussed on tax cuts and the cost-of-living crisis.

One of the things that received scant attention is the health service. Whilst the polling suggests that the British public believes the economy is the most important issue affecting the UK (67%), health comes a strong second (39%).¹ The health service is facing an unprecedented crisis in its modern history due to a combination of capacity issues and structural factors.

The scale of the challenge facing the health service

Health is set to be a particularly challenging policy area for the next Prime Minister. The health service is currently experiencing a perfect storm. Hospital waiting lists are at a record high,² and public satisfaction with the NHS is at its lowest level since the 1990s.³ Moreover, the NHS in England is going through the largest structural reorganisation in a decade, following the Health and Care Act’s creation of Integrated Care Systems.⁴ This is on top of major staffing shortages⁵ and a social care system on its knees.⁶ Not to mention that the NHS is still recovering from the disruption and critical care backlogs² created by the COVID-19 pandemic, which exposed serious health inequalities.⁷ 

Tackling challenges is a herculean feat by anyone’s standards. The next Prime Minister will have to balance taking on these issues with the reality of the fiscal landscape following the pandemic and the constraints inflationary pressures place on public spending. The leadership candidates have had little to say about the health service so far. However, there have been some announcements that will affect health policy in the next Conservative administration. 

What the candidates say… 

Liz Truss 

Liz Truss’ campaign has been characterised by a series of bold tax-cutting measures designed to tackle the cost-of-living crisis and revive the economy in a bid to appeal to the right of the Conservative Parliamentary Party and the Tory membership. The Foreign Secretary received less parliamentary support than Rishi Sunak⁸ but is leading the polls with the Tory membership and the favourite to win the contest.⁹

The only clear commitment Truss has made about health is in an interview with BBC Radio 4, stating that she is “completely committed” to fulfilling the Government’s promise to increase spending on the NHS.¹⁰ When asked if this still applied if her tax cuts failed to deliver economic growth, she said, “I’m completely committed to that NHS spending, to the hospitals, to the doctors”¹⁰, which appears to reaffirm the commitment. However, this statement is general and does not refer to specific spending commitments. At this stage, it would appear the health policy is low on the agenda of the Truss campaign, with the strategic focus firmly on tax cuts and the economy.

The success or failure of her economic policies of tax cuts will have implications for the UK’s economic growth, inflation rates, public spending and department budgets. This will almost certainly impact health spending. However, the precise impact of such policies is difficult to determine with certainty prior to their implementation. Whilst her policies challenge the current economic orthodoxy and the view of many leading economists, it remains to be seen whether they will pay off.

Rishi Sunak

The former Chancellor Rishi Sunak received more parliamentary support than Liz Truss in the earlier stages of the leadership contest8 but is currently trailing her in the polls with the Tory membership.⁹

Sunak initially resisted calls for immediate tax cuts on the grounds that tackling inflation and improving the public finances was necessary before pursuing such fiscal measures.¹⁰ He voiced concerns that tax cuts risked fuelling the rise of inflation, requiring more borrowing or spending reductions.¹⁰ Sunak has subsequently qualified his original position by pledging a scrap VAT on energy bills for a year from October and cutting the basic income tax rate in 2024 from 20% to 19%.¹⁰ The success or failure of these economic policies will have implications for the achievability and affordability of some of his wider pledges. 

In contrast to Liz Truss’ campaign, Rishi Sunak has made several policy pledges related to health and social care. These include:

• Speeding up the clinical trials approval process by creating a streamlined single approval service for UK clinical trials to make the system safer and faster than the one we inherited from the EU¹⁰; 
• Increasing the number of community diagnostic hubs to 200 by March 2024, including offering more diagnostic services in repurposed empty high street shops¹⁰ 
• Setting up a Vaccines style “backlog taskforce” with independent leadership to drive reform across the health service¹⁰ 
• A commitment that everyone waiting over 18 weeks for an appointment will be contacted within 100 days and be advised when they can expect to receive treatment¹⁰ 
• Expanding the network of specialist surgical hubs and centres that offer low complexity procedures, and accelerating the use of virtual wards so people can recover in their homes¹⁰ 
• Increasing the number of hospitals beds targeted by areas of need¹⁰ 
• Expanding the NHS App and NHS 111 into an “NHS front door for patients”¹⁰ 
• Cutting routine reappointments and allowing patients (with advice from doctors) to choose when they return to see a consultant¹⁰ 
• Introducing a temporary £10 fine for patients who fail to attend a GP or outpatient appointment¹⁰

These pledges go some way to addressing waiting list challenges, critical care backlogs, access to services and general capacity issues the NHS is currently experiencing. Establishing a vaccine-style task force to drive reform and improve the backlog created by the pandemic is a particularly striking idea; however, there is little detail as to its exact role and remit at this stage.

These announcements leave major issues unaddressed, such as workforce shortages, the social care crisis and health inequalities. Despite these limitations, it is clear from these announcements that health policy is a significant issue on Rishi Sunak’s agenda, albeit not the main area of focus. The lack of detailed announcements on health policy during the Tory leadership campaign sparked concerns that this vitally important area of public policy is being overlooked.

The NHS Crisis: A top priority for the next Prime Minister

Adele Water writing in the BMJ, suggested that the Tory leadership contest exhibited a degree of complacency about the scale of the crisis facing the NHS.¹¹ She stated, “The cupboard of health policy ideas from the UK’s two prospective Prime Ministers is worryingly bare”.¹¹ 

Concerns about health policy’s lack of prominence led to The Royal College of Physicians issuing a joint statement with seven Royal Colleges and the Academy of Royal Colleges calling for health and social care to be a top priority during the Conservative Party leadership election. The statement asks the next Prime Minister to make the following commitments:

• Commit to planning and providing a health and care workforce that meets the needs of the population, particularly by increasing medical school places and clinical training places.¹² 
• Commit to reducing health inequality by tackling the causes of ill health so that in the long run we reduce pressure on the NHS by reducing preventable illness.¹² 
• Commit to fixing social care so that we end the cycle of working-age adults and old-age adults being admitted to hospital, or delayed in leaving hospital, because of insufficient social care packages to help them live independently.¹²

Increasing the NHS workforce, reducing health inequality and fixing the social care system will be three of the next Prime Minister’s major health policy challenges. In this sense, the lack of attention these issues have received in the Tory leadership campaign is both surprising and disappointing.

However, as the dust settles after a new Prime Minister is announced on September 5^th 2022, health issues will likely rise up the agenda. As the prospect of a winter flu crisis and resurgence of COVID-19 cases looms large as we approach the autumn, there will be the need for NHS England to gear up for a seasonal vaccination rollout. This means that health issues will become a national political priority once again. Our next Prime Minister must set out his priorities for tackling the NHS crisis at the earliest possible opportunity; the future of the health service depends on it.

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