Tory plans for the NHS mean more dither and delay on social-care reform

Analysis: If every ambition set out in the Queen’s Speech is achieved, the health service could look very different by the time Boris Johnson seeks re-election, writes Shaun Lintern

Conservative ministers have repeatedly promised action on social care, a service which is deep in crisis, and which impacts heavily on the NHS (Getty)

Boris Johnson’s chief adviser, Dominic Cummings, fresh from the Tories’ election victory, reportedly told Whitehall mandarins they must deliver on the NHS ”though the heavens may fall”.

You don’t need to look any further than the Queen’s Speech for evidence of this approach, with a glut of new laws for the NHS that collectively promise major reforms to the way healthcare is delivered in this country.

But the Conservatives are continuing their finger-in-the-ear approach to social care and pressing on with the long-grass option of “cross-party consensus”. By the time Mr Johnson seeks re-election, the health service could look very different if every ambition set out on Thursday is achieved.

Inevitably, Brexit looms large and, as expected, the government will bring forward plans to streamline the way drugs and medical devices are trialled and adopted.

The aim is to make sure that Britain remains a market of choice for global pharmaceutical companies as they make future decisions between the UK, with its population of 60 million, and Europe’s 500 million citizens.

Keeping Britain on that playing field is not only economically smart – the industry is worth £74bn – it also makes sense for the NHS, which needs ever more effective treatments for an ageing, sicker population.

Interestingly, the government’s manifesto commitment to reform the structure of the NHS and sweep away some of the most controversial changes brought in by David Cameron appears to have gone off the boil.

Ministers will bring forward only “draft” legislation to reform the NHS in line with proposals from NHS England, which are aimed at fulfilling its long-term plan and bringing about more integrated care.

What this could mean in practice is still a little hard to discern, but the NHS is keen to shift care out of hospitals and deliver it closer to people’s homes with more community-based proactive care and better joined-up work to both save money and improve outcomes.

To achieve this, NHS England has asked the government to remove elements of competition law that require NHS contracts above £615,000 to go out to tender. In effect, it wants to row back on the outsourcing agenda so that NHS organisations can become integrated care providers that deliver services across large regions.

The fact that there was no firm legislation on Thursday may be a clue that the new government, emboldened by its majority, is not inclined to carry out a sweeping structural reform of the NHS.

As always, the devil will be in the detail of these planned new laws and we will need to carefully assess how the jigsaw of legislation fits together.

One huge piece of the puzzle remains missing, however. Conservative ministers have repeatedly promised action on social care, a service which is deep in crisis, and which has a significant impact on the NHS.

Speaking on The World at One on Thursday, the health secretary, Matt Hancock, said he hoped a new social-care system would be in place by 2024.

If the public and taxpayers have to wait that long for a meaningful solution, then Mr Cummings and his newly adopted Conservative Party may well see the “heavens fall”.

Part of the government’s holding plan for social care is a miserly £1bn investment and a consultation on a plan for local councils to raise an extra £500m from rises in council tax.

This is not what Mr Johnson promised on the steps of Downing Street and, for every moment he “dithers and delays”, elderly and vulnerable patients are suffering.