How do you solve a problem like... building a coalition?

Love it or loathe it, coalition governments seem here to stay.

There may be trouble ahead.... argues Rachel Rowson
There may be trouble ahead.... argues Rachel Rowson

With the polls tighter than ever, another political ‘marriage’ might be necessary to form the next government.

This puts the parties and the electorate in a strange situation as the policies which are being pushed out on the doorstep, in speeches and through the mass media might not be taken forward even if the party in question makes it into government.  

So, if policy is drawn up after the event, what are likely to be the red lines and tradable pledges in a new coalition, and what might this mean for the future of health policy?

Since 2010, the most controversial area in health policy has been how the NHS would be organised.

Despite the Programme for Government saying that there would be no more top-down reorganisations, the cut-and-shut policy saw the biggest reorganisation of the health service in history. 

This was based on the Conservative ideas of choice, competition and greater use of private providers being smashed together with the Liberal Democrat desire for more local accountability and directly elected health boards.  

The passing of the Health and Social Care Act provided a hard lesson that compromising and trying to ‘split the difference’ isn’t always a good way to run the country.

All of the parties learned from this experience and this time around the three main parties have informally said that they could work with a system that has Simon Stevens’ Five Year Forward View at its core.  

This is an important point of reference for creating some harmony in the NHS as it leaves politicians to talk in sound bites, without meddling in the core workings of the system.  

There are still red lines however. 

Labour is committed to removing some of the competition framework.  

This sounds radical, but in reality this would simply see that the default position isn’t enforced competition, but that services can still be competitively tendered when required.

It would also re-establish direct ministerial oversight of the NHS.

The Conservative Party would want to see maintained investment in the health service with the main sound bite that "a strong NHS needs a strong economy".  

At the moment it deliberately doesn’t want to make any big policy stands on health as this plays into Labour Party home territory.

For the Liberal Democrats their red line for health in the 2015 election is on mental health and continuing work on ‘parity of esteem’.  

Of all of the policy areas the Liberal Democrats would be unwilling to budge on this is one, which the Conservative Party and Labour would happily adopt.

So if we have a government made up of some combination of the three main parties, health policy should be on a steady course as set out in the Five Year Forward View.  

The main battle for whoever forms the next government will be how to defend investment in the NHS and win the argument with the Treasury to protect spending beyond 2015-16.

Rachel Rowson is MD of MHP Health


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