"Well I hope the New Statesman have now got their headline," the Conservative shadow health minister Mark Simmonds said at a heated moment in the debate with the Labour Health Secretary, Andy Burnham, and the Liberal Democrats' health spokesman, Norman Lamb. "Which is that the Conservative Party is the only party to maintain and guarantee funding for the National Health Service."
Funding was one of the principal dividing lines in the debate on the NHS that took place a week before the general election on 6 May. All three parties devoted substantial sections of their manifestos to health, and the Tories revealed their commitment to preserving funding for the service in one of their early campaign posters. "I'll cut the deficit, not the NHS," proclaimed an airbrushed David Cameron from billboards around the country. Yet the subject made few headlines and occupied little airtime--especially in the leaders' television debates--during the election campaign.
Given that health commands more of the national budget than any other sector, it is surprising that the party leaders have not done more to divert the public conversation to this policy area. Budgetary concerns preoccupied each of the politicians in our debate, and the Conservatives' pledge to ring-fence the NHS budget was met with opposition.
"A major flaw in Conservative thinking is to see the NHS in isolation from other key public-sector budgets, because the NHS depends on those services for its own ability to function and be productive," said Burnham. Instead of blindly preserving the NHS budget, he argued, efficiencies had to be found.
He added that, while in government, he had been "ahead of the game" in seeking savings, despite the vast challenges involved. "We are entering a new era for the NHS. The era of expansion has come to a close and we now have to get much more for the public from the expanded system."
Lamb broadly agreed, and expressed his astonishment at the Tories' unwillingness to consider making savings in the NHS. "Mark said nothing about this budgetary challenge," said Lamb, "and that really scares me, because there's a real danger that by talking about ring-fencing you take your eye off the ball ... Even if you have small real-terms increases in funding, the NHS still faces a massive challenge to keep within financial means."
The charge from Labour and the Lib Dems was clear: the Conservatives are unrealistic in their pledge to leave the NHS untouched. However, there was some common ground between the Tory and Lib Dem spokesmen. Simmonds said that he would seek to reduce much of the "central bureaucracy" within the health system, while Lamb, supporting decentralisation, emphasised the importance of working more closely with local authorities and employers to improve health outcomes. Drawing on the example of the pasty-maker Ginsters, which has successfully reduced sickness absence, he said that encouraging this kind of employer action was essential as health budgets are squeezed.
One major budgetary fear expressed by the audience related to mental health care. Representatives from the charities Mind and Sane were anxious that the historical underfunding of mental health services would return. Hasty reassurances followed. Burnham promised to "complete the job" on rolling out psychological therapies, and he and Simmonds agreed on the importance of protecting the mental health research budget. But Burnham took the opportunity to reiterate the difference between Labour and Conservative policy. Pointing out the interdependence of mental health, housing, work and education, he argued again that to separate the health budget from these other sectors simply didn't make sense.
There was also disagreement over the organisation of the health service. The Conservatives said they wanted to avoid another major restructuring. "One of …