Does Health Matter in the Tory Leadership Battle?

Peter Russell

July 12, 2019

Leaving the European Union has dominated politics since before the 2016 referendum, so it is perhaps no surprise that Brexit is the dominant focus of the current Conservative leadership contest.

However, Jeremy Hunt and Boris Johnson have both been linked  to the NHS, although their levels of experience in the sector are very different.

Mr Hunt was a long-standing Health Secretary whose tenure included a long-term funding plan for the health service but was beset by a strike by junior doctors. He seemed to like the job so much that he successfully resisted being moved on in the 2018 Cabinet reshuffle.

Mr Johnson was famously associated with a pro-Brexit slogan on the side of a bus advocating that money sent to Brussels could be better spent on the health service instead.

Both candidates have more recently made public sector spending pledges, including promises to make good on a long overdue overhaul of the healthcare system. In a BBC TV debate last month, Mr Hunt admitted that "some of the cuts in social care did go too far", and this week on ITV said he favoured "a 10-year plan for social care".

In the same debate, Mr Johnson, who has received the backing of former leadership contender and current Secretary of State for Health and Social Care, Matt Hancock, said: "We need a national consensus about social care because we've got to take politics out of this, and we need to bring people together across parties to get it done."

Members of one political party are now choosing not just their new leader but the next Prime Minister of the whole of the UK.

In an open letter this week to the next Prime Minister, Richard Murray, chief executive of health think-tank The King's Fund, outlined three policy areas where he believed political action was required to support the nation's health.

These were:

  • Funding and reforming an adult social care system "that is no longer fit for purpose"

  • Tackling the stall in life expectancy and widening health inequalities by embedding health across government policy, for example through bolder use of tax and regulation, and building on the success of the soft drinks industry levy

  • Providing health and care leaders with the political support they need to shore up the workforce by, amongst other things, making it easier to recruit skilled professionals from overseas

We asked Sally Warren, director of policy at The King's Fund, and former director of EU exit preparedness and response at the Department for Environment, Food & Rural Affairs, for her assessment of health and social care matters in the Conservative leadership contest.

Q&A

It may not be surprising that Brexit has dominated the Conservative leadership contest but have you been surprised how little we have heard about health and social care?

There's been very little said about health, social care, and about population health.

Where we have heard from the candidates, it's tended to be quite high-level pledges without much detail about how they would intend to fix a problem they said that they would fix, and how they would be able to afford any spending commitments.

It's been a campaign where one issue has dominated, and it's meant that some other key domestic issues haven't had quite the same outing.

What do we know about both candidates' credentials in the health sector? Jeremy Hunt, of course, was a long-serving Secretary of State.

He's clearly an individual who understands the health sector well from his 6 years as Secretary of State. So, he'd bring that knowledge, understanding, and sets of relationships to Number 10.

But, clearly, being Prime Minister brings a much bigger set of issues.

Boris Johnson, when he was Mayor [of London] also engaged with a number of health issues. So, they both have experience which will be relevant to them.

Both candidates have committed to a number of spending pledges, and the pace with which they might be able to introduce those with some of their other commitments will be something that they’ll have to juggle.

I'm not sure that from what we've heard from Mr Johnson that we would anticipate he would be tighter on spending for the NHS and care system than Mr Hunt. He's certainly talked about the need for committing to the £20 billion that's already been confirmed by this government; and he's talked about social care; he's talked about fixing the pensions issue.

All of those things would suggest he recognises investment is needed across the health and social care sector.

Whoever wins, what do you anticipate will be their first priorities for healthcare?

It depends on the nature of our departure from the EU.

So, if this is a no-deal in October, there are clearly some very significant logistical challenges for our supply chain – particularly our pharmaceutical supply chain – which need to be properly planned and contingencies put around.

There will be a set of issues around how attractive we are as countries for migration from the EU – and we've already started to see reductions in that over the last 2 years.

So, I think a no-deal exit would definitely create real challenges for the system, and we need to have confidence in the Government's contingency plans for that.

If it's an exit with a deal – so some sort of implementation period and negotiations about future arrangements – that's obviously a much smoother type of exit and will give our sectors longer to be able to transition to what the new relationship would be. But clearly it would still represent change, particularly in our immigration approach, and clearly training of the care workforce in the UK isn't something you can turn on and off overnight – the pipeline of training takes a number of years, so that will be something that's very important.

In a recent 'open letter' to the next Prime Minister, your chief executive set out his three priorities for health and social care, which included making improvements to public health. Have the candidates shown they are committed in this area?

I think that we heard from Mr Johnson about wanting to review the evidence around so-called 'sin taxes', and Jeremy Hunt has been reflecting more on working with manufacturing – a carrot and stick approach.

I think both of the candidates recognise that this is a real challenge, and I think that properly addressing this issue does require action against a whole range of government policies, and that does need to be evidence based where it can. I think there's been really strong evidence about how effective some of the steps have been, such as the soft drinks levy.

I think we also have to recognise that no country has tackled successfully all of the issues of population health, and especially obesity.

Sometimes we will be at the cutting edge of evidence, but to solve the scale of the problem that we're facing requires more action.

So, I'm wanting both candidates to recognise that we can't carry on as we are, that we do need to take action to improve the health of future generations.

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