Annual Policy Review 2014




  • Cap on the cost of social care at £75,000
  • Creation of NHS England and Clinical Commissioning Groups
  • Devolution of public health to local authorities

More to do 

  • Making the case for the Coalition’s NHS reforms and regaining the trust of the medical profession
  • Providing more care in community settings to ease pressure on hospitals
  • Implementing Francis recommendations
  • A 7-day service


  • Greater role for independent sector providers

The unexpected

  • A&E waiting times crisis
  • CQC in turmoil following Mid-Staffs and other high profile failings
  • Resignation of Sir David Nicholson
  • Ongoing concern about NHS 111 phone line
  • Immigrant / “health tourist” use of the NHS


  • Failure to deliver the efficiency savings needed to ensure a barely growing real terms health budget keeps up with demand
  • Continued public spats with the medical profession
  • Lack of public acceptance that some hospitals or services may need to close 


As a reward for successful stewardship of the Olympics, former DCMS Secretary Jeremy Hunt was promoted to the health brief in September 2012. One of the hardest jobs in British politics, the chalice was poisoned further by the controversial NHS reforms introduced by Andrew Lansley, himself a veteran in the health portfolio of almost eight years.

By the time Mr Hunt took over, Mr Lansley was struggling to maintain support among the wider healthcare community, and a new face was seen as essential.

Mr Hunt’s major accomplishment has been to bring forward a Care Bill that will cap the cost of social care for older people at £75,000. While this is considerably less generous than the £35,000 cap recommended by Andrew Dilnot’s report for Government on adult care costs, it still represents a significant step forward in a thorny area where many politicians have failed before.

Mr Hunt has also made progress in providing patients with more information about the people treating them, with moves to publish surgeons’ survival rates and to introduce Ofsted-style inspections for GPs.

But his “to do” list is far longer. A&E services are said to have reached crisis, following a number of contentious attempts to rationalise / close emergency units, and the introduction of the out-of-hours telephone helpline service, 111, has been less than smooth.

In mitigation, Hunt has tried to pin the blame on the GP contract negotiated by Labour in 2004, which controversially enabled GPs to opt out of providing out-of-hours care, but these claims have been met with predictable anger by the medical profession.

At the end of 2013 Sir Bruce Keogh announced “radical” weekend working plans, leaving hospitals contractually bound to deliver a full service, seven days a week. Implementation of these plans across the NHS, including pilots in primary care, is likely to dominate the 2014 health agenda.

Achieving sizeable cost savings remains a top priority for the NHS. The outgoing Chief Executive at NHS England, Sir David Nicholson, has made it clear that his original ambition to find £20bn worth of savings by 2015 did not go far enough. Now the NHS must save an additional £30bn by 2020/21. In this tough fiscal context the recently announced heads of agreement for the 2014 Pharmaceutical Price Regulation Scheme (PPRS) included an unprecedented commitment to keep NHS expenditure on branded medicines flat for two years, with industry underwriting any further expenditure by the NHS within agreed boundaries.

Value Based Assessment (VBA) proposals continue to weigh heavy on the Department, NICE and industry.

A consultation is set to run through 2014, but it is broadly accepted that Lansley’s original, ground-breaking proposals for a new way of interpreting the value of medicines are now reduced to mere tinkering around the edges.

Issues of access and uptake of medicines will remain on the agenda long after VBA is finalised. The Office of Life Sciences is due for a shake-up, with David Willetts, the BIS Minister responsible for Life Sciences, intent on tackling the issue head on.

The passing of the NHS reforms and the early stages of implementation only represent the tip of the iceberg. The real challenge for Mr Hunt starts now, with pressures on the NHS set only to rise with increasing levels of frailty, rising incidence of chronic conditions, and the dementia challenge ever present. Talk of new models of integrated care and whole system transformation will dominate the conversation in 2014, and as of April all eyes will be on NHS England’s new Chief Executive, Simon Stevens, a former Labour adviser and one of the world’s leading healthcare reformers.

Going into the election, the NHS will be one of the key battlegrounds. Having promised no top-down reorganisations and then delivered one, the Conservatives will be desperate to convince voters the NHS is safe in their hands. Labour holds a significant polling lead in this area, and while the Shadow Health Secretary is hidebound by both his own record in office and his predictions of NHS collapse, he hopes to go into the election with a popular policy reform: the long wished-for integration of health and social care.