The coalition agreement: national security and the NHS

Welcome to the fourteenth in a series of posts going through the full coalition agreement section by section. You can read the full coalition document here.

The national security section of the coalition agreement is brief, outlining the creation of a National Security Council, the commencement of a defence review and a promise to “deny public funds to any group that has recently espoused or incited violence or hatred. We will proscribe such organisations”. The pledge on deportation is carefully balanced: “Britain should be able to deport foreign nationals who threaten our security to countries where there are verifiable guarantees that they will not be tortured. We will seek to extend these guarantees to more countries”. Civil liberties will be strengthened via a review of control orders, with a look at how to allow intercept evidence in court (and so reduce the need for such extreme measures).

By contrast, the health section is one of the longest, packed full of details. One of the legacies of David Cameron’s attempts to reposition his party and past tax and spend debates with Labour is that the Conservatives were pledged to real terms increases in health spending each year. This was in fact a more generous pledge than the Liberal Democrat one – and it’s this more generous pledge which has made it into the coalition agreement.

Beyond that there is a range of commitments to reduce top-down orders and control, cut administration and quangos and give front line staff, patients and Primary Care Trusts (PCTs) a stronger role in the health system. Potentially running slightly counter to that is the commitment taken from Conservative plans to “establish an independent NHS board to allocate resources and provide commissioning guidelines”. That should take power away from the Secretary of State for Health but risks becoming another central source of orders and targets.

Access to a high quality GP service, dentistry, cancer, children’s hospices and dementia are the specific health areas picked out for commitments alongside a more general commitment to helping elderly people live at home for longer. Although not in the document, my understanding is that the Liberal Democrats are also pushing hard for mental health to feature in the list of areas to get extra resourcing too. Nick Clegg has often spoken out on this topic, decrying mental health’s role as a Cinderella service despite the widespread nature of mental health problems.

Finally, there’s a hint of the possibility of a radically different future for the NHS developing over time with the promise to “give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers”. In other words, it’s a vision of the NHS which is not defined by who provides the service but by what the public can demand.

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