Introduction

Health and the National Health Service (NHS) is a politically sensitive policy area for governments. Health policy has a high media and political profile, and is often an issue of party-political contention. The NHS is a key public service and an indicator of the competence of governments. The health budget represents a large and increasing proportion of public spending, for which central government is held responsible. In addition, health policy entails a host of challenging problems, which cannot be ignored: the rising demand for health services; shortcomings in the quality and safety of services; inefficiencies in the use of resources; problems in accessing services in a timely fashion; inadequate coordination of services (especially between health care and social care); and significant public health challenges, such as rising levels of obesity and widening health inequalities.

Although all recent governments have faced these problems, the Conservative–Liberal Democrat coalition government's task was made even more difficult by the adverse economic climate and its own budgetary policies. It was also exacerbated by the relatively generous increases in NHS funding under New Labour (which had already begun to plan for much greater efficiency savings before it left office). The coalition protected the NHS budget to some extent, but this was insufficient to meet rising demands for health care arising from demographic trends (such as the ageing population) and the costs of new technology. Meanwhile, austerity policies and budget cuts elsewhere, notably, in local authority social care and other services (such as housing), placed greater demands on the NHS. In addition, the new government embarked on what, for most observers, was an unexpected root-and-branch reorganisation of the NHS, which was both expensive and a major distraction from efforts to address the key health policy issues mentioned earlier.

This chapter begins by outlining the major themes of coalition policy, how they related to the policies of the two governing parties and how they continued or departed from the policies of the previous Labour government. It then briefly examines the coalition government's record on health and the NHS. Next, the major factors shaping policy in this period are explored. Finally, the chapter examines how policies may develop following the 2015 general election, and formation of the first Conservative majority government for almost 20 years.