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“Nye Bevan deserves credit for founding the NHS in 1948” Jeremy Hunt told Conservative Party Conference. But he made clear that it was a Conservative Health Minister in 1944, Sir Henry Wilink, whose white paper in fact announced the setting up of the NHS.

In a speech that focused heavily on the Conservative Party’s stewardship of the NHS, highlighting the biggest expansion in mental health seen to date, the decrease in patient harm, and the ‘shining light’ of transparency to improve standards, Jeremy Hunt was resolute in his conviction that the Conservatives are still the party of the NHS.

This intent, to underline the Party’s track record and successes during their seven years in government, has been a constant. Philip Hammond spent much of his speech to Conference giving a history lesson on modern capitalism over the last 35 years and the almost doubling of living standards, as a result. The impassioned language the Chancellor used to compare these achievements, with what he believes to be a “resolutely negative agenda from a bygone era” put forward by Corbyn and McDonnell, came across however not as someone taking the fight to the left, but as a desperate need to shore up his own defences. This may not be helped by the fact that, even with his best efforts, there is only so much passion that can be delivered by someone with the nickname “Spreadsheet Phil”.

The prevailing atmosphere also does not help matters – a stark contrast to Manchester two years ago. Rather than a Party still buoyed by the General Election that returned the first Conservative majority government in 18 years, the mood this year very much reflected a Party battered and bruised by an unexpected and relatively disastrous election. This even though it does have a “stronger mandate in popular vote than Angela Merkel” in the recent German elections. In a word, the mood was sombre.

This change to previous years also could be seen in the demographic of Conference attendees. First and foremost, there were certainly fewer of the party faithful in Manchester than two years ago. More than that however, once the lobbyists and professional politicos are taken out of the equation, the proportion of younger supporters struggled to make their presence felt.

Unsurprisingly, the majority of fringe events focused on the UK leaving the EU, how to achieve a successful Brexit, and/or the consequences (intended or otherwise) of this decision – with both sides of the Brexit debate taking every opportunity to put their case before the party faithful. Even during events solely to discuss the need for better collaboration between health and social care, Brexit took a foothold in the discussion.

Theresa May’s problems do not stop there. In his exuberant speech to Conference, following a week in which the Foreign Secretary has been at the heart of stories about party division, Boris Johnson urged Tories to “let the lion roar.” This ability to connect with party members and (potentially) the wider country in a way that Theresa May previously has failed to, has meant the Prime Minister spent much of her time in Manchester again combatting the Boris question. Few commentators dare to guess what his game is, but its certainly one that May would rather not be playing.

In arguably her most passionate speech so far as Prime Minister, May was at pains to show her personality behind the podium. Speaking beyond the party faithful to the electorate at home, she was clear that the driving force behind everything is to “root out injustice and give everyone in our country a voice.”

This sentiment has manifested itself in the implementation of an opt-out system for organ donation, an independent review of the Mental Health Act, and a Brexit deal that is “fair for all”. Staying close to her core Conservative beliefs, May praised the wealth creators that generate the taxes that pay for public services and remained clear that when politicians promise the earth but deliver little, disillusionment with politics grows. Therefore, the government will adopt a balanced approach to both the economy and public spending. This would not impact the UK’s place on the global stage, whether in defence, trade, aid or security. An encouraging sentiment, but only time will tell how this cooperation will be shaped, once Britain is outside the EU.

There were noticeably fewer fringes this year focusing on the NHS and healthcare more generally. This was noted by Mike Thompson (Chief Executive of the ABPI) who suggested during a fringe meeting on whether the NHS is ready for the medicines of the future, that there is not as much health policy debate in this country adequately to reflect the importance of healthcare in the UK.

With a specific focus on the direction of travel for the NHS, it was clear from fringe events hosted by the National Pharmacy Association and Association of Optometrists that there is a great desire for wider health professionals to be given the scope to play a greater role in prevention and early intervention within the community. In both instances, there was a strong belief, backed up by evidence, that these two groups of health professionals are currently an untapped resource that could be better utilised, not only to improve clinical outcomes but release sizeable efficiency savings without the need for significant system change and restructuring. The theory of creating headroom and the opportunity for individuals to do more with less would seem to be a well placed sentiment for a Conservative conference – it was just a shame attendance at these events couldn’t be higher, with one attracting an audience of just 10 people.

However, it was reassuring finally to attend a fringe meeting that actually involved a government minister – even if Philip Dunne MP made clear at the outset that his ministerial role did not cover any directly relevant policy areas and so he would not comment on specific policies. Instead, the discussion focused on patient data as the key to driving system wide transformation and the delivery of the Life Sciences Industry Strategy. The narrative of more personalised care continued throughout the debate with a particular focus on genomic testing, immune therapies and the emerging field of gene editing technologies. It was clear that both Dunne and Thompson were keen to project an uplifting and collaborative tone throughout the event; as such it took contributions from the floor to suggest that value as a concept in the NHS is being side-lined to an ever-greater extent by the need for efficiency savings. Moreover, it was a health economist in the audience that pointed out that under these conditions, unless a sufficient amount of headroom is created, clamping down on unwarranted variation can have the unfortunate side-effect of hampering patient access to innovative technologies.

This would seem to be the perfect illustration of the Conservative Party Conference this year – a concerted effort to project positive progress, yet with the constant reminder that, underlying this rhetoric, there are significant challenges still to be resolved.

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