Andy Burnham, Shadow Secretary of State for Health, famously told the New Statesman fringe meeting last year, “It’s the economy stupid, but don’t forget about healthcare”, quoting the celebrated US election aphorism. There are many groups which Labour could choose to harness in the 2015 general election who feel they have been disenfranchised. This might include the NHS workers who saw their automatic pay rise disappear today, and who collectively have been feeling the pressures of a £2bn reorganisation which they did not request for. Also disabled citizens do not have any particular reason to like this government, with many welfare benefits decisions made by ATOS being overturned by appeal.

Austerity itself is a policy which is recognised by public health physicians to have had a detrimental effect on individuals’ psychological wellbeing. While austerity might test the mental resilience of people in current economic times, there has indeed been an academic debate about the impact of austerity on mental health in general, including the incidence of suicide in European countries. The Health and Social Care Act, in addition to being a voluminous and complicated piece of legislation, suffered some fairly textbook reasons in management of ‘barriers to change’. One was the often cited reason that the NHS is ‘inefficient’, howsoever that is measured, given that the NHS is actually one of the most efficient healthcare systems in the world, according to official data. Also, the business case for the change is not particularly compelling. Despite price competitive tendering of contracts in the NHS likely to cause an outsourcing of legal accountability and increased total costs, the section 75 regulations as finally enacted made price competitive tendering the default option. Also section 164(2A) means that NHS entities can earn not 50% or more from private sources of income, which is a huge percentage. Private companies exist in law to maximise shareholder dividend.

To sell then integrated care on the back of a failed austerity plan is therefore ludicrous, and yet that is exactly what George Osborne did today. Osborne talked about the ‘billions’ that would be saved in ‘joined up’ care, but this is not the sole goal of integrated care. Integrated care is not simply about saving money; it should be about offering healthcare that it is most suitable for a person or patient at any particular time. Also, the language of Osborne and Danny Alexander, Chief Secretary to the Treasury, was one that integrated care would only be of benefit to the taxpayer when considering the elderly. Danny Alexander, in discussion with Andrew Neil on the BBC today, talked about the ‘potential burden of the elderly’ to the taxpayer, which is an affront to those elderly citizens who have themselves contributed much to the fabric of the UK, in tax or otherwise.

Labour will be making a mistake too if it attempts to sell integration on the back of austerity. It is unclear sometimes quite whom Labour represents, when the private finance initiative (PFI) was strongly opposed by UNISON in the early 2000s. Despite being a creation of the John Major government, Labour had embraced PFI, and Osborne has sought to improve its implementation. Likewise, the actual rationale for integrated care cannot be sold as a money-saving exercise. The country is already deeply cynical of the billions of ‘efficiency savings’, apparently on the back of cuts int he workforce of thousands, not being ultimately being ploughed back into frontline care. The admiration of Chris Ham of Kaiser Permanente is well known, but there is no reason to disbelieve that Labour has no intention of embracing ‘managed care’. The language of the ‘dementia crisis’ has been racheted up of late, and if this is combined with a general ideological attack on the elderly, the narrative no longer becomes one of how we deliver care for all of the population, but how people can make private provision for their future through private health insurance.

Whenever such a debate is brought up, it immediately gets dismissed as ‘conspiracy theories’, but a genuine debate about how integrated care is being ‘sold’ to an exhausted public needs to be had. If today’s statements by George Osborne are anything to go by, part of the ‘case’ of the Conservatives appears to be very much an economic one. While management theory has never adequately resolved how stakeholders interact in forming strategy, if the debate on integrated party gets subsumed by any particular entity this could be detrimental. Labour may be 10-15% ahead in the polls on the NHS, but even Labour cannot take its support on the NHS for granted. Ironically, as the current Government discusses how to regulate against aggressive lobbying, maybe it’s time that the “vested interests” which Osborne so confidently mentioned today come under some scrutiny of their their own regarding the formation of English health care policy?