Pragmatism versus populism will prove a tough test for the Tories

As HSJ reveals, the prospect of a Conservative government is already having a chilling effect on local reconfiguration decisions, after leader David Cameron pledged a moratorium on closures.

Short term populism will come at the price of making a Conservative health secretary personally accountable for service closure decisions

Reconfiguration encapsulates four often conflicting pressures: listening to local people, improving quality and safety, saving money and - a key Tory principle - keeping politics out of the running of the NHS.

Opposing service closures has provided the Tories with rich campaigning material. Mr Cameron began his health policy speech three weeks ago by naming the places where Tories were out “trying to keep local services alive”.

But this would look very different from the other end of the telescope. To begin with, imposing a moratorium would be an explicitly centralist measure, stamping on local decisions. Mr Cameron promised the moratorium because he believed closures were often driven by short term policy considerations. But the moratorium would be the mirror image of this - stopping closures to meet short term policy considerations.

Then there is the money. The McKinsey & Co report leaked in HSJ analysing the implications of achieving savings of £20bn demonstrated this could not be done without driving up the efficiency of acute services. Creating a climate in which local commissioners will steer clear of tough decisions for fear of incurring the wrath of the health secretary will impair the ability of the NHS to make savings. Closures which would improve quality and safety would be similarly hit.

Listening to local people is easy when you are holding a placard, trickier when you are responsible. Tory candidates who have secured support by cheerleading local shroudwavers will incur voters’ wrath the next time around if those same services are eventually closed while a Tory government is in power.

And the moratorium is bad politics. Short term populism will come at the price of making a Conservative health secretary personally accountable for service closure decisions. Nothing could be further removed from taking the politics out of healthcare.

Service reconfigurations should be decided locally.