There are tough political choices behind Miliband's £2.5bn

Earlier this year, when we and 20 other organisations published the “2015 Challenge” manifesto, we expressed frustration about the silence from politicians on the big challenges facing health and care. I am delighted to see that Ed Miliband is playing his part in breaking that silence.

‘We have to be clear that funding for the NHS is a political choice’

The NHS is taking centre stage during the party conference season, which bodes well for the forthcoming election campaign. We need to ensure politicians help foster an honest debate about the future of the service so that everyone better understands what great health and social care looks like and how to fulfil their responsibility to deliver better health with our support.

We want national politicians to frame the context, make political decisions about the level of funding for health and social care and then establish a national framework within which local organisations can lead, in partnership with the people they serve.

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It is not possible for national politicians to determine local solutions from Westminster, but it is possible to either enable them or obstruct them.

Take responsibility

We have to be clear that funding for the NHS is a political choice. Politicians need to take responsibility for this and its consequences. We need to be straight with people: the NHS can’t absorb current pressures and deliver everything it currently does without more funding.

‘A fund over a period of five years to help drive the transformation of services is exactly what we have been calling for’

On the headline in Mr Miliband’s speech – a commitment to five years of funding worth £12.5bn to the NHS to help transformation – we recognise the tough political choices that are behind such an announcement. As we and a number of other organisations have made clear, the financial challenge facing the health service needs to be tackled if the service is to remain sustainable. A fund over a period of five years to help drive the transformation of services is exactly what we have been calling for.

We also welcome that this extra investment must not just be about more of the same. People’s needs have changed since the NHS was founded. We need new models of care delivered by the right workforce.

This means culture change and new ways of working in the community that better support people’s health where they live and work, help to decide where best to go for help, or what steps to take to stay well. Not only does this require the right medical, nursing and care staff, but it needs to tap in to the huge army of support within the voluntary sector and people’s ability to support themselves and their peers.

One piece of the jigsaw

These are seismic changes and will not happen overnight. Crucially, they will require new investment to help make the transition. For example, to help move care into the community, local health services may establish a period where current services continue to be funded in parallel with investment in new models of care. This “double running” would help patients to migrate gradually from one service to the other, softening transition risks and helping people to recognise over time the benefits of investing in community care.

‘A sustainable funding settlement for social care is essential’

Whether the amount set out by Mr Miliband is enough remains to be seen. Labour are clear that this is only one piece of the jigsaw and other announcements on spending will bring the full picture. We also can’t forget the impact that cuts to social care have on people’s health and wellbeing, and on NHS services. A sustainable funding settlement for social care is essential.

We are already facing a very tough time financially this year, and next year could be the straw that breaks the camel’s back. We need to take money off the table, by which I mean NHS organisations need certainty about funding in the future and the space to work together on solutions, rather than being pulled apart by a lack of resources.

This is why we are calling for a 10 year funding settlement for the NHS so we have the stability we need to get this right for people now and for future generations.

The timing of any transition fund is critical to provide the very best value and to support new services rather than simply propping up the old ones. We might require some investment simply to keep things safe until we are ready for more substantive change. This is something that will need to be assessed locally as each place has its own challenges.

More than the money

The solutions might not be greatly different from place to place but they do need to be tailored by local leaders from health, local government and the public to meet the needs of the population they all serve.

‘Change in the NHS is about more than just money, it needs new ways of working and changes to culture’

Change in the NHS is about more than just money, it needs new ways of working and changes to culture. Labour has focused on more staff. To coin an old phrase, we need more staff working differently if we are to succeed.

The 2015 Challenge manifesto should be seen by politicians as a gift in helping achieve the consensus around what needs to change to improve people’s health and coordinate health and social care services around their needs. It isn’t just the NHS Confederation’s view but the view of partner organisations across health, social care, local government, voluntary sector and patient bodies.

As the election campaign kicks off, all political parties must focus on ensuring that their proposals will genuinely enable these sectors to work together to transform health and care.

Dr Johnny Marshall is director of policy at the NHS Confederation