With Parliament dissolved and the 2015 General Election now five weeks away political parties are beginning to outline where they stand on healthcare as an election issue. While political parties may have preferred to try and de-politicise healthcare, the relentless media focus on NHS performance, especially in relation to waiting times and the increase in accident and emergency attendances, emergency admissions and delayed discharges suggest this is unlikely to be an option.
Indeed, opinion polls show that for many Britons, when determining their choice of party, healthcare remains the dominant concern for the third consecutive month in a row with the economy the second most important issue (38 per cent and 31 per cent respectively).
By contrast, at the time of the last election, in 2010, the economy was the top most important issue (55 per cent), although healthcare was still the third most important issue (20 per cent).1
What's different this time round is that there is a general consensus amongst political parties and expert commentators that NHS England's Five Year Forward View, published in October 2014, contains the right prescription for the NHS. The report provides a five-year plan for evolving the NHS, to create a more equitable care landscape, better able to cope with surging demand on services and, at the same time, tackle the £30 billion funding gap that will develop by 2020-21 if change doesn't happen.
This plan also emphasises that tough choices need to be made as to how much government money should be spent on the NHS and how it should be allocated. Consequently, the party(s) that finds itself taking up the reins of Government after the 2015 General Election will need to make these choices at the earliest opportunity and implement them as quickly as possible.
An analysis of the recent pronouncements on the NHS by some of the key political parties shows that the main differences in approach are on how much the party is prepared to spend "to save the NHS", without providing much clarity on how this might be achieved:
The Conservatives pledge to 'ring-fence' the NHS budget and increase health spending from 2015-2020 in line with inflation so as to maintain a 'real-terms' increase. Furthermore, that by 2020, all patients are to have access to a GP from 8am to 8pm, seven days a week; an additional 5,000 GPs will be trained and mental health services will be funded with an extra £1.25 billion. Redundancy payments to NHS staff will be capped at £95,000 with the exception of those earning less than £27,000 per year.
Labour pledge to focus on a 'whole person care' approach which will target physical and mental health equally, with health and wellbeing boards overseeing a drive towards integrated care. It plans to repeal aspects of the Health and Social Care Act and bring in a statutory exemption for the NHS from EU Procurement and Competition law. An annual fund of £2.5 billion will be set up to pay for 20,000 nurses, 8,000 GPs and 3,000 midwives. Appointments to see a GP within 48 hours will also be guaranteed and food marketed to children will have sugar, fat and salt limits.
The Liberal Democrats pledge to increase NHS spending by £8 billion per year by 2020/21 and to provide an extra £500 million per year for mental health services. Health and social care budgets will be pooled and health and wellbeing boards will be given a stronger role. NHS mergers will no longer to come under jurisdiction of Competition and Markets, and commissioners will not have to put all services out to tender. Additionally, an annual £250 bonus will be introduced for carers working at least 35 hours per week over 12 months.
The Green Party pledge to repeal the Health and Social Care Act and introduce an 'NHS tax' to increase funding to EU average. It would also abolish prescription charges, expand free dentistry, and abolish foundation hospital status which would reduce trust income from private patients. Promotion of tobacco and alcohol would be banned and social care would be free for over 65s.
UKIP pledge to increase NHS spending by £3 billion per year, with social care funding for older people increased by £1 billion per year. NHS-approved medical insurance would be compulsory for all UK visitors and residents of less than five years. The Monitor and Care Quality Commission would be replaced with 'county health boards' and NHS managers would require a statutory 'licence to manage'. They would also end hospital car parking charges.
Plaid Cymru has promised more cash for Welsh public services. It proposes to train and recruit an extra 1,000 doctors as well as more district and community nurses and other healthcare professionals. Plaid Cymru also plans to seek parity with Scotland in healthcare funding per head of population; introduce a tax on sugary drinks, plain packaging for tobacco products and to keep NHS prescriptions free.
SNP proposes to protect the NHS budget and spend more on frontline services. Its plans include delivering efficiencies by reducing the number of senior managers in the NHS by 25 per cent, streamlining the work of health boards and integrating still further integration NHS 24 and the Scottish Ambulance Service. It also aims to keep free NHS prescriptions and car parking.
Perhaps part of the solution to meeting the funding gap, that's likely to continue if the plans for investment are not met by commensurate savings elsewhere, is for any new government to apply a standard test to all new healthcare policy initiatives. For example, a recent Health Foundation report details three key 'tests' or questions for testing the 'credibility' of health policy2 :
- 'Will it maintain or improve quality in the short term?'
- 'Will the policies transform NHS care for the medium or long term?'
- 'Will the policies achieve financial balance?'
These tests are designed to achieve three aims: maintaining and improving care quality now, transforming the way care is delivered for the future, and achieving financial balance. Alone, or one at the expense of another won't work. Applying these tests might help control the size of any future deficit.
For now we can but watch and wait (and of course cast our own vote) to see how far the electorate is swayed by the above propositions, especially those who say concerns about healthcare will determine their choice of party at the ballot box. But whatever the outcome, there is now enough evidence and cross party support in England, linked to the 5YFV, to suggest that the message that simply providing more money without radical transformation and implementation of new ways of working is untenable. So let's hope that the initiatives now underway (the Vanguards, the technology test bed sites, the Better Care Fund pilots etc.) continue to receive political support and are implemented quickly and evaluated effectively. At the same time, a reveiw of the funding differentials between the four countries in the UK may also be necessary. In this way, those who require the support of a high quality NHS will continue to receive it, whatever their needs or ability to pay.
Footnotes
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