The NHS – ‘weaponised’ or ‘neutralised’?

It was inevitable that the NHS would be a key ‘battle ground’ in the General Election – or “weaponised”, as Labour leader Ed Milliband put it. NHS England chief executive Simon Stevens put funding at centre stage when he warned last autumn of a £30bn a year potential funding gap for the service, of which ‘only’ £22bn could be achieved by efficiency improvements.

That missing £8bn is now at the heart of a major row between the main parties. The Conservatives have accepted that the extra £8bn funding for the NHS is needed and promised they will find it. Health secretary Jeremy Hunt says the figure will be raised through higher tax revenues, generated by improved economic performance. Labour says this in effect an unfunded “IOU”.

The Tories are also talking seriously about further reforms. Not, this time, so much about the structure of the service, more about working practices. This is centred on moving to a ‘seven day a week, 24 hours a day’ NHS, which will surely require a managerial and cultural revolution in hospitals, GP surgeries and other health treatment centres.

“For years it’s been too hard to access the NHS out of hours,” said David Cameron. “But illness doesn’t respect working hours. Heart attacks, major accidents, babies – these things don’t just come from nine to five. And the truth is that you are actually more likely to die if you turn up at the hospital at the weekend. Some of the resources, like scanners, are not up and running. The key decision-makers aren’t always there.

“So I can tell you this. With a future Conservative Government, we would have a truly seven day NHS. Already millions more people can see a GP seven days a week, but by 2020 I want this for everyone… with hospitals properly staffed, especially for urgent and emergency care… so that everyone will have access to the NHS services they need seven days a week by 2020……the first country in the world to make this happen.”

Labour is also seeking major changes in the way the NHS is run, but its focus is on much greater integration of health and social care. Its manifesto states: “We will integrate health and care services into a seamless system of whole-person care. This will bring together three fragmented services into a single service to meet all of a person’s care needs — physical, mental and social.”

The last government’s Health and Social Care Act would be repealed by Labour, removing the move towards the contracting-out and privatisation of healthcare. This would, presumably, lead to another bout of organisational change within the NHS, alongside the new structures required for health and social care integration. According to its recently published 10 Year Plan for the NHS, a Labour government would also protect and support the not-for-profit sector in its provision of healthcare, guaranteeing longer-term contracting arrangements. The plan also refers to stronger controls on the selling of products high in sugar, fat and salt and restricting the marketing of high strength alcoholic drinks.

Another stark difference between Conservative and Labour policies comes with the apparent return to performance targets under a Labour government. “We will guarantee a GP appointment within 48 hours”, it says, adding that “we will guarantee that patients wait no longer than one week for vital cancer tests and results by 2020”. It pledges to recruit 8,000 more GPs and 20,000 more nurses. Other proposed Labour reforms include providing a single point of contact within the NHS for patients with complex needs, the “radical” improvement of mental health support and capping the profits of companies providing healthcare services under contract for the NHS.

Labour has also promised to increase NHS funding. However, it has refused to match the Conservatives’ £8bn extra money commitment. Instead Miliband said: “We will always do what is necessary for the NHS. We will never let the NHS down.” Labour Party front bencher Rachel Reeves appeared to spell out what this meant when she told Radio 4’s PM programme that “we are committed to raising £2.5bn” extra for the NHS in England.

This has created the perhaps surprising situation that Labour is making the smallest funding promise of the main three parties, with the Liberal Democrats committing itself to the £8bn extra. Its manifesto states, without equivocation, “We’ll invest the £8bn NHS bosses say they need to maintain the high quality care you expect, free when you need it.”

Like the other big parties, the Lib Dems are also seeking NHS reform. It pledges improvement to mental health care, promising “equal care and support for everyone with mental health problems”. In another echo of Labour Party promises, it also wants “joined-up care” between health and socialservices. The party also wants more support for carers of those in ill-health, offering each carer a £250 payment annually – intended to pay for a respite break. In addition, the Lib Dems say that they will raise pay and improve conditions for health care staff, thereby improving the quality of care for patients.

Yet there are serious questions about whether the parties’ promises deal with the scale of the financial problems facing the NHS in England. Sir David Nicholson, its last chief executive, laid into the election debate by suggesting that the potential deficit of £8bn was an optimistic figure as it relied on achieving efficiency savings that may be impossible. These comments reinforced analysis conducted by the Health Foundation, which pointed out that increased reliance on agency staff following the Francis inquiry into Mid Staffordshire meant that NHS productivity was going down, potentially increasing the need for extra money.

Meanwhile, leading social care commentator Andrew Cozens warned that none of the parties is promising to protect spending on social services, let alone increase it. Without this, he warned, extra strain would be placed on healthcare. Despite the bidding war by the parties, it looks as if the financial deficit within the NHS could be set to widen after the election, not close.

Box – In Scotland

The SNP is in a strong position to dominate politics in Scotland for years to come. Its election manifesto makes clear it sees itself as the successor to Labour as the party to trust with the NHS. It makes great play that it has defended the NHS from privatisation, for example in cleaning services. The SNP manifesto plays on what it has done in government: adding £826m into the annual health revenue budget; cutting waiting times; introducing a one stop cancer diagnosis system; improving cleaning standards and therefore cutting acquired infections in hospitals; and making healthcare access times more flexible, to meet the needs of working and family lives.

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