What do our political parties stand for when it comes to healthcare policy? With an election looming, most probably on 6 May, it’s time to examine their political promises. The following is a summary of a useful cross comparison on the King’s Fund website.
Conservatives
Much Conservative policy is a continuation of the current government’s policies. David Cameron said in November 2009: “If you look at the changes we are making to the NHS - extending foundation trusts, opening up the supply of health care, GP commissioning, improving patient choice - these are all changes that are grinding to a slow and tortuous halt under Labour.”
1. NHS funding: the Tories are committed to ‘protect’ health spending in real terms. It has also promised to cut the cost of NHS ‘administration’ by one third.
2. Reducing targets: “all of the politically motivated process” targets would be scrapped, according to the draft manifesto. It does not specify exactly which targets would be removed or whether the party will continue to monitor waiting times. It has criticised the use of cancer and A&E waiting times in the past.
3. Focus on outcomes: outcomes mentioned include survival rates for cancer, stroke and heart disease as well as patient-reported outcomes and satisfaction levels.
4. More patient choice and information: patients would have more choice and more information would be available online, but there are not enough details to establish how this differs from the government’s current approach.
5. More competition: the NHS will be ‘opened up’ to new independent and voluntary sector providers and a payment-for-results-type system will be implemented, although there are no details about how this differs from the current Payment by Results system.
6. Hospitals: mixed-sex wards would be removed by increasing the number of single-sex rooms “where resources allow” and to tackle hospital-based infections by withholding payment where a patient acquires an avoidable infection.
7. Changes to drug pricing: drug availability would be reformed, especially the role of “unaccountable bureaucrats” at NICE, and proposes that drug companies are paid according to the “value of their new treatments”.
8. Stopping local service closures: the Tories promise to stop the “forced closure of A&E wards”.
9. New Department of Public Health: the Department of Health will become the Department of Public Health and “will be focused much more strongly on the prevention of disease, rather than just its cure”.
10. Tackling health inequalities: a ‘health premium’ will be added to public health funding in order to tackle health inequalities. It would signal a new approach to the current inequalities component of the NHS allocation formula, though details are scarce.
11. Independent board: it would allocate resources around the country and make access to the NHS “more equal”. Previous statements suggested that the independent board would also set national guidelines on commissioning, performance manage local commissioners, develop national contracts for local use, directly commission some specialist services, and resolve local disputes between PCTs and local authorities over health plans.
12. Commissioning: GPs “will be given the power to hold” real cash budgets with which to commission care for their registered patients, rather than the notional budgets they have had under Labour’s policy of practice-based commissioning.
13. Expanding maternity services: new providers will be encouraged to deliver maternity care, especially ante- and post-natal support, and local maternity networks will be launched to help women access the care they need.
Labour
Key policies and pledges made by the Labour party over the past six months include:
1. NHS funding: the government has said that the 95% of the NHS budget “that supports patient care” will rise in line with inflation in 2011/12 and 2012/13. Other money-saving measures, include cutting 30% of management costs in SHAs and PCTs over four years.
2. Right to treatment within 18 weeks: it wants to move away from a culture of targets to one in which patients know their rights and are able to exercise them. Subject to a consultation process currently under way, it is planning to ‘lock in’ the maximum waiting times achieved under the current targets by making them a legal right and including them in the NHS Constitution.
3. Right to cancer test results within one week: Gordon Brown announced that patients would have a new right to have diagnostic tests for cancer carried out and reported back within one week. This will be phased in from 2011/12.
4. Right to health checks: the government is also planning to make five-year health checks for people aged 40 to 74 a legal right under the same consultation process.
5. Choice of GP: practice boundaries are to be scrapped so that patients can register with a GP of their choice, for example, near where they work. Commitments to increase choice of GP have been made before (in 2006 and 2008) but it is not known how many people are prevented from joining the GP practice of their choice.
6. Reform of social care services and funding: plans for a ‘National Care Service’ were outlined in a green paper published in July 2009. Under this service everyone would have their needs assessed in the same way and have the same proportion of their costs paid for regardless of where they live. In addition, a pledge to provide free personal care to those with highest need was made by Gordon Brown in his party conference speech.
7. Scrapping car parking charges: the government plans to phase out car parking charges for inpatients over three years.
Liberal Democrats
The Liberal Democrats have not yet published firm proposals, but here’s a summary of their thinking so far:
1. Elected health boards: the Lib Dems would replace PCTs with new ‘local health boards’. The party has argued that local people currently have very little meaningful say in how PCTs spend their money and limited powers to object to changes in services. It is not clear whether the boards would be fully elected, although earlier papers suggested a mixture of elected and appointed members. The most recent paper proposes to allow local health boards to raise taxes locally (supplementing national taxation).
2. Personal care for the elderly: current policy documents refer to ‘universal care payments’ to over 65s who require personal care based on need rather than ability to pay. It is not clear what form this will take in the manifesto because of concerns about affordability.
3. Carers: guaranteed respite care for the 1 million carers who work the longest hours.
4. Cutting bureaucracy: SHAs will be abolished in order to reduce bureaucracy and waste and because their role is considered to be redundant in a more devolved NHS. Other strategies to reduce bureaucracy include cutting the amount spent on quangos by one-fifth and capping the pay of high earners to the equivalent of the Prime Minister’s salary. Lib Dems have also called for the abolition of four quangos (National Patient Safety Agency, Independent Reconfiguration Panel, National Treatment Agency and Connecting for Health).
5. Entitlements not targets: targets are to be abolished and replaced by ‘entitlement to treatment’, under which patients who are not treated on time should be offered alternative treatment from a private provider, paid for by the NHS. The party proposes that there should be different waiting time guarantees for different conditions - rather than the current blanket 18-week target - and that mental health services should be included in all waiting time guarantees.
6. Scrapping the National Programme for IT: it would go along with the agency responsible for implementing it (Connecting for Health); Choose and Book would be scaled back to become a ‘simple’ electronic booking system, and the National Care Record System abandoned. Local initiatives would be encouraged instead.
7. Staff ownership of organisations: staff would be allowed to vote for their hospital trust to become a wholly owned employee trust. Norman Lamb has also called for more volunteering within the NHS.
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