Voters say that health is an election priority – second only to the economy in some polls. But whether the parties’ manifesto pledges on the NHS will influence people’s decisions in the polling booth is another matter. In part, this is due to the high level of consensus between the three main parties on the key NHS policies. In some places their manifestos are almost indistinguishable.
All the parties are committed to a tax-funded NHS, free at the point of use – not a surprising position for either Labour or the Liberal Democrats, but the Conservatives‘ conversion to this particular canon of public sector piety is more recent. In their 2005 manifesto, they promoted a policy to use NHS funds to subsidise the bills of patients paying for private sector treatment, to bring waiting lists down. But this was ditched soon afterwards and David Cameron’s commitment to the current NHS funding system has been unwavering since 2006, notwithstanding mutterings amongst some Conservative backbenchers about the need to discuss alternative funding options in the future.
All the parties support choice, more information for patients and better access to GPs, especially out of hours. They all promise action to improve public health (although concrete proposals are somewhat thin on the ground). And they all indicate that the independent sector has a role to play in the NHS, although the Conservatives are the most enthusiastic about extending its use.
There are, of course, some important policy differences, but will they capture voters’ imaginations before polling day? The Conservatives are promising an independent board to run the NHS and a new national body to represent patients; they say they will transform the Department of Health into a new Department of Public Health. Both the Liberal Democrats and Conservatives promise to cut a swathe through current government targets – on the grounds that they generate unnecessary bureaucracy – but they have been coy about which ones they would actually scrap. The two week cancer wait? The four hour A&E wait? Although they may have been unpopular with staff, these targets have brought benefits to patients. Both Labour and the Liberal Democrats favour a post-target approach to waiting times, which hinge on patient guarantees, backed up by legal force and, in the case of the Lib Dems, a promise of treatment in the private sector.
There are the requisite new offers without which any manifesto would be incomplete: Labour is offering a new one-week “right” to cancer test results within a week and routine health checks for everyone between 40 and 74. The Conservatives promise a Cancer Drug Fund to provide access to expensive cancer drugs. The Liberal Democrats promise guaranteed respite care for one million carers.
The most eye-catching pledge, politically speaking, is the Conservatives’ promise to stop the forced closures of A&E and maternity units. Given the state of the public finances and the likelihood that service reconfiguration will be needed in future (for clinical and financial reasons), this is a pledge they might wish to tone down if they win power. The most radical proposal is to be found on page 43 of the Liberal Democrats’ manifesto: to have elected Local Health Boards which, in time, could raise local taxes to fund the NHS. There are many uncertainties about this – whether the public would vote for the Board members, how clinicians would respond – but it is a concrete proposal for delivering what all the parties aspire to: a more locally accountable, responsive NHS.
Ruth Thorlby is Senior Fellow in Health Policy at the King’s Fund
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