Newspapers reported last week that senior Conservative politicians have admitted that the wholescale top-down reorganisation that they implemented with the Health and Social Care Act 2012 was the biggest mistake they made in Government, and that Chancellor of the Exchequer, George Osborne MP, has said he regrets not stopping the reforms. These are just another indication that the National Health Service (NHS) will be one of the key battlegrounds for the political parties in the run up to the General Election in May next year.
Contrast this with 2009, when UK health care organisations and charities struggled to engage politicians in any serious debate about the health service; this year all of the political parties focused on the NHS at their party conferences, with party leaders all making pledges on health care services and NHS spending during their conference speeches.
Osborne is probably right, from a political perspective, to regret not blocking former Secretary of State for Health Andrew Lansley’s reform proposals. Before the last election, no one was really talking about the NHS. It was not perfect, and there were issues that needed to be addressed—but, by and large, the public was happy with the service and it was not one of the big election issues.
The NHS has always been considered toxic for the Conservative party, with the end of their last period in government in the mid 1990s marked by news stories of patients dying on trolleys in hospital corridors because the system could not cope. Some commentators believe that the smart thing for them to have done on taking office in 2010 would therefore have been to leave it alone. The majority of professional bodies and Royal Colleges representing the staff who work in the NHS told them as much.
Instead, however, they embarked on a top-down restructure so massive, David Nicholson, the former NHS Chief Executive, told NHS leaders “it could probably be seen from space”.
And the result? The NHS has gone from being a non-issue at the last General Election to being a key debate at the next. It has, once again, become a political football with all of the political parties making promises of more funding and improved services in the hope of convincing the electorate that the service is safe in their hands.
Ed Miliband, the Labour Party leader, has said his party will repeal the unpopular Health and Social Care Act, whilst at the same time promising there will be no further top-down restructure of the NHS—two proposals that would seem contradictory, considering a repeal of the Act would remove a number of the new organisations created in 2013. Shadow Secretary of State, Andy Burnham, has suggested there would be some ‘reorganisation’, but that would be different to another ‘restructure’.
Labour has also committed to make the NHS the preferred provider, effectively limiting the involvement of private companies, social enterprises and charitable organisations in the provision of health services—a move clearly designed to win the support of the health unions and workers who strongly oppose what they see as the ‘privatisation’ of the health service.
To appeal to a public that values its relationship with its local doctor, Labour has pledged to guarantee everyone a GP appointment within 48 hours. It has also promised to recruit 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives. These seem to be fairly arbitrary figures (although the Royal College of GPs called for 8,000 more GPs in July) but increasing the number of healthcare professionals working in the NHS will play well with the public.
Prime Minister, David Cameron, has promised a real-terms increase in funding for the NHS, but he has not specified how much above inflation that increase will be, leaving the service uncertain as to how it will continue to fund vital services. He has promised an additional 5,000 more GPs, which will be welcomed by doctors’ organisations and the public, but it falls short of what they have been calling for, and what Labour is promising.
The Conservatives are also promising that by 2020, all patients will have access to a GP from 8:00 AM to 8:00 PM, seven days a week, which will appeal to working people and parents who have become increasingly frustrated in recent years about the difficulties in making appointments to visit their family doctor.
Nick Clegg, Liberal Democrat leader and deputy Prime Minister, made mental health services his priority in his conference speech, committing to give mental health parity of esteem with physical health by announcing an extra £500 million for mental health services and a new 18-week treatment target at his party conference. This is in keeping with the Liberal Democrats’ history of championing equality issues and bringing them into the mainstream.
Clegg also promised a real terms increase in NHS funding of £1 billion in 2016/17 and 2017/18 and Liberal Democrat Health Minister Norman Lamb MP has pledged to seek changes to the 2015/16 budget to provide increased funding to the NHS in the Chancellor’s autumn statement, responding to concerns that the funding crisis facing the NHS is an immediate one.
Where there was agreement among the parties was in the need for care to be more integrated around the individual—removing the organisational divide between health and social care, but also between acute and primary healthcare services. In this vein, we can all expect to hear politicians of all colours talking about the small seaside town of Torbay in Devon, which has already integrated its health and social care services to much acclaim.
But it is not just the three main political parties that will spend the next seven months debating the NHS; the Green party has promised to introduce an NHS tax to provide additional funding for the service, to increase and protect the funding of community services and abolish prescription charges; and UKIP has pledged evening opening hours for GPS surgeries, scrapping hospital parking charges and a new regulator to license NHS managers.
Which set of proposals will be most attractive to the public will remain to be seen, but we can be sure there will be much more debate and disagreement over what is best for the NHS, and importantly how it can be funded, over the weeks and months ahead in the lead-up to May 2015.
Donna Castle is an associate director in APCO Worldwide’s London office. She can be found on Twitter @donnacastle.