Public confidence in the National Health Service (NHS) has suffered blow after blow, according to a report published in the British Medical Journal. The research found that hospital mistakes hit one in nine patients and cost the NHS £2m a year.
So with the NHS to the fore of the public consciousness, we can expect to see the three main political parties all attempting to show their caring, sharing side in the run up to the election. But do their strategies for improving the health service – and funding their decisions – differ greatly?
The Labour Party’s health policy document boasts of the government’s improvements to the NHS since it took office in 1997.
The document reads: “We have met our key pledge to cut waiting lists by 100,000. There are 500,000 more operations a year than when the Tories left office and outpatients have fallen by more than 100,000 since the number peaked.”
It also mentions:
l 16,000 more nurses and nearly 5,000 more doctors than in 1997 l Thirty-eight new hospital developments given the go-ahead – and every A&E department that needs it is being modernised l NHS Direct – the 24-hour nurse-led healthcare and advice helpline – available across the UK l Tories’ two-tier internal market scrapped and on track to save £1bn in red tape by 2001/02 l Action taken to end the postcode lottery of care with drugs for breast cancer and Alzheimer’s now available in all parts of the country l Free eye tests for the over-60s and free flu jabs for those over 65.
The NHS, born in 1948, was the brainchild of Aneurin Bevan, a Labour MP. He thought everyone has a right “to free access to the highest quality healthcare – a health service based on need, not ability to pay”. But medical inflation means that providing free services is becoming a greater burden on the tax-payer.
In his Budget statement last month, chancellor Gordon Brown announced that hospitals and the NHS are to be additionally funded by cigarette taxes which have risen by five per cent above inflation – by 25 pence a packet since Labour came to power. The price of a packet of 20 cigarettes has risen 6 pence since 8 March. Under Labour’s spending plans, the NHS will receive an extra £1bn over the next three years to fund acute hospital trusts, services, modernise wards and pay for new equipment. The cash injection will also fund inflationary pay increases and improve nursing recruitment.
However, the Liberal Democrats (Lib Dems) launched an alternative budget in which leader Charles Kennedy vowed to give the NHS a huge boost if his party was in government. He said under the Lib Dems, health spending would increase through an extra 50p-in-the-pound upper tax rate.
Britain’s poorly paid nurses and midwives would receive a £1,000 a year pay rise as a result and there would be a five-year plan to increase the numbers of doctors, nurses and beds. The long waiting lists and rationing within the NHS would also be prioritised as issues to be resolved.
Over a five-year period, the Lib Dems would introduce around 3,300 more training places for doctors and 11,400 for nurses and midwives. Low-paid nurses would be motivated by an annual rise of £1,000 a year. Other NHS staff would be “boosted” by pay increases with additional funds available.
The Lib Dems have guaranteed there will be no stealth taxes, such as the insurance premium tax (IPT) which was introduced in 1995, to pay for their plans. “Unlike the other parties, we will not pretend you can get something for nothing, and they should not pretend you can cut taxes without cutting public services,” says Kennedy.
The Lib Dems also want to eliminate the postcode lottery, whereby some treatments are only available in some parts of the country. The party would create a “pharmaceutical agency” – which would use the purchasing power of the NHS to cut the price of established drugs and secure more sophisticated medicines and technologies at affordable prices. It has also proposed to phase out prescription charges.
Long term care (LTC) funding could prove to be a topical issue in this year’s electioneering. The Royal Commission on Long Term Care, set up by Labour, recommended that the payment for all long term personal care costs be met by the state so people are not forced to sell their homes to pay for their care. However, the Labour government has decided to fund only “nursing” rather than “personal” care.
In response to this, the Lib Dems have launched a campaign to recommend the introduction of free personal care for the elderly in England and Wales, with the party boasting that the Scottish Executive is using Lib Dem influence to implement the provision of free nursing care for all older people in Scotland.
Paul Burstow MP, the Liberal Democrat spokesman for older people, says: “Care should be offered free on the basis of need, not means.”
The Conservative Party’s solution to LTC was outlined at a recent economic lecture to the think-tank Politeia. Dr Liam Fox, the shadow health secretary, promised that people who saved at least £20,000 to cover the cost of residential LTC would not have to sell their homes if that money ran out.
He said that his party would match Labour’s promise to fund all nursing care costs – however, it has yet to draw up more detailed plans on covering social care and accommodation expenses through insurance schemes.
Dr Fox believes the state could not accept liability for all individuals in old age. He says: “We must care for our elderly people and reward those who have shown individual responsibility by making sufficient provision for themselves.”
The policy is aimed at pleasing what he called the “angry property-owning democracy” who bought into share flotations and eagerly awaited the “pension revolution” but have been forced to sell their homes to pay for residential LTC.
He says: “These people who made provisions for themselves were being penalised in order to fund those who had made none. Pauperising the thrifty to fund the feckless was the ultimate betrayal in the eyes of those who Margaret Thatcher called ‘our people’”.
Dr Fox says the Conservatives would introduce a “bonanza” by spending on top of what Labour says it will spend on the NHS. He says: “We also want to encourage people to spend in the private sector on top of what the NHS is providing.”
Under Conservative party plans, people would buy private services to increase the total capacity of the healthcare system through individual insurance or as part of a company insurance scheme. Company-sponsored insurance is favoured because it offers prices conferred by community rating. This means that benefits are spread more widely than if tax incentives were offered for individual policies. Currently, company schemes are taxed but the Conservatives propose to abolish this.
The de-politicising of the delivery of the NHS is also a priority. They believe in reducing the power of the Secretary of State, who Dr Fox calls “Big Brother in Richmond House”. Doctors, not managers, would be allowed to decide which patients to treat. And ward sisters would be given more responsibility.
The health insurance industry looks set to prosper if the Conservatives win. They believe people who choose to have their treatment in the private sector are off-loading the pressure on the NHS and helping reduce waiting times for other patients. The Conservatives believe extra choice in healthcare should be available to the many, not the few. Some argue that the Conservatives will in effect be privatising the NHS by creating a thriving non-NHS sector. But Dr Fox reasons that choice is no bad thing. He says: “I have no problem with people obtaining healthcare in the private sector, if they can afford to do so and that is their choice.”