Promises, promises; can anyone really save the NHS?
DENTAL BULLETIN, ISSUE 47
With one week to go before the UK once again goes to the polls and a large number of voters still undecided on how to cast their vote, there is still a huge amount to play for in the General Election 2017. The handling of the NHS is critical to any party’s success, so we have scrutinised the Conservative, Labour and Liberal Democrat’s offerings in the lead up to June 8th. Will anyone be able to save the NHS? If you don’t have the time or energy to trawl through hundreds of pages of manifesto pledges, read below for a helpful summary of NHS commitments.
The Conservative Party:
- A commitment to the founding principles of the NHS; a service that meets the needs of everyone, based on clinical need not ability to pay and care should be free at the point of use.
- Spending will be increased by £8 billion in real terms over the next 5 years.
- Create a “truly seven-day healthcare service”, with GP weekend and evening appointments for all by 2019. Hospital consultants will be supervising patients every day, with weekend access to key diagnostic tests.
- Current 95% A&E target and 18 week elective care standard will be maintained.
- Prioritise during the EU negotiations that the 140,000 staff from EU countries “can carry on making their vital contribution to our health care system”, whilst continuing to invest in training medical students. Will encourage and develop new roles and create a diverse set of potential career paths for the NHS workforce.
- The most ambitious investment in building and technology that the NHS has ever seen, to ensure that care is delivered properly and efficiently.
- The NHS will become a “better employer”, strengthening the entitlement for flexible working and introducing better support services for employees.
- To implement the recommendations of the Accelerated Access Review to make sure that patients get drunk treatments faster, whilst ensuring value for money for the NHS.
- GPs will be expected to provide greater access, more innovative services and offer better facilities. A new GP Contract will be introduced.
- The role of the CQC will be extended to cover health related services commissioned by local authorities.
- 10,000 mental health care professionals will be recruited. The co-ordination of mental health services with other local services will be improved.
- Radical changes to social care for the elderly. Aligning the current means-testing for domiciliary care with that for residential care. The value of the family home will be taken into account, along with other assets and income when assessing the amount of funding that an individual will receive from the state. The current cap of £23,250 will be increased to £100,000. Individuals will be able to defer payments if receiving care at home in order to avoid selling their home during their lifetime.
- End of life care will be improved. Families who lose a baby will be offered additional bereavement support.
None of the above pledges have been costed in the published manifesto.
The Labour Party:
- A commitment of over £30 billion in extra funding over the next Parliament. Paid for through increased income tax for the highest 5% of earners and an increased tax on private medical insurance. Money will be freed up by halving the fees currently paid to management consultants.
- A new office for budgetary responsibility will be introduced to oversee health spending and scrutinise how it is spent. “Sustainability and transformation plans” will be halted, and a review undertaken, asking local people to contribute, considering patient need rather than available finance. A new regulator “NHS Excellence” will be introduced.
- Privatisation of the health service will be reversed. A legal duty will be introduced on the Secretary of State to ensure that excessive private profits are not made out of the NHS at the expense of the patient.
- Promise investment to give patients a modern, well-resourced service. Guaranteeing access to treatment within 18 weeks, taking a million people off the NHS waiting lists by the end of the next Parliament. Patients will be seen in A&E within 4 hours. Mixed sex wards will end.
- The Cancer Strategy for England will be fulfilled by 2020.
- Funding will be increased to GP services and cuts to pharmacies halted, and the current position reviewed.
- Patients will be given fast access to the most effective new drugs and treatments, and “value for money” agreements will be negotiated with pharma companies.
- To make the country “autism friendly”; with specialised care plans in place and access to condition management education.
- High quality and personalised end of life care.
- A commitment to completing the trial programme for PrEP, and rolling the treatment out to high risk groups to reduce HIV infection.
- Free parking for patients, staff and visitors at hospitals by increasing tax on private medical care premiums.
- For the work force the pay cap will be scrapped, with an independent review body making the decision. Bursaries and funding for health related degrees will be scrapped (University tuition fees will be scrapped).
- The rights of EU nationals working in the NHS will be immediately guaranteed.
- The foundations for a “National Care Service for England” will be laid. Social care budgets will be increased by £8 billion. Place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.
- Funding for mental health services will be ring fenced. Out of area placements for young people will be ended by 2019. Early intervention for children and young people’s mental health services will be prioritised. Counselling services will be available in all secondary schools.
To read the manifesto in full click here.
The Liberal Democrats:
- Pledge to put a penny on the pound on Income Tax to raise £6 billion in extra revenue for NHS and Social care funding. This money would be directed to key areas, including social care, primary care, mental health and public health.
- Commission a dedicated health and care tax following consultation.
- Guarantee the rights of all EU NHS and social care staff to remain in the UK.
- End the public sector pay freeze for NHS workers and reinstate nurse bursaries.
- Transforming mental health care and reducing associated waiting times to no more than 6 weeks for a therapy appointment for depression or anxiety. No young person will wait for more than two weeks for treatment when they first experience psychosis. The focus will be on young people and pregnant women/ new mothers.
- An end to out of area placements and improving front line services in schools and universities. Ensure LGBT and inclusive mental health services receive funding and support.
- Establish a cross party health and social care convention to carry out a review of the long term sustainability of the health and social care finances and workforce. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility.
- Improving the integration of health and social care; ultimately creating one service with pooled budgets.
- Implement a cap on the cost of social care and increase the earnings limited from £100 to £150 per week for eligibility for carers’ allowance, and reduce number of care hours a week for qualification.
- Provide more choice of end of life care and move towards free end of life social care. Expanding the work of hospices.
- Promote easier access to GPs, expanding evening and weekend opening, encouraging the use of on line appointments, whilst supporting GPs to prevent practice closures.
- Using innovative funding to promote GP led multidisciplinary health and care hubs and ensure access to local pharmacies.
- Helping people stay healthy in the first place through a National Well Being strategy, including public awareness campaigns on cancer and by developing a strategy to tackle childhood obesity and a sugar tax.
- Introduce a minimum unit pricing for alcohol.
- Make PrEP for HIV prevention available on the NHS.
To find out more you can find the Liberal Democrats manifesto here.
What will these pledges cost?
The Institute of Fiscal Studies has undertaken its own review of the funding behind each of the above pledges and state as follows;
The Conservative manifesto: Would suggest an increase in Department of Health (DH) spending to £132 billion (in today’s prices) in 2022–23, if the other (non-NHS) aspects of DH spending were frozen in real terms over this period. This would be an average growth in real spending of 1.2% per year between 2016–17 and 2022–23.
The Labour manifesto: promised a larger increase in health funding. Labour would increase spending relative to current government plans by £7.7 billion in 2017–18, rising to £8.4 billion (in nominal terms) by 2021-22. This could take DH spending to around £135 billion (in today’s prices) in 2021–22. This would be an average 2.0% per year real increase in spending between 2016–17 and 2021–22.
The Liberal Democrats manifesto: have pledged to increase spending on health and social care in England, Wales and Northern Ireland by approximately £6 billion each year, with £2 billion ring-fenced specifically for social care. This could imply DH spending of £131 billion (in today’s prices) in 2021-22, and average growth in spending of 1.4% per year in real terms between 2016–17 and 2021–22.
However they also conclude that the planned spending of all three parties is well below the historical 4% per year growth in health care spending per year that has been seen since 2009/10. The difference between the parties spending plans is in fact reasonably modest and as such the NHS will continue to suffer financially whoever will win the general election.
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Julia Furley, Senior Barrister