This general election campaign is the first for many years where the National Health Service is not centre stage. The NHS as a political football appears to have been kicked into touch. There has been no “Jennifer’s Ear” – the famous fracas of the 1992 election which turned the opposition Labour Party’s health campaign into a total fiasco and helped fuel a Tory win.
There has been hardly a headline on patients being denied expensive life-extending drugs.
The Tories and the Liberal Democrats did not even get excited about the breast cancer patient who mistakenly thought her story was being used on an NHS leaflet when it was actually for Labour’s political propaganda.
In fact, the health service has been barely mentioned by any of the political parties.
Yet healthcare remains a priority in the minds of voters and, despite the many improvements since Labour came to power in 1997, there are still big challenges to face in the future.
The progress over the past 13 years has resulted in dramatically reduced waiting times for most hospital treatments, better access to GPs (apart from out of hours’ care, which is worse than ever) and sustained cuts in deaths due to cancer and heart disease. This has been accompanied by an unprecedented increase in funding to £100 billion a year.
But a rapidly ageing population, escalating obesity and alcohol-related illnesses, and growing health inequalities, will continue to put expanding pressures on the health service which will be difficult to overcome even without the future budgetary restraints.
Whoever wins the election must transform the NHS from purely being a sickness service that diagnoses and treats into one that promotes health and prevents sickness.
It must put the same energy and innovation into reducing alcohol consumption and encouraging healthy eating as it did into tackling smoking.
If alcohol consumption and the related rise in alcohol-related hospital admissions and rates of liver disease continue to escalate as they have done since 1998 and the significant increases in obesity and obesity-related ill health persist unabated, they could push the NHS to financial breaking point. Tackling these preventable causes of ill-health must be the way forward and cannot be done by the Department of Health alone, but will need cross-departmental action.
Every party has promised to restrain the NHS budget, although the complex arguments over how they will do it are not completely clear. Of course, each one insists it will cut administration and management costs. It is what they always say during every election campaign and during their years in opposition.
When the Tories were in power, Labour continually hit out at bureaucracy and red tape, criticised the number of pen pushers, and promised to slash it all. During the Labour years, the headlines were identical except for the fact that this time it was the Tories doing the attacking.
Further, despite every party promising to reduce numbers, there is still a growing army of managers. Scandalously, thanks to Labour’s invention of foundation trust hospitals, these managers are now getting above-inflation pay rises while the rest of the workforce received a below-inflation pay deal.
The trusts, as independent organisations, are able to ignore Department of Health guidelines that the pay rises for senior managers should be no more than 2.2 per cent. Instead bosses of foundation trusts received an average pay increase last year of 6.9 per cent – more than double that given to nurses.
It’s proof that I was correct in tearing up my Labour Party membership card in protest over the setting up of foundation trusts.
If it can’t control how much hospitals pay the bosses, how can the Department of Health hope to control other costs? The Department of Health and the NHS have already promised they will deliver £4.35 billion of savings in the next year. Will this mean below-inflation pay rises for the chief executives – or maybe no pay rise at all.
The Conservatives have promised that, if they win the election, they will introduce a new pay cap where no public sector worker earns more than 20 times that of the lowest. It’s an excellent idea, but it could mean they lose the votes of virtually every foundation trust chief executive in the country.
The other good thing the Tories have promised is to get rid of targets, the bugbear of every NHS member of staff. As Labour introduces more and more targets – the latest being a legal right to see a cancer specialist within a week of referral and making waiting times a legally enforceable guarantee for all patients – the Tories plan to replace them with a focus on clinical outcomes such as survival rates for cancer, stroke and heart disease.
This would mean, rather than being overwhelmed with the thousands of targets they have to meet, NHS medical teams could concentrate on clinical outcome data. This would allow comparisons between different hospitals and lead to professional pride between medics, ensuring those that are underperforming act to improve their service.
But election promises are just that – promises. If we have to decide in whose hands the NHS is most likely to be safe, we must judge on past behaviour. On that, Labour wins hands down. It is surely the one party that will keep to the founding principles of the NHS of being fair, efficient and accountable to the society that pays for it. Despite its foundation trusts and its targets, Labour is the one party that will develop an NHS capable of delivering quality to all patients, in all areas, all of the time.
As a recent report by the King’s Fund think tank says: “The NHS was in intensive care in 1997 and is now in active rehabilitation, delivering more care to more people. There is no doubt that it is closer to being a high-performing health system now than it was in 1997.”
