After the Tories reneged on their promises last time, what happens to the NHS has become a question of trust for many voters
In marked contrast to 2010, the NHS has become one of the central battlegrounds of the current election campaign.
The three main parties in England are all grappling with how to provide the extra funding the NHS needs, how and to what extent the NHS Five Year Forward View should be implemented, and how to deal with the legacy of the deeply damaging Health and Social Care Act.
So how to assess the competing pledges and promises, and who comes out on top?
Conservative health plans have been dominated by the last-minute decision on funding, with the party now claiming it will pump an extra £8bn into the service.
Unfortunately for David Cameron and Jeremy Hunt, this sudden conversion seems to have fooled no one – recent polling shows the Tories falling even further behind Labour on the NHS. This is presumably due to the fact that there has been no explanation as to how this money will be raised or what else will be cut to provide it.
The Tory pledge of a seven-day NHS sounds alluring. After all, who wouldn’t want the NHS to offer the same high quality of care, regardless of the day of the week or the time of day?
However, rather than pledging the extra staff needed to make such a commitment a reality, through their actions in government the Tories have made it quite clear that they expect the burden for this extra work to be borne by health workers, particularly in the shape of cuts to unsocial hours payments.
Moreover, there is absolutely no recognition in Conservative plans of the need to – at the very least – temper the worst excesses of the expanding NHS market that is gobbling up more and more scarce resources and distracting the service from making real improvements to the delivery of care.
Liberal Democrat plans include a number of ideas that look appealing, not least the focus on traditionally under-valued mental health services.
The Lib Dems do also seek to address the mess created by the coalition’s reorganisation. Their manifesto claims the party are committed to repealing any parts of the Health and Social Care Act which lead to forced privatisation and to ending the role of the Competition and Markets Authority in health.
This seems to be an attempt to reach out for common ground with Labour, but for those us who were campaigning at the Lib Dem spring conference in Gateshead in March 2012, just days before the Act became law, such words have a horribly hollow ring to them.
Having repeatedly attempted to quash internal dissent on coalition health policy, the party leadership lost a vote at the eleventh hour in which the grassroots made clear its desire for the Lansley legislation to be voted down in the House of Lords. As health workers know to their cost, the reality unfortunately proved very different.
Labour’s plans for Whole Person Care represent a brave blueprint for the far-reaching integration of health and social care.
In order for this to achieve its full potential, however, the party may need to go further in deciding how to provide the extra funding for social care that would bring care services and workforce terms and conditions up to something approaching parity with the NHS.
Labour’s £2.5bn Time to Care fund aims to bring in thousands of extra health and care staff.
Although this amount falls short of NHS England’s demands, it represents an important first step and comes with the guarantee of immediate extra money, and crucially it is based on a credible and progressive plan to raise money from the mansion tax, from tobacco companies and from cutting down on tax avoidance.
Where Labour’s plan is at its strongest is on the welcome – some would say overdue – recognition of the limits of the market.
The party’s plans seek not only to repeal the entire competition section of the Health and Social Care Act, but also to shield the NHS from the ravages of EU competition law in future.
This represents something of a break from the policies of the previous Labour government and a genuine attempt to ensure the NHS remains an integrated national service.
A question of trust
The NHS is an issue of the heart for many voters – it goes to the soul of what this country stands for.
People remember how the service and its staff saved the life of a relative, brought their children into the world, or provided solace and support when a loved one died.
So the question of which party is most trusted to look after our most cherished institution is at least as important as those commitments written in black and white – all the more so after the Lansley plans destroyed all the promises of ‘no more top-down reorganisations’ just two months into the coalition’s time in power.
With the election now only days away, it is right that health remains a top issue for voters. And Labour’s poll lead on the NHS seems well-deserved.
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