Having read the general election manifestos so you don’t have to, I have written the following piece for Guardian Healthcare Professionals Network. There is an area of significant difference between the parties on the NHS, and – perhaps not a massive surprise – it’s the role of the private sector.
If you do want to read the general election manifestos, which I find is often the best way to get an overview of what each party wants to do, you can do so through the following links, to PDF copies in each case: Conservatives, Labour, Liberal Democrats, Scottish National Party, UK Independence Party, Green Party, Plaid Cymru and National Health Action Party.
With the NHS as one of the general election’s highest-profile topics, it is remarkable how little the political parties disagree. All are offering billions more in funding, greater support for mental health and dementia, faster access to GPs and more integration between health and social care.
The differences are largely ones of degree. The Conservatives and Liberal Democrats both pledge an additional £8bn for the NHS in England by 2020, the figure requested by NHS England chief executive Simon Stevens. Labour promises an increase of £2.5bn, the UK Independence party £3bn, the Scottish National party £9.5bn (across the UK) and the Green party £12bn. In some cases, unlikely combinations of parties promise exactly the same: both Labour and Ukip want to add 8,000 more GPs, 20,000 more nurses and 3,000 more midwives.
But there is one area where the parties differ widely: the role of the private sector. The Conservative party wants to see more NHS organisations becoming employee-owned companies, Labour wants to reduce private sector involvement – and the Greens want to end it.
The Conservative manifesto plans to encourage “the entrepreneurial spirit of public servants” by introducing and encouraging a “right to mutualise” for public sector organisations, so they are owned by staff not the government. This could accelerate a trend in the NHS: Health and Social Care Information Centre statistics show that around 14,000 NHS staff worked for 17 community interest companies (private firms that have a declared community benefit) plus one community benefit society. Fewer than 300 NHS staff worked for such organisations in May 2010.
By contrast, the Labour manifesto commits to repealing the Health and Social Care Act 2012 passed by the Conservative and Liberal Democrat coalition. It would end competition between providers, in favour of making NHS organisations the preferred providers of services, impose a cap on profits made by companies providing clinical services and ensure the NHS was protected from the Transatlantic Trade and Investment Partnership (TTIP) Treaty.
The Green manifesto goes further, saying that “all other parties have encouraged the marketisation and privatisation of provision”. Not only would the party repeal the Health and Social Care Act, it would also abolish competition, the purchaser-provider split, market-based commissioning and procurement and restrict the role of commercial companies. It would ban new private finance initiative (PFI) deals and set aside up to £5bn to buy out existing ones. Through greatly increased spending of £20bn more by 2020, it would increase the combined NHS and social care workforce by 400,000.
Although healthcare is devolved to each of the UK’s four nations, both the Scottish National party and Plaid Cymru have said in the leaders’ debates that they share the Green party’s anti-austerity approach to the NHS and would support it at Westminster. SNP leader Nicola Sturgeon says her party would support the repeal of the Health and Social Care Act and other measures designed to protect the English NHS from “the privatisation agenda”.
The National Health Action party, founded in 2012 to challenge the coalition government’s healthcare reforms with candidates standing in 12 constituencies, would increase NHS spending by at least 4% a year, initially paid for by a penny on the basic rate of income tax. A Labour-led government that included any of these parties would be likely to go further on reducing the role of the private sector in the NHS than a Labour-only government.
Despite gaping differences with the Greens, SNP and Plaid Cymru on most other subjects, Ukip shares some of their approach to the NHS. It too wants to end the use of PFI contracts and exclude the NHS from TTIP. However, Ukip differs in planning to bar migrants from non-emergency NHS services for five years after they start paying taxes.
The Liberal Democrat manifesto states that it would repeal any parts of the Health and Social Care Act “which make the NHS vulnerable to forced privatisation through international agreements”, although it adds that the European Union has guaranteed that TTIP will not stop member states providing public services directly.
Aside from the role of the private sector, parties have other distinctive policies that would affect the NHS workforce. As well as its pledges on increased numbers of GPs, nurses and midwives, Labour wants to recruit 5,000 new homecare workers, with NHS organisations identifying family and friends who care for patients and linking them to such support. It also wants to increase public involvement in the NHS, giving patients and local people “a seat at the table” in any changes to services, such as hospitals.
Although it shares the idea of seven-day access to GPs with the Conservatives, the Liberal Democrat manifesto specifically identifies phone and video appointments as a way to achieve this, as well as placing GP surgeries within hospital emergency departments. The party would encourage mergers between existing NHS organisations with the aim of forming local integrated healthcare providers.
The Conservative manifesto includes plans to make it harder for staff in “essential public services” including the NHS to go on strike. January saw employees across England preparing for a 12-hour strike over pay followed by a month-long work to rule, after two four-hour stoppages last autumn. The strike, led by Unison, was suspended after the government improved its offer for the lowest-paid staff. A Conservative government would require such a strike to be backed by at least 40% of those entitled to vote for it, as well as a majority of those who actually turned out.
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