2005 General Election

An election is not a referendum. The question is not whether you approve of everything the Labour Government has done. The question is whether you think some other party could do better. There are things this government has done about which the Socialist Health Association has reservations, mostly because we want the policy to be implemented more thoroughly or more quickly, or we think there will be unintended consequences. But when opposition is weak alternative policies are not given much attention. Despite our unhappiness with some parts of Labour health policy a Labour victory is greatly to be preferred to any other likely alternative. Details of Labour party health policy are here.

An Independent Audit of the National Health Service under Labour (1997–2005)

Kings Fund Election Briefing

NHS Confederation Election Briefing

This page of resources is for people who have an interest in the effect of the election on health and what to know what the opposition parties are proposing. It only deals with the positive proposals of each party, not attacks on other parties' policies. There is more about healthcare than public health and wellbeing because it is easier to identify. The bullet points are taken directly from material produced by the various parties in their own words. The points in italics are our comments.If you have any questions or comments or want us to include any more issues please let us know.

Conservatives

(this section includes items drawn fromAndrew Lansley's interview with Health Service Journal 24/2/05)

• Our aim is to clean up hospitals and cut waiting lists – to deliver the standard of healthcare patients have the right to expect. This requires real reform, and no-nonsense, tough decisions by the Government. Labour have tried and failed to run the NHS from Whitehall, with politicians taking the decisions. Our approach is to let those who know best run the NHS, listen to those whom the NHS serves, and restore the primacy of the doctor-patient relationship.

Cleaner hospitals

• Patients deserve the peace of mind that they will be cured in hospital – not pick up new illnesses. So our first priority is to fight hospital infection by cleaning up dirty wards in the NHS.
  Local Inspection Teams will have the power to ‘search and destroy’ the superbug. They will have the final say in deciding whether infected wards are closed. We will require hospitals to publish information, by clinical department, on hospital-acquired infections so that patients can make informed choices about where to receive their operation. The National Institute of Clinical Excellence will prepare evidence based infection control standards. And we will fund hospitals to recruit more nurses and install new technology to fight the superbug. Hospitals will be required to show who is responsible for delivering a clean and safe environment in the hospital. One hundred and fifty years ago, Florence Nightingale asked ‘who’s in charge?’ Today, no one knows. So we will bring back Matron to take charge and deliver clean and infection-free wards.

• An end to waiting lists
  

• Our next priority is to cut waiting lists. Our proposals will increase the number of beds available to NHS patients. We will spend more, give hospitals the freedom to invest, focus resources on front-line services and give independent providers the Right to Supply to the NHS. Conservatives do not believe that the state should have a monopoly on providing healthcare and we welcomed Labour’s introduction of private sector companies into the NHS. However, we must go
  further. In Europe, a significant proportion of hospitals – 30 per cent in France and 50 per cent in Germany – are in the private sector. If a voluntary or commercial hospital can provide high-quality, cost-effective treatment, then it will be allowed to do so. We will give private providers the Right to Supply care to NHS patients. Patients will have access to treatment at any independent hospital which can perform their operation for NHS prices and to NHS standards.
• Private patients have paid their taxes like everyone else. If they choose to go private and free up NHS space for other patients, they should not be punished, but helped. If an independent hospital charges more for an operation than the NHS, patients will be entitled to 50 per cent of the NHS cost as a contribution towards their bill. We believe that a combination of freedom for professionals and patients’ Right to Choose care from the public or independent sector will mean no needless waits for hospital treatment by the end of the next Parliament. Waiting lists as we know them will become a thing of the past.
• This will mean that people with money to pay can jump the queue.

Choice and a voice for patients

• Currently, patients in need of hospital treatment must join the waiting list at the hospital chosen for them. At best, they are entitled to a single alternative hospital – a hospital that may have dirty wards and long waiting lists. Labour plan to give patients a limited choice of ‘four or five’ hospitals, determined by bureaucrats, by the end of 2005. Under a Conservative Government, patients will have the Right to Choose the hospital or care provider that is best for them. All patients will have a choice of treatment at any hospital – NHS or independent – which can perform their operation to NHS standards at NHS costs. No-one will be required to pay for NHS treatment or NHS operations. Patients will receive information on hospitals’ infection rates, waiting times, treatment outcomes and patient experience surveys. They will make decisions with their GP on the best and most convenient hospital and specialist for their needs.

Extra money, extra value

• Under a Conservative Government, funding will follow the patient, and go directly to front-line care. We will invest an additional £34 billion a year by the end of our first Parliament, over and above the level that we inherit from Labour. The 28 Strategic Health Authorities will be abolished. The number and functions of Primary Care Trusts will be reduced to no more than 150, saving over £1.25 billion for front-line care. The quangos and inspectorates which currently dominate the NHS will be cut.
  By slimming down the Department of Health, by halving the number of quangos through eradicating waste and by scrapping a tier of health bureaucracy completely, we will ensure that, in addition to the growth in the NHS budget, billions of extra pounds will get through to front-line services.

This effectively re-establishes a market system. Although there might not be so many bureaucrats there would be an increase in the numbers of managers, marketting people and accountants. They might not be on the NHS payroll, but the proportion of taxpayers money spent on non-clinical services seems likely to rise.

Abolishing targets which distort clinical priorities

• A Conservative Government will abolish all centrally-set targets on hospitals. The National Institute for Clinical Excellence (NICE) will lay down clinical standards including appropriate waiting times, but hospitals will run themselves and be accountable to patients and GPs for their performance. Targets will be retained for Public health and some aspects of Primary Care.

All hospitals to be Foundation hospitals

• Under a Conservative Government, all hospitals will become Foundation hospitals. In contrast to Labour’s plans, Foundation hospitals will be free to hire staff, set their own employment policies and borrow to invest. Hospitals will be paid according to the treatments they deliver, rather than through centrally-allocated budgets. This means that they will be free to innovate and invest in new capacity free of government red tape. Hospitals which improve patient care and productivity will prosper. Small community hospitals which have the support of local patients and GPs will not be closed by bureaucrats. Monitor will regulate both public and private secondary care.

Restoring the family doctor service

• A Conservative Government will give GPs responsibility for commissioning care for their patients, because GPs are in a better position to know what is in their patients’ interests than the health bureaucracy. GPs will have the ability to manage budgets on behalf of their patients in order to develop services and promote effective community healthcare, avoiding unnecessary hospital admissions. We will cut the PCT bureaucracy which interferes in GP practices and requires ever-increasing data collection. And we will reform emergency care, so that out-of-hours services are properly integrated with ambulance services, hospital A+E departments, walk-in centres, minor injury units and NHS Direct, with a leading role for GPs in commissioning care to meet the needs of patients.
• Conservatives have launched a campaign to shield family doctors running small practices from being forced out of the NHS by Labour Government reforms.And an incoming Conservative government would provide special funding to ease pressure on small GP operators now facing the prospect of having to merge into the large "super surgeries" planned by Labour throughout Britain.

Better care for people living with chronic conditions

• There are seventeen and a half million people in the UK suffering from long-term and chronic diseases such as diabetes, asthma or multiple sclerosis. Currently, provision for chronic disease sufferers is fragmented and patchy. Assessment of need is highly complex and bureaucratic. Patients are not in charge, and complain of a lack of information, poor access to services and an inability to influence the health care they receive. GPs cannot necessarily get the services their patients need. Conservatives will put patients at the heart of the system by giving them the Right to Choose their care, and enforcing the standards they have a right to expect. Giving patients choice will ensure health services develop to meet health needs, drive up quality and lead to better outcomes for patients. We are determined to ensure that those living with chronic conditions get access to the best standards of care. A Conservative Government will instruct the National Institute for Clinical Excellence to develop standards of healthcare for chronic conditions. Examples will include trained respiratory nurses for those with asthma or chronic obstructive pulmonary disease; chiropody services for diabetes; continuing physiotherapy or speech therapy after a stroke; earlier access to diagnosis for MS patients; or bone density scans for those with osteoporosis. Long-term disease must not be pushed to the margins of NHS care. Our substantial investment in the NHS will enable us to expand services rapidly to meet the needs of patients with long-term conditions. Patients will be given full information and advice on their conditions so that, with their GPs, they can work out individual care plans. Commissioning will shift from Primary Care Trusts to GPs and, where appropriate, to direct payments so that patients can obtain their care from whichever provider is right for them.

Cancer care

• Cancer services are a top priority for the NHS and the public. Yet the UK continues to have cancer mortality rates well above other European countries. We are committed to develop NHS cancer services as good as any in Europe. We will implement a public awareness and information campaign to ensure that the public and GPs can access cancer screening and diagnostic services quickly when risks or symptoms of disease are identified. We will scrap targets which give some patients access to services, whilst others wait much longer, or lead to long waits for radiography or radiotherapy. Through national standards, we will ensure timely access to care. We will ensure that resources for cancer services get to where they are needed, and enable GPs and cancer networks to commission services more effectively. And we will support research through the NHS so that the generous public support for cancer research leads to new treatments and discoveries which can benefit patients as fast as possible.

More doctors and nurses

• There is an urgent need for more doctors, nurses and other professionals – including midwives, physiotherapists, radiographers and biomedical scientists – in the NHS. Threequarters of doctors plan to leave the NHS early. There are 25,000 nurse vacancies and record numbers are leaving the profession, forcing the NHS to rely on recruiting nurses from overseas, too many of them from countries which badly need better healthcare themselves. We are confident that by giving professionals more responsibility, the NHS will attract and retain doctors and nurses far more effectively. Nurses will play a greater role in the delivery of care, acquiring responsibility for prescribing drugs and becoming specialists in the management of certain conditions.
  School nursing and an expansion of community nursing will offer a broader range of career paths, as will policies in the NHS to encourage staff to continue their commitment to the NHS. This will make it unnecessary to recruit staff from countries which cannot spare trained health professionals.
• Conservatives will also expand the number of training places by inviting bids for additional medical places. We will support a career path for clinical academics and offer national scholarships to medical and dental students. For nurses and midwives, we will offer enhanced access to bursaries to support them through their training, reducing the high drop-out rate.

The health of the nation

• In contrast with the delivery of primary and secondary care, public health is a clear responsibility of central government. Conservatives will create a unified service to provide coherent and consistent public health messages that are based on the evidence. Parliament, not the Government, will appoint an independent Commission for Public Health which will undertake enquiries, commission research and recommend strategies to government and society to meet public health objectives.

Personal responsibility and effective health campaigns

• Governments need to promote the responsible behaviour which is necessary for a healthy life. In the past, major public health gains arose from environmental legislation – such as the Clean Air Acts – and new discoveries like vaccination. But today, given the nature of our public health threats, the health of the nation will only improve as people are persuaded to take responsibility for their lifestyle, diet and behaviour. As the Conservative Government showed in the 1980s and 1990s in the case of HIV/AIDS, campaigns can be effective in preventing the spread of an epidemic. We will launch a sexual health strategy which will ensure that young people are targeted with a clear message of the risks of early or unprotected sex. We will promote a campaign to empower young people to resist peer pressure to engage in irresponsible sex, drug abuse or binge drinking. School nurses will actively promote public health. We will also provide a tenfold increase in the number of residential rehabilitation places – enough to provide treatment for every young hard drug addict in the country. Conservatives believe that people are responsible for their health. We do not believe that food producers are to blame if people eat unhealthily, or that pubs are to blame if people drink or smoke. Therefore we will seek voluntary, not statutory solutions to public health problems.
  A Conservative Government will agree a code with the pub industry which will remove smoking from around 80 per cent of pub space. We will ensure the industry achieves a smoke-free environment wherever children are present, and protect staff who wish to work in a smoke-free environment. We will also increase opportunities for sport and exercise in schools and in the community. Every child will have the right to choose two hours of after-school sport with qualified coaches, through a nationwide ‘Club2School’ scheme funded from the National Lottery. A Conservative Government will also help schools retain and enhance their sports facilities, instead of having to sell them off. We will make sure that the £750 million that Labour have designated for spending on sports facilities – most of which is being held back – is actually spent.

Helping people with the costs of long-term care

• Currently 40,000 people every year are forced to sell their home in order to pay for residential care. Most elderly people have worked hard and paid taxes and National Insurance throughout their lives. Conservatives believe they are entitled to dignity and peace of mind in their retirement. A Conservative Government will create a Partnership Scheme so that people who pay for three years’ long-term care (either directly or through insurance) will be guaranteed free care for the rest of their lives. This policy will be available to all those who need care, regardless of their assets. The Royal Commission on Long-Term Care estimated that such a scheme would cut the costs of long-term care insurance by nearly a third. Wholly free care will still be available to those without the means to pay for the first three years. This will mean no one should be forced to sell their home to pay for long-term care.

More choice and flexibility in social care

• We will review Labour’s burdensome regulatory regime and scrap all those rules which do not enhance the quality of care. No care home should have to close because of unnecessary government red tape. We wish to see patients with serious illnesses – especially children and young people – receive more of their care at home. One way of doing this is by expanding respite care to make the task of looking after a relative easier. We will increase the range of choices on offer by giving families the Right to Choose their respite care, with greater flexibility to suit the needs of the family.

Mental health

• A Conservative Government will introduce a Mental Health Bill setting out the framework of standards for mental healthcare and giving patients, with their doctors and carers, the Right to Choose the treatment they need. Compulsory treatment should be used only as a last resort, when patients pose a serious risk to themselves or others. Already many NHS mental health services are provided in the independent sector. Our policies will increase the diversity of providers and bring prices down. We will also expand the number of psychiatric care places designed for adolescents.

Dentistry

• Our proposals are intended to bring NHS dentists back to the High Street and to make dental care affordable for all. We also wish to encourage preventative oral healthcare. Currently, dentists are paid a ‘fee for service’ for their adult patients, with over 300 prescribed treatments costed centrally. This has led to a ‘drill and fill’ approach at the expense of preventative care. Conservatives will introduce capitation payment for dentists to promote preventative treatment for adults (as already happens in the case of children). We will also introduce a low-cost monthly payment system so that patients not exempt from NHS charges can choose to be covered against large unplanned bills. Patients will of course be able to continue on a ‘pay-as-you-go’ basis if they wish.

• Immigration

The proposals on immigration are not intended to impact on health, but they are directly at least in part in reducing the number of non-European work permit holders. Many of those immigrants are admitted in order to work in health. If they cannot do so there may be renewed labour shortages, especially in nursing. If immigrant labour were restricted to the point wanted by some, the loss of income tax could mean an extra 1p in the pound from the rest of us.

• We will abolish Strategic Health Authorities and reduce the number of arms' length bodies which inspect and monitor NHS organisations.
• Give democratic control to local people, through making commissioning of health currently
  decided by Primary Care Trusts a function of the elected local authority which has responsibility
  for social services.
• Scrap the unelected Strategic Health Authorities, giving their health care commissioning role to
  local authorities, or consortia of local authorities where necessary.
• Free personal care for the elderly.
• Age discrimination legislation should go beyond employment and include the provision of goods and services by both the public and private sectors. This would mean that the NHS and
  Social Services providers would be under a duty not to discriminate unjustifiably on the basis of age.
• Boosting recruitment and improving retention of doctors, nurses and clinical staff.
• A wide preventative health agenda including free eye and dental checks for all and targeted health ‘MOTs’ that expand screening to catch diseases early.
• More cash to support staff for scanners
• we will offer diagnosis by the quickest practical route, public or private, so the NHS can treat you more quickly. We will do this by including diagnostics in the tariff system for paying for health services, so that if a mutual or private provider can deliver tests and scans at reasonable cost they will be available to NHS patients.
• We will make more tests and scans available in places like GPs. surgeries and pharmacies, and
  within new one-stop primary care centres.
• We will publish waiting times for tests and scans which the Labour government has failed to
  do. The Healthcare Commission will include these waiting times as part of the standards by
  which they inspect hospitals and they will publish this to inform patients.
• Integrating NHS and social care at local level with individual ‘Personal Care Plans’ for those with long-term illnesses.

Mental health

• The principle of reciprocity should be upheld so that where there is compulsion there must be an entitlement to appropriate care and independent appeal.
• Allowing patients to nominate a person to act on their behalf, and to have advance statements.
• A guarantee of access to trained advocacy.

Tackling the causes of ill health

• Universal Healthcare - Healthcare is an entitlement of every UK citizen. Ulster Unionists believe that only a Health Service free at the point of use and accessible to all can meet the needs of the 21st century. The current National Health Service is falling far short of the public's expectations. Ulster Unionists are determined to transform Northern Ireland's NHS into a first class service which puts patients first.
• Shorter Waiting Times: - We are working to rapidly shorten waiting lists and waiting times and deliver better services to those with chronic illness. Emergency Nurse Practitioners in Acute Hospitals offer the potential to shorten waiting times by prioritising acute cases and, where appropriate, dealing with less serious cases.
• Developing Local Hospitals: - We support the development of local hospitals to provide increasingly sophisticated methods of investigation, diagnosis and day procedures - expanding far beyond what is currently available in community hospitals. The quality of services provided at a Local Hospital should match the standard provided at Acute Hospitals.
• Acute Healthcare in Fermanagh & Tyrone: - Ulster Unionists believe that urgent consideration must be given to the exact location of an Acute Hospital to serve the Southwest of the Province.
• Care for the Elderly: - Ulster Unionists are fighting for the introduction of free personal care for the elderly.
• Partnership with our Neighbours: - Collaborative partnerships with neighbouring regions in the rest of the United Kingdom should be encouraged where this will benefit Northern Ireland.
• Integrated Healthcare Clinics: - Ulster Unionists will introduce Integrated Healthcare Clinics (Polyclinics) across every population centre in Northern Ireland.
• Concentration of Key Services: - Concentrating key acute services and expertise in a specified number of hospitals enables our society to provide world-class quality of care and treatment for patients with complex health conditions.
• Accessibility of Key Services: - Ulster Unionists recognise that while the quality of treatment and care for patients will be improved by greater concentration of acute hospitals, this must be balanced against the accessibility of these services to patients and their families. All large centres of population should have a local hospital nearby to meet the needs of the community.
• Reform of Healthcare Structures: - An effective management structure is fundamental to the delivery of first-class healthcare provision. We fully accept that there is a pressing need for reform within the existing management structures. At present the Health Services is administered by the Department of Health, Social Services & Public Safety, 4 Health & Social Services Boards, 19 Health Trusts, 5 Special Agencies, 4 Consumer Councils and now 15 new Local Health & Social Care Groups. These structures are over-burdensome for a population of 1.7 million. The roles of each of these organisations are often unclear, and this tends towards duplication and wastage of public money and resources.
• A new emphasis on Partnership & Accountability: - Ulster Unionists are determined to improve co-ordination and planning so that patients receive a seamless service between primary and community care, local hospitals and acute hospitals. We favour a more collaborative and community-based approach to healthcare management in order to ensure that the needs of service users are dealt with at as local a level as possible. We believe that the Health Service management structures must be answerable to the Northern Ireland Assembly for management decisions at all levels.
• Proposals for Reform: - In reforming the Health Service management structures, it will be necessary for the Department of Health, Social Services & Public Safety to take direct responsibility for central planning within the service, if management is to be held directly accountable to the Assembly. Ulster Unionists consider that reducing the number of Health & Social Services Boards from 4 to 3 is not sufficient to deal with the problems of top-heavy management. We consider that there should be one Regional Hospital Authority and one Regional Primary Care and Social Services Authority to replace the boards. These new bodies would take on responsibility for Workforce Planning, Commissioning of Services (in tandem with Local Health & Social Care Groups) and Overall Change Management.
• The Party envisages that the key administrative units should be a relatively small number of integrated Trusts, each with responsibility for acute hospitals, local hospitals and community care in a pre-defined geographical area - as is currently exemplified by the case of the Ulster Community & Hospital Trust. We consider that an appropriate model would be to establish 9 Trusts on the basis of the 9 Acute Hospitals to be developed. We also envisage that the four Health Councils should be amalgamated into a single statutory health & social services consumer body. Its purpose would be to foster closer links with the communities of Northern Ireland and monitor the work of the Regional Authorities and the proposed new Trusts.

Sinn Fein

Health for All sets out Sinn Fein's proposals for the creation of an all-Ireland equitable healthcare system. It deals with a number of broad areas:
Preventative healthcare;
Health promotion and education;
All-Ireland harmonisation;
Establishment of a new National Health Service;
Development of primary healthcare;
Childrens policy.

Traditionally the debate on health has focused solely on hospitals, doctors and nurses while ignoring the causes, which if addressed could alleviate major health problems in our society. However this policy document addresses the issues of poverty and it's associated problems as well as environmental issues of water, air quality, food safety, waste management and transport - all of which are increasingly impacting on our health and quality of life. We also address the need for a major review of primary healthcare, delivery of acute services and the inequalities which have been caused by the market led approach to health.

Sinn Fein is committed to:

• An all-Ireland health service which will harmonise and maximise the use of resources;
• A new National Health Service which embraces the key principles of openness, accountability and inclusiveness at all levels of planning and operation;
• Healthcare free at the point of delivery and funded through general taxation;
• An increase in healthcare funding to bring Ireland into line with the European average of 8% of Gross Domestic Product (GDP);
• The eradication of the social, cultural and economic inequalities (including poverty and disadvantage) which have a direct and detrimental bearing on public health;
• A comprehensive all-Ireland strategy to tackle poverty;
• Equality of access to quality health and social services ;
• A national public health plan for the provision and resourcing of acute care;
• Primacy of primary care over hospital care. All medical and social care services to be designed to give maximum continuity of care and accessibility to all regardless of geographical location;
• A ministry dedicated to children;
• A Food Safety Implementation Body, separate from the Department of Agriculture;
• Health proofing of all public policies;
• A community development approach to be adopted in terms of policy and strategy.

SDLP

• The SDLP believes the health service is grossly under-funded but that available resources must be more efficiently used.
• We want to see a primary-care led health service with GP fund-holding replaced by fully empowered primary health and social care groups, bringing together all primary care professionals and community representatives on a genuine partnership basis to address local needs on a “bottom-up” basis, rather than the “top-down” arrangements proposed by the Minister, with Groups as committees of the Boards.
• We want to see the number of Boards and Trusts reduced and savings reinvested in front-line health and social care to address staff shortages and waiting lists.
• We are campaigning for fair access to health services for the rural community including the retention of maternity services for low-risk patients in local hospitals and believe provision can be enhanced through the work of “CAWT”, the cross-border co-operative strategy.
• Additional priorities include the implementation of the Assembly Committee’s report on Children’s Residential Care and the implementation of the Royal Commission report on long-term care for the elderly.

This material is produced and published by the Socialist Health Association 22 Blair Road Manchester M16 8NS

October 25, 2005