New NHS policy documents from the Government and the Opposition indicate the ground on which the 2010 election battle over this crucial domestic issue will be fought.
Both Labour and Conservative parties emphasise the importance of preventative and community healthcare in meeting the financial and clinical challenges of the coming years, in which healthcare needs are predicted to increase while the NHS budget will be subject to severe constraints.
However, Labour’s policy document gives more weight to the provision of specific services that can achieve this goal, whereas the Conservative policy document gives more weight to decentralisation and an increased role for private health providers.
Labour promises a leaner NHS
NHS strategy from the Department of Health places emphasis on improving quality and productivity through ongoing service reforms.
According to NHS 2010-2015: from good to great. Preventative, people-centred, productive, published in December, the key priorities for managing the impending NHS budget cutbacks are protecting patients, supporting clinical staff, shifting resources to the frontline and cutting back bureaucracy.
The measures outlined include:
• A new payment system that links hospital income to patient satisfaction, rising to 10% of payments over time.
• Dedicated one-to-one carers for patients with cancer or serious long-term conditions.
• Plans to offer frontline staff an employment guarantee in return for flexibility, mobility and pay restraint.
• More freedom for successful hospitals to expand their services into the community, including GP centres.
• Personal care plans and health budgets, enabling patients to choose how and where they will be treated.
• A legal right to an 18-week waiting time for treatment after GP referral (two weeks for cancer patients).
• A legal right for everyone aged 40-74 to an NHS Health Check every five years to assess their risk of heart disease, stroke, diabetes and kidney disease.
Health Secretary Andy Burnham said: “For the NHS to become truly great, it must become more preventative and people-centred. This means top quality care is our goal and patient safety our top priority. Quality care is not always about spending more money, but about spending it in the right places. Moving care from hospitals into homes and communities is better for patients and more efficient.”
Burnham also stated that “where there is underperformance and the NHS is an incumbent provider, we will give the NHS the first opportunity to improve to the level of the best” – but that this did not mean “freezing out the independent sector”. The strategy underlines the importance of partnership between the NHS and the private sector.
Tories promise a decentralised NHS
The Conservative Party has pledged to scrap NHS process targets, open up the NHS further to independent sector providers, and enable patients to choose their own providers at all levels of healthcare.
The Conservative ‘Reform Plan for the NHS’, the first chapter of its Draft Manifesto 2010, places emphasis on decentralisation. It consolidates a number of policy statements made in late 2009 – and echoes a number of Labour commitments, including the conversion of all hospital trusts to Foundation Trusts. The document’s assertion “We can’t go on with an NHS that puts targets before patients” was a key theme of Lord Darzi’s Next Stage Review.
The key statement for the medtech industry is: “To give patients even more choice, we will open up the NHS to include new independent and voluntary sector providers – if they can deliver a service that patients want, to a high standard and within the NHS tariff, then they should be allowed to do so. To make sure all providers have the right incentives to succeed, we will implement a ‘payment by results’ system throughout the NHS.”
While this commitment challenges the recent claim by Health Secretary Andy Burham that the Government will view the NHS as the “preferred provider” of healthcare, the approach is closely allied to the current Labour policy of keeping ISTCs within the NHS tariff system and avoiding advance payments for work not carried out.
The Conservatives’ plans for public health reflect their commitment to decentralisation. They intend “to provide separate public health funding to local authorities, which will be accountable for – and paid according to – how successful they are in improving their local communities’ health.”
In addition, they intend to “give patients with chronic illnesses or a long-term condition access to a single budget that combines their health and social care funding which they can tailor to their own needs”. This is, in fact, a programme being piloted by the current Government.
The Conservatives say little about how they will deal with the impact of the anticipated funding restrictions, except that they will make the NHS more “efficient”. In this, again, the ‘Reform Plan’ echoes the Government’s strategy document.
The stated commitments of the two leading parties regarding the NHS are strikingly similar. The differences are more in emphasis and rhetorical impact than in actual policy. However, they may point to greater differences that will emerge in the detailed policy-making of the government following the 2010 General Election.