There is no specific commitment on overall NHS spending in the manifesto (the Liberal Democrats have previously said they will match Labour's spending commitments), and while they pledge to increase spending 'in some parts of the NHS' they do not say which parts. Savings are identified in the manifesto: the Department of Health will be reduced by a half, strategic health authorities scrapped, some quangos will be cut and no NHS manager will be paid more than the prime minister.
There is also a commitment to 'integrate health and social care', but there are no details about how this will happen. On social care funding, the Liberal Democrats had previously shown a preference for a partnership model – where the state and the individual both contribute to the costs of long-term care – but in the manifesto the party has retreated from any policy details, promising instead to 'immediately' establish an independent commission to develop future proposals for long-term care.
On public health, the Liberal Democrats favour a ban on below-cost selling of alcohol and support 'the principle of minimum pricing', but say it needs 'detailed work' on how it could be used to reduce irresponsible drinking. Health inequalities, absent from Labour's manifesto, are to be reduced by giving extra payments to GPs whose patients come from deprived areas.
The Liberal Democrat's most radical proposal, which is not new to the manifesto, is the commitment to set up locally elected health boards in place of primary care trusts. The party has long argued that the current accountability arrangements result in a democratic deficit, where the only direct form of citizen involvement takes place for hospitals (via foundation trust governors), but not for the local health bodies that allocate the bulk of the NHS budget, namely PCTs. The manifesto also commits the party to pursuing the next logical step in the future: to allow some NHS funding to come from locally raised taxes 'to fund local NHS services that need extra money'. Both elections and local taxation represent a major departure from the 1948 settlement and raise intriguing questions about how people would respond to the opportunity to vote on their local NHS services, and what sort of variations would result if NHS services were more closely linked to local citizens' preferences and taxation revenue.
There are some very specific pledges: to prioritise dementia within the health service's research and development budget (although it is not clear whether this would mean ahead of cancer or other diseases), and a promise to set up a working group to determine 'appropriate levels of financial assistance' for those suffering as a result of HIV-contaminated blood products.
Overall, the manifesto speaks the same language of choice and local control as the other parties. The elected health boards offer a tangible – if controversial – mechanism to deliver this, but it is not clear whether this will generate much enthusiasm with the electorate.