If there's a sense of déjà vu about the health section of the Conservative manifesto, it's because it pretty much mirrors the draft version published in January.
It still contains the ideas unique to the party: an independent NHS board, a Department of Public Health and Healthwatch (an organisation to represent the public and patients at national level). It also reiterates the promise to scrap targets in favour of outcome measures. However there's still no clarity about which targets will go, although a caveat has been added: the targets that will be dispensed with will be those with 'no clinical justification', a hint, perhaps, that the rapid access targets for cancer might stay.
Yet, despite clear differences on some issues, there are others where the ideas in the Conservative manifesto are difficult to distinguish from Labour: more foundation trusts, more patient choice, more performance information to make choices, a 'payment by results' system, another phone number alongside 999 and more access to talking therapies. Other ideas suggest an evolution of current policy, for example the plan to give GPs more power over their budgets is an extension of practice-based commissioning. Some ideas would be supported by all parties – more support for carers or better palliative care, especially for children, for example.
Unlike Labour, the Conservatives talk about the action they would take to reduce health inequalities, including a 'health premium' targeted at the 'poorest areas with the worst health outcomes' and funding for public health to be channelled to 'local communities'. But the earlier promise to ring fence public health spending has gone, so it is not clear whether these promises will actually result in any additional money being spent on public health. There are also proposals for improving access to dentistry, another topic absent from Labour's manifesto.
The two new additions to the manifesto reflect the political debates that have erupted since January: a repudiation of the so-called 'death tax' for funding social care (which has been dropped by Labour, for now anyway) and a pledge to create a 'Cancer Drug Fund' from money 'saved by the NHS through our pledge to stop Labour's jobs tax', ie, national insurance. The media have recently highlighted several cases of cancer patients struggling to pay privately for drugs not approved by NICE, where the local health authority has decided not to fund them. Regardless of where the money comes from to pay for this – notional savings or an actual increase in the NHS budget – it is not clear what this proposal would mean for the status of NICE, which was set up to grapple with such decisions using clinical and economic evidence, while taking into account the interests of all current and potential NHS patients.
The health section has some echoes of the Conservative's overall political approach, to empower citizens to take control of their own lives and, in some cases, more control of public services. There is no suggestion of citizen control of health services, (that has traditionally been Liberal Democrat territory), but there is an emphasis on more local autonomy for staff and decentralising power to patients. Even so, there are also glimpses of quite an active state in Conservative plans, not least with the manifesto commitment to stop 'the forced closure of A&E and maternity wards'. Even if the Conservatives do manage to fund real increases in NHS spending, it is likely that financial pressure, changes in demand and technological developments will mean that local services will have to change. Will this be a manifesto commitment the Conservatives come to regret?