Difficult choices on health as the election campaigns kick off

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You could be forgiven for thinking it started months ago, but today the general election campaign began in earnest. Polling data presented by MORI at a recent event held at The King's Fund suggests that health care will be one of the key issues voters will use to decide how to vote. Recent debates also suggest that social care will feature in the campaign.

All the main parties are committed to an NHS based on need not ability to pay, and to protecting frontline services despite the current financial squeeze. While there is little to separate them on principles, they do have different ideas about how the NHS should be managed.

During the election campaign, The King's Fund aims to be a useful source of independent comment and analysis on the main parties' health policies and to contribute to an informed debate on the key issues facing the health and social care system.

Whichever party forms the next government, it is clear that they will have to support the NHS in maintaining high-quality services through tougher financial times. The King's Fund's analysis on NHS efficiency and finances shows that, by 2013/14, current spending plans will leave a £21 billion gap between the most reliable estimates of NHS future funding needs and the money likely to be available to it.

As the population ages, more people will be living longer with conditions such as diabetes, heart disease and dementia. Providing effective, efficient and high-quality care to this group will demand a fundamental shift in how care is delivered, moving care closer to where people live, including in their home. This may require difficult choices for politicians confronted with a general public who appear to identify the NHS with beds and buildings.

And although successive governments have understood the importance of preventing illness, we still face significant and growing public health challenges that must be addressed. Alcohol abuse and obesity are complex problems to solve, and will need action from central government as well as from the NHS and local government. Public health has been a soft target for spending cuts in the past. In a challenging economic climate, incoming ministers will need to hold their nerve and resist the temptation to sacrifice long-term gains in favour of policies that deliver short-term political dividends.