The election campaign has kicked off, and with many voters still undecided about their intentions on 6 May, there is everything for the main political parties to play for. This is shaping up to be one of the most unpredictable elections for many years, so how much of a battleground is health likely to be?
Voters say that health is the second most important issue in deciding which party to vote for. In the third and last of The King's Fund election debates the Secretary of State for Health, Andy Burnham, set out Labour's stall. Under the banner of an NHS that needs to be 'people-centred, preventative and productive', Burnham was not short of commitments, promising cancer test results within a week, rights to choose any GP, for mothers to give birth in a place of their choice and for people to die at home, a national care service that brings together the NHS and social care and much more care delivered outside hospital.
The response from the audience, some of them from local NHS organisations, was a sense of disconnect between the parties' pitch to the voters and what they are seeing on the ground, where tough choices are being discussed and implemented in anticipation of the dramatic slowdown in funding growth beyond 2011. As one person put it, there is a 'conspiracy of good news' from politicians unwilling to discuss how they will drive through the efficiencies they talk about. There are other blind spots too: a reluctance to discuss hospital closures and staff losses, for example.
But this is not just the politicians' fault. The problem here, according to MORI's research, is that the public have not yet grasped the magnitude of the funding crisis, while at the same time they believe more strongly than ever that the NHS must meet their needs. For example, a third of people believe that all drugs should be funded regardless of cost, while another 40 per cent think that the most effective drugs should be funded regardless of cost. These views are not immutable: many NHS trusts have found that when members of the public are presented with real dilemmas about competing health priorities a more mature debate is possible.
However election campaigns are generally not known for their dispassionate and reasoned debates and it is unlikely that there will be much detail from the parties about how they will deliver an NHS that has to do more for the same amount of money. The electorate could be in for a shock as events unfold from 7 May onwards.