The Lib Dem manifesto: the end of the PCT?

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The final piece of the NHS election jigsaw is now in place with the publication of the Liberal Democrats' manifesto. It contains a mixture of proposals which are vague, radical and specific. It also contains a lot of overlap with the other parties, which is not surprising given the political consensus over the NHS. So targets will be reduced, bureaucracy will be cut, and there will be better access to GPs and out-of-hours care, in common with Labour and the Conservatives.

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.


Jonathan Graham

Comment date
15 April 2010
We have had different healthcare systems develop in Scotland, England, Wales and Northern Ireland. Is it not time to analyse how these are performing and decide what is the best way forward? I am interested in the healthboard model as i think it would better support local need but i would like to see some detailed analysis of it's strengths and weaknesses before it is adopted more widely

Dr Paul Worthington

Comment date
22 April 2010
It's important to recognise that there are significantly varying systems of healthcare in place and evolving across the UK; any statements from the party leaders on health need to be seen in that contet. The evaluation of different models has real value. However, there's not really a single Health Board model. There are differences between the Scottish and Irish approach, and Wales has only just been through a re-organisation, moving from 22 Local health Boards to 7 Health Boards.

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