The King's Fund health manifesto - The real agenda for the next government

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Combating the rising tide of preventable ill health, ensuring some stability in the more market driven NHS, ensuring patient choice enhances and does not jeopardise equity, and kick-starting an open debate on the future of NHS spending - these should all take centre stage in the next government's health agenda.

That was the call from The King's Fund today as the health charity outlined key health priorities for the next government at a debate on the future of the NHS. Politicians from the three main political parties delivered their manifesto plans for the NHS to a 150-strong audience of practitioners, policy makers, front-line health professionals, NHS leaders and the media.

The King's Fund believes the next government faces six major health challenges, regardless of who wins the General Election. These are:

The new NHS market: the next government must address potential problems associated with the introduction of stronger market incentives to the NHS. New reforms such as 'payment by results' and patient choice, while welcome, will create a less stable health economy which could destabilise services. Urgent work is required to set out plans to oversee the new market; for example, having clear policies on how financial failures of hospitals should be managed, while protecting vital local services. Action is also needed to ensure patients have access to a comprehensive range of services and that all patients - particularly the most disadvantaged - are able to make choices.

Future NHS spending: the next government will need to kick-start an open debate on the future of NHS spending as the huge increases over the last five years are unlikely to be sustained beyond 2007/8. Ministers will need to decide the ideal level of growth for health care spending and what the impact on the rest of the economy will be of health care taking a growing slice of the nation's wealth. On top of this, a parallel debate will be needed on the long term demand for and supply of social care for older people, and how this might be funded. Sir Derek Wanless, who has been commissioned by The King's Fund to look into this issue, will map out the likely costs over the next twenty years.

Ending waiting times: all political parties have set ambitious targets to reduce waiting times for operations. If these are to be achieved, the next government needs to invest heavily in diagnostic staff and equipment, more doctors, nurses and allied health professionals and make greater use of the independent sector.

New focus on 'forgotten' areas: mental health, the care of older people and improving care for the 17 million people in the UK with long-term conditions have traditionally been neglected - although The King's Fund welcomes the improvements that have been made. The next government must focus more heavily on helping people manage their conditions more effectively in the community so they do not need expensive and disruptive hospital treatment.

Commissioning: The King's Fund strongly supports moves to devolve power to the NHS front line by handing family doctors their own budgets to commission services. This should help to increase the influence of front-line clinical staff and make the NHS more responsive to the needs of patients. But while devolution may well be a good thing, unfettered devolution could be a disaster as there are dangers with moving from a highly managed system to a barely regulated market. Careful thought will need to be given to how the market will be regulated, while the right relationships between primary care trusts (PCTs) and GP practices are crucial to ensuring family doctors enjoy appropriate freedom while still receiving strategic direction from PCTs.

Public health: any new government coming to power will face a significant public health challenge with the rising tide of obesity, diabetes and sexually transmitted infections, as well as increased problems of drug and alcohol abuse. To meet these challenges Ministers should commit to a full ban on smoking in all enclosed public places, be prepared to look again at the decision to extend alcohol licensing hours and have the courage to ban junk food advertising to children. Ministers should take a stronger stand on ways to use regulation, especially if industry fails to take voluntary action on issues such as food labelling.

The King's Fund chief executive Niall Dickson said:

'The stakes are high in the health service. The last eight years have seen unprecedented levels of funding, big reductions in waiting times, progress in tackling the big killer diseases of cancer and heart disease, as well as more clinical staff. But more needs to be done. MRSA rates compare badly with other countries; there are still staff shortages and major pressures in mental health; patients are spending too long on so-called hidden waiting lists, such as those for diagnostic tests prior to treatment; and the NHS faces a huge challenge in combating the rising tide of preventable ill health.

'These are the major challenges for the next government. All the main political parties agree that greater choice and devolving power to the front line is the way forward. In truth, there is less difference between the parties on health than they would have us believe. However, the time is right now to debate the real issues that will affect patients now and in the future'

Notes to editors

1. For further information or interviews, please contact The King's Fund media and public relations office on 020 7307 2585, or 07831 554927. An ISDN line is available for interviews on 020 7637 0185.

2. The King's Fund debate on the future of the NHS featured Health Minister John Hutton MP, Shadow Health Secretary Andrew Lansley MP and Liberal Democrat health spokesperson Paul Burstow MP. The debate took place at the King' Fund, 11-13 Cavendish Square, London, W1G 0AN. The politicians then faced questions from the specially selected audience of patients, practitioners, policy makers, front-line staff and the media. King's Fund chief executive Niall Dickson chaired the event.

3. The King's Fund recently published An independent audit of the National Health Service under Labour (1997- 2005) on Sunday, 20 March. It found the Government has made huge strides in reforming the health service since coming to power in 1997, but warned there are still important problems to be solved and that as yet there is no firm evidence to show the reforms have produced a marked improvement in the nation's health.

4. The King's Fund is also in the process of producing a number of election briefings that draw on the independent expertise of its policy and research staff to provide concise overviews of today's hot topics in health and social care. Briefings on patient choice and mental health have already been completed, and further ones are being produced in the following policy areas: care and care services; health care and the private sector; health inequalities and diversity; hospital cleanliness; international health care comparisons; managing long-term conditions; NHS foundation hospitals; NHS funding and the effect of market forces; NHS performance and regulation; NHS workforce; patient and public involvement; primary care; the private finance initiative; and public health.

6. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.