In the run-up to the general election we are keeping track of the political debate around health and social care on our election tracker. The recent party conference season saw a flurry of pledges from the main parties, and we now have a much clearer idea of some of the commitments that will make up their manifestos. So where do the three main parties stand now that the conference season is over?
All the main parties made new pledges to increase NHS funding. The Lib Dems offered the clearest commitment – a real-terms increase of £1 billion in 2016/17 and 2017/18, with the possibility of higher increases after that. By indicating that they will press to re-open next year’s funding settlement, they are the only party so far to acknowledge the severity of the immediate financial pressures facing the NHS. They also ended the conference season on a distinctive note by promising to put mental health ‘on the front page of our manifesto’ and to ensure that at least half of their promised £1 billion in additional funding would be spent on mental health services.
The Conservatives promised a real-terms increase in funding over the course of the next parliament without being specific about how much above inflation this would be.
Labour’s funding proposals are less clear. It now appears that the party’s eye-catching commitment to establish a new £2.5 billion Time to Care Fund will not be implemented in full until 2017/18. As they have not yet announced their overall spending plans, it is not clear whether this would be on top of a real-terms increase in funding, although Shadow Chancellor Ed Balls has previously said he would be ‘staggered’ if Labour did not ring-fence the NHS budget.
All three main parties have also promised to improve access to general practice. The Conservatives’ headline pledge is for patients to be able to access a GP from 8am to 8pm, seven days a week, by 2020. This is backed by a commitment to train 5,000 more GPs. The Lib Dems are also committed to GP surgeries being open in the evenings and weekends and to encouraging practices to work together in federations. Labour’s offer is to guarantee patients a GP appointment within 48 hours.
There are clear dividing lines on competition. While Jeremy Hunt’s conference speech gently extolled the benefits of private sector involvement in the NHS, Labour used their conference to amplify their pledge to repeal the Health and Social Act. In practice, this means scrapping Part 3 of the Act, which relates to competition, and reducing the amount of income that foundation trusts can earn. Andy Burnham also reiterated his commitment to making the NHS the preferred provider of services and sketched out a possible new role for Monitor in promoting integrated care and overseeing the financial sustainability of local health economies. Meanwhile, the Lib Dems stated that NHS mergers will no longer come under the jurisdiction of the Competition and Markets Authority and that commissioners will not have to put all services out to tender.
All the parties talked the language of integrated care and were careful to say that they would not embark on another structural reorganisation of the NHS. Andy Burnham said that his vision for ‘whole person care’ would be at the heart of Labour’s manifesto, although some of the detail about how it will work remains unclear. Indicating that a single commissioning body would be established ‘led by local government’, he also announced that hospitals will be asked to evolve into ‘integrated care organisations’ responsible for co-ordinating the provision of health and social care services.
Jeremy Hunt also called for health and social care to be integrated in his conference speech, but gave no specifics about this other than a strong endorsement of the Better Care Fund as the vehicle for achieving it. In his conference speech, Norman Lamb went much further, stating that he would like to see all health and social care funding pooled by 2018, although this does not yet appear to be official party policy. Both Labour and the Lib Dems indicated that they would strengthen the role of health and wellbeing boards, holding out the possibility that they could commission GP services. The Lib Dems also outlined plans to extend the thinking behind integrated care to other public services, by establishing Better Outcomes Boards to jointly commission a range of local services.