One of the central issues for voters as they cast their ballot in the 2015 UK general election will be the future of the NHS. All the parties have made their pitch, each party setting out their position by juxtaposing it with the plans of their rivals. The trouble is, upon closer inspection, all of the parties are making very similar promises (Triggle, 2015).
The choice between very similar sounding options on 7th May is the product of the development of the NHS over decades. The NHS was established by the Atlee's Labour government in 1948 to be free at point of use and funded by taxation. Based on the report of the liberal William Beveridge, it represented the next step in the reform and modernisation of social welfare begun by the Liberal Party just after the turn of the century.
The free at the point of use principal was soon put to the test. With funding the service proving expensive, it was not long before charges were introduced - beginning with prescription charges. Over the years more costs have been gradually pushed away from the public purse - road accident charges to car insurers, and dental care charges, eye care charges, hospital car parking charges all to the service user.
Toward the end of her time as Prime Minister, Margaret Thatcher introduced a new 'internal market' system, where the state would not directly provide the healthcare. Instead it would procure it, on behalf of the service user, from independent hospital trusts that would have to compete to provide the service (Laurance, 2013).
Those changes initiated a direction of travel arguably continued in the Labour Party's embracing of Private Financial Initiatives (PFIs) under Blair and Brown. The benefits of the system to which Labour clung were that it opened up a short term source of funding to get hospitals built (BBC, 2002). But in the long term it has led to a huge build up of debt for hospital trusts, while allowing the private companies to profit massively (Cooper, 2014).
As for the Lib Dems, there has long been a broad party consensus on finding ways to increase choice and to ensure oversight and to devolve power (Brack et al, 2007). That made the Health and Social Care Act 2012 a complicated matter, with strong campaigning opposition to elements of the reform from within the party led by the likes of Dr Evan Harris (Harris, 2012).
Yet even with these ways of extending the means of funding the NHS and trying to find increase in service 'efficiency', the NHS is still falling short and there are fears that it will affect services (Campbell, 2015). There is little belief that Andrew Lansley's reforms have helped to ease the pressures. NHS chief executive Simon Stevens has said that the institution needs an extra £8bn a year to meet an expected £30bn shortfall by 2020 (Baker et al, 2015).
In response, all of the main parties of offered more funding, each with their own priority (Wright & Moodley, 2015).
Labour's primary position has been to distance itself from, first, the coalition's policies, and then, second, from those of New Labour. This means promising to repeal the Health and Social Care Act 2012 and introducing a cap of private profits from NHS contracts (Wintour, 2015). With NHS funding a major issue, Labour have also promised an increase of £2bn by 2016, and a £2.5bn fund for recruiting more nurses, GPs and midwives.
The Conservatives have promised to ringfence healthcare spending to protect it from cuts and to increase the budget by £2bn each year of the next parliament. However, that increase in funding is tempered by Cameron's announcement that his party would also be extending NHS services to full 24 hour coverage (Channel 4, 2015). They also later announced - to criticism of making unfunded pledges - that they would match the £8bn increase called for by the NHS (BBC, 2015).
By contrast to the other two main parties, the Liberal Democrats were initially the only party to pledge to increase NHS funding each year through to 2020 to ensure it will be, in real terms (adjusting for inflation), £8bn more than today - the amount that the NHS has stated is needed. Their main priority will the treatment of mental health, which they would put on parity with physical health and for which they would provide more funding (Perraudin, 2015).
UKIP have once again shown their chameleon-like skill at identifying the most popular mainstream policy and jumping on board - being sure to propose funding the NHS through their usual obsessions (Mason, 2015). However the personal views on the NHS of their leader Nigel Farage have been criticised by Dr John Lamport of the National Health Action Party (Lamport, 2015). He criticised Farage's praise for the Dutch and French style insurance-based system as an expensive doorway to privatisation.
However, despite their differing priorities, the similarities between the main parties and the general direction of travel towards privatisation has, for many, been a long term concern (BBC, 2003). Senior health professionals have criticised the coalition (Boseley, 2015), and others have called for whoever forms the next government to provide the funding that the NHS needs (Baker et al, 2015). These calls come with fears amongst medical professionals that after the election, charges may be introduced for basic NHS services (Campbell, 2015{2}).
Smaller third parties have taken up the fight against this perceived drift into privatisation. The National Health Action Party
(NHA) represents a broadly Left-wing vision of rolling back
privatisation. The NHA supports 1p rise in tax to pay for an increase of
funding of £4.5m a year, phasing out prescription charges and repealing the Health and Social Care Act 2012 (BBC, 2015{2}).
However, regardless of who wins the next election, the closeness of the main parties' policies makes it likely that there will be some sort of cross-party commission to figure out the future of the NHS (Triggle, 2015). That commission will have to face the same questions that the public will at this election: do we want lower taxes or well funded public services? Because trying to have both means stretching those services ever more thinly (Toynbee, 2015).
When considering that question it's worth noting that the UK has comprehensive healthcare for which it spends far less, as a share of GDP, than most other comparable countries (Campbell & Watt, 2014). The NHS also remains an overwhelming popularly supported service (NatCen, 2015). In order to keep that service functioning, we need to understand the choices on offer about its future and to ask ourselves: when the future of the NHS is being debated, what values do we want to be represented and to underwrite its future?
References
Nick Triggle's 'Spot the difference'; on the BBC; 23 April 2015
Jeremy Laurance's 'Margaret Thatcher's impact on the NHS'; in The Independent; 8 April 2013.
'Blair woos unions over PFI'; on the BBC; 27 September 2002.
Richard Alleyne's 'Blair defends PFI as NHS trusts face bankruptcy'; in The Telegraph; 26 June 2012.
Benedict Cooper's 'To save the NHS, Labour must face the ugly truth of PFI debts'; in the New Statesman; 10 July 2014.
Duncan Brack, Richard S Grayson & David Howarth's (eds.) 'Reinventing the State: Social Liberalism in the 21st Century'; Politico's; 2007.[Buy Now
]Evan Harris' 'For the NHS's sake, we Lib Dems must ditch the health and social care bill'; in The Guardian; 6 March 2012.
Denis Campbell's 'Patient care will deteriorate as NHS heads for £2bn deficit, says thinktank'; in The Guardian; 26 March 2015.
Dr Maureen Baker, Professor Jane Dacre, Dr David Richmond, Dr Jean-Pierre van Besouw, Dr Hilary Cass, Professor Sir Simon Wessely & Dr Clifford Mann's 'The NHS needs an extra £8bn a year to survive and meet its challenges'; in The Guardian; 15 March 2015 .
Oliver Wright & Kiran Moodley's 'General Election 2015: Everything you need to know about the NHS'; in The Independent; 20 February 2015.
Patrick Wintour's 'Ed Miliband vows Labour would cap profits of private health companies'; in The Guardian; 27 March 2015.
'David Cameron pledges NHS available 24/7'; on Channel 4; 28 March 2015.
'Election 2015: Tories 'confident' about £8bn NHS pledge'; on the BBC; 11 April 2015.
Frances Perraudin's 'Lib Dems pledge £2bn extra funding for mental health'; in The Guardian; 31 March 2015.
Rowena Mason's 'Nigel Farage promises £18bn of tax cuts as he launches Ukip manifesto'; in The Guardian; 15 April 2015.
Dr John Lamport's 'Is Nigel Farage talking bollocks about the NHS?'; on OpenDemocracy; 23 March 2015.
'NHS competition 'costs lives''; on the BBC; 29 January 2003.
'Election 2015: NHA Party 'serious about fixing the NHS''; on the BBC; 23 April 2015{2}.
Sarah Boseley's 'More than 140 top doctors attack government record on NHS'; in The Guardian; 7 April 2015.
Denis Campbell's 'Basic NHS services could be charged for after general election, BMA chief says'; in The Guardian; 3 April 2015{2}.
Polly Toynbee's 'The NHS needs serious money, but our politicians are refusing to face it'; in The Guardian; 26 March 2015.
Denis Campbell & Nicholas Watt's 'NHS comes top in healthcare survey'; in The Guardian; 17 July 2014.
'BSA survey reveals overwhelming support for the NHS but the public don’t mind who provides care'; from NatCen; 25 February 2015.
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