Policy Comparison 7 - Health & the NHS

OK, so this is another devolved area, so the issues are not necessarily directly going to affect me, except if the Westminster government decided to cut spending on the NHS it would mean a proportional budget cut to the Scottish government. As I've already blogged about, it would be interesting in those circumstances to see what an SNP government would do in response. At the moment we have free care for the elderly in Scotland, whilst that remains a big issue in this election south of the border.

I remain sceptical of promises from all parties to protect spending on health. Similarly I remain sceptical of claims to save huge amounts of money by cutting red tape and bureaucracy. This is easy election language, but if it was that easy it would already have been done. Yes, there is bureaucracy in the NHS which could be streamlined, but it costs money to re-structure and analyse where cuts can be made and often where cuts are made, even if they are not in frontline services, they have a knock-on effect. So I wouldn't pay too much head to extravagant claims about cutting bureaucracy.

Another issue I's like to comment on is decentralisation. As with crime, I remain entirely unconvinced about the idea of directly elected local health authorities. I think it would produce voter fatigue, turn managers into politicians, encourage even more short-termism. In addition, I'm not sure that regional variation is a very good thing in health terms - it does me no good to live an area which is excellent at treating cancer if i've got to go 300 miles to get good treatment for what's actually wrong with me. I want the standards across the board to be raised and think that decentralisation is a way of masking the fact that the politicians really don't know how to do this.

So what are they actually saying:

Conservatives

• We will never change the idea at the heart of our NHS "that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay".
• We are committed to protecting health spending in real terms.
• Our reform plan is based on the methods of the post-bureaucratic age - decentralisation, accountability and transparency.
• Instead of bureaucratic accountability there will be democratic accountability.
• We will decentralise power, so that patients have a real choice.
• We will publish information about the kind of results that healthcare providers are achieving, we will make sure there is no hiding place for failure. If patients don't like what they are offered, they will be able to find something better.
• Making doctors and nurses accountable to patients, not to endless layers of bureaucracy, will also save billions that are currently spent on needless bureaucratic checks "meaning we can spend more on the frontline services that make a real difference".
• When patients not only have the power to choose where they get treated but also the information to make an informed choice, then hospitals and GPs that don't provide good care will have to raise their game. Doctors and nurses will need to use their new-found freedom to meet the needs of the most important people in the NHS - patients.

Here we have all the cutting bureaucracy and decentralisation talk that I've already dealt with above. I also think that there's something quite offensive in the suggestion that choice will improve things as it will make doctors and hospitals raise their game - this implies that the problems at the moment are because front-line staff aren't trying hard enough? No, problems are much deeper rooted than that and will take more than that to fix it. I think their noble commitment to the NHS and protecting spending will be undermined by an erroneous philosophy of choice - they are offering people the wrong choices here.


Greens

• This Party's approach involves increasing the level of awareness of when to seek health care and when to allow things to get better naturally. It is also important to protect those suffering mental health problems from discrimination wherever it may occur.
• A key policy is to reverse the sale of NHS services and hospitals to private companies, for example we are going to bring cleaners back into the NHS team.
• We will start by promoting cycling and walking to school, which will reduce pollution and help to combat childhood asthma.
• Ensuring schools provide healthy meals will reduce the levels of obesity in children.
• We will introduce a NHS tax to make the level of funding for the NHS transparent for all. There will be the ability to increase taxation locally, if people decide, so that local NHS services can benefit directly, just as the police and schools can at present.
• We will reduce the level of spending on defence to provide further funds for health care. These changes in funding will allow us to abolish prescription charges.
• Our focus on increasing community based services and community health centres will keep care as local as possible.

I like the focus on prevention and promoting healthy lifestyles. I like the reversal of involving private companies. The local tax and community health centres seem a better way of giving local people more say and involvement. Abolishing prescription charges would be a good thing, but not a priority for me. Overall, I feel what's here is good, but there's a lack of detail on improving health services like hospitals, etc...


Lib-Dems

• We will give local people democratic control over their local health services. This would give local people the opportunity to save hospital services currently under threat.
• We will abolish strategic health authorities, which are remote and unaccountable.
• We will reduce the plethora of contradictory NHS targets and guarantee high standards in health care to each citizen.
• We will introduce a 'patient contract', which will specify the services and treatment an individual can expect to receive from the NHS and highlight the patient's rights to information about treatment and medical records.
• We will give patients greater autonomy over how they manage their condition in specific areas within the NHS.
• We will give individuals with long-term conditions an agreed Personal Care Plan.
• We will make a 'universal care payment' based on an individual's need, not their ability to pay, for those aged over 65 who require personal care.
• A Dutch approach would be used in the event of a super bug outbreak. Patients would be isolated, staff sent home and medical wards closed down.

On the positive side - I think the choice being offered here is a better one - autonomy over managing their condition where they are being treated, rather than having to choose between competing treatment centres. The Personal Care Plan also seems like a good idea to me, as does the universal care payment, if they can afford it. That said we're back to this local democracy of health care, which in effect would out different areas in competition with each other for a limited pot of money - if one hospital doesn't close money will have to be saved elsewhere. To me, what we'd end up with is a very uneven and inequitable system.


Labour

• We will introduce a new guarantee of diagnostic tests for cancer, with results, within one week of GP referral.
• We will introduce free one-to-one home care by specialist nurses for every cancer patient in England, as well as giving more patients the option of receiving treatment at home instead of having to go to hospital.
• We will introduce a new right to free health checks for everyone aged between 40 and 74, to prevent at least 9,500 heart attacks and strokes every year and save 2,000 lives.
• We will work to eliminate mixed sex accommodation in hospitals, with a £100 million ring-fenced Privacy and Dignity Fund to help Trusts make swift adjustments to hospital accommodation.
• The Family Nurse Partnership Programme, which provides intensive support from highly trained nurses for the most vulnerable first-time mothers, will be expanded from 30 to 70 sites by 2011, with a view to rolling out across England over the next decade.
• To help tackle child obesity, every 11 to 14-year-old will be given hands-on cooking lessons, making cheap, healthy dishes from fresh ingredients.

My main issues here are where is the money coming from and why haven't they done it already. There's a lot of positive ideas here, especially like the Family NUrse Programme idea. I think they do need to recognise that Obesity is down to more than just diet, some lifestyle measures would need to be considered as well.

UKIP

• This Party will safeguard NHS spending at current levels whilst rooting out waste and inefficiency.
• This Party will create elected county health boards to replace strategic health authorities and primary care trusts.
• County health boards to franchise out the running of health services to private companies, charities, non-profits and co-operatives. They will be on fixed budgets, ensuring the free-at-the-point-of-delivery principle of the NHS but to ensure efficiency savings through innovation.
• Franchisees will ensure Matrons uphold excellent cleanliness in hospitals.
• County health boards will be able to withdraw franchises from sub-par franchisees.
• Controlling immigration will prevent health tourism and ease the burdens on the NHS.
• This Party will also allow individuals to opt out of the NHS by providing healthcare vouchers.
• This Party will restore free eye tests and dental checks for all UK citizens.

Trying to be positive, free eye-tests (which we have in Scotland) and especially dental checks would be good. Other than that, there's the BS rhetoric of cutting bureaucracy, greater privatisation and decentralisation and a rather quaint fixation with Matron (sorry, can't help thinking Kenneth Williams "Oooh Matron!"). No, No, No. Immigration probablt brings more staff into the NHS from Doctors to lowly paid care-workers, than health tourists, so NO again.


BNP

• Replace 100,000 NHS bureaucrats with doctors, nurses and dentists.
• Invest sufficient money in the NHS to provide a decent service to the British people.
• Bring hospital cleaning back in-house and make high cleanliness a top priority.
• End the scandal of foreign health tourism.
• Train and pay to retain British doctors, nurses and dentists instead of looting the Third World of staff who are desperately needed in their home countries.
• Revitalise the healthcare system by boosting staff and bed numbers, slashing unnecessary bureaucracy and by addressing the root cause of low recruitment and retention - low pay.
• We will see to it that no money is given in foreign aid while our own hospitals are short of beds and the staff to run them.
• More emphasis must be placed on healthy living with greater understanding of sickness prevention through physical exercise, a healthier environment and improved diets

On the less harmful note, we have more anti-bureaucracy rhetoric, but then you get the racism dressed up as concern for the third world as a justification for sending foreign doctors home and the distasteful scrapping of all foreign aid. And then again, mixed in are some good ideas (probably stolen from the greens) about encouraging healthy living.

Summary

So this time round it would be:

1. Greens - as much on trust over Labour as policy, although I really like what's there, I just think there a definitely details missing
2. Labour in contrast, I lack trust in, but they have the details if the over-arching vision.
3. Lib-Dems - unsure about some of their ideas, but others seem to be the right way of giving patients greater choice, unlike the ones below.
4. Conservatives - I did try, for objectivity's sake, to find something I could like here, but I just couldn't.
5. UKIP - scary
6. BNP - scarier.

Just immigration and Welfare left to go now,