David Cameron 180We decided to shine the pre-election spotlight on the political parties to find what they might be offering in terms of health and social care. Bibi Berki steps up to the brief and also asks some health professionals and leads how they want the political landscape to shape up post-election

If you could bend the ear of the main party leaders and influence what goes into their election manifestos, what would you say?

This would be your big chance, as a health practitioner, to tell them about the day-to-day issues you encounter, the gaps you see in service provision or about the imbalances, where some health matters take precedence over others.

Perhaps you work in a so-called Cinderella sector, such as mental health, which you feel has been neglected by successive governments. Maybe you are more concerned about recruitment among midwives and school nurses and have first-hand experience of the pressures of short-staffing.

As the campaigns in the general election enter their most intense period, the Journal of Family Health has assessed just how much your concerns about the future of family and child health care feature in the policies of the main parties and asks what you think should be up there among the pledges and announcements.

As all the parties demonstrate, you can’t fight an election on the nation’s health without talking money.

The cost of our health service – and the concomitant issues of waste and debt – is invariably at the top of the agenda in the election debate. As the health service sinks further and further into debt (nearly £500 million at the last count), the issue has moved beyond urgency. Things are critical.

Monitor, the NHS’s regulator, says that one of the key causes of financial pressure is a growing demand for services. It says that some hospitals are struggling to keep up, with the ability to hit key targets getting harder.

And the three main political parties have duly come out fighting with big numbers: the Prime Minister recently reiterated that his government had put £12.7 billion into the health service since taking office. His Chancellor, George Osborne, has said he will put an extra £2 billion into frontline health services. He’s described this as a ‘down payment’ on a plan drawn up by NHS bosses calling for an extra £8 billion a year above inflation by 2020.

Labour has responded by saying it will commit an extra £2.5 billion on top of Mr Osborne’s plan and will fund this in a variety of ways including the controversial ‘mansion tax’. The Liberal Democrat Party pledges an extra £1 billion for the NHS every year to be funded, among other things, by a tax on the shares of high-earners.
Furthermore, they say that half of this money would go towards mental health.

So that’s the headlines dealt with. What about how that money will be spent and what areas of health and social care will be on the receiving end? Here’s a brief breakdown of policy outlines at the time of going to press.

Integrating health & social care

The Conservatives promise that all patients will have access to a GP from 8am to 8pm, seven days a week by 2020. They say they intend to train 5,000 more GPS, also by 2020. They also say they are committed to providing full weekend hospital care in England - in line with the NHS’s own five-year plan.

Another flagship Conservative policy is the Manchester health devolution experiment. From this month [April], a Greater Manchester Health and Wellbeing board will be appointed, which will work closely with existing clinical commissioning groups of GPs. A year later it will take control of its own budget. The aim is that by integrating health and social care services in the region, pressure on hospitals will be eased and care services improved. The overarching principle is that the local providers should control what is spent and where it is spent. The Chancellor has said of the policy: ‘This is what the NHS wants to see as part of its own future.’

Health minister Jeremy Hunt has acknowledged that one of the biggest challenges which lie ahead is the transformation of the NHS and social care sector, in partnership with the voluntary sector. Speaking at last month’s Association of Chief Executives of Voluntary Organisations (ACEVO) Health & Social Care conference, held in central London, he said we need to ‘change the models of care and bring care to the home’.

Delivering whole person-centred care

The Labour party proposes ‘whole person care’ and plans health and wellbeing boards which will oversee commissioning and give Monitor a role in this new integrated system. This whole person care service is at the core of the party’s 10-year plan for the NHS, along with a repeal of privatisation laws.

Speaking at the ACEVO conference, shadow health minister Andy Burnham sought to allay fears in the voluntary sector that his plan to restore NHS trusts’ preferred provider status for delivery of health services would hit charities as well as private companies. Notfor-profit care organisations would be given ‘a form of preferred provider’ status under legislation that a Labour government would introduce to replace parts of the coalition’s 2012 Health and Social Care Act. The move, he said, would recognise their contribution to strengthening communities. Leader Ed Miliband also pledges to cap the amount of profit private firms can make from the NHS in England.

The party says it will introduce an annual £2.5 billion ‘time to care’ fund to pay for 20,000 nurses, 8,000 GPs, 5,000 care workers and 3,000 midwives. It also says it will guarantee GP appointments within 48 hours and a maximum one-week wait for cancer tests and results. On a broader level, and to tackle the growing calls for better illness prevention, the party plans to set maximum levels of fat, salt and sugar in food aimed at children.

Raising the profile of mental health

The Lib Dems have done much to raise the profile of mental health care while in coalition and have, to some extent, made the issue their own in the political arena. An injection of £1.25 billion announced in the Budget for mental health services was first revealed by the Deputy Prime Minister Nick Clegg. He said the money would mainly go towards helping more than 100,000 young people by 2020. Some of it would also go towards supporting pregnant women and new mothers.

Mr Clegg said: ‘There would be an outcry if a child with diabetes was left to cope without support or treatment. But that’s exactly what’s been happening with young people’s mental health services. ‘That’s why I am determined to start a seismic shift to revolutionise children’s mental health care and end this unacceptable injustice.’

The Lib Dems have also contributed to the integration debate, saying they would pool health and social care budgets. Another new policy would be the introduction of an annual £250 bonus for carers looking after someone for at least 35 hours a week over a 12-month period.

Five Year Forward View

Of course, the NHS is not a passive observer of all this feverish policy-making on its behalf. NHS England’s Five Year Forward View, published last Autumn, brought together the major health bodies as well as patient groups, clinicians and experts in order to ‘create a collective view of how the health service needs to change over the next five years if it is to close the widening gaps in the health of the population, quality of care and the funding of services’.

NHS England described this process as a ‘move towards a different NHS’.

One of the focuses of this Forward View will be – and here is the buzzword again, just as in the party proposals – the creation of more integrated services. The plan is to bring together hospitals, community services, GPs and carehomes to make it easier for all these sectors to provide the right care.

Simon Stevens, NHS England’s chief executive, told ACEVO delegates that he wanted this to be the approach of the first wave of health and social care ‘integrated personal commissioning’ pilots starting in April, under which people living with long-term conditions will be enabled to spend their own annual budgets for care and support.

Consortia that will oversee the pilots must include at least one NHS clinical commissioning group, one local authority and one voluntary organisation. Stevens has said that as many as five million people could have budgets by 2018.

Political consensus?

Election campaigns are all about ‘the message’ and the prevailing wisdom is that it needs to be short and memorable to be effective and to win you votes. But can the huge and meandering subject of health and social care be reduced to sound bites?

In a profession where staff range from hospital-based specialists to home-visiting care-workers, there are a huge number of issues for politicians to address. Are they addressing them? Community care seems to be on the agenda, but are the funds going to be there to help deliver real change?

One area which seems to have cross-party concensus is mental health. All three main parties have now unveiled pledges for a greater emphasis on mental health support and the Chancellor announced in his budget an additional £15 million a year, over the next five years, on care for women who experience mental health problems during the peri- or ante-natal period. It’s a move welcomed by Cathy Warwick, the chief executive of the Royal College of Midwives who called it a ‘step in the right direction’. It may, she added, go some way to redress the ‘patchy, inadequate and inconsistent’ support currently on offer.

It’s also been applauded by 4Children, the children’s and family charity, whose chief executive, Imelda Redmond, said: ‘The Chancellor has rightly focused attention on a forgotten problem which has a devastating long-term impact on children and families. Intervening early to prevent families reaching crisis point has to be central.’