This page has been printed from:
http://www.canserforum.com/print/articles/2010-general-election-promises-promises/

2010 General Election: promises, promises…

April 2010

Dear Colleagues,

As the country gears itself up for a General Election in May, what are the implications for health, and in particular cancer?

The public media has already started using health issues, and cancer in particular, to tease out debate, and though the three main parties have openly named health as a key election priority, only two have specific plans for cancer. One thing is for sure, we will have heard much during their campaign as the footballs of health and cancer are kicked around the political playing field.

In this issue of Cancer Services Forum we hope to give you a brief summary of the political parties’ dressing room talks on healthcare and cancer care—and how they would fund their plans—before the big match on the 6th May.

Ian Watson, National GP Cancer Lead

 

Healthcare delivery could either be facing a farreaching shake-up (if whichever party wins the election sticks to its promises) or not (if the winning party discovers it cannot fund its manifesto). But what impact could the General Election on 6 May 2010 have for cancer services in particular?

The 2010 General Election campaign kicked off in April with the usual fanfares and media hullabaloo, and the main political parties have all launched their election manifestos (Table 1). One thing is clear—every party in principle supports the NHS, i.e. comprehensive healthcare for everybody, provided on the basis of clinical need, not ability to pay, and free at the point of delivery. The differences lie in how the parties think the service needs to be improved and how any changes can be funded.

  UK Lab UK Con UK LD UK Green UK BNP UK UKIP Wales Plaid Cymru Scotland SNP N. Ireland DUP/SDLP/Sinn Fein/UCU
Does the manifesto make claims about health services? Yes1 Yes2 Yes3 Yes4 NA5 Yes6 Yes7 NA8 NA9-12
Does the party have a health policy? Yes13 Yes14 Yes15 Yes16 Yes17 Yes18 Yes19 No Yes-DUP20  Yes-Sinn Fein21
Is health a key election priority? Yes Yes No Yes No No No No Yes-DUP20
Does the party set out specific plans for cancer services? Yes Yes No No No No No No No

Lab=Labour; Con=Conservative; LD=Liberal Democrat; BNP=British National Party; UKIP=UK Independence Party; SNP=Scottish National Party; DUP=Democratic Unionist Party; SDLP=Social Democratic and Labour Party; UCU=Ulster Unionist Party and Conservative Union; NA=not available at time of writing.

Table 1: Gearing up for the 2010 General Election: key political parties with manifesto statements and policies on health

 

Strengthening the NHS

Labour’s goal is “to build a better health service by protecting NHS spending and by shifting to more preventative and personal care, clear patient guarantees and greater care in the home”. Its manifesto includes the following promises:1
• No topdown changes to the structure of primary care trusts or strategic health authorities
• A legally binding guarantee of a maximum 18 weeks’ wait for treatment or the offer of private treatment
• Encouragement of preventative healthcare through routine check-ups for the over-40s and a major expansion of diagnostic testing

The Conservatives promise to “back the NHS”, with increased health spending every year. They plan to scrap politically motivated targets that “get in the way of providing the best care”, and increase patient access to vital drugs and services that would prolong or improve their lives by reforming the way drug companies are paid for NHS medicines.2 In a draft manifesto produced in January 2010, the Conservatives explained their plans would include:22
• A ”payment for results” system throughout the NHS to make sure all providers have the right incentives to succeed
• Changes to the way drug companies are paid for NHS medicines so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of their new treatments

The Liberal Democrat manifesto highlights the party’s sense of duty to improve the NHS. Many of the proposals focus on reducing beaurocracy and increasing efficiency, through:3
• Cutting the size of the Department of Health (DH)
• Abolishing or reducing the budgets of quangos
• Scrapping strategic health authorities
• Limiting the pay of top NHS managers
• Making the NHS work better by:
• Extending best practice on hospital discharge
• Maximising the number of daycase operations
• Reducing delays before operations
• Moving consultations into the community
• Sharply reducing centralised targets and beaurocracy, and replacing them with entitlements guaranteeing that patients get diagnosis and treatment on time or the NHS will pay for the treatment to be provided privately

Understandably, for Scotland, Wales and Northern Ireland, where responsibility for health has been devolved to the relevant regional assembly, the “Westminster election” has elicited fewer statements on health, with most parties focusing their campaign on how best to allocate political responsibilities between UK and regional government.

 

Funding

Perhaps not surprisingly, the parties provide few details on the costs of implementing their proposals and how these costs would be met. Labour promises to scale down the NHS IT programme, saving “hundreds of millions of pounds” and to deliver up to £20 billion of efficiencies in the frontline NHS over the next 4 years.1

The Conservatives promise to increase spending on health in real terms every year and to cut the cost of NHS beaurocracy by one third.2 They also have plans to fund increased access to cancer treatments by redirecting funds that would be spent on National Insurance (NI) (see below).

The Liberal Democrats state that their first healthcare priority will be to increase spending in some parts of the NHS by cutting waste in others (e.g. management costs, beaurocracy and quangos); they stress that they do not plan to make net cuts in spending on frontline health services.3

 

Cancer service delivery

Only the leading two parties, Labour and Conservative, have made any promises directly relevant to cancer service delivery, as set out in Table 2.

Party Manifesto statement relevant to cancer service delivery
Labour1

The cancer guarantee will ensure that all patients see a cancer specialist within 2 weeks of GP referral and that all cancer tests will be completed and the results received within just 1 week—helping save tens of thousands of lives over the next 10 years

All cancer patients will be offered one-to-one dedicated nursing for the duration of their care and we will work with Marie Curie Cancer Care and other providers to guarantee everyone who wants it the opportunity to receive palliative care in their own home at the end of their lives

The NHS Constitution will guarantee the legal rights of patients, wherever they live, to all treatments and drugs approved by the National Institute for Health and Clinical Excellence (NICE) for use in the NHS. We will continue to improve the process of approving new drugs and treatments so that these can be made available to NHS patients more quickly. We will ensure all leading drugs available internationally are assessed by NICE and those which are deemed effective will be available within 6 months of referral

 
Conservatives2

We will measure our success on the health results that really matter—such as improving cancer and stroke survival rates or reducing hospital infections

Using money saved by the NHS through our pledge to stop Labour’s jobs tax, we will create a Cancer Drug Fund to enable patients to access the cancer drugs their doctors think will help them. To help the fight against cancer further, we will:

• Give thousands more people—especially young people—access to effective drugs to treat rare cancers by changing the way these drugs are commissioned

• Encourage clinical trials of innovative techniques to diagnose and treat cancer

• Support the roll-out of screening programmes for common cancers

 Table 2: Labour and Conservative manifesto statements relevant to cancer service delivery

 

The Conservatives had already put their cards on the table before launching their manifesto by stating publicly, in response to a Labour budget proposal to reduce the country’s financial deficit by raising NI contributions, that they would not implement this increase. This would free up money in the NHS budget to pay for new cancer therapies that are currently not available on the NHS (e.g. because they have not been recommended by NICE).23 This announcement provoked considerable response from the media and key stakeholders:
• “The £200 million or so they [the Tories] say will be needed to fund these cancer drugs essentially has to come out of the current budget…This is like making a saving on a tax that hasn’t been implemented yet, so it’s not particularly a cost that the NHS has to bear at the moment. It’s a sleight of hand to say the least because the money isn’t there to be saved yet, so the money will have to come out of existing budgets.” (Professor John Appleby, King’s Fund’s chief economist, speaking on BBC Radio 4’s Today programme)24
• “It is misleading to suggest that access to life-saving drugs is restricted if they are not fully recommended. It means NICE has looked carefully at the specific groups of patients that will get most benefit. Likewise, looking at the number of drugs recommendations in isolation does not reflect what other more effective drugs may already be available.” (DH spokeswoman)25
• “It’s wrong to recommend the use of treatments where the additional benefit is uncertain. This is misleading for patients and wastes scarce NHS resources… Not all patients with a particular condition benefit from a drug and some drugs only work well for some patients or at a particular stage in a disease. That’s why we target the use of some new drugs, or make a partial recommendation.” (Sir Andrew Dillon, chief executive of NICE)25

None of the other parties focus on cancer, except for Scottish Labour, which promises to introduce a new right (by 2015) for Scottish patients to be seen by a cancer specialist and get results within 2 weeks of referral, instead of the current target of 31 days—an attempt to bring Scotland in line with England for cancer referrals.26

 

What do the parties think of one another’s plans?

Unsurprisingly, the parties have spent almost as much time deriding their opponents’ plans as on developing their own.

 

Labour on the Conservatives

“They [the Conservatives] started the year promising austerity and tough action on the deficit, but having come under pressure they have now changed their tactics, with a series of improbable rabbits out of seemingly bottomless hats… In the last week, the Tories have promised to cut taxes for employers, for employees, for married couples, and even the NHS; they’ve promised new cancer drugs for anyone who wants them and a new programme to create an army of community activists; and all at the same time as they have kept up their rhetoric on cutting the deficit faster and deeper than Labour. The words are cheap but the cost to the British people will be staggering.”26
(Douglas Alexander MP, in a briefing to Labour Party campaign staff and volunteers)

“The do-it-yourself Tory agenda for public services described today won’t work unless the frontline is properly protected and properly funded. But the Tories will have to cut spending very sharply to make all their manifesto tax and spending promises add up… They say they will reduce taxes, protect spending and lower the deficit. This is something-for-nothing ‘Santa Claus’ economics.”27
(Peter Mandelson, Labour’s Chair of Election Strategy responding to the launch of the Tory manifesto)

 

 

 

Liberal Democrats on Labour

Labour claim: All cancer tests will be completed and the results received within just 1 week. Verdict: How can we believe them? It’s completely unfunded. Gordon Brown announced at the Labour Party Conference in September 2009, that patients who fear they may have cancer will be guaranteed diagnostic tests within a week. According to Parliamentary Answers, the capital costs of new diagnostic equipment will be about £650 million between the periods 2011–12 and 2014–15. The revenue costs in the same period will be £1.25 billion. Labour has offered no explanation as to how this will be paid for.28

 

Liberal Democrats on Conservatives

Tory claim: We will scrap the politically motivated targets that have no clinical justification.

Verdict: Unfair. The Tories are planning to scrap targets but have no means to ensure people get their treatment on time. Waiting lists could easily grow again if there is no mechanism to ensure people get their treatment.

Tory claim: Using money saved by the NHS through our pledge to stop Labour’s jobs tax, we will create a Cancer Drug Fund to enable patients to access the cancer drugs their doctors think will help them.

Verdict: Unfair. John Appelby from the Kings Fund described the Tories’ cancer drug commitment as a ‘sleight of hand’. It’s unfair to promise cancer sufferers drugs with money the NHS doesn’t have.29

 

 

 

Conclusion

A General Election is the best opportunity for cancer care commissioners, healthcare professionals and the public at large to take the future into their own hands by voting for a party that promises to run the NHS effectively and efficiently. Unfortunately, experience has taught us that a General Election is also a great time for political parties to woo us with over-optimistic promises. All of the leading parties involved in this year’s election have made major pledges to improve the NHS and increase funding to frontline services.

Only Labour and the Conservative Party have gone into any detail about cancer service delivery. Whether their promises can really be funded as easily as they claim can only be known by the Whitehall experts, but it will be interesting to see how the winner fares—make sure you read your e-copy of Cancer Services Forum in the run-up to the next General Election.

 

References

  1. The Labour Party Manifesto 2010: A Future Fair For All. http://www2.labour.org.uk/uploads/TheLabourPartyManifesto-2010.pdf (accessed April 2010).
  2. Invitation to Join the Government of Britain: The Conservative Manifesto 2010. http://www.conservatives.com/Policy/Manifesto.aspx (accessed April 2010).
  3. Liberal Democrat Manifesto 2010: http://network.libdems.org.uk/manifesto2010/libdem_manifesto_2010.pdf (accessedApril 2010).
  4. The Green Party. http://www.greenparty.org.uk/ (accessed April 2010).
  5. British National party. http://bnp.org.uk/ (accessed April 2010).
  6. UKIP Manifesto April 2010: Empowering the People. http://www.ukip.org/media/pdf/UKIPManifesto2010.pdf (accessed April 2010).
  7. Plaid Cymru. Think Different Think Plaid: 2010 Westminster Manifesto. http://www.plaidcymru.org/uploads/publications/467.pdf (accessed April 2010).
  8. Scottish National Party. http://www.snp.org/ (accessed April 2010).
  9. Democratic Unionist Party. http://www.dup.org.uk/ (accessed April 2010).
  10. Social Democratic and Labour Party. http://www.sdlp.ie/ (accessed April 2010).
  11. Sinn Féin. http://www.sinnfein.ie/ (accessed April 2010).
  12. Ulster Unionist and Conservative Union. http://www.uup.org/ (accessed April 2010).
  13. Labour Party. Health. http://www.labour.org.uk/policies/health (accessed April 2010).
  14. Conservative Party. Where we stand: health. http://www.conservatives.com/Policy/Where_we_stand/Health.aspx (accessed April 2010).
  15. Liberal Democrats. What we stand for: health. http://www.libdems.org.uk/health.aspx (accessed April 2010).
  16. Green Party. Health and the NHS—policies in detail. http://www.greenparty.org.uk/policies/ nhs_2010/nhs_detail.html (accessed April 2010).
  17. BNP. Health. http://bnp.org.uk/policies/health/ (accessed April 2010).
  18. UKIP. Policy statement: health. Delivering better care, safeguarding the NHS. http://www.ukip.org/media/policies/UKIPhealth.pdf (accessed April 2010).
  19. Plaid Cymru. Action plan on health. http://www.plaidcymru.org/uploads/publications/52. doc (accessed April 2010).
  20. Democratic Unionist Party. DUP policy priorities. http://www.dup.org.uk/PolicyDocs. asp (accessed April 2010).
  21. Sinn Féin. Health. http://www.sinnfein.ie/health (accessed April 2010).
  22. Conservative Party. Draft Manifesto Chapter One: our reform plan for the NHS. http://conservativehome.blogs.com/files/health-draftmanifesto.pdf (accessed April 2010).
  23. Press Association. Tory pledge on blocked cancer drugs. http://www.guardian.co.uk/uk/feedarticle/9016355 (accessed April 2010).
  24. Tory pledge to offer restricted cancer drugs “will be funded by cuts elsewhere in the NHS budget”. http://www.dailymail.co.uk/news/article-1263642/Tory-pledge-offer-restrictedcancer-drugs-funded-cuts-NHS-budget.html (accessed April 2010).
  25. Tory cancer claims mislead patients, says drug body. http://www.guardian.co.uk/politics/2010/ apr/02/tory-cancer-patients-nice-lansley (accessed April 2010).
  26. Tory election headlines are being achieved at the cost of economic credibility - Alexander. http://www2.labour.org.uk/tory-election-headlines-economic-credibilityalexander, 2010-04-05 (accessed April 2010).
  27. When the Tories say “we’re all in this together”, what they really mean is “you’re on your own” - Mandelson. http://www2.labour.org.uk/tories-were-all-in-this-togethermandelson, 2010-04-13 (accessed April 2010).
  28. A Future Failed. The Liberal Democrat response to the Labour manifesto. http://www.libdems.org.uk/siteFiles/resources/PDF/2010%20Genera%20Election/A%20Future%20Failed%20Labour%20Manifesto.pdf (accessed April 2010).
  29. Fake Change. The Liberal Democrat response to the Conservative manifesto. http://www.libdems.org.uk/siteFiles/resources/PDF/2010%20Genera%20Election/Fake%20change.pdf (accessed April 2010).