With the general election fast approaching, many people will be considering which political party to vote for. Smaller political parties, including the Green Party, UKIP, the Scottish National party and Plaid Cymru, have shared centre stage but, ultimately, any government formed will contain at least one of the three largest political parties. The health spokespeople for the Conservatives, Labour and the Liberal Democrats give their views on some of the important policies that will affect healthcare in the UK. What is the future for the controversial Cancer Drugs Fund? Will there be any further top-down reforms of the NHS? Will the NHS be protected from the Transatlantic Trade and Investment Partnership — an open trade agreement being negotiated between the United States and Europe?
George Freeman, the Conservative Party’s Minister for Life Sciences
The Conservative Party intends to continue piloting new approaches to health and social care, such as the devolution settlement in Greater Manchester that will see the region take full control of its NHS budget.
Jamie Reed, Labour’s Shadow Health Minister
Labour will repeal the Health and Social Care Act 2012. It also intends to recruit 8,000 more GPs and 20,000 more nurses, paying for this through its proposed ‘mansion tax’ on properties worth more than £2m.
Norman Lamb, the Liberal Democrat’s Minister of State for Care and Support
The Liberal Democrats promise equal care for those with mental health problems and a pledge of £500m per year for better mental health care.
We posed the following question to each of the political parties:
- If in government, how would you secure sustainable funding for the NHS over the coming ten years?
- Do you think the organisation of the NHS requires further reform?
- Is the future of the Cancer Drugs Fund secure?
- Would you consider abolishing or reforming prescription charges?
- If in government, would you support the Transatlantic Trade and Investment Partnership (TTIP)?
- Would you offer any protection to the NHS from TTIP?
- What is your policy on assisted dying?
- Do you support the Medical Innovation Bill (Saatchi Bill), aimed at protecting doctors who try experimental treatments from litigation, and why?
If in government, how would you secure sustainable funding for the NHS over the coming ten years?
Conservative: The only way to fund the NHS sustainably is to have a strong economy – and we’re the only party with a long-term economic plan providing that security. Five years ago we inherited an economic mess from Labour. Other countries with similar debts and deficits had to cut their health spending. But David Cameron kept his promise to increase NHS spending. We can afford it because we’ve put Britain on the path to recovery. In 2014, our economy grew at the fastest rate in the G7, and because we’ve also taken difficult decisions elsewhere, we have secured significant additional investment in the NHS this Parliament – spending £12.7bn extra. We will continue to give the NHS real-term rises in funding in every year of the next Parliament, too.
Labour: A Labour government would raise £2.5bn a year for the NHS through a mansion tax on properties over £2m, tackling tax avoidance by hedge funds, and a levy on the tobacco companies. We would recruit 20,000 nurses, 8,000 GPs, 5,000 homecare workers and 3,000 midwives, giving the NHS time to care. This is part of our plan to integrate health and social care services into a seamless system of “whole-person care”, bringing together three fragmented services into a single service coordinating all of a person’s needs – physical, mental and social – with preventing illness and promoting good health at its heart.
Liberal Democrats: We have pledged to meet the recommendations of Simon Stevens, the head of the NHS in England, to invest an extra £8bn a year in the NHS by 2020. But at the same time, the projection of an £8bn shortfall by 2020 relies on pretty heroic assumptions about improvements in efficiency across the NHS. Liberal Democrats have called on other parties to commit to work together on a non-partisan commission to review our health and care system immediately after the election to make sure it is financially sustainable for the future. Crucially, this process needs to involve the public to give people a real say over priorities for their health and care services.
Jamie Reed: No more top-down reorganisation of the NHS
Do you think the organisation of the NHS requires further reform?
Conservative: The NHS doesn’t need a big reform – it needs to be allowed to evolve. And it needs less political interference, not more. That’s why we’ve taken politicians and Whitehall officials out of the day-to-day management of the NHS and put it in the hands of clinical and healthcare professionals. Unlike Labour, whose health spokesman Andy Burnham has been setting out the radical changes they’d make – including giving control of the NHS to local authorities, turning the system on its head. We are backing the NHS’s own plan for the future, the Five-Year Forward View, while Labour just offers more uncertainty.
Labour: Services do need to change — long-term conditions like cancer, heart disease and dementia now account for 70% of all NHS spending, and many people have more than one condition. Our health and care services haven’t changed to reflect this new reality: they respond to each of our needs separately, focusing on the body part or the individual problem rather than the whole person behind it. This means care is fragmented, problems get missed and people have to tell their story over and over again to different parts of the system. However, we will not repeat the mistakes of the Tory-led Government, which forced through a damaging, top-down reorganisation of the NHS overwhelmingly against the wishes of NHS staff. We have been clear that there will not be a top-down reorganisation. We will work through the structures we inherit, but we will put the right values back at the heart of the NHS – cooperation and collaboration, not privatisation and fragmentation.
Liberal Democrats :
Last year the NHS was rated best in the world by the independent Commonwealth Fund. It is something we are rightly proud of. But those who care about the NHS must also recognise that it is not perfect: we can only make it better by confronting those cases where poor care has occurred. There is nowhere that change is more urgently needed than in mental health — and in particular children’s mental health. Mental health has been given a poor deal for years — and Labour perpetuated this bias in its years in office, excluding mental health from the waiting time standards it established for physical health and from the “Payment by results” system that channels extra funding into physical health treatment. Liberal Democrats in government have been working to give mental health a completely equal footing with physical health across the NHS. We have introduced the first access and waiting standards, and legislated for complete equality for mental health. Recently we launched a groundbreaking report setting out a blueprint for the future of young people’s mental health services, which are inadequate across much of the country, backed by £1.25bn of new investment.
Is the future of the Cancer Drugs Fund secure?
Conservative: Yes — for as long as David Cameron remains Prime Minister. We introduced the £1.16bn Cancer Drugs Fund that has already helped more than 60,000 people get potentially life-saving treatments they would not otherwise have had. It’s vital that as many patients as possible have access to the latest, best drugs – which is why, in January 2015, we announced an additional £60m worth of funding. And we’ve gone further. We have launched a major Accelerated Access Review to speed up patient access to innovative medicines and medtech, which will look at the role of the National Institute for Health and Care Excellence and ways we can set out a clearer runway to get new medicines into the NHS.
Labour: When the Cancer Drugs Fund expires in March 2016, we will replace it with an expanded Cancer Treatments Fund to improve access to treatments for all cancer patients — including to the latest forms of radiotherapy, surgery and drugs. Any patient who currently receives a drug from the Cancer Drugs Fund would continue to be offered that drug under the Cancer Treatments Fund. This approach, alongside our plan to guarantee cancer tests and results within one week, will help us reach our ten-year goal to have the best cancer survival rates in Europe, saving up to 10,000 lives a year.
Liberal Democrats :
The Liberal Democrats would continue to invest in research and set ambitious goals to improve outcomes for the most serious life-threatening diseases such as cancer, as well as working to make sure funding for cancer treatment is spent as effectively as possible.
George Freeman: Cancer Drugs Fund will remain as long as Cameron is Prime Minister
Would you consider abolishing or reforming prescription charges?
Conservative: We’ve been able to control prescription charges and keep prices stable, because we’re building a strong economy that gives us the freedom to put more money where it makes a real difference to patients’ lives. Around 90% of prescription items are dispensed free, and in this Parliament we have frozen the cost of pre-payment certificates which keeps costs down for those who need regular prescriptions.
Labour: For people with long-term medical conditions prescription charges can impose a considerable cost, particularly at a time when household incomes are already being squeezed. The last Labour government commissioned Ian Gilmore (the then President of the Royal College of Physicians) to carry out a review on how to implement and phase in exemptions for people with long-term conditions. A future Labour government would be open to looking at this issue again.
Liberal Democrats :
We don’t have any current plans to change the law on prescription charges. The existing laws provide a fair system which ensures that nobody should be restricted from their medical treatment because of their financial position. I think it’s right that specific groups should not have to pay any prescription charges, including those who are pregnant, on Universal Credit or are aged under 18 years or over 60 years.
If in government, would you support the Transatlantic Trade and Investment Partnership (TTIP)?
Let’s be clear about what this means – TTIP is a free trade deal that would bring £10bn to the UK economy each year – giving greater financial security to British people and their families with more jobs and cheaper goods. It will help provide much-needed security for hardworking taxpayers, and as the negotiators themselves have made clear, we have secured safeguards so that it could never force a backdoor change in the way the government decides to deliver NHS services.
Labour: Labour supports trade agreements which can bring significant benefits through boosting trade and growth, securing and creating jobs, and bringing down costs and extending choice for consumers. However, Labour shares the concerns that have been raised about the impact that TTIP could have on public services, particularly the NHS. Labour will only support an agreement that promotes decent jobs and growth, avoids a race to the bottom, and safeguards workplace and consumer rights.
Liberal Democrats :
TTIP, by simplifying the way that we trade with other countries, will give a real boost to the countless small businesses in Britain that trade overseas by cutting the burden of regulation. Free trade is the basis of Britain’s economy, and agreements like the TTIP are incredibly important in giving our businesses the best possible chance to compete in the global market.
Would you offer any protection to the NHS from TTIP?
Conservative: TTIP will not and cannot change the fact that it is up to the UK Government to decide how UK public services, including the NHS, are run. It will not force us, the United States or any other country to open up their national health systems to private providers. The decision as to who provides NHS services will remain firmly with local NHS doctors through local commissioning groups: one of this government’s key reforms.
Labour: Yes – Labour will ensure the TTIP Treaty cannot impose procurement or competition obligations on the NHS and Labour will introduce a Bill to repeal the marketisation of the NHS in our first Queen’s Speech.
Liberal Democrats :
Britain already has trade agreements in place with over 100 countries around the world — without this undermining our NHS. The EU has repeatedly made it clear that TTIP will have no impact on the way that individual countries choose to run their health systems. If we were not completely confident that this was the case, Liberal Democrats would not support it.
Norman Lamb: Existing prescription charge system is fair
What is your policy on assisted dying?
The issue of assisted dying is an incredibly emotive one. While everyone wants to ease the suffering of terminally-ill patients, there are no easy answers. Any change in the law on assisted dying is therefore an issue of individual conscience. We feel it’s a matter for Parliament to decide on a free conscience vote. But we are determined to continue to recognise and support the provision of end-of-life care. Death comes to us all in the end, and the NHS needs to be helped to provide a dignified and pain-free end of life.
Labour: Issues around assisted suicide and euthanasia have always been dealt with as a matter of conscience. The ethical issues involved are complex, and we recognise that people hold strong and deeply divided views on them. It is appropriate that Parliament should lead on debates of this nature and provide the forum where all opinions can be heard.
Liberal Democrats :
Assisted dying is not a matter for party politics — in the Houses of Parliament it remains a matter of conscience for individual MPs, and rightly so. I personally believe that someone who is terminally ill and is likely to die in the near future — possibly after immense suffering — should be able to choose to end their life if we can put the right safeguards in place to protect the vulnerable. I completely respect the views of many of my colleagues who disagree.
Do you support the Medical Innovation Bill (Saatchi Bill), aimed at protecting doctors who try experimental treatments from litigation, and why?
The Saatchi Bill was intended to try to promote the use of innovative medicines and treatments for NHS patients by tackling the effect of fear of litigation on deterring clinicians from trying innovative treatments. We are strongly committed to promoting the use of innovative medicines (and innovative use of existing medicines where supported by data and evidence of safety and efficacy) which is why we have launched the Early Access Scheme and the Accelerated Access to Innovative Medicines and Medtech Review, and are investing so heavily in NHS genomics and the data and digital infrastructure to drive ‘intelligence-based prescribing’. Ministers in Parliament were supportive of the Bill’s aims to promote medical innovation, and cooperated with the sponsors to safeguard patient safety, but as a Private Members Bill it now can’t get on the statute book this year because it didn’t get enough cross-party support.
Labour: Labour is supportive of efforts to bring innovative treatments to patients faster and improve the uptake of innovative treatments in the NHS. With reference to the Saatchi Bill, Labour called for a series of safeguards to ensure that decisions are made with sufficient regard to efficacy and safety. In addition, we were clear that the bill must not reduce patients’ opportunities for taking part in established clinical research. There are a number of other barriers to innovation that also need to be addressed, including the bureaucracy around setting up research and clinical trials and the delay in access to new drugs and treatments.
Liberal Democrats :
I support the principle of the Medical Innovation Bill. We must seek to ensure that doctors are confident that they are able to try innovative treatments within a clear framework which protects patient safety and safeguards them from litigation. However, it is important that bills of this nature are given careful scrutiny. Many organisations such as the British Medical Association and the Wellcome Trust have raised their concerns about the bill. I am not interested in pushing this into the long grass and that’s why I have written to Jeremy Hunt, Secretary of State for Health, detailing my concerns over the lack of time there was to consider the bill. I have also proposed that a proper review is conducted to ensure that the Medical Innovation Bill achieves what it sets out to achieve without any unintended consequences. Such an examination of the issue should involve patient organisations, legal bodies, royal colleges and medical unions. This review could then lead to draft legislation, if it is deemed necessary, going through full parliamentary scrutiny later this year.
[The Liberal Democrats vetoed the debate of the Medical Innovation Bill in March, after our questions have gone out to the political parties — EDITOR.]