Health and social care election tracker
How did health and social care issues shape the political landscape in the run-up to the 2015 UK general election?
Labour warns of NHS deficit as campaigns reach closing days
Ed Milliband warns of a £1.9 billion ‘financial bombshell’ facing the NHS as Labour releases an unpublished analysis by umbrella body NHS Providers, suggesting that two-thirds of trusts expect to be in deficit in 2015/16.
The revelations come as all parties make a last-ditch bid to
voters, with Labour campaigning hard to make the
NHS the dominant issue in the run-up to polling day. At a rally on the same
day, Milliband calls on voters to use their vote to ‘rescue
the NHS’, while Andy Burnham tells the
Financial Times that he would argue for ‘the best settlement that I can
possibly get’ for social care funding alongside the NHS.
Think tanks call for a 'dose of realism' from parties
The chief executives of two leading health and care think tanks call for a ‘dose of realism’ from the parties about their NHS funding pledges. Writing jointly to the Guardian, Chris Ham of The King’s Fund and Nigel Edwards of the Nuffield Trust say that ‘promises of jam tomorrow are not enough’ given the immediate pressures facing the service. They also caution that the £8 billion quoted as the amount needed by the NHS is ‘the bare minimum’ needed to maintain standards of care.
Miliband promises to hit the ground running
Ed Miliband announces that if elected, Labour would launch a recruitment drive for new nurses on its first day in office. Pledging to fund 1,000 extra training posts in 2015, he adds that a Labour administration would use an early Budget to start raising money to pay for this from a mansion tax and a levy on tobacco firms during its first year in government.
The speech forms part of a week of intensive Labour campaigning on health issues, launched the previous day with a poster claiming that the NHS is 'on life support'.
Parties vie on staff pay
The Liberal Democrats and Labour both promise to end real-terms pay cuts for NHS staff. Nick Clegg pledges that the Liberal Democrats in government would issue guidance to advisory bodies such as the NHS Pay Review Body to ensure public sector pay increases at least in line with inflation from 2016–18.
Meanwhile, Andy Burnham tells the audience at the health and care debate that Labour would guarantee no real-terms pay cuts for NHS staff. This goes further than the party’s manifesto, which merely calls for greater heed to be paid to pay review body recommendations. Jeremy Hunt refuses to be drawn when pressed on the same issue.
The week before, Mr Burnham suggested to the Unison annual health conference the Labour would initiate a review of the Agenda for Change pay system of NHS pay rates and assured the audience that additional pay for unsocial hours would be maintained.
Candidates clash over health and care plans
Candidates from the four major parties discuss health and social care issues at a debate organised by The King’s Fund and other leading health organisations. Jeremy Hunt, Andy Burnham, Norman Lamb and UKIP’s Dr Julia Reid make their pitches for government, followed by a public question and answer session with an audience of professionals, patients and policymakers.
Nick Clegg launches Liberal Democrat Manifesto
Nick Clegg presents the Liberal Democrat manifesto. As expected, its cover features a guarantee of ‘equal care’ for mental health as one of five policy priorities, signalling that the issue would be central to negotiations with other parties if there is a hung parliament.
The manifesto confirms the pledge to find the extra £8 billion a year in NHS funding called for by 2020 in the NHS five year forward view. It also confirms commitments to secure local agreement on fully pooled health and social care budgets by 2018, transfer responsibility for social care to the Department of Health and remove NHS mergers from the jurisdiction of the Competition and Markets Authority.
Labour Party launches manifesto
The Labour Party publishes its programme for government. It highlights the pledges that a Labour administration would repeal the Health and Social Care Act 2012 and prioritise the integration of health and social care. It also confirms the promise to establish a £2.5 billion-a-year ‘time to care’ fund to pay for 20,000 more nurses, 8,000 more GPs and 3,000 more midwives.
Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view. Defending this decision, Andy Burnham tells the Health Service Journal that the Forward View ‘leaves many big questions unanswered’ and that Labour would make ‘other fundamental changes’ which would change the assumptions it is based on. He claims that Labour is the only party with a ‘costed, fully funded proposal’ and says he does not rule out funding increases above the £2.5 billion it has pledged.
Milliband pledges 3,000 new midwives as Labour publishes health manifesto
Ed Miliband announces that his government would create 3,000 extra midwife posts if elected. Launching Labour’s health manifesto in Leeds, he pledges that the party would enshrine in the NHS constitution the right to dedicated one-to-one maternity care during labour and childbirth.
The health manifesto reiterates Labour’s plans to provide integrated whole-person care bringing physical health, mental health and social care into a single service. But the party claims that it would avoid a major structural overhaul of the NHS, warning that integration 'cannot be imposed by top-down edict'.
Labour attacks coalition record on access to doctors
Labour claims that under the coalition, patients are less likely than in 2010 to be able to get a doctor's appointment at evenings and weekends. As the party unveils a poster warning 'The Tories have made it harder to see a GP', Andy Burnham claims that NHS funding cuts are diverting patients to A&E services, with the proportion of surgeries open at evenings and weekends falling from 77 to 72 per cent.
Government parties refute Labour’s analysis, arguing that figures used are out-of-date and exclude the Prime Minister’s Challenge Fund to extend access to general practice.
Parties clash over NHS in TV debate
Party leaders trade blows on health policy as they set out their priorities in the only head-to-head debate of the campaign. In the televised discussion, Ed Miliband urges Britons to use their vote ‘to fight for the future of the NHS’ while David Cameron speaks of his personal experience of using the service, calling it the ‘most important national institution and national public service that we have’. Nick Clegg says that the NHS needs ‘hard cash’, reminding the audience that the Liberal Democrats are the only party so far to have explicitly promised an extra £8 billion a year for it if elected.
Nigel Farage is criticised by other leaders for raising the issue of so-called ‘health tourism’, including the claim that 60 per cent of those diagnosed as HIV positive in the UK each year are foreign nationals. Farage defends his comments two days later, as a YouGov poll finds that half of respondents would support UKIP’s flagship policy of a five-year ban on NHS treatment for those coming to live in the UK from other countries.
Miliband launches Labour campaign with pledge to cap private profits in NHS
Ed Miliband announces that if elected, Labour would introduce a cap on the profits made by private companies providing NHS services in England. Speaking at the East London site of the 2012 Olympics at an event that Labour bills as the launch of its general election campaign, he promises to ‘stop the tide of privatisation’ by setting a default cap of 5 per cent profit on private sector contracts worth more than £500,000. Miliband adds that Labour would end the ‘cherry-picking’ of easier or more profitable contracts by private providers.
The speech, which reiterates Labour’s five main pledges for government, shows that the party is keen to keep the NHS at the forefront of its campaign. It follows the first televised major party leader interviews the previous night, which saw Miliband and David Cameron interviewed separately on Sky News and Channel 4.
MPs introduce 'NHS Reinstatement Bill'
12 MPs present a Private Members’ Bill calling for the re-establishment of the Secretary of State’s legal duty to provide NHS services in England.
The Bill, introduced by Green Party MP Caroline Lucas and backed by Labour, Liberal Democrat, SNP and Plaid Cymru MPs, would dismantle much of the present architecture of the NHS by abolishing NHS England, CCGs and NHS trusts and transferring their responsibilities to regional committees of a new national health authority. It would also restrict the role of private companies in the NHS, abolish Monitor and repeal the legal framework governing competition in the NHS.
The Bill has no chance of becoming law but its supporters say they will challenge candidates from all parties to say whether they support the Bill during the election campaign.
Mental health pledges from Clegg and Miliband
Nick Clegg promises to sign the NHS up to a 'zero suicide' campaign as the Liberal Democrats and Labour set out their stalls on mental health. Speaking at a government mental health conference held at The King's Fund, Clegg says that 'every part' of the NHS in England should sign up to eliminate suicides, building on commitments already made by health leaders in some local areas. In a very political speech, Clegg adds that his party wants 'to go much, much further' on mental health, reiterating plans to invest £500 million to improve mental health care in each year of the next parliament.
Meanwhile, Ed Miliband promises that a Labour government would end 'the scandal of the neglect of child mental health', as he presents the report of an independent Mental Health Taskforce, commissioned by the party and led by Sir Stephen O' Brien, Chair of Barts Health NHS Trust. The report proposes a package of priorities and measures to improve mental health services, with greater emphasis on better support, prevention and early intervention.
Labour opens a lead on the NHS as voters say it is a top concern
Ipsos MORI’s first Political Monitor survey of 2015 shows 46 per cent of those asked naming health care, the NHS or hospitals as a very important issue in deciding how they will cast their vote. This is more than any other issue, and up from 29 per cent in the same poll in September 2014. It echoes the findings of a ComRes poll for ITV News, published on Wednesday, in which 50 per cent of respondents named the NHS as one of their top three concerns (up from 39 per cent in the same survey last month).
In YouGov’s most recent poll for The Sun, taken in early January, health was identified as one of the most important issues facing the country by 46 per cent of those surveyed, up from 33 per cent the month before. While these results partly reflect sustained public focus on NHS performance and continued pressures on A&E services, the NHS is now consistently vying with the economy and immigration as the top concerns for voters.
Meanwhile, polling by Conservative peer Lord Ashcroft shows Labour with an 18-point lead over the Conservatives as the party most trusted to tell the truth on the NHS. This is a significant shift from recent polls that have shown Labour or the Conservatives with a narrow lead on the issue.
Burnham unveils Labour public health proposals
Andy Burnham pledges that a Labour government would ‘take tougher action’ to protect children from the harmful effects of sugar, alcohol and tobacco. Launching a paper detailing the party’s approach to public health, he announces plans to set maximum limits on levels of fat, salt and sugar in food marketed to children, and that the party is considering the option of a time watershed for TV advertising of products high in sugar, fat or salt.
The party’s overall approach is to pursue more interventionist and regulatory policies as regards child health, but to empower adults to make healthier choices by raising the level and consistency of information available to them. Other proposals in the paper include giving local councils clearer powers to restrict the number of fast food outlets, and targeting cheap high-alcohol drinks that ‘fuel binge drinking’.
The announcement follows a speech by Liz Kendall the day before, in which she set out Labour’s plans to improve support to people providing informal care to family members. These included introducing a new NHS duty to identify family carers, and introducing a single point of contact with care services for carers of relatives ‘with the greatest needs’.
Election debate hots up as NHS pressures mount
Ed Miliband faces criticism over allegations that he outlined Labour plans to ‘weaponise’ the NHS as part of its general election strategy.
These allegations follow heated exchanges about winter pressures facing the service, a subject that overshadowed the opening week of the parties’ campaigns for 2015. Miliband later outlined Labour’s five-point plan to ‘end the mounting A&E crisis’ in an interview with the Daily Mirror.
As the Conservatives unveil the six key themes for their manifesto, the NHS is notable by its absence. In a speech, David Cameron says his party’s plans to eliminate the deficit would be accomplished while ‘not a penny’ is cut from the NHS. However, he gives no indication of whether a future Conservative government would go further than the pledge already made to maintain NHS spending in real terms beyond 2016-17.
Parties begin 2015 NHS campaigning
Labour fires the starting pistol on a new year of NHS campaigning, showing that health and care remain at the top of the pre-election agenda. Douglas Alexander, the party’s Chair of General Election Strategy, publishes a 27-page dossier criticising the coalition’s management of the service, arguing that it ‘cannot survive five more years of David Cameron’. He claims that on current trends the NHS of 2020 could see waiting lists of 4 million, and more than half a million older people no longer able to access to social care.
Labour also reiterates its own NHS proposals, including the creation of a £2.5 billion a year Time to Care Fund and repeal of the coalition’s Health and Social Care Act, and unveils its first election poster for 2015, which parodies David Cameron’s 2010 pledge to ‘cut the deficit, not the NHS’. In an interview with the BBC, David Cameron highlights extra NHS funding made available by the government in December, and calls on all parties to unite behind this commitment and the vision outlined in the NHS five year forward view.
Meanwhile, Nigel Farage tells Sky News that, while ‘overall health spending is going to go up over the next few years’, efficiency savings could still be made, pinpointing NHS middle managers as a potential target. He also says that a UKIP government would ‘winnow out’ doctors and nurses not meeting a prescribed standard of spoken English.
Labour's new plans for cancer treatment
Andy Burnham outlines Labour’s new plans for an annual Cancer Treatments Fund. This would replace the Cancer Drugs Fund when it expires in March 2016, building on current provision to include non-pharmaceutical treatments such as radiotherapy and surgery. £50 million from a pharmaceutical industry rebate would be added to the existing Cancer Drugs Fund budget to create a new fund of £330 million per year.
Speaking to the Britain Against Cancer conference, Burnham also pledges that a Labour government would publish a new cancer strategy within six months, and would commission Cancer Research UK and others to recommend ways to tackle under-treatment of older cancer patients.
Cancer caused lively debate during the 2010 general election campaign, after David Cameron unveiled Conservative plans for a Cancer Drugs Fund, then worth £200 million per year.
MPs vote to support Labour NHS bill
A bill that would reverse reforms introduced as part of the coalition's Health and Social Care Act 2012 has cleared its first parliamentary hurdle, with MPs voting by 241 votes to 18 to give it a second reading. Seven Liberal Democrats, two Conservatives, both UK Independence Party MPs and the Green Party’s solitary member joined forces with Labour members to vote in favour of its provisions, while only Conservatives opposed.
The Bill is introduced as a Private Member's Bill by Labour MP Clive Efford, who claims that it would ‘cut the heart out’ of the coalition government's health reforms. It has the public support of the shadow health ministerial team and foreshadows legislative changes Labour would make if elected. It has been used by Labour as a campaigning focus and to test support for these aspects of the coalition’s reforms among Lib Dem MPs ahead of the general election. It now awaits a date for committee stage, although there is unlikely to be enough time in the parliamentary calendar for it to become law.
The Bill contains provisions to 're-establish' the Secretary of State’s responsibility for the NHS in England, with a duty based on 'social solidarity'. It would also amend the role of Monitor, reduce the amount of income that foundation trusts can earn from treating private patients, and repeal rules related to the compulsory tendering of NHS contracts, made under Section 75 of the Act.
Health policy a central issue on Rochester and Strood by-election trail
Health is a high-profile issue in the Rochester and Strood by-election, caused by the defection of Conservative MP Mark Reckless to UKIP. Politicians and commentators are watching events closely for an indication of the public’s priorities and mood ahead of the general election.
In an October poll, voters in the constituency identified the state of local NHS services as the most important issue facing them and their families, ahead of issues such as immigration, crime and employment.
Some of this debate has focused directly on the local hospital, Medway Maritime Hospital. This has been in special measures since July 2013, with regulators judging that it had made ‘no progress’ by July 2014.
Burnham gives more detail on Labour plans
Andy Burnham says a future Labour government would ‘strengthen’ the role of NICE and consider making its clinical guidelines mandatory rather than advisory.
In a wide-ranging interview with the Health Service Journal, he suggests that health and wellbeing boards could develop a role ‘signing off’ commissioning plans, with clinical commissioning groups acting as an ‘executive’. He also suggests that he would 'repatriate' commissioning support units to support CCGs and HWBs.
Additionally, Burnham confirms that the NHS would be given the ‘first chance’ to provide services under Labour’s preferred provider policy. Services would be opened up to competition only if commissioners judge the NHS is unable to meet their requirements.
Labour makes new cancer pledge
In an interview with The Times, Ed Miliband announces a 10 year ambition for Britain to have the best cancer survival rates in Europe. This is backed by a guarantee that patients will have to wait no longer than a week for cancer tests and results by 2020. The pledge will be paid for from the proceeds of the tobacco levy announced at the Labour Party Conference. This follows moves from Labour to respond to concerns that its plans will result in a top down reorganisation. Writing in HSJ, Debbie Abrahams MP says whole person care would be implemented through an ‘evolutionary’ process.
At a glance: key pledges so far
- A real-terms increase in NHS funding
- All patients to have access to a GP from 8am to 8pm, seven days a week by 2020
- 5,000 more GPs to be trained
- A £2.5 billion Time to Care Fund to pay for 20,000 nurses, 8,000 GPs, 5,000 care workers and 3,000 midwives
- Whole person care to be at the heart of Labour’s manifesto
- The Health and Social Care Act to be repealed
- A guaranteed appointment with a GP within 48 hours
- The NHS to be the preferred provider of services
- A real terms increase in NHS funding of £1 billion in 2016/17 and 2017/18
- An extra £500 million for mental health services
- Health and wellbeing boards to be increased in size and given power to hold budgets
- NHS mergers will no longer come under the jurisdiction of the Competition and Markets Authority and commissioners will not have to put all services out to tender
- All patients to be issued with a ‘care footprint’ detailing the costs of their care
Labour Party Conference: Miliband seizes the initiative on NHS funding
Labour become the first party to make a significant commitment on NHS funding, as Ed Miliband pledges to establish a £2.5 billion 'Time to care' fund. This will pay for 20,000 nurses, 8,000 GPs, 5,000 care workers and 3,000 midwives. It will be funded by the proceeds of a mansion tax, measures to tackle tax avoidance and a levy on tobacco companies.
In his speech to the conference, Shadow Health Secretary Andy Burnham announces that all hospitals will be asked to evolve into integrated care organisations, as well as support for carers and a right to die at home.
In an interview with HSJ following his speech, Burnham indicates he is considering changing Monitor's role to make it responsible for promoting integrated care and overseeing the financial sustainability of local health economies, rather than individual organisations.
Where are the parties saying about public spending and NHS funding?
What the parties say about funding for health and social care will be heavily influenced by their wider plans for public spending and reducing the budget deficit. Here we set out their positions. The main parties have all made commitments to eliminate the deficit during the next parliament, although there are differences, particularly in their approach to capital spending, which will affect their room for manoeuvre on public spending.
Labour deny tax increases are on their agenda
"People feel they are paying too much tax already"
In an interview with The Telegraph, Ed Balls rules out the introduction of a so-called ‘death tax’ – a levy on estates to fund adult social care – or a 1p increase on national insurance for the NHS by a future Labour government.
Andy Burnham calls for pause in NHS private contracts
Labour launches its summer offensive on the NHS by attacking the coalition's health reforms. In a speech in Manchester, Andy Burnham draws the battle lines for the election campaign by claiming that privatisation of the NHS is proceeding 'at pace and scale' and calling for a moratorium on contracts for NHS services being given to private providers until after the election.
Labour confirms pledge to match coalition spending plans
Labour's National Policy Forum endorses the leadership's pledge to match the coalition's spending plans for 2015/16 (not including capital spending). No details of significant changes to the health and social care policies already outlined by the party emerge from the Forum. The policies endorsed by the Forum will be published at Labour's party conference in the autumn and will form the basis of their election manifesto. Meanwhile, shadow health minister Andrew Gwynne outlines plans to establish a new body to oversee service reconfigurations. The new body would manage public consultations on proposed service changes and have the power to amend the changes proposed.
Cameron and Miliband clash over NHS waiting times
David Cameron and Ed Miliband clash over NHS waiting times at Prime Minister's Questions. The Guardian reports a party source saying that Labour intends to make the NHS 'one of the major issues in the run up to the next election.'
NHS Confederation conference
All three of the main party spokespeople address the NHS Confederation’s annual conference on the same day.
Norman Lamb goes much further than he has before in calling for a legal obligation to pool health and care budgets. Andy Burnham indicates that reform should come before an increase in NHS funding. Meanwhile, Jeremy Hunt links the future sustainability of the NHS to improving patient safety and changing care outside hospitals.
Labour inquiry questions purchaser/provider split
An inquiry by the Parliamentary Labour party concludes that competition increases health inequality and that there is little evidence that the purchase/provider split has improved quality, while it has led to additional transactional costs. Among a number of recommendations to the party, it suggests that health and wellbeing boards and clinical commissioning groups should be able to direct NHS and social care spending through integrated budgets, and that the NHS should be more democratically accountable.
Labour pledges action on exploitation of care workers
An independent review commissioned by the Labour Party calls for an end to 15-minute time slots for home care visits and for the remit of the Care Quality Commission to be extended to protect care workers from exploitation. Ed Miliband welcomes the report and pledges a future Labour government would end 15-minute visits.
Ed Miliband revives GP appointment guarantee
Ed Miliband announces that Labour would introduce a guarantee for all patients to get a GP appointment within 48 hours, effectively promising to reinstate a target abandoned by the coalition in 2010. He promises £100 million to pay for this, mainly funded by reducing costs associated with competition. The old target caused some embarrassment for Tony Blair during the 2005 election campaign when an angry patient complained that it prevented her from booking an appointment with her GP more than 48 hours in advance.
Who should commission primary care?
In response to NHS England’s proposals to give clinical commissioning groups a stronger role in commissioning primary care, Andy Burnham suggests that Labour would consider giving this responsibility to health and wellbeing boards.
A year to go to the election
With a year to go until the general election, comparatively little is known about how the party manifestos will shape up. All the main parties are currently consulting their members on the policies that will eventually make up their manifestos.
We know most about where Labour are heading – their health offer is likely to focus on their proposals for whole person care, although some significant questions remain about how this will be implemented and paid for. The Lib Dems are beginning to differentiate themselves from their coalition partners by setting out their own policy positions – expect more of this as polling day draws nearer. We know least about how the Conservative manifesto will shape up – the way their policy process works means that little will be revealed before their party conference in the autumn. Among the other parties, UKIP’s health policy remains a blank slate, other than a requirement for migrants and visitors to the UK to show proof of health insurance as a condition of entry, while the Green party have pledged to ‘restore the NHS to public ownership’ and introduce free personal care for older people. Finally, this election will see a new name on some ballot papers, with the National Health Action Party pledging to field up to 50 candidates.
Labour’s ambitions for public health
A policy paper leaked to the Daily Mail indicates that Labour are considering a wide range of measures to improve public health including regulations to limit the levels of fat, salt and sugar in children’s food and a minimum unit price for alcohol.
Labour considers an increase in National Insurance to fund an increase in NHS funding
'We have to think about the second phase of the life of the NHS. It has to be reborn. Otherwise it will be unsustainable in a few years' time.'
Newspaper reports suggest that Labour are considering proposals to increase National Insurance to pay for an increase in NHS funding.