BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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News
NEWS UK GENERAL ELECTION 2015
What the political parties are pledging on the NHS With the UK general election approaching, the main parties are launching their manifestos this week. Gareth Iacobucci outlines their pledges on the NHS and healthcare Gareth Iacobucci The BMJ
Conservative Party https://www.conservatives.com/manifesto
Money • Continue to increase spending on the NHS, supported by a strong economy, so the NHS stays free at point of use
• Spend at least £8bn a year above inflation by 2020 to fund and support the goals of NHS England’s Five Year Forward View • Invest more in primary care
• Guarantee that people will not have to sell their home to fund their residential social care
Organisation • Continue to integrate health and social care through schemes such as the pooling of budgets in Greater Manchester and the Better Care Fund
• Implement the findings of the Innovative Medicines and Medical Technology Review
• Increase the use of cost effective new drugs and technologies and encourage large scale trials of innovative technologies and health services
Staffing • Before its manifesto launch, the Conservatives pledged to train an additional 5000 GPs (pledge not specified in the manifesto)
Access and new targets • Enable everyone in England to be able to see a GP from 8 am to 8 pm, seven days a week, by 2020 • Provide same day GP appointments for patients aged over 75 • Lead the world in fighting cancer and in finding a cure for dementia • Improve standards in all areas of care
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• Provide people with full access to their own electronic health records, while retaining their right to opt out of records being shared electronically • Enforce the new access and waiting time standards for people with mental ill health, including children and teenagers
• Ensure that women have access to mental health support during and after pregnancy, while strengthening the health visiting programme for new mothers • Increase support for full-time unpaid carers
Use of private sector • No pledges specified
Public health • Introduce plain packaging of cigarettes
• Take action to reduce childhood obesity and continue to promote clear food information
• Be the first country to implement a national, evidence based diabetes prevention programme
Labour Party www.labour.org.uk/page/-/BritainCanBeBetterTheLabourPartyManifesto2015.pdf
Money • Invest £2bn in a new “Time to Care” fund, paid for by a mansion tax on properties worth over £2m, a levy on tobacco firms, and tackling tax avoidance
• Increase the proportion of the mental health budget that is spent on children
Organisation • Integrate physical health, mental health, and social care services into a single system of “whole person care” that offers personal care plans and a single point of contact for people with the greatest needs Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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• Bring local healthcare and social care commissioning and budgets together to join up services and make sure providers are incentivised to help people stay healthy and keep out of hospital • Repeal the Health and Social Care Act 2012
• End time limited (15 minute) social care visits and introduce “year of care” budgets to incentivise better care in the home
Staffing • Recruit 20 000 more nurses, 8000 more GPs, and 3000 more midwives (through the “Time to Care” fund)
• Recruit 5000 new homecare workers in the NHS to support people to stay in their home (through the “Time to Care” fund) • Tackle exploitation of care workers so that travel between appointments is not an excuse for paying below the minimum wage and ban “zero hour” contracts • Incorporate mental health into NHS training to help tackle problem of undiagnosed mental illness
Access and new targets • Guarantee a GP appointment within 48 hours—and on the same day for those who need it
• Guarantee that by 2020 patients will wait no longer than a week for vital cancer tests and results • Give mental health the same priority as physical health
• Aim to ensure that the great majority of patients can access talking therapies within 28 days and that all children who need school based counselling can access it • Introduce a system of safety checks to identify risks facing vulnerable older people and enable preventive measures to be put in place, such as grab rails to prevent falls
Use of private sector • Make the NHS the preferred provider of healthcare services • Cap profits on all private sector contracts. (Previously Labour had said that this would apply to contracts worth more than £500 000, at 5%. It had also said that it would permit the raising or lowering of the cap to reflect specific terms of individual contracts) • Support the principles behind the Transatlantic Trade and Investment Partnership Treaty but ensure that the NHS is protected from the treaty
Public health • Set new national ambition to improve the uptake of physical activity • Take targeted action on high strength, low cost alcohol products that fuel problem drinking • Set maximum permitted levels of sugar, salt, and fat in foods that are marketed substantially to children
• Put climate change “at the heart of foreign policy,” making the case for ambitious emissions targets for all countries and for a goal of net zero global emissions in the second half of this century
For personal use only: See rights and reprints http://www.bmj.com/permissions
Liberal Democrats http://bit.ly/1FK2fco
Money • Invest £8bn additional funding in the NHS by 2020. Raise NHS spending by £1bn a year above inflation until books are balanced in 2018, funded by scrapping the “shares for rights” scheme, increasing dividend tax on the highest earners, and tightening the cap on pension tax relief. Once the deficit is eliminated, raise the NHS budget in line with economic growth so that it will be getting at least an extra £8bn a year by 2020 • Invest half the initial £1bn in providing care in people’s own homes and communities, preventing emergency admissions and making it easier to discharge people after a stay in hospital
• Increase spending on mental healthcare in England by £500m a year by 2016-17 (half of which was delivered in this year’s Budget). Provide money for similar investments in Scotland, Wales, and Northern Ireland • Establish a world leading mental health research fund, investing £50m to further our understanding of mental illness and develop more effective treatments
• Introduce a “patient premium” to encourage GPs and other community clinicians to work in disadvantaged areas • Commission a fundamental review of NHS and social care finances in 2015
• Work with the regulator Monitor to reform NHS funding systems, moving away from payments for activity to tariffs that encourage joined-up services and preventive care • Review rules for exemption from prescription charges to ensure they are fair to people with long term conditions and disabilities
• Work towards a global deal to release significant additional funds for finding a cure or preventive treatment for dementia, doubling NHS research spending for this condition by 2020 • Introduce an annual carer’s bonus of £250 for carers looking after someone for 35 hours or more each week • Work to raise the amount you can earn before losing Carer’s Allowance from £110 to £150 a week
• Consult on introducing five days’ paid additional “care leave” a year for carers who qualify for the Carer’s Allowance
• Introduce a cap on the cost of social care so that people don’t have to sell their home to pay for their care
• Provide more choice at the end of life, and ensure that social care at the end of life is free for people placed on their local end of life register if evidence shows it to be affordable and cost effective
Organisation • Join up health and care at the national level, shifting full responsibility for care policy and funding to the Department of Health for England • Secure local agreement on the full pooling of budgets between the NHS and care services, with a target date of 2018, consulting on a legal duty for this. The details of how services are commissioned will remain a matter for
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BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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local areas. Build on the recent proposal to integrate health and care funding in Manchester
• Continue to develop health and wellbeing boards to take a broad view of how services can improve wellbeing in their area, ensuring democratic accountability for local care • Combine the public health, adult social care, and health outcome frameworks into a single national wellbeing outcomes framework, to ensure that the NHS and local government work together towards common goals
• Support new joined-up services such as GPs providing services such as scans and blood tests closer to home, or hospitals having GP surgeries within the emergency department
• Encourage the development of joined-up health providers, which cover hospital and community services, including GPs, thus learning from international best practice. Permit NHS commissioners and providers in a local area to form a single integrated health organisation where appropriate • Transform care for pregnant women, new mothers, and women who have experienced miscarriage or stillbirth and help them get the early care they need • Implement proposals outlined in the report of the government’s Children’s Mental Health Taskforce, using the £250m a year announced in this year’s Budget. This will include building better links with schools, ensuring that all children develop mental resilience, and getting support and care quickly to those who are struggling
• Integrate mental health and physical health services and change the way that mental health is funded, removing block contracts and replacing them with performance based payment mechanisms • Bring together a group of independent experts and academics to help develop a mental health research strategy and communicate findings to health commissioners
• Radically transform mental health services, extending the use of personal budgets, integrating care more fully with the rest of the NHS, introducing rigorous inspection and high quality standards and comprehensive collection of data to monitor outcomes and waiting times, and changing the way services are funded so they do not lose out in funding decisions in future • Publish a national wellbeing strategy, which puts better health and wellbeing for all at the heart of government policy. This will cover all aspects of government policy, including transport, access to nature, and housing, at a national and local level
• Encourage health services to link up with local authority social care teams and voluntary services to join up care
Staffing • Introduce care navigators so that people get help finding their way around the system, and set standards to improve the physical health of people with mental health problems
• Ensure that all frontline public service professionals, including in schools and universities, get better training in mental health—helping them to develop their own mental resilience—as well as learning to identify people with mental health problems • Support community services and volunteers working to combat loneliness, particularly in later life For personal use only: See rights and reprints http://www.bmj.com/permissions
• Better utilise the network of community pharmacists across the country so they become the first point of contact for advice on minor illnesses and are joined up with GPs and community health teams • Give the NHS a legal duty to identify carers and develop a “carer’s passport” scheme to inform carers of their rights in the NHS, like more flexible visiting hours, and to assert their role as expert partners in care and gain access to support
Access and new targets • Enable hundreds of thousands more people to access talking therapies for anxiety and depression. The long term goal is to see everyone who can benefit being treated, but an interim target will be set to get 25% of these people into treatment
• Guarantee treatment within two weeks of being referred by a GP for young patients experiencing psychosis for the first time • Improve waiting time standards for mental healthcare so that no one with depression or anxiety waits more than six weeks for treatment • Ensure that no one in crisis is turned away, with new waiting time standards and better crisis care in hospital emergency departments, in the community, and through phone line services. This will enable the ending of the use of police cells for people facing a mental health crisis • Give patients easier access to GPs and more choice, with more practices opening at evenings and weekends and offering phone and Skype appointments
• Set ambitious goals to improve outcomes in the most serious life threatening diseases, such as cancer, and long term conditions such as dementia
• Set clear goals for earlier diagnosis and improved aftercare for conditions such as cancer and heart disease • Improve patient safety by updating the laws on regulation of health professionals and on cosmetic procedures
• Get the best for the NHS out of innovative drugs and treatments while continuing to ensure value for money for the NHS in negotiations on the cost of drugs, promoting the use of generic drugs where appropriate
• Support, including through rules on public funding and research, for moves to ensuring that all clinical trials are registered, with their methods and summary results reported publicly
Use of private sector • Repeal any parts of the Health and Social Care Act 2012 that make NHS services vulnerable to forced privatisation through international agreements on free markets in goods and services
• End the role of the Competition and Markets Authority in health, making it clear that the needs of patients, fairness, and access always come ahead of competition and that good local NHS services do not have to be put out to tender • Ensure that member states’ rights to provide public services directly and not open them to competition are explicitly enshrined in the Transatlantic Trade and Investment Partnership and any future trade agreements Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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Public health • Develop a public health campaign to promote the steps people can take to improve their own mental resilience, the wellbeing equivalent of the “five a day” campaign
• Promote evidence based “social prescribing” of sport, arts, and other activity to help tackle obesity, mental health problems, and other health conditions, and work to widen the evidence base for this • Continue to introduce evidence based screening programmes, encouraging increased participation with informed consent
• Support effective public awareness campaigns such as Be Clear on Cancer, working closely with charities to raise awareness of the signs and symptoms of serious diseases • Keep public health within local government, where it is effectively joined up with preventive community services
• Restrict the marketing of junk food to children, including restricting TV advertising before the 9 pm watershed, and maintain the effective “five a day” campaign
• Encourage the “traffic light” labelling system for food products and publication of information on energy, fat, sugar, and salt content in restaurants and takeaway food. Reduce smoking rates, including by completing the introduction of standardised packaging for tobacco products • Introduce a tax levy on tobacco companies so that they contribute fairly to the costs of healthcare and smoking cessation services, subject to consultation on the detailed design and practicalities
• Carefully monitor the growing evidence base on electronic cigarettes and ensure that restrictions on marketing and use are proportionate and evidence based. For example, support restrictions on advertising that risks promoting tobacco or that targets under 18s, such as those introduced in 2014, but do not support a statutory ban on “vaping” in public places
• Introduce a minimum price on a unit of alcohol, subject to the outcome of the legal challenge in Scotland, and support the greater use of local authority powers and criminal behaviour orders to help communities tackle alcohol related crime and disorder • Pass a Nature Act to increase access to green spaces and a Green Transport Act to cut air pollution
Scottish National Party Manifesto not published in time for this article. Listed are the policy pledges the party has made on health so far.
Money • Increase NHS spending year on year in real terms to allow Scotland’s health budget to rise by £2bn by 2020 • End austerity policies
• Invest £100m to tackle delayed discharge • Retain free prescriptions in Scotland
Organisation • Streamline the work of health boards
Staffing • Reduce the number of senior managers in the Scottish NHS by 25% over the next parliament
Access and new targets • Ensure shorter cancer waiting times with policies such as one stop cancer diagnosis
Use of private sector • Protect the NHS from privatisation
• Oppose the Transatlantic Trade and Investment Partnership
Public health • Set a target for less than 5% of the population to smoke by 2034 • Push through legislation on minimum alcohol unit pricing (currently subject to a legal challenge led by the Scotch Whisky Association)
Plaid Cymru (Party of Wales) www.partyof.wales/uploads/Plaid_Cymru_2015_Westminster_ Manifesto.pdf
Money • Encourage innovation and attract more research funding • Retain free prescriptions in Wales
• Introduce a New Medicines and Treatments Fund for treatments not ordinarily available for patients on the NHS, with decisions applying nationally across Wales
Organisation • Integrate health and social care
• Propose a Medical Accountability Bill, including a duty of candour
• Support e-health and telemedicine to increase quality and speed of patient care • Support the AllTrials campaign (alltrials.net) for publication of all clinical trials
Staffing • Recruit 1000 extra doctors
• Develop a national workforce plan to ensure sufficient healthcare staff across Wales • Increase the number of district and community nurses
• Focus on providing training in Wales for more doctors, paramedics, nurses, and other professional healthcare workers. This will include a focus on ensuring sufficient Welsh speaking healthcare professionals and social workers to meet the needs of a bilingual society
• Increase resources for ambulances and staffing and ensure that there is sufficient emergency care available, including advanced practitioners such as nurses and paramedics, to treat people at the scene
• Integrate healthcare and social care
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BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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Access and new targets • Implement a national cancer plan
• Work to ensure that all patients with cancer have access to a specialist cancer nurse so that they are supported throughout treatment and beyond, including providing clinical advice and support with important practical issues such as finance and employment
• Increase access to talking therapies, as well as funding support for eating disorders and drug and alcohol treatment • Increase resources for mental health services for young people
Use of private sector • Reject the marketisation and privatisation of the NHS • Strongly oppose the inclusion of the NHS in the Transatlantic Trade and Investment Partnership
Public health • Support a tax on sugary drinks and a reduction in sugar in food and drink • Support the introduction of plain packaging on tobacco products and other measures to stop addiction to smoking • Introduce better regulation, including stricter marketing rules, on electronic cigarettes
• Introduce a 50p minimum price per unit on alcohol sales
• Introduce a Climate Change Act for Wales, adopting challenging but achievable greenhouse gas reduction targets for 2030 and 2050
Green Party www.greenparty.org.uk/assets/files/manifesto/Green_Party_ 2015_General_Election_Manifesto.pdf
Money • Immediately increase the overall NHS budget by £12bn a year
• Increase the overall NHS budget by 1.2% each year to take account of an ageing population. When combined with the yearly £12bn increase this will raise NHS budgets by around £20bn by 2020 • Ensure that spending on mental health rises
• Increase alcohol and tobacco taxes to help fund yearly increases in NHS spending
• Free social care for over 65s funded by taxation in the same way as the NHS • Free dentistry, chiropody, and prescriptions in England
• Set aside £5bn to buy out existing private finance initiative (PFI) contracts where this represents good value for money • Restore primary care funding to 2005 levels (11%) and review extending this further • Invest in dementia services to ensure that support is available to patients and carers
Organisation • Repeal the Health and Social Care Act 2012 and implement the NHS Reinstatement Bill For personal use only: See rights and reprints http://www.bmj.com/permissions
• Restore the obligation on the government to provide a comprehensive health service • Abolish competition and the purchaser-provider split • End market based commissioning and procurement
• Always consider whether services currently offered in hospital could be offered in the community • End mixed sex accommodation in hospitals
Staffing • Expand the workforce to drive the wholesale improvement of mental health services • Respect the NHS pay review body, bring the NHS’s pay back into line with inflation, and negotiate improved conditions
Access and new targets • Ensure that no one waits more than 28 days for access to talking therapies
• Ensure that everyone experiencing a mental health crisis has safe and speedy access to high quality care 24 hours a day, seven days a week • Ensure that everyone who requires a mental health bed can access one in their local NHS trust area unless they require specialist care and treatment. If this is required it should be within a reasonable distance of where the patient lives • Improve access to addiction services
• Work to ensure that cancer outcomes in the United Kingdom are as good as in the rest of Europe
Use of private sector • Restrict the role of commercial companies in providing NHS services
• Promote transparency by ending commercial confidentiality • Require NHS staff to declare financial interests that conflict with their role • Stop further PFI contracts and end the inappropriate sale of NHS assets
• Seek ways to buy out existing PFI contracts where this would represent good value for money (using the £5bn set aside)
Public health • Build systems to measure and improve the ecological impact of healthcare, from carbon costings of treatments (building them into National Institute for Health and Care Excellence guidelines) to setting targets on recycling in NHS trusts and the issue of waste disposal • Tackle air pollution by following more rigorous World Health Organization standards
• Extend value added tax at the standard rate to less healthy foods, including sugar, and spend the money raised on subsidising around one third of the cost of fruit and vegetables • Set a minimum price of 50p per unit of alcohol
• Treat drug addiction as a health problem rather than as a crime Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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• Adapt an evidence based approach to the step by step regulation of drugs currently banned under the Misuse of Drugs Act—starting with cannabis—as well as legal highs, with a view to introducing a system that brings the market under state control • Introduce a system of assumed consent for organ donation • Support the right to an assisted death, within a rigorous regulatory framework
• Go much further than the Climate Change Act in pursuing reductions in energy consumption. Set a target to reduce greenhouse gas emissions to 10% of their 1990 levels by 2030
UK Independence Party www.ukip.org/manifesto2015
Money • Committed to keeping the NHS free at the point of delivery • Provide an extra £3bn a year to the NHS in England by the end of the next parliament • An extra £170m a year for mental health services, phased in during the first two years of parliament
• An extra £130m a year by 2017 for research into dementia
• £200m to make parking at English hospitals free to patients and their visitors • Increase social care funding by £1.2bn each year, phasing in this increase over two years • If fracking becomes possible and profitable in the UK, social care costs will be capped at £35 000 and paid for with any tax revenue from shale oil and gas exploration and ringfenced in a Sovereign Wealth Fund
Organisation • Bring health and social care together under the control of the NHS
• Ensure that visitors to the UK and migrants, until they have paid national insurance for five years, have NHS approved private health insurance as a condition of entry to the UK, saving the NHS £2bn a year. Of the £2bn saved, £200m will be used to end hospital car parking charges in England
• Replace the health regulators Monitor and the Care Quality Commission with elected county health boards to be more responsive scrutineers of local health services. These will be able to inspect health services and take evidence from whistleblowers • Scrap the European Union’s Clinical Trials Directive, to boost clinical research
Staffing • Fund 20 000 more nurses, 8000 more GPs, and 3000 more midwives • Introduce a “licence to manage” as a statutory requirement to ensure that managers are competent and to prevent bullying managers being moved sideways or re-employed as external consultants • Scrap the EU Working Time Directive to give trainee doctors more time to learn essential new skills For personal use only: See rights and reprints http://www.bmj.com/permissions
• Abolish zero hour contracts for home care workers, with full pay while they are on duty
Access and new targets • Pilot programmes to put GPs on duty in every hospital emergency department seven days a week, and roll out if successful
• Allow GPs to spend more time actually seeing patients by reducing data collection, target chasing, and revalidation and appraisal work that interferes with the time GPs can spend delivering care
Use of private sector • Stop further use of private finance initiative contracts in the NHS
• Exclude the NHS from the Transatlantic Trade and Investment Partnership to prevent parts of the NHS being sold to US companies
Public health • Improve mental health services, including offering treatment for addiction, direct access to specialists for pregnant women and mothers of children under 12 months, and help for people with mental illness to return to work • End to postcode lottery for psychiatric liaison services in acute hospitals and emergency departments
National Health Action Party Manifesto not published in time for this article. Listed are the policy pledges the party has made on health so far.
Money • Fund the NHS to level of other G7 countries (minimum annual funding uplift of 4%). Use a 1p rise in income tax to fill the NHS spending gap while multibillion pound savings from other policies kick in • Abolish prescription charges
• Introduce free personal social care for elderly and disabled people • Tackle the crisis in general practice with injection of funding • Reject further austerity
Organisation • Repeal the Health and Social Care Act 2012 and implement the NHS Reinstatement Bill • Restore obligation on government to provide a comprehensive health service
• Abolish the internal market and replace it with a system based on resource allocation, not commissioning
• Any changes to emergency departments and hospitals must be based on evidence, with clinical reasons that have the support of the local population and staff • Integrate NHS health provision and local authority social care
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BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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Staffing • Ensure adequate staffing in hospitals, general practices, and community care
• Reduce the dependence of the NHS and the Department of Health on management consultants and increase the influence of healthcare professionals, staff, and patients
Access and new targets • Ensure “parity of esteem” for mental health services • Strengthen maternity services
• Make the social determinants of health an absolute priority in the design and development of all government policies
Use of private sector • Halt privatisation, end competition, and scrap the market in the NHS • Reinstate the NHS as the preferred healthcare provider • Remove the requirement to tender out contracts to the private sector • Renegotiate private finance initiative deals
• Oppose the Transatlantic Trade and Investment Partnership
Public health • Introduce plain packaging of all tobacco products and stricter controls on advertising. Investigation into electronic cigarettes • Introduce minimum unit alcohol pricing, tougher penalties and stricter enforcement of rules regarding sale of alcohol, stricter controls on marketing of alcohol, and calorie labelling
• Introduce a sugar tax for processed food and simpler, more overt labelling to enable consumers to make informed choices • Impose more stringent requirements on the fast food industry to cut the use of additives, including sugar and salt • Impose stricter rules on links between public health research, public officials, and the food, drink, and drug industries
• Promote healthy lifestyles with greater access to exercise and sport in schools and communities, as well as long term investment in urban transport so that walking and cycling will be safe and attractive options • Ensure adequate funding of public health education and policies within the public sector Cite this as: BMJ 2015;350:h2031 © BMJ Publishing Group Ltd 2015
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Page 1 of 7
News
NEWS UK GENERAL ELECTION 2015
What the political parties are pledging on the NHS With the UK general election approaching, the main parties are launching their manifestos this week. Gareth Iacobucci outlines their pledges on the NHS and healthcare Gareth Iacobucci The BMJ
Conservative Party https://www.conservatives.com/manifesto
Money • Continue to increase spending on the NHS, supported by a strong economy, so the NHS stays free at point of use
• Spend at least £8bn a year above inflation by 2020 to fund and support the goals of NHS England’s Five Year Forward View • Invest more in primary care
• Guarantee that people will not have to sell their home to fund their residential social care
Organisation • Continue to integrate health and social care through schemes such as the pooling of budgets in Greater Manchester and the Better Care Fund
• Implement the findings of the Innovative Medicines and Medical Technology Review
• Increase the use of cost effective new drugs and technologies and encourage large scale trials of innovative technologies and health services
Staffing • Before its manifesto launch, the Conservatives pledged to train an additional 5000 GPs (pledge not specified in the manifesto)
Access and new targets • Enable everyone in England to be able to see a GP from 8 am to 8 pm, seven days a week, by 2020 • Provide same day GP appointments for patients aged over 75 • Lead the world in fighting cancer and in finding a cure for dementia • Improve standards in all areas of care
For personal use only: See rights and reprints http://www.bmj.com/permissions
• Provide people with full access to their own electronic health records, while retaining their right to opt out of records being shared electronically • Enforce the new access and waiting time standards for people with mental ill health, including children and teenagers
• Ensure that women have access to mental health support during and after pregnancy, while strengthening the health visiting programme for new mothers • Increase support for full-time unpaid carers
Use of private sector • No pledges specified
Public health • Introduce plain packaging of cigarettes
• Take action to reduce childhood obesity and continue to promote clear food information
• Be the first country to implement a national, evidence based diabetes prevention programme
Labour Party www.labour.org.uk/page/-/BritainCanBeBetterTheLabourPartyManifesto2015.pdf
Money • Invest £2bn in a new “Time to Care” fund, paid for by a mansion tax on properties worth over £2m, a levy on tobacco firms, and tackling tax avoidance
• Increase the proportion of the mental health budget that is spent on children
Organisation • Integrate physical health, mental health, and social care services into a single system of “whole person care” that offers personal care plans and a single point of contact for people with the greatest needs Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2031 doi: 10.1136/bmj.h2031 (Published 15 April 2015)
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• Bring local healthcare and social care commissioning and budgets together to join up services and make sure providers are incentivised to help people stay healthy and keep out of hospital • Repeal the Health and Social Care Act 2012
• End time limited (15 minute) social care visits and introduce “year of care” budgets to incentivise better care in the home
Staffing • Recruit 20 000 more nurses, 8000 more GPs, and 3000 more midwives (through the “Time to Care” fund)
• Recruit 5000 new homecare workers in the NHS to support people to stay in their home (through the “Time to Care” fund) • Tackle exploitation of care workers so that travel between appointments is not an excuse for paying below the minimum wage and ban “zero hour” contracts • Incorporate mental health into NHS training to help tackle problem of undiagnosed mental illness
Access and new targets • Guarantee a GP appointment within 48 hours—and on the same day for those who need it
• Guarantee that by 2020 patients will wait no longer than a week for vital cancer tests and results • Give mental health the same priority as physical health
• Aim to ensure that the great majority of patients can access talking therapies within 28 days and that all children who need school based counselling can access it • Introduce a system of safety checks to identify risks facing vulnerable older people and enable preventive measures to be put in place, such as grab rails to prevent falls
Use of private sector • Make the NHS the preferred provider of healthcare services • Cap profits on all private sector contracts. (Previously Labour had said that this would apply to contracts worth more than £500 000, at 5%. It had also said that it would permit the raising or lowering of the cap to reflect specific terms of individual contracts) • Support the principles behind the Transatlantic Trade and Investment Partnership Treaty but ensure that the NHS is protected from the treaty
Public health • Set new national ambition to improve the uptake of physical activity • Take targeted action on high strength, low cost alcohol products that fuel problem drinking • Set maximum permitted levels of sugar, salt, and fat in foods that are marketed substantially to children
• Put climate change “at the heart of foreign policy,” making the case for ambitious emissions targets for all countries and for a goal of net zero global emissions in the second half of this century
For personal use only: See rights and reprints http://www.bmj.com/permissions
Liberal Democrats http://bit.ly/1FK2fco
Money • Invest £8bn additional funding in the NHS by 2020. Raise NHS spending by £1bn a year above inflation until books are balanced in 2018, funded by scrapping the “shares for rights” scheme, increasing dividend tax on the highest earners, and tightening the cap on pension tax relief. Once the deficit is eliminated, raise the NHS budget in line with economic growth so that it will be getting at least an extra £8bn a year by 2020 • Invest half the initial £1bn in providing care in people’s own homes and communities, preventing emergency admissions and making it easier to discharge people after a stay in hospital
• Increase spending on mental healthcare in England by £500m a year by 2016-17 (half of which was delivered in this year’s Budget). Provide money for similar investments in Scotland, Wales, and Northern Ireland • Establish a world leading mental health research fund, investing £50m to further our understanding of mental illness and develop more effective treatments
• Introduce a “patient premium” to encourage GPs and other community clinicians to work in disadvantaged areas • Commission a fundamental review of NHS and social care finances in 2015
• Work with the regulator Monitor to reform NHS funding systems, moving away from payments for activity to tariffs that encourage joined-up services and preventive care • Review rules for exemption from prescription charges to ensure they are fair to people with long term conditions and disabilities
• Work towards a global deal to release significant additional funds for finding a cure or preventive treatment for dementia, doubling NHS research spending for this condition by 2020 • Introduce an annual carer’s bonus of £250 for carers looking after someone for 35 hours or more each week • Work to raise the amount you can earn before losing Carer’s Allowance from £110 to £150 a week
• Consult on introducing five days’ paid additional “care leave” a year for carers who qualify for the Carer’s Allowance
• Introduce a cap on the cost of social care so that people don’t have to sell their home to pay for their care
• Provide more choice at the end of life, and ensure that social care at the end of life is free for people placed on their local end of life register if evidence shows it to be affordable and cost effective
Organisation • Join up health and care at the national level, shifting full responsibility for care policy and funding to the Department of Health for England • Secure local agreement on the full pooling of budgets between the NHS and care services, with a target date of 2018, consulting on a legal duty for this. The details of how services are commissioned will remain a matter for
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local areas. Build on the recent proposal to integrate health and care funding in Manchester
• Continue to develop health and wellbeing boards to take a broad view of how services can improve wellbeing in their area, ensuring democratic accountability for local care • Combine the public health, adult social care, and health outcome frameworks into a single national wellbeing outcomes framework, to ensure that the NHS and local government work together towards common goals
• Support new joined-up services such as GPs providing services such as scans and blood tests closer to home, or hospitals having GP surgeries within the emergency department
• Encourage the development of joined-up health providers, which cover hospital and community services, including GPs, thus learning from international best practice. Permit NHS commissioners and providers in a local area to form a single integrated health organisation where appropriate • Transform care for pregnant women, new mothers, and women who have experienced miscarriage or stillbirth and help them get the early care they need • Implement proposals outlined in the report of the government’s Children’s Mental Health Taskforce, using the £250m a year announced in this year’s Budget. This will include building better links with schools, ensuring that all children develop mental resilience, and getting support and care quickly to those who are struggling
• Integrate mental health and physical health services and change the way that mental health is funded, removing block contracts and replacing them with performance based payment mechanisms • Bring together a group of independent experts and academics to help develop a mental health research strategy and communicate findings to health commissioners
• Radically transform mental health services, extending the use of personal budgets, integrating care more fully with the rest of the NHS, introducing rigorous inspection and high quality standards and comprehensive collection of data to monitor outcomes and waiting times, and changing the way services are funded so they do not lose out in funding decisions in future • Publish a national wellbeing strategy, which puts better health and wellbeing for all at the heart of government policy. This will cover all aspects of government policy, including transport, access to nature, and housing, at a national and local level
• Encourage health services to link up with local authority social care teams and voluntary services to join up care
Staffing • Introduce care navigators so that people get help finding their way around the system, and set standards to improve the physical health of people with mental health problems
• Ensure that all frontline public service professionals, including in schools and universities, get better training in mental health—helping them to develop their own mental resilience—as well as learning to identify people with mental health problems • Support community services and volunteers working to combat loneliness, particularly in later life For personal use only: See rights and reprints http://www.bmj.com/permissions
• Better utilise the network of community pharmacists across the country so they become the first point of contact for advice on minor illnesses and are joined up with GPs and community health teams • Give the NHS a legal duty to identify carers and develop a “carer’s passport” scheme to inform carers of their rights in the NHS, like more flexible visiting hours, and to assert their role as expert partners in care and gain access to support
Access and new targets • Enable hundreds of thousands more people to access talking therapies for anxiety and depression. The long term goal is to see everyone who can benefit being treated, but an interim target will be set to get 25% of these people into treatment
• Guarantee treatment within two weeks of being referred by a GP for young patients experiencing psychosis for the first time • Improve waiting time standards for mental healthcare so that no one with depression or anxiety waits more than six weeks for treatment • Ensure that no one in crisis is turned away, with new waiting time standards and better crisis care in hospital emergency departments, in the community, and through phone line services. This will enable the ending of the use of police cells for people facing a mental health crisis • Give patients easier access to GPs and more choice, with more practices opening at evenings and weekends and offering phone and Skype appointments
• Set ambitious goals to improve outcomes in the most serious life threatening diseases, such as cancer, and long term conditions such as dementia
• Set clear goals for earlier diagnosis and improved aftercare for conditions such as cancer and heart disease • Improve patient safety by updating the laws on regulation of health professionals and on cosmetic procedures
• Get the best for the NHS out of innovative drugs and treatments while continuing to ensure value for money for the NHS in negotiations on the cost of drugs, promoting the use of generic drugs where appropriate
• Support, including through rules on public funding and research, for moves to ensuring that all clinical trials are registered, with their methods and summary results reported publicly
Use of private sector • Repeal any parts of the Health and Social Care Act 2012 that make NHS services vulnerable to forced privatisation through international agreements on free markets in goods and services
• End the role of the Competition and Markets Authority in health, making it clear that the needs of patients, fairness, and access always come ahead of competition and that good local NHS services do not have to be put out to tender • Ensure that member states’ rights to provide public services directly and not open them to competition are explicitly enshrined in the Transatlantic Trade and Investment Partnership and any future trade agreements Subscribe: http://www.bmj.com/subscribe
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Public health • Develop a public health campaign to promote the steps people can take to improve their own mental resilience, the wellbeing equivalent of the “five a day” campaign
• Promote evidence based “social prescribing” of sport, arts, and other activity to help tackle obesity, mental health problems, and other health conditions, and work to widen the evidence base for this • Continue to introduce evidence based screening programmes, encouraging increased participation with informed consent
• Support effective public awareness campaigns such as Be Clear on Cancer, working closely with charities to raise awareness of the signs and symptoms of serious diseases • Keep public health within local government, where it is effectively joined up with preventive community services
• Restrict the marketing of junk food to children, including restricting TV advertising before the 9 pm watershed, and maintain the effective “five a day” campaign
• Encourage the “traffic light” labelling system for food products and publication of information on energy, fat, sugar, and salt content in restaurants and takeaway food. Reduce smoking rates, including by completing the introduction of standardised packaging for tobacco products • Introduce a tax levy on tobacco companies so that they contribute fairly to the costs of healthcare and smoking cessation services, subject to consultation on the detailed design and practicalities
• Carefully monitor the growing evidence base on electronic cigarettes and ensure that restrictions on marketing and use are proportionate and evidence based. For example, support restrictions on advertising that risks promoting tobacco or that targets under 18s, such as those introduced in 2014, but do not support a statutory ban on “vaping” in public places
• Introduce a minimum price on a unit of alcohol, subject to the outcome of the legal challenge in Scotland, and support the greater use of local authority powers and criminal behaviour orders to help communities tackle alcohol related crime and disorder • Pass a Nature Act to increase access to green spaces and a Green Transport Act to cut air pollution
Scottish National Party Manifesto not published in time for this article. Listed are the policy pledges the party has made on health so far.
Money • Increase NHS spending year on year in real terms to allow Scotland’s health budget to rise by £2bn by 2020 • End austerity policies
• Invest £100m to tackle delayed discharge • Retain free prescriptions in Scotland
Organisation • Streamline the work of health boards
Staffing • Reduce the number of senior managers in the Scottish NHS by 25% over the next parliament
Access and new targets • Ensure shorter cancer waiting times with policies such as one stop cancer diagnosis
Use of private sector • Protect the NHS from privatisation
• Oppose the Transatlantic Trade and Investment Partnership
Public health • Set a target for less than 5% of the population to smoke by 2034 • Push through legislation on minimum alcohol unit pricing (currently subject to a legal challenge led by the Scotch Whisky Association)
Plaid Cymru (Party of Wales) www.partyof.wales/uploads/Plaid_Cymru_2015_Westminster_ Manifesto.pdf
Money • Encourage innovation and attract more research funding • Retain free prescriptions in Wales
• Introduce a New Medicines and Treatments Fund for treatments not ordinarily available for patients on the NHS, with decisions applying nationally across Wales
Organisation • Integrate health and social care
• Propose a Medical Accountability Bill, including a duty of candour
• Support e-health and telemedicine to increase quality and speed of patient care • Support the AllTrials campaign (alltrials.net) for publication of all clinical trials
Staffing • Recruit 1000 extra doctors
• Develop a national workforce plan to ensure sufficient healthcare staff across Wales • Increase the number of district and community nurses
• Focus on providing training in Wales for more doctors, paramedics, nurses, and other professional healthcare workers. This will include a focus on ensuring sufficient Welsh speaking healthcare professionals and social workers to meet the needs of a bilingual society
• Increase resources for ambulances and staffing and ensure that there is sufficient emergency care available, including advanced practitioners such as nurses and paramedics, to treat people at the scene
• Integrate healthcare and social care
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Access and new targets • Implement a national cancer plan
• Work to ensure that all patients with cancer have access to a specialist cancer nurse so that they are supported throughout treatment and beyond, including providing clinical advice and support with important practical issues such as finance and employment
• Increase access to talking therapies, as well as funding support for eating disorders and drug and alcohol treatment • Increase resources for mental health services for young people
Use of private sector • Reject the marketisation and privatisation of the NHS • Strongly oppose the inclusion of the NHS in the Transatlantic Trade and Investment Partnership
Public health • Support a tax on sugary drinks and a reduction in sugar in food and drink • Support the introduction of plain packaging on tobacco products and other measures to stop addiction to smoking • Introduce better regulation, including stricter marketing rules, on electronic cigarettes
• Introduce a 50p minimum price per unit on alcohol sales
• Introduce a Climate Change Act for Wales, adopting challenging but achievable greenhouse gas reduction targets for 2030 and 2050
Green Party www.greenparty.org.uk/assets/files/manifesto/Green_Party_ 2015_General_Election_Manifesto.pdf
Money • Immediately increase the overall NHS budget by £12bn a year
• Increase the overall NHS budget by 1.2% each year to take account of an ageing population. When combined with the yearly £12bn increase this will raise NHS budgets by around £20bn by 2020 • Ensure that spending on mental health rises
• Increase alcohol and tobacco taxes to help fund yearly increases in NHS spending
• Free social care for over 65s funded by taxation in the same way as the NHS • Free dentistry, chiropody, and prescriptions in England
• Set aside £5bn to buy out existing private finance initiative (PFI) contracts where this represents good value for money • Restore primary care funding to 2005 levels (11%) and review extending this further • Invest in dementia services to ensure that support is available to patients and carers
Organisation • Repeal the Health and Social Care Act 2012 and implement the NHS Reinstatement Bill For personal use only: See rights and reprints http://www.bmj.com/permissions
• Restore the obligation on the government to provide a comprehensive health service • Abolish competition and the purchaser-provider split • End market based commissioning and procurement
• Always consider whether services currently offered in hospital could be offered in the community • End mixed sex accommodation in hospitals
Staffing • Expand the workforce to drive the wholesale improvement of mental health services • Respect the NHS pay review body, bring the NHS’s pay back into line with inflation, and negotiate improved conditions
Access and new targets • Ensure that no one waits more than 28 days for access to talking therapies
• Ensure that everyone experiencing a mental health crisis has safe and speedy access to high quality care 24 hours a day, seven days a week • Ensure that everyone who requires a mental health bed can access one in their local NHS trust area unless they require specialist care and treatment. If this is required it should be within a reasonable distance of where the patient lives • Improve access to addiction services
• Work to ensure that cancer outcomes in the United Kingdom are as good as in the rest of Europe
Use of private sector • Restrict the role of commercial companies in providing NHS services
• Promote transparency by ending commercial confidentiality • Require NHS staff to declare financial interests that conflict with their role • Stop further PFI contracts and end the inappropriate sale of NHS assets
• Seek ways to buy out existing PFI contracts where this would represent good value for money (using the £5bn set aside)
Public health • Build systems to measure and improve the ecological impact of healthcare, from carbon costings of treatments (building them into National Institute for Health and Care Excellence guidelines) to setting targets on recycling in NHS trusts and the issue of waste disposal • Tackle air pollution by following more rigorous World Health Organization standards
• Extend value added tax at the standard rate to less healthy foods, including sugar, and spend the money raised on subsidising around one third of the cost of fruit and vegetables • Set a minimum price of 50p per unit of alcohol
• Treat drug addiction as a health problem rather than as a crime Subscribe: http://www.bmj.com/subscribe
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• Adapt an evidence based approach to the step by step regulation of drugs currently banned under the Misuse of Drugs Act—starting with cannabis—as well as legal highs, with a view to introducing a system that brings the market under state control • Introduce a system of assumed consent for organ donation • Support the right to an assisted death, within a rigorous regulatory framework
• Go much further than the Climate Change Act in pursuing reductions in energy consumption. Set a target to reduce greenhouse gas emissions to 10% of their 1990 levels by 2030
UK Independence Party www.ukip.org/manifesto2015
Money • Committed to keeping the NHS free at the point of delivery • Provide an extra £3bn a year to the NHS in England by the end of the next parliament • An extra £170m a year for mental health services, phased in during the first two years of parliament
• An extra £130m a year by 2017 for research into dementia
• £200m to make parking at English hospitals free to patients and their visitors • Increase social care funding by £1.2bn each year, phasing in this increase over two years • If fracking becomes possible and profitable in the UK, social care costs will be capped at £35 000 and paid for with any tax revenue from shale oil and gas exploration and ringfenced in a Sovereign Wealth Fund
Organisation • Bring health and social care together under the control of the NHS
• Ensure that visitors to the UK and migrants, until they have paid national insurance for five years, have NHS approved private health insurance as a condition of entry to the UK, saving the NHS £2bn a year. Of the £2bn saved, £200m will be used to end hospital car parking charges in England
• Replace the health regulators Monitor and the Care Quality Commission with elected county health boards to be more responsive scrutineers of local health services. These will be able to inspect health services and take evidence from whistleblowers • Scrap the European Union’s Clinical Trials Directive, to boost clinical research
Staffing • Fund 20 000 more nurses, 8000 more GPs, and 3000 more midwives • Introduce a “licence to manage” as a statutory requirement to ensure that managers are competent and to prevent bullying managers being moved sideways or re-employed as external consultants • Scrap the EU Working Time Directive to give trainee doctors more time to learn essential new skills For personal use only: See rights and reprints http://www.bmj.com/permissions
• Abolish zero hour contracts for home care workers, with full pay while they are on duty
Access and new targets • Pilot programmes to put GPs on duty in every hospital emergency department seven days a week, and roll out if successful
• Allow GPs to spend more time actually seeing patients by reducing data collection, target chasing, and revalidation and appraisal work that interferes with the time GPs can spend delivering care
Use of private sector • Stop further use of private finance initiative contracts in the NHS
• Exclude the NHS from the Transatlantic Trade and Investment Partnership to prevent parts of the NHS being sold to US companies
Public health • Improve mental health services, including offering treatment for addiction, direct access to specialists for pregnant women and mothers of children under 12 months, and help for people with mental illness to return to work • End to postcode lottery for psychiatric liaison services in acute hospitals and emergency departments
National Health Action Party Manifesto not published in time for this article. Listed are the policy pledges the party has made on health so far.
Money • Fund the NHS to level of other G7 countries (minimum annual funding uplift of 4%). Use a 1p rise in income tax to fill the NHS spending gap while multibillion pound savings from other policies kick in • Abolish prescription charges
• Introduce free personal social care for elderly and disabled people • Tackle the crisis in general practice with injection of funding • Reject further austerity
Organisation • Repeal the Health and Social Care Act 2012 and implement the NHS Reinstatement Bill • Restore obligation on government to provide a comprehensive health service
• Abolish the internal market and replace it with a system based on resource allocation, not commissioning
• Any changes to emergency departments and hospitals must be based on evidence, with clinical reasons that have the support of the local population and staff • Integrate NHS health provision and local authority social care
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Staffing • Ensure adequate staffing in hospitals, general practices, and community care
• Reduce the dependence of the NHS and the Department of Health on management consultants and increase the influence of healthcare professionals, staff, and patients
Access and new targets • Ensure “parity of esteem” for mental health services • Strengthen maternity services
• Make the social determinants of health an absolute priority in the design and development of all government policies
Use of private sector • Halt privatisation, end competition, and scrap the market in the NHS • Reinstate the NHS as the preferred healthcare provider • Remove the requirement to tender out contracts to the private sector • Renegotiate private finance initiative deals
• Oppose the Transatlantic Trade and Investment Partnership
Public health • Introduce plain packaging of all tobacco products and stricter controls on advertising. Investigation into electronic cigarettes • Introduce minimum unit alcohol pricing, tougher penalties and stricter enforcement of rules regarding sale of alcohol, stricter controls on marketing of alcohol, and calorie labelling
• Introduce a sugar tax for processed food and simpler, more overt labelling to enable consumers to make informed choices • Impose more stringent requirements on the fast food industry to cut the use of additives, including sugar and salt • Impose stricter rules on links between public health research, public officials, and the food, drink, and drug industries
• Promote healthy lifestyles with greater access to exercise and sport in schools and communities, as well as long term investment in urban transport so that walking and cycling will be safe and attractive options • Ensure adequate funding of public health education and policies within the public sector Cite this as: BMJ 2015;350:h2031 © BMJ Publishing Group Ltd 2015
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