What are the parties prescribing to keep the NHS in rude health?
- Credit: PA
It goes without saying now that at every General Election the NHS becomes a key political battleground as every party fights to prove they have the answers for this important and emotive issue. Reporter KIM BRISCOE outlines the key challenges and policies for health and social care.
The cost of healthcare is rising rapidly, fuelled by expensive new technologies and drugs, and an ageing population with increasingly complex health and social care needs.
And NHS England predicts there will be a mismatch of nearly £30bn a year by 2020/21 if growing demand is met by no further annual efficiencies and continued flat real-terms funding.
In its Five Year Forward View, published last October, it warns that action will be needed on all three fronts – demand, efficiency and funding – and less impact on any one of them will require compensating action on the other two.
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NHS England thinks £22bn of this funding gap can be bridged by making care more efficient, for example looking after older people closer to their homes rather than treating them with expensive hospital care.
But that still leaves £8bn to find, if we are to have a health service providing the high level of care that patients expect.
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So far the NHS has responded well to challenges to become more efficient and make savings, but financial pressures are growing, with more than a quarter of hospitals reporting deficits in 2013/14, and many more set to follow suit this year.
Since 1950, the NHS has enjoyed an average growth in funding of about 4pc a year, but in this parliament it's been only about 0.8pc a year.
Beccy Baird, of independent think-tank The King's Fund, says: 'The NHS did really well for the first couple of years, doing more for less and doing everything it could.
'We are coming to the end of the line of the big levers the NHS could pull to reign in spending. Most of the NHS budget goes on staff and they have had a pay freeze, which is a good way of holding down costs, but that lever has now gone.'
Meanwhile, cuts in funding have led to a reduction of more than a quarter in the number of people who receive publicly funded social care.
All this means the next government will arrive in office with the NHS facing financial meltdown and social care in crisis.
Dr Tim Morton, chairman of the Norfolk and Waveney Local Medical Committee, which represents GPs, says funding is crucial, for social care as well as health.
He says: 'We have to have an open an honest debate about what the NHS can deliver and about what patients can expect and what they can't expect.
'We have developed a 24/7 culture without the resources to supply that demand.'
Access to GPs
Many of the manifestos include pledges to improve access to GPs. But the problem is that surgeries in East Anglia are struggling to recruit GPs, with Watton and Costessey just two of the towns hit by recruitment problems in recent years.
Doctors say medical students don't want to become GPs, so where all the extra GPs will come from needs to be answered, especially as it can take years to train them up.
And the British Medical Association is warning that its survey of 15,000 GPs found that a third of those were considering retiring from general practice within the next five years.
The King's Fund says the current model of general practice dates back to 1948, and questions whether it needs to be looked at again.
Dr Morton says he feels promises being made by politicians demonstrate that they have no true understanding of the problems.
He says: 'We are fed up of the political grandstanding and the headline-grabbing promises.
'What we need instead is a very honest and open debate about the future of general practice.
'We are in a situation where we don't have enough GPs to deliver an effective and safe health care patients.'
He adds: 'Where are all the extra GPs going to come from? We can't fill GP training schemes and we can't recruit.'
A&E and out-of hours
The region's hospitals and ambulance service have been at the sharp of increased demand.
Getting people out of hospital and improving social care needs to be a priority if our accident and emergency departments are to cope better, according to Beccy Baird of the King's Fund. Community nursing is very important, joining up with care homes and keeping people out of hospital should be priorities.
Dr Morton says: 'Many of the problems of the hospitals are due to social care problems and not being able to discharge.'
Slowly, mental health services are starting to gain some more recognition from politicians.
Ms Baird said: 'Everybody is talking a lot more about mental health which is only a good thing.
'There are a lot of things we know we need to do and aren't doing, particularly around crisis care.'
In February Norfolk and Suffolk NHS Foundation Trust became the first mental health trust in the country to be placed in special measures, after the Care Quality Commission rated the trust 'inadequate', raising concerns about the safety of services, staffing levels and leadership.
Ms Baird said: 'Mental health trusts have had their funding squeezed and they are funding differently to other trusts which has made it harder for people to get really underneath how to provide service effectively and efficiently.
'They have tended to feel cuts more.'
She said crisis care and people being sent out of area for treatment are concerns which need to be addressed.
Health and social care
All the main parties seem to be agreed on one thing – that health and social care needs to be better integrated, even if they have set out different ways in which to achieve this ambition.
However, how to address the significant and growing pressures facing social care services, has been largely left unanswered by the manifestos.
With Norfolk and Suffolk predicted to have a growing number of older people in the coming years, how we care for our elderly is likely to become a key challenge for our health and social care system.
There's a strong drive towards provided more care in the community, closer to people's homes, rather than in hospitals, but it might not add up to large savings.
Ms Baird said: 'The evidence around is that's it's much more about providing sensible, good quality services for patients rather than it being about saving money.'
Dr Morton says: 'The problem is an elderly population and increased demand on NHS resources. It needs to be about how we effectively use health and social care toegther.
'The elderly population need extra social care.'
Beccy Baird said: 'The NHS is constantly being battered by changes and distractions and reorganisations.
'The only way of really getting hold of this is to radically alter the way in which we provide services, but the NHS need a bit of head room to do that.
'That is not easy to effect if you are being shouted at about targets.
'You need to give the NHS the resources it needs and the time and space to just do it.'
The main parties' health pledges
The Tories have committed to at least an extra £8bn a year over and above inflation by 2020 for the NHS, and to ensure seven-day access to key NHS services, such as GPs,for all patients by the end of the next parliament.
The manifesto also includes pledges to guarantee same-day GP appointments for everyone over 75, reintroduce the right to a named GP, and improve transparency by giving patients access to full information about the safety record of hospitals and other providers.
ANALYSIS: The extra money is much-needed, and even then it's just the minimum required to plug the funding gap, but questions still remain on how this will be funded and it is essential that increased spending on the NHS does not come at the expense of further cuts to social care budgets. A seven-day NHS is the right ambition but delivering it by 2020 will be a tall order.
The Greens are pledging to increase NHS funding by £20bn a year by 2020. This is matched by commitments to restore the proportion of NHS spending on primary care to 11pc, and to spend an extra £9bn a year to provide social care free at the point of use. The manifesto also restates the party's commitment to introduce an NHS Reinstatement Bill to abolish competition and the commissioner–provider split, and restore the Health Secretary's responsibility to provide a comprehensive health service.
ANALYSIS: It's all about whether their numbers add up, and some the ways in which they hope to fund these spending plans could be seen as being very optimistic. The Greens also say they would carry on spending more each year than the government gets from revenue.
Labour is promising that people will be able to see a GP within 48 hours, which the party says will help to tackle A&E waiting times.
The party plans to recruit 20,000 more nurses, 8,000 more GPs, 3,000 more midwives and 5,000 new care workers, to guarantee a maximum one-week wait for cancer tests, to create fairer access to mental health services and to prioritise the integration of health and social care.
It is also pledging to repeal the controversial Health and Social Care Act, making changes to ensure the health secretary has a duty to guarantee a national service free at the point of use, removing enforced competition and ensuring private patients aren't put before NHS patients.
ANALYSIS: It is hard to see how the plans to dismantle the Health and Social Care Act could be achieved without yet more disruptive structural changes to the NHS. The big question is about funding, with Labour now the only one of the three main parties not to have pledged to find the £8bn a year in additional funding called for and which leaves a significant gap at the heart of its plans.
The Lib Dems are promising £500m investment to transform mental health services, the extra £8bn a year NHS leaders say is needed, and a commitment to deliver integrated care, including a pledge to transfer responsibility for social care to the Department of Health and a target date of 2018 to pool NHS and social care budgets locally. They plan to introduce a package of support for carers, including a £250 Carer's Bonus every year and to remove NHS mergers from the jurisdiction of the Competition and Markets Authority.
ANALYSIS: Again, the funding of the extra £8bn needs to be looked at more closely, as detail shows it won't be available until 2017/18, so it will not address the immediate financial pressures facing the NHS.
The party has led the way in pushing mental health up the agenda and plans to prioritise spending on mental health and community services would be welcomed.
UKIP pledges the party would spend £3bn a year more on the NHS and £1.2bn a year more on social care over the next parliament.
The party wants to ensure that GPs' surgeries are open at least one evening per week, where there is demand for it, and to initiate pilot programmes in English hospitals to put GPs on duty in A&E departments seven days a week. It pledges funding for 8,000 more GPs, 20,000 more nurses, 3,000 more midwives and the construction of a dedicated, fully-staffed military hospital as well as investment of £130m a year into researching and treating dementia by 2017.
It also pledges that migrants and visitors to the United Kingdom will be required to have medical insurance and that full entitlement to NHS services will only be granted once someone has paid taxes in the United Kingdom for at least five years.
Other commitments include fully integrating health and social care under the control of the NHS and abolishing hospital parking charges in England.
ANALYSIS: The funding pledges fall far short of what the NHS is going to need in coming years, which would mean a further squeeze on services. Enforcing the pledges around medical insurance and entitlement to NHS services is likely prove difficult and problematic.