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ELECTION SPECIAL: health policy round-up

05 May 2010 Breaking News

With health second only to the economy in voters' priorities according to several polls, Health Insurance magazine has produced a handy guide to the health policies of the three main parties to give you an idea of what the landscape might look like under a new government. We've also collected comment from a range of experts, including your fellow intermediaries.

Scroll down for a summary of what the parties are saying about six key policy areas and, as ever, let us know what you think at news@hi-mag.com 

Happy voting!

FUTURE FUNDING

KEY FACT: By 2014, the NHS could face a funding gap of £21-41m.

Source: Institute for Fiscal Studies

Both the Labour and the Conservative parties have pledged to protect the NHS budget, despite the extent of the structural deficit facing the country. The current government has said that 95% of the NHS budget "that supports patient care" will rise with inflation in 2011/12 and 2012/13 while the Conservatives have promised to increase health spending in real terms every year while cutting administration costs by a third. The Liberal Democrats have pledged to halve the size of the Department of Health and reduce the amount spend on health quangos by a third, including scrapping strategic health authorities.

However, most commentators are warning that cuts to the NHS are an inevitable consequence of the extent of deficit facing the incoming government.

"Public spending cuts will undoubtedly mean cuts to the NHS budget as well (despite what any of the major parties say in the lead up to the election)," said Dr Peter Mills, independent healthcare consultant at Glasslyn Healthcare Solutions. "If NHS funding is reduced in real terms then it is likely that waiting times in certain areas will increase which could provide an opportunity for private medical insurers to offer products and services to bridge this gap."

Whether this creates new opportunities for intermediaries is uncertain. Paul Roberts of IHC Ltd is not expecting an increase in demand for private solutions.

"Selling protection products will take a long time to recover and the belief that "it won't happen to me" will remain paramount," he said. "The industry needs to find products that offer lower cost points of entry to attract new customers."

WAITING TIMES

KEY FACT: The average wait for inpatient care has fallen from 13.2 weeks in March 1997 to 4 weeks in March 2009. The average wait for outpatient care has fallen from 4.8 weeks in March 2005 to 2.4 weeks in March 2009.

Source: The King's Fund

Waiting times for hospital care have traditionally taken centre stage in the battleground over health policy. Labour is now emphasising the decline in waiting times as a major success of its investment in the NHS since 1997.

At a recent Laing & Buisson conference, John Howard, senior consultant at national employee benefit consultants Buck Consultants, suggested that "the best kept secret is that for most non-serious operations in the NHS you do not need private medical insurance".

However, Paul Roberts disagrees. "Eighteen weeks is much better than before but still unacceptable to most business leaders to wait for valuable employees to be treated," he argues.

Even taking Labour's progress into account, there are questions about whether the shorter waiting times achieved in recent years can be sustained. Health thinktank The King's Fund warns in its latest publication A high performing NHS, that this might prove challenging as funds tighten in future.

Nevertheless, Labour has continued to promote the waiting times message, pledging in its manifesto to enshrine in law as patient rights the current targets such as the maximum two-week wait to see a cancer specialist. It has also promised that from 2011/12 patients will have a new right to have a cancer diagnostic test and results within one week.

Although the Conservatives have threatened to scrap "politically-motivated" targets it seems unlikely that those such as the two-week cancer wait will disappear under a Tory government.

"There's still no clarity about which targets will go, although a caveat has been added: the targets that will be dispensed with will be those with ‘no clinical justification', a hint, perhaps, that the rapid access targets for cancer might stay," said Ruth Thorlby of The King's Fund.

HOSPITALS

KEY FACT: There has been a 59% decrease in the number of MRSA episodes reported in England between 2007-2009.

Source: Health Protection Agency

Whichever government wins the election will inherit the complex problem of achieving greater efficiency in the NHS by reconfiguring services while facing fierce local opposition to hospital closures. The London Strategic Health Authority has already published a plan to reduce bed numbers in the capital by a third, to fierce opposition from the British Medical Association (BMA).

The Conservatives have promised to stop the "forced closure" of A&E and maternity wards, a pledge which some commentators feel the party will come to regret. The party has already had to dilute its pledge to build an extra 45,000 single rooms in NHS hospitals, to tackle the problems of mixed-sex accommodation and hospital-acquired infections, and is now promising to increase the number "as resources allow".

The Labour government has pledged to offer one-to-one dedicated nursing for all cancer patients and to transfer more care to patients' homes but the King's Fund's Thorlby notes that no timescales have been put on these commitments "leaving some wriggle room were Labour to be re-elected".

"Our experience of caring for 14,500 NHS patients in their own homes shows it can be more cost-effective, helps avoid hospital-acquired infections, and produces higher levels of patient satisfaction," said Steve Flanagan, managing director of Bupa Home Healthcare. "This is a key way for the NHS to meet its goals of improving its services against the background of the current economic climate and pressure on public spending."

WORKING WITH THE PRIVATE SECTOR

KEY FACT: The number of patient cases dealt with in private hospitals but paid for  by the NHS increased from 53,500 in 2007 to 151,000 in 2008.

Source: Laing & Buisson

While health secretary Andy Burnham caused a stir recently by referring to the NHS as the "preferred provider" of NHS services, all three parties remain committed to harnessing the private sector to deliver care on the NHS.

Whoever wins on the 6^th it seems likely that patients will continue to have the choice of receiving private treatment on the NHS, despite vocal opposition from the BMA. This may increase pressure on private hospital groups to differentiate their services for private patients from those available to NHS ones.

However, according to Adrian Fawcett, chief executive of BMI Healthcare, the country's largest private hospital group, the parties' proposals to involve his sector don't go far enough.

"The private and independent sectors need a seat at the healthcare planning table rather than continuing to be a ‘fail-safe' - stepping in to help only as and when needed", he said. "The NHS could utilise the spare capacity in the private and independent sectors to the benefit of the patient and cost-effective healthcare delivery. Our manifesto recommendations include the ability for people to pay extra for services carried out in the private sector, rather than lose their NHS entitlement, and a call to offer tax relief for people who self-pay for treatment or who have private medical insurance on the grounds that incentivising those that can afford it to increasingly take personal responsibility for their own healthcare helps reduce the burden on the NHS. " 

DRUGS

KEY FACT: UK per capita spending on cancer medicines currently stands at 60% of the European average.

Source: Association of the British Pharmaceutical Industry

As highlighted by a recent Health Insurance investigation, access to expensive new cancer drugs on the NHS remains varied. However, only the Conservatives have opted to raise it as an election issue, promising to establish a £200m Cancer Drugs Fund to ensure no cancer patient is refused access to drugs that have been licensed since 2005, if their doctors say they need them. They have also proposed to improve access to drugs for rare cancers by empowering specialists at a regional level to make funding decisions rather than allowing PCTs autonomy.

Reaction to this suggestion has been cautious.

"It is not clear what this proposal would mean for the status of NICE, which was set up to grapple with such decisions using clinical and economic evidence, while taking into account the interests of all current and potential NHS patients," said Ruth Thorlby of The King's Fund.

"In principle the Conservative Cancer Drugs Fund seems like an innovative approach to the ever escalating costs associated with treating cancer," said Dr Peter Mills. "It is, however, unlikely that the proposed £200m saving would get close to funding the demand for the existing high cost drugs (e.g. Avastin, Herceptin) let alone any new ones that are in the pipeline. My opinion is that the coming years will see the launch of more cancer drug top-up policies from insurers to cover the cost of such treatments should an individual be diagnosed with cancer."

LONG-TERM CARE

KEY FACT: Three in four of those over 65 will need some care during their retirement; and around one in five will face care costs of more than £50,000.

Source: Department of Health

While the three parties' health manifestos arguably contain little in the way of clear blue water, the funding of social care has proved a genuine battleground during the build-up to the general election. While Labour has pledged to extend the NHS model to social care, establishing a National Care Service by 2015, funded through compulsory contributions, the Conservatives have warned against Labour's "death tax" and proposed instead a voluntary insurance scheme. Meanwhile the Liberal Democrats have said they would scrap Labour's Personal Care At Home Bill and use the money saved to provide guaranteed respite care for one million carers.

"Voluntary insurance to pay for care with the possibility of a top-up to cover the cost of home care is fine for the people who can afford it but falls well short of a solution to the funding crisis facing the care system," said Michelle Mitchell‚ Age UK charity director.

"Political parties must not overlook the role of financial products to fund care. They will play an important role for any future government," said Chris Horlick, managing director of care at immediate annuities provider Partnership.