News / Election analysis

The election campaign appeared to kick off with a whimper rather than a bang. No ‘snap’ election was called, nor a faltering government forced to go to the polls after losing a dramatic late-night vote of confidence in the House of Commons. As planned, parliament was formally ended (prorogued) on 26 March and dissolved four days later. But even before it was dissolved, the political parties engaged in battle on the NHS.

 With the NHS traditionally seen as safe ground and a vote winner for Labour, the party was out of the traps quickly. On 27 March, leader Ed Miliband announced that, if elected, he would cap the profits of private firms that provide clinical services to the NHS. He said firms would have to reimburse the NHS if profits exceeded 5% on contracts worth more than £500,000. Contracts with private providers were ‘draining money away’ from the NHS, he suggested, adding that the default profits threshold could be set above or below 5% depending on the circumstances.

 The next day the Conservatives hit back, with David Cameron committing to a ‘truly seven-day NHS’ in England by 2020. The drive towards seven-day operation will be familiar to many in the NHS and is in line with the Five-year forward view. Political commentators said Mr Cameron was determined to neutralise the Labour advantage on health and hoped the policy would chime with the voters. The British Medical Association said seven-day operation would have to be properly costed, funded and staffed.

 The NHS was now established as one of the top battlegrounds and so it remained throughout the first four weeks of the campaign – in stark contrast to the 2010 general election, when it was barely debated at all. The focus quickly turned to funding. The Conservatives made a further NHS announcement, with health secretary Jeremy Hunt committing a future Tory administration to finding the additional £8bn a year the forward view said would be needed by 2020. Up to that point, only the Liberal Democrats had pledged to fund the £8bn.

 Relatively quiet up to now, the Lib Dems entered the health fray, with their leader Nick Clegg challenging the Tory and Labour leaders to show how they would find the forward view £8bn. Mr Clegg said his party would find the shortfall through the additional £2bn allocated to the NHS in the autumn statement and by closing some tax reliefs, such as on capital gains tax. He also pledged to establish a £500m a year ‘care closer to home’ fund. This would expand home and community care and encourage GP practices to work together to provide diagnostic services traditionally provided in hospitals. The party’s Manifesto for the mind pledged to spend £3.5bn over six years on mental healthcare in England. This would include funding for new services to help new mothers with depression and to help reduce mental health waiting times.

 The first TV debate took place and the party leaders clashed over the NHS. Ed Miliband urged viewers to use their vote to secure the future of the service, while David Cameron called it the most important national institution. However, Nick Clegg said the NHS needed hard cash. UKIP leader Nigel Farage raised the issue of health tourism and claimed 60% of those diagnosed as HIV positive in the UK each year were foreign nationals. After the debate, a YouGov poll found 50% of respondents backed UKIP’s policy of preventing those coming into the UK receiving NHS treatment for five years.

 In the second week, Mr Hunt reiterated the Conservative commitment to NHS funding. In a BBC Radio 4 interview, he said: ‘We will give whatever they need – it might be more than £8bn, it might be less.’ The £8bn was later confirmed by chancellor George Osborne, who said the money would be in addition to the £2bn ‘down payment’ made in his autumn statement.

 Meanwhile, Labour attacked the coalition government record on access to GPs in England. It claimed there were fewer GP surgeries open in the evening and weekends than before 2010. A party election poster warned: ‘The Tories are making it harder to see a GP’. Labour health spokesman Andy Burnham claimed the proportion of surgeries open in the evenings and at weekends had fallen from 77% to 72%. The Lib Dems and Conservatives said the figures were out of date and did not account for the challenge fund to extend GP access.

 The use of technology to create a paperless NHS was uppermost in the minds of the Lib Dems. They promised to get behind an NHS digital revolution with £250m for new technology. The money would come from the sale of no longer used NHS assets, the party said.

 Week three was all about manifestos. Labour published a health manifesto ahead of its overarching manifesto, its key policies being the creation of 3,000 extra midwife posts and the implementation of integrated physical, mental and social care. The latter would not be imposed by a top-down reorganisation, it said. Launching its election manifesto on 13 April, the party reiterated its commitment to providing a £2.5bn ‘time to care’ fund to provide the additional midwives, 20,000 more nurses and 8,000 more GPs. Mr Burnham said further funding could be found. He said the Five-year forward view left many questions unanswered and a Labour government would make other changes that would alter the assumptions on which it was based.

 The Tories were next – reaffirming their commitment to the additional £8bn in funding and seven-day access to services by 2020 in their manifesto. Same-day GP appointments for over-75s were guaranteed under a Conservative government, while there would be greater access for patients to the safety record of hospitals and other providers. A Conservative government would continue to join up services. This included piloting new ways of integrating care, such as the Greater Manchester initiative, and through the better care fund. The manifesto added there would be a focus on dementia, diabetes and cancer – the Conservatives would continue to invest in the cancer drugs fund, for example.

 The Lib Dems also confirmed their commitment to the £8bn forward view funding and put mental health at the heart of their offering. The party wants to secure local agreement on pooled NHS and social care budgets by 2018, transfer responsibility for social care to the Department of Health and to stop the Competition and Markets Authority ruling on NHS mergers.

 Away from the parties, the most telling contribution to the health debate came from former NHS England chief executive Sir David Nicholson. He told BBC Radio 4’s Today programme that the health service in England had a ‘substantial financial problem’ that was being ignored during the election campaign. The NHS, particularly the hospital sector, was accruing large deficits that would become ‘crystal clear’ in the autumn, he said. He expected there would be emergency action such as vacancy freezes to address the problem.