Cameron promises ‘a future barely recognisable from the present’ but the vast majority of his so-called proposals are already in place, just as John Appleby has said: higher funding for deprived populations (such as the area where I work as a doctor); more transparency of information about performance and standards (and quite right too); ending mixed sex accommodation; choice of provider; GPs’ pay linked to performance – all have been very much on the government’s agenda for years.
And cheeky too to highlight cancer mortality: yes, it’s true that it is higher in Britain than many other European countries but cancer mortality has improved very significantly under this government as a result of action taken to address the gap in comparison with the more laissez faire approach of the Tory years. Stroke survival? Yes, that too has been targeted in recent years with specific action to speed up access to immediate CT scanning and clot busting treatment.
Cheap jibes there are aplenty: ‘Making doctors and nurses accountable to patients rather than endless layers of bureaucracy.’ What does this mean precisely? The NHS is an immensely complex organisation that requires artful management, and administration costs are relatively very low in this country. Cameron counterposes targets (bad) with patient care (good). But tell me just who has benefited from much shorter waits in A&E, and from the transformation in the time to wait from referral to treatment, both key targets?
And where is the detail about the changes in commissioning arrangements that Andrew Lansley has hinted at? Cuddly GPs are to be encouraged to commission (we have that currently too in practice-based commissioning) but there is a notable silence about possible plans to outsource commissioning more widely…
Dame Jane Roberts, consultant child and adolescent psychiatrist
On the face of it Conservative plans for the NHS do not appear to be terribly radical and are founded on what I believe is a genuine commitment to securing a high quality health service. However, the move to give GPs commissioning budgets might actually undo some of the progress made in recent years by taking responsibility away from PCTs that are designed specifically for this task. While promising no further structural reorganisation the Conservatives are taking a gamble by charging clinicians with managing budgets and designing services, not just practising medicine. But the broader picture is gloomy for both parties – reduced health budgets will mean tough years ahead for the NHS whatever the outcome of the election.
David Furness, head of strategy, Social Market Foundation
As with so much Tory policy, Cameron’s plans for the NHS amount to a combination of insignificant meddling and unachievable soundbites. To the eyes of a GP like me, the most ill-considered proposal is to force family doctors to manage the entirety of their patients’ budgets, which would entail commissioning their hospital care. Not only has this been heavily criticised by the BMA as unworkable, it’s a policy that can hardly be described as change for a Conservative Party that introduced something similar (GP fund holding) when it was last in government 15 years ago. This draft manifesto provides ample evidence of the brazen shallowness of Cameron’s offer to voters.
Dr Neil Goulbourne, general practitioner, Coventry and medical lead, Coventry NHS healthcare and walk-in centre