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Political parties and NHS proposals

Perhaps unsurprisingly Labour is well ahead on NHS issues according to a new poll by Health Service Journal/FTI Consulting.

The growth in support for Labour comes after a month of well publicised performance challenges for the service, and concentrated campaigning on the NHS by the party.

Yet despite a winter in which the NHS has repeatedly made headlines over declining emergency performance, Labour's gains have largely not been at the expense of the Conservatives: its ratings are within one percentage point of where they were in June, while Labour's have improved.

Instead, Labour has been taking gains from smaller parties including UKIP and the Liberal Democrats. And this presents somewhat of a conundrum for the party when it comes to trying to win the election.

At the start of the year Labour launched its 10-year plan for health and care, which was met with a mixed reception.

Their proposals are admirable - a 'zero-based review of spending'; increased access to primary care, more emphasis on prevention, and the creation of a £2.5bn Time to Care Fund that Labour's leader Ed Miliband says will pay for 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives.

But health secretary Andy Burnham's biggest challenge is his key idea for the NHS - bringing health and social care closer together.

Howard Catton, the Royal College of Nursing's head of policy and international affairs says that he wants to see the political parties exploring more of the detail.

"I want to see some discussion about what these new models of integrated care might look like.

"If you look across the proposals for all the main political parties there are common themes around collaboration and varying degrees of integration and there is a move away from talking about competition to that of integration and leading of systems", he adds.

Elsewhere some are surprised by how little the Conservative Party has discussed the NHS so far in its pre-election proposals.

Its main focus has been on extending GP surgery opening hours with David Cameron promising “eight till eight” and weekend access to GPs for the whole population by the end of the next parliament, a pledge to ring-fence the health budget, keeping pace with inflation, and a recent promise to reduce waiting times for initial dementia assessments to six weeks.

Crystal Oldman, chief executive of the Queen's Nursing Institute says that while any party can say they will invest in more nurses the detail of where they will come from and where in the NHS they will work is more important.

"We need to see much more discussion around primary care and community working because it is in primary care that the majority of interactions with health take place," she says.

Ms Oldman also wants to see politicians focusing more of their attention on end-of-life care.

Meanwhile for the Liberal Democrats Nick Clegg's attempt to personally lead the government's focus on mental health has yet to translate into public trust - only 4% of the public say they trust him most to run the NHS, less than Nigel Farage who gets 6%.

Whether Clegg's move to be the first politician to commit to fully meet the £8bn funding gap identified by NHS England can do anything to shift this, remains to be seen.

Other Liberal Democrat proposals include a cross-party review on NHS spending and a cross-party 'Dilnot-style' commission on how the NHS can meet the needs of an ageing society contained within its policy paper Age Ready Britain.

The commission would “analyse future demand for health and social care, and make recommendations for how best to meet the needs of an ageing society”. It would be expected to engage extensively with the public, civil society organisations, and lead a national debate on “how we make the UK age ready”.

The Lib Dems are also proposing a second commission on supporting longer working lives.

One thing the polls do show is that despite the seeming media consensus that the NHS is close to, if not already in, a winter crisis, the Conservatives' position on health has held up.

Labour may still be the party the public trusts most with the NHS, but its lead on the issue is by no means stable.

Obi Amadi, lead professional officer at Unite Community practitioners and health visitors association (CPHVA) says that the parties need to make their policy proposals clearer.

"We all know from the various polls that the voting public rate the NHS and healthcare in their top three vote influencers, so it is really important that parties take this into account and make their proposed policies very clear.

"We would want to see from the next government a real investment in primary care. We have been hearing it for years, but there has not been a significant shift so far. Rather than making a patchy attempt, some pump priming funds are needed to really get it established.

"We also want to see what the main parties are saying about the wider determinants of health, mental health, housing, environment, education, poverty and employment, as these all have an important impact on health and wellbeing," she adds.

Meanwhile Mr Catton warns politicians against constantly using nurses and nurse numbers as a type of "currency" to be traded.

"The hope is that yes the number of nurses does increase but it is equally important to look at the skill mix and making sure we have the right numbers and grade of nurses in the right settings."

The key message from Labour is that the NHS as we know it will not survive another Conservative Government and that care needs to become increasingly integrated for the NHS to survive at all.

The Tories meanwhile say that a strong economy is the only way to ensure the future of the NHS while for the time-being any new policies it has for health service remain elusive.

And for their part the Lib Dems have set their sights on plugging the funding gap and addressing mental health service issues.

Using the NHS as a political weapon during election fever is as old as the institution itself, but as always it remains to be seen how important it will be in influencing the vote at the ballot box.