- Posted Tuesday April 1, 2014
The NHS is likely to be a major issue for all political parties in the run-up to the next general election. One much-criticised comment about the main political parties is that they are much the same, and look the same, and the problem is heightened towards general election time when the public have to make a choice. That’s what democracy is all about, after all.
Unfortunately, making an effective choice is like shopping in Asda. You go to the tinned food section because you want a tin of beans. They may have different makes and very different labels, so do you pick the tin on the left, the middle or the right? It makes no difference. When you get it home, it still contains beans.
Newcomers to the block UKIP are perhaps the most diverse of the major parties in most things, and they claim to offer a real difference in choice from the other more established parties. They certainly have some diverse views. It is timely to take look at their plans for the NHS to see just how different they may be.
In line with many of their ideas the UKIP health service policy is somewhat without meat on the bones – more of a strategic approach. This is to be expected as they are emergent, and it could be argued that they do not need detailed plans, as they are unlikely to form a government, at least at this time around. However, opponents will seize on the lack of detail as a weakness, barring them as real contenders as they have not thought things through. But how true is this? They are certainly without the major resources needed to formulate detailed proposals at the present time, and without a large and organised (and expert) party “machine” this would be difficult to do. Much of their time seems to be attempting to control their rogue factions appearing in the press every so often.
They certainly support the concept of treatment free at the point of delivery (whether you think this is currently actually happening or not) but the fact is that demand on the NHS is increasing, and funding is getting less, especially in primary care, and some monetary changes are still essential, before it all breaks.
UKIP oppose central control, and want to revert to local Health Boards, also giving “some” Boards the freedom to impose prescription charges. Central control is seen as bureaucratic and eating money. UKIP wants to drastically reduce the DoH to remove this waste and give the public “more control”. We have heard of public control before of course from each of the other parties, and this has been implemented in varying degrees via commissioning and public involvement, so is not a radically new concept. How UKIP differs is not certain. It is clear however that central departments and the DoH will be substantially cut.
UKIP state that they will;
- Direct the majority of health care spending to elected County Health Boards, making spending decisions directly accountable to the public locally.
- Cut the DoH and bring in professional procurement skills to reduce the huge amounts of money wasted in procurement and resource allocation.
- Prioritise UK taxpayers and citizens, ending health tourism by requiring all those without entitlement to pay in advance. Treatment on the NHS is the prerogative of British passport holders and tax payers. Those without entitlement will be strongly advised to have adequate health insurance, as British citizens do when travelling abroad.
- Restore traditional nursing, especially the non-university-trained State Enrolled Nurses or equivalent.
- Engender a Universal Duty of Care to ensure that everyone is responsible for reporting inadequate care and driving up standards.
In many ways this represents a return to some of the traditional values of past times, especially in a return to skilled vocational nursing and the delivery of hands-on patient nursing care. It will be interesting to see what the RCN stance is on this. It may be a return to more traditional patient needs-based nursing standards, where for some, patients not targets come first.
Health Boards are yet another cycle of the same old structures - what goes around comes around - but I think health tourism sanctions will be a popular vote-winner among the rank-and-file general public, who are, in the main, opposed to any form of system-abuse. But the devil is in the detail, which is not there.
The UK Independence Party is also exploring alternative models, such as those used in Australia, Germany and the Netherlands, taking the best of the NHS and the alternatives, but they have firmly rejected a USA insurance-based system. In due course this should lead to being able to offer people a choice, should they wish to use it.
They intend to:
- maintain the existing principles of the NHS
- scale down the Department of Health
- create elected County Health Boards
- devolve budgets and responsibilities straight to CHB members
- restore traditional nursing training and roles whilst safeguarding skills and knowledge
- give everyone a joint responsibility to improve standards for all
- restore free eye and dental checks
Many people have expressed concern that the move to university training has changed the opportunities for those born with a vocational calling who wish to provide the crucial core nursing care. UKIP will therefore restore hospital-based vocational training, similar to the old State Enrolled Nurse (SEN) system. Whilst highly educated and higher skilled nurses are now an integral and vital part of the healthcare team, the all-important core nursing skills will be restored.
The costs and provision of training for these vocational nurses (and similar roles in other healthcare areas) will be the responsibility of the CHBs.
If UKIP suddenly find themselves in a position of power, they are likely to struggle to implement change of any magnitude within the life of their parliament without detailed plans already in place and ready to go. I suspect that for this reason I see a series of “hits” rather than a full-on overhaul. The current government kicked off fundamental changes to the NHS straight after the last election, and these have not proven to be complete or successful even now, running out of time with a new election on the horizon. Any new government will certainly have to run with what is in place (CCGs) etc for a considerable period.
The healthcare debate is likely to escalate over the next few months as political parties start to bite. Keep your grocery eye peeled for the new label.
More on this later.