I got angry at the Lib Dems again

Don’t read this unless you are an idiot, this mostly exists for my purposes. If you start to read it, you surrender your right to point out that it is self-aggrandising onanism — I don’t care that it is.

The policies reviewed are taken from BMJ 2015;350:h2031

Conservative

Ticketty-tum, here they come, Tory
Ticketty-tum, here they come, Tory

Money — Of course, everyone is going to claim they will increase spending. Anything else by any party would be suicide: you can see that from the rest of the parties’ pledges and I promise you now that the DUP, UUP, SDLP, the MRLP and the National Liberal Coupon share the policy of putting more money into the NHS per year, at least nominally. From now on, I will not comment on any broad claims to “increase spending” because they are pointless.

More interestingly (though outwith the scope of this post) is the shared focus between the right-wing parties of government on home ownership, which even reaches into health policy. There is no pledge which guarantees you will never have to go without food or miss rent payments in order to afford care, which makes me think that this policy is not about social care, it’s about home ownership.

In all, the Conservative Party have no differentiating healthcare funding policies.

Organisation — There isn’t much here to see here. There is no point, in a piece which is implicitly comparing policies, in reviewing policies on which everyone agrees (see the “Money” section above) and I’d be very surprised if any party doesn’t support the integration of health and social care. I would also be very shocked if there was a party which doesn’t support cost-effective drugs and “innovative” health services.

What interests me about this section — and I am throwing around the concept of “interest” with liberal abandon — is that the manifesto mentions the government’s own dry and uninspired MedTech review, but not the ABPI’s recommendations on stratified medicines. While the latter report is imperfect and inevitably plagued by an undercurrent of self-interest, it is no less an interesting document which could positively influence future practice. Either the people behind this manifesto haven’t done their reading or, far more likely, the Conservatives don’t want to be seen to take their lead from industry. This is greatly to their detriment.

Again, from what is actually written, there is little to say.

Staffing — Aiming to train more GPs (and to train GPs better) is a pledge that implies a good understanding of the problems facing the health service. I have read in various that the UK is short 8000 GPs and the start of any cogent discussion would have to be a promise in the manifesto to increase GP numbers, surely.

However, this oft-repeated pledge is not in the Conservative manifesto. Therefore I give it equal weighting to other ex-manifesto pronouncements from the Tory party, such as “I’m too busy to take my kids to the GP, so I go to A&E” and “homeopathy works”, both from our current health secretary.

This section of the manifesto gets no points either.

Access and Targets — Anyone who grew up under New Labour will be aware that targets, least of all uncosted ones, are not always the most precise way to improve outcomes. For that reason it is perhaps troubling that this is the only section which seems to have been written with deliberation in the health segment of the document. However, targets listed in a manifesto at least indicate the direction that a party aims for — or claims to aim for, let us not forget 2010 — and I’ll judge them on that basis. After all, what other basis can you have?

GP access: good. Prioritising mental health: good. Supporting carers: good. Six out of ten, a convincing facsimile of a party that doesn’t mind if the vulnerable die, with a non-gratuitous bias in favour of the Tory-voting old.

Improve standards in all area of care: not a policy.

Use of private sector — This section is conspicuous by its absence. One can assume that this means that no change is intended, which is disappointing but not surprising.

Public health — This section of the programme is adequately do-gooding. However, it’s hard to be anything but positive in public health policy, if you care to include anything about it at all. Credit to the party for acknowledging the need, but the content is minimal. The one area of special focus is diabetes, which is an important problem, but no more so than heart disease. There is no insight to be found here and I would not be surprised to hear that one of the people who wrote this manifesto has diabetes in the family.

On a harsh reading: 4/10

*NB a rapid response to the BMJ article to which I refer is very critical of the policy (not listed under health) of removing benefits from patients who fail to attend counselling of whatever kind for mental health problems, obesity or addiction. This not only undermines the good work done to destigmatise mental health but also violates several overlapping codes of ethics in regard to coercion in medical treatment. The lesson here is that not all of a party’s intentions for vulnerable patients can be captured in the health section of their manifesto.

Labour

red tory
Diet Dr Tory with Cherry

Money — In the current times of straitened political manoeuvring, you have to commend any party that makes an attempt to cost their investments. 20 years ago Labour could argue that public spending was an investment, but those days are passed now and the necessary phrasing of this policy is positive, considering contemporary constraints. The name “Time to Care” is the worst kind of meaningless PR spin-tank nonsense, but if you rename it “recruitment fund” in your head and change nothing else then you must realise it is harmless.

I have no comment on the proportion of the mental health fund spent on children. Neither adult nor child mental health is enough of a priority, so proclaiming on this issue is all deckchairs and Titanics. Uninspired but leaning towards positive.

Organisation — The health and social care pledge is an obvious one, but phrased in such a way to suggest that the person who wrote it understands the need and has at least one suggestion to achieve it. The desire for a single doctor in charge of a complex care pathway is an almost constantly articulated desire in patients. Any steps towards this are admirable. While the likelihood of delivery-as-promised is slim, especially as the Labour party do not oppose compartmentalisation and semi-privatisation of the health service, any mention of this concept must necessarily be commended.

Other pledges take a broad and long-term view, at least compared to the standard Labour model for policy-making (think, for example, of the energy price-freeze) and the pledge to repeal the massively unpopular, ineffective and ideologically-driven Health and Social Care Act is a sitting duck for the Labour Party.

This section is the most impressive section of the most impressive section of the Labour Party’s manifesto, which is to say it’s not bad.

Staffing — At this point in the life of the NHS, more GPs and more nurses is certainly a cost-effective investment. Obstetrics is not particularly my area, so there is a possibility that this pledge is mostly populist (based on the theory that people like midwives and enjoy revelling in the mental image of a world where there were many more midwives) but I’d be reluctant to deduct points for a policy that aims to increase provision of productive employment in the caring professions.

While the goal of increasing the number of midwives is open to question, the need for mental health training as a staffing priority is not and this is a vital policy.

Targets and access — Ah, home! We set our feet for the first time on predictable New Labour territory. Most of this is not worth taking seriously for the reasons outlined in the Tory section. I have a slight preference for the Labour over the Tory here, because mental health and the concept of prevention (both forward-looking areas for study) have been imposed on the innately short-termist world of targets.

Use of private sector — I dream of the day when this section is unnecessary. Labour here reach the minimum standards required in 2015 by aiming to make the NHS the preferred provider of healthcare services. The cap on profits is fatuous nonsense and is directly contradictory to supporting the principles behind TTIP (please, please Google this if you don’t already know about it).

One tiny scrap of positivity is that Labour want to exempt the NHS from TTIP. Fair enough, it would be totally politically tin-eared for any party not to, though it’s very strange to agree with something on principle apart from where it is popular not to.

Public health — This is at least as bad as the Conservative public health policy and in some ways substantively worse. Micromanagement of free choices in nutrition is a total non-starter in a world where your party and others are unwilling to regulate these things wholesale. “Sin taxes” disproportionately hit the less well-off and reduce productive economic activity because the kind of people who spend all or most of their money can buy fewer things. In this instance it isn’t even a tax and won’t fund public services. Worst of all, this kind of policy forces me to talk like an economist. I am not impressed by any Labour Party policies on public health, except the policy which is about energy and transport rather than health and as such is not in my purview.

7/10

 

Liberal Democrat

I promise to enact every policy that no one likes or cares about
I promise to enact every policy that no one likes or cares about

I’d like first to point out that this section is substantially longer than the previous two put together, and provides significantly less than half the motivation to read it. In fact, if you put together all six of the mini-festoes here listed, the Lib Dems account for well over a third (closer to a half) of all the words written. Clearly this is a tactical decision: the party often boasts that it has achieved a large proportion of its manifesto pledges. Rarely do you hear (from the party, at least) that these pledges include minute re-organisations in some technocratic minutiae and exclude the headline manifesto pledges.

I shan’t be writing proportionately more to account for the number of obscure pledges.

Money — The first is a very disappointing pledge. They aim to match Tory spending, yes, and it attempts explain how it will be paid for, which is advantageous as previously described, but there is an ideological failure at the core of it. The strong implication is that if the deficit is not paid off, the NHS will suffer: it follows that public spending is a black hole, the NHS in particular, and that it is not a priority on the same level as central debt management. This is irresponsible and ideological, it puts the NHS in danger. There is no recognition that failing to fund the NHS in order to manage central government debt will lead to greater debt being incurred on behalf of NHS trusts; nor that central debt is cheaper to manage than NHS trust debt; nor that inability to hire salaried clinical staff will mean that more is spent on agency staff who are less committed to the trust and will add exponentially to the debt — to say nothing of the savings to the public purse from a strong health service. This is an ideological hatchet-job disguised as prudent fiscal management. I’d expect no less from the Orange Book liberals.

The rest is a curious mix and seems to me to support the famous right-wing adage that governments should not be in the business of picking winners. Aside from mental health (which the Lib Dems deserve credit for introducing into mainstream discourse, but now that it’s widely recognised as a priority they seem no further ahead with implementation than the rest) it’s a scattershot list of priorities. This is not to say that dementia is not important, it’s just strange to mark it out as the most important condition when there’s loads of other things that suck the life out of people at a much younger age.

The pupil…patient premium is an offensive attempt to bring cross-platform branding into a manifesto and the home-owner care guarantee is a bad policy for the same reasons as it was when the Tories came up with it first.

This section raises more questions than it answers. I intend not to be sucked in again by the sheer volume of asinine nonsense in the next few, but we shall see how we go.

Organisation — I had to go out and buy some maple syrup in order to swallow all of this waffle.

What’s the point in talking about “joined-up care” when you support the provisions of the 2012 Health and Social Care Act, which aims for cooperation to be subsumed by competition and targets? What is the point of talking about “[getting] the best out of innovative drugs” or “[ensuring] patient safety” at all? What do they mean by an integrated outcomes framework?

How does one transform pregnancy care? Is it a function of wishing it transformed, or are there tactics in mind? If so, where can they be found? Is this part of the mental health strategy? What does any of this mean?

All the reviews and reorganisations are very worthy, but they don’t amount to a bold vision. Taken together, this is gibberish: it all has the air of a business pitch for a client that you don’t know much about.

Staffing — There is, finally, something of value to be found in the yellow swamp. Training professionals in mental health awareness is the first true preventative measure mentioned and it should be welcomed, as should the recognition of the relationship between mental health and physical health. An emphasis on rights for carers is also a worthy aim: it’s a priority that has long been recognised, but has never been given much attention in terms of funding. Loneliness in later life isn’t a priority in terms of its economic value, but it is important if government aims to improve the lives of people and society. This is a long-sighted and humanitarian policy, as such it is a pleasant surprise to see it in a Liberal Democrat manifesto. Though I have my reservations about the care navigator idea (wouldn’t Labour’s idea of a clinician in charge of care be more simple and more popular with patients?) it is along the right lines in that it is likely to help patients manage a complex and often alienating system.

However, this short section (otherwise so good and so concise that I suspect someone other than the general author of this manifesto is responsible for it) is let down by the condescending talk about promoting the use of pharmacists. The Lib Dems, who haven’t bothered touching the health portfolio in government, should not be proclaiming on the subject of triage when they’re supporting a government where the health secretary is in favour of the middle classes sharp-elbowing their way into A&E. The recognition of triage as a policy priority is one thing, if you intend to do anything about it, but this is nothing.

Postscript note for the editorial team: you cannot better utilise things. Insofar as the word utilise has a unique meaning, it means “best use”. Failing all else, communicate in English.

Access and new targets — This section was either written by someone who isn’t aware of current developments in medicine or by someone who is hoping that their audience is not aware of current developments in medicine. Some of the targets imposed here are already existing and realistic targets imposed by the Department of Health, and the target to introduce targets is possibly the first known sighting of a meta-policy. Still, set the bar low enough and you’re sure to clear it.

The clinical trials register policy is more or less credible, but implies a bewildering lack of understanding of the problems behind clinical trial registration: the bodies that are duplicitously or negligently failing to publish negative trials are rarely reliant on substantial public funding. The better invocation of the same policy, simply stated, is from Plaid Cymru, from whom the Lib Dems could learn a lot.

Points should be given for mentioning generics, but I feel as though it’s an obvious point to make and the other parties won’t have mentioned it because it’s condescending to imply that doctors don’t know to prescribe cheaper versions of the same drug. These points can’t be considered to be substantial nor informed without even alluding to NICE reform.

Use of the private sector — I’m not sure about the organisational wisdom of repealing parts of the Health and Social Care Act that make the NHS vulnerable to EU competition laws, rather than the whole thing, and it is a bit half-arsed and populist to protect only the NHS from those laws, but there is a suggestion of further expansion. I would also have some reservations about the radical pro-public sector crusading of a coalition party.

Otherwise we here have a rare example of policy-making for the public good. If the rest of the agenda reflected the posturing here, this review would be much different.

Public health — The first lesson in public health is that you should not send complicated messages, nor demand onerous changes to lifestyle that are liable to change. That final point is salient: health education should be national and unified. Insofar as there is a specific policy in this section, it is the wrong one.

The general thrust of the other ideas have the right priorities in mind, though the same criticisms apply here as applied to Labour’s micromanagement of health priorities. Considering the sheer number of policies, it is disheartening to see no plans to reinforce advice in support of fresh green vegetables for example, instead opting to extend the reductionist and limited traffic light system.

3/10 – so all-over-the-place that it makes a mockery of giving a single score to the whole thing. Individual sections range from 0-9.

 

Scottish National Party

class war
Full communism for Scotland

The BMJ doesn’t list manifesto policies for the SNP, so this will necessarily be perfunctory. Health, in any case, is a devolved matter, so the SNP’s Westminster manifesto in regards to health is a matter of little consequence to anyone.

Money — Ending austerity in terms of the NHS and increasing funding to the NHS are technocratically valid policies. The both are unimaginative but wise in that they recognise the value of fiscal multiplication as it applies to health. It is also good to stop people staying in beds when they are healthy, it is also a profitable way to spend money. Free prescriptions are popular and inexpensive.

As uninspiring and competent as Scottish people have come to expect from their new party. It might well bewilder the commentariat that this kind of policy inspires pre-war level political participation, but I can only assume it’s a movable comment on the state of their opposition.

Organisation — So bland, vague and inoffensive that it could belatedly win John Major back ‘round. This pair of policies was last seen splitting a butter sandwich and discussing Deal or No Deal.

Staffing — This popular pledge could be carried out well or badly and is hardly a priority per se (although, the fact that there is no manifesto makes it grotesquely unfair to criticise policy omissions — this does not mean I am likely to stop).

Access and new targets — With the above caveats in force and with the best will North of the wall, there are no policies here, only aspirations.

Use of private sector — The only two correct opinions — that the NHS should not be privatised and that we should not agree to any EU treaty that forces privatisation and prioritises a company’s right to profit over a government’s right to care for its charges — are expressed here.

Public health — Right enough, reducing smoking is a laudable health goal, though not a policy. Minimum alcohol pricing is a sticking plaster on a deeper wound and while I have no doubt that sticking plasters stop people bleeding on the carpet, this is not enough, never has been and won’t be after the 7th. Greater ambition is needed, though I commend the setting of simple goals.

It would be unfair to rate this for several reasons given above.

Plaid Cymru

WALES
Full communism for…Wales?

The same provisos apply to PC as did to SNP.

Money — These are surprisingly bad policies, free prescriptions aside.

Encouraging innovation and attracting more research funding is a game in which successive UK governments have found themselves failing. Luckily the country remains a centre for biomedical education and the production of loquacious smartarses, which has made a drastic decline unlikely, but recent policies targeted at stimulating research and development spending (such as plans to cut tax on patents to zero for companies headquartered in the UK) have not had the desired effect. Recently Pfizer, the world’s biggest pharmaceutical company (and one which has emphatically not contributed proportionally to “innovation”) tried to buy AstraZeneca, a UK-headquartered pharmaceutical company. Historically, Pfizer and others like it have bought companies, fired tens of thousands of employees to achieve “synergies” and made their profits that way rather than by developing drugs to make patients’ lives better. As well as the stagnation and the massive loss of skilled, well-paying jobs, these processes have slowed the flow of drugs to market and reduced competition. This is because, if both companies have a similar drug in development, one will be shelved so as not to cut into the other’s profit, making things more expensive for the NHS and patients in general.

A late appeal to British nationalism saved AstraZeneca, the treasury, the NHS and the nation from that specific mess, but the underlying problems with incentivising big pharma to relocate to the British isles remain.

Additionally, the new medicines fund mentioned undermines NICE and the systematic model that the NHS uses for approving and recommending drugs, in favour of a system which privileges popular and glamorous diseases and treatments over those which are most cost-effective and useful. Typically, these diseases are the ones that “patient advocacy groups” do the best job of promoting. Which patient advocacy groups have the most money and are best able to promote their drug publicly? Well, in part it’s drugs for diseases that affect rich people, but mostly it’s groups that are put together, organised and funded by the pharmaceutical industry!

It is perhaps unfair that this rant has found itself in the Plaid Cymru section, but unless they have any more creative ideas for supporting research then they are equally culpable for propagating the myth and language of “innovation”.

Organisation — Someone, in one of the parties, is aware of clinical trial registers! Full marks to PC here and plaudits as well for giving priority to telemedicine. The importance of a medical accountability bill would depend entirely on its contents, though I’m not sure about a duty of candour. It seems to me to be a blunt instrument where perhaps it would be better to support the implementation of shared decision-making training more broadly, but it absolutely depends on the content, phrasing and binding clauses of such a bill. So who knows?

Staffing — Assuming that the 1000 extra doctors PC aim to recruit covers only Wales, that is a fair policy. Recruitment is especially a problem in Wales (presumably because people do not want to live there and I can understand that) so it is a good priority to have. However, this does not represent a costed and practical plan.

Access and targets — Why is there such a fixation on cancer in every party? The conspiracy theorist in me refers back to the patient advocacy groups mentioned before: cancer is a fantastic area for profit and has mysteriously picked up a reputation as the disease that must be eradicated, in front of autoimmune diseases, mental illnesses and metabolic disorders, all of which claim far more lives prematurely. Still, it would be churlish to disagree with the implementation of a national cancer plan, though nothing in the manifesto details whether the plan would be any good.

Otherwise, a focus on addiction and mental health services is to be welcomed.

Use of private sector — Again, the only two valid opinions that can be held on privatisation are held by this party.

Public health — Regressive taxation, regulation of small things and policies that are about the environment rather than health abounds here. No worse than the rest.

6/10 — I had high hopes, but clearly no one with any insight has been involved with this manifesto

 

Green Party

u tellin me we cant afford free social care, i fuckin swallow you hole fucker im, fuck
u tellin me we cant afford free social care, i fuckin swallow you hole fucker im, fuck

Money  — I disagree with the Green Party plenty but this is a really good start. Of course, the consensus is that we can’t afford the NHS and that it’s comically bloated and inefficient, despite recently being rated by a US-based non-partisan thinktank as the most efficient, the most fair and the best overall healthcare system in the world. Often the people who say this wish to compare it to the German or French system, which cost 11.3 and 11.9% of GDP respectively. If the pie-in-the-sky Greens got their way, we would be spending an astronomical…10.6% of GDP on health. Even if you include the 5bn set aside to pay off PFI contracts — which, to the uninitiated, would mean paying down the NHS’s own deficit much faster and more profitably than paying down the national deficit — we’d still be well below the OECD average for the year in which we did it. This all is to say nothing of the left-wing basket case that is the United States: to bring our public health spending per capita into line with theirs, we’d have to raise our investment by £171 billion per year.

I can’t speak of the costing of nationalising chiropody and dentistry, frankly I don’t know to what extent they are currently privatised, but the thrust here (a fully funded NHS which can make decisions in the long-term) is not just right: it’s financially sound.

Organisation — I know nothing about the effect of mixed sex accommodation or the cost of ending it. I suspect that if the funding is there then it should be done if desired. The emphasis on the reduction of market forces in the NHS is admirable and the high principles of the document are a positive sign.

A little more detail would be nice, but its lack is acceptable in a party that will not have a majority in the near future.

Staffing — In a country which has accepted into its discourse the mantra that you must pay the best to get the best, paying clinical staff well seems like an obvious choice. Not so with successive governments who agree that paying nurses in line with inflation is a luxury we can’t afford.

Access and targets — As ever, points for identifying mental health as a priority. Addiction, too, is a good thing to prioritise, but very vague on how to achieve better cancer outcomes to the point that their cancer targets are among the least inspiring in the whole political constellation.

Use of private sector — Buying out PFI contracts is a prudent investment, avoiding further PFI contracts will save the country billions that can go towards better things. The interest on PFI is far greater than the interest on government bonds: this policy is genuinely like using a 1% interest loan to pay off a payday lender who’s sitting on your doorstep waiting to kneecap you. The rest is ideologically solid while providing nothing for the banks to worry about in regards to our public finances, though a conspiracy theorist might disagree.

Public health — Copy and paste previous criticisms about micromanagement and regressive taxes. Treating addiction as a health problem rather than a crime is a positive development and assumed organ donation and dignified dying legislation is perhaps unpopular to the general public and certainly fodder for the tabloids, but I would wager keeps a good number of ethicists and doctors onside.

The climate change stuff is less health-related and more general “Green Party policy”, so I will not comment.

I would review UKIP’s policies but I don’t for a minute think they’re sincere, which is qualitatively different from being unachievable.

slipper

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