Parties debate future of NHS
pharmafile | April 22, 2010 | News story | Sales and Marketing | NHS, general election
The UK general election debates turned to health policy on Thursday, with the Lib Democrats, Conservatives and Labour outlining their policies for the National Health Service.
The three way debate between the health spokesmen – Lib Dem Norman Lamb, Conservative Andrew Lansley and Labour’s Andy Burnham – was hosted in London by the King’s Fund, the RCN, the BMA and the NHS Confederation.
National opinion polls currently suggest a hung parliament is likely, with no party commanding a big enough majority to form a government alone. The recent surge in support for the Lib Dems means they could form a coalition with either Labour or the Conservatives, making their policies far more significant than before.
Labour’s Andy Burnham unintentionally drew a laugh from the audience of NHS professionals and journalists when he said ‘I agree with Norman,’ echoing Gordon Brown’s alignment with Liberal leader Nick Clegg’s views in an earlier televised debate.
Among the key issues debated were NHS finances, and how to address public health problems like obesity, smoking and alcohol abuse. Perhaps the most pressing long term problem – how to pay for long-term nursing care in an ageing society – was also hotly contested.
There was, however, little mention of the role of medicines in the future of healthcare, despite the Conservative manifesto pledge to improve access to new cancer drugs compared to Labour, and also promising to introduce a new Value Based Pricing system for new medicines.
NHS spending
Labour and the Conservatives have both guaranteed that they would sustain NHS budgets at current levels, and not make cuts to help pay off the public debt.
Norman Lamb reiterated the Lib Dem policy that big cuts could be made to NHS spending without harming frontline services, mainly by cutting in half the size of the ‘massively overblown central bureaucracy’ of the Department of Health, as well as taking an axe to the many health quangos that now exist.
Lamb also said there was scope to save money by cutting NHS managerial posts. “At the height of the recession last year, 5,000 extra managers were recruited – it’s absolutely crazy,” he said.
He cited an NHS Confederation report which found 60 different regulatory bodies for the NHS, and pledged to cut these by a third, while protecting the health service posts which helped patient care.
Andy Burnham and Andrew Lansley said they did not believe cost savings would have to mean job losses.
The Lib Dems say they would introduce a minimum price on alcohol to help counter the growing health problems caused by alcohol abuse.
Burnham refused to back such a plan as a first recourse, and said promotion of exercise and healthy lifestyles would have a knock on effect. “Let’s carry the public with us on this” and preferred policies which were “more about engaging than finger wagging.”
Andrew Lansley asserted that there was ‘no evidence’ to suggest a minimum price could help improve health, but this was disputed by audience member Dr Keith Brent, deputy chairman of the BMA, who said there was plenty of evidence to suggest minimum prices would help.
Another contentious issues was ‘reconfiguration’ – otherwise known as closure of some local services. Lansley and Burnham clashed over Labour’s reconfiguration in Greater Manchester, including the reduction of maternity units in the area from 12 to eight.
Andy Burnham attacked Lansley for pandering to popular opinion, despite what he said was good evidence which showed that reconfiguration would improve patient care and even save lives.
Lansley said a recent upsurge in the birthrate in the area meant the cutbacks were now affecting patients.
Norman Lamb challenged the evidence-base and the transparency of the restructuring plans, point out that the McKinsey report which originally recommended reconfiguration in London had still not been made public.
On the thorny issue of funding nursing care and services for the elderly and long-term sick, Andy Burnham claimed the high ground, saying his party was the only one putting forward a comprehensive solution to the problem.
Labour propose a social care equivalent to the NHS, free at the point of care with no means testing. The Lib Dems and the Conservatives both say this would be an unfair tax system, with the Tories advocating voluntary contributions from individuals, and the Lib Dems refusing to define a policy without further debate.
All three parties also endorsed the integration of health and social care and the greater use of e-health technology, underlining their consensus in many policy areas. All three politicians also supported the creation of more autonomous NHS foundation trusts, but called for more transparency and public engagement in how they were run.
Watch the full debate online on the King’s Fund site
Value Based Pricing
Speaking after the debate, Andrew Lansley told Pharmafocus that Value Based Pricing (VBP) of medicines was a manifesto pledge, and said it wanted to introduce the system by 2014.
VBP aims to set prices according to the value that a given medicine can provide.
He made it clear the system was not being introduced as one of the ways to find short-term cost savings in the NHS.
Lansley said the system would fit into a wider reorganisation of the NHS, in which an NHS Board would be set up to oversee day to day control of the health service.
The Board would be independent of the Department of Health, which would have responsibility for negotiating reimbursement prices of medicines with the pharmaceutical industry.
NICE would no longer set cost effectiveness thresholds, and a Value Based Pricing scheme would draw on best practice in health economics from France and Sweden; this included factoring in the wider benefits to society when a medicine helps keep a patient healthy.
He added that if the Conservatives were elected, pharma companies would be invited to take part in pilot studies of VBP straight away in order to explore how the system could work best.
He said the system was superior to the current ‘patient access schemes’ which see discounts on some drugs according to how well patients respond.
“This would be a much more rational system than the patient access schemes which are haphazard and random,” he said. He said this would mean the proposed Labour government idea of the ‘Innovation Pass’ being scrapped.
The Lib Dems do not support VBP, but have made it an election pledge to generate savings from greater use of generic medicines.
Andrew McConaghie
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