Today, Louise Bours MEP, UKIP’s Health spokesman, has launched the latest version of their policy on the NHS. Following our Pinning Down Farage series, I thought it would be worth looking at what’s changed and what has stayed the same.
Eternally a member of the People’s Army tendency, Bours kicked off her speech with a denunciation:
“The establishment parties have stolen the NHS from the people in order to use it as vote generator.”
Having done so, she proceeded to deliver a 3000 word address on why the NHS is a reason you should vote UKIP, apparently without irony.
Winding up her vote generator, she pledged:
“…an additional £3 billion more for the NHS every year; an affordable sum paid for ultimately by the savings we will make from leaving the European Union, but in the shorter term from other savings we will identify within our manifesto. We will insist this money goes into frontline resources, yes that’s real doctors, nurses and care, not middle management or expensive spin doctors.”
As far as I can tell, she meant £3 billion extra for the NHS on an ongoing basis, not “£3 billion more for the NHS every year”, which would involve £3 billion in the first year, £6 billion in the second year and so on incrementally. It’s telling that this would “ultimately” come from leaving the EU, not immediately as UKIP spending plans previously implied. The other savings will be interesting to note as and when they are announced.
Quite how a government can “insist” a vast bureaucracy like the NHS only spends the money on “doctors, nurses and care” is an interesting question – hiring 20,000 new nurses, as Bours promises, is likely to involve having people to manage them, people to run their payroll, people to carry out the logistics to ensure they have uniforms, equipment and medicine and so on.
“To cut GP waiting times UKIP will also free GPs from the burden of unnecessary data collection, target chasing, revalidation and appraisal work that actively prevents them from engaging with patients.”
That sounds fine – target-chasing is a perennial problem in the NHS. But what about “revalidation and appraisal work”? That’s the process by which GPs have to prove they are competent and up to date in their medical knowledge. Is UKIP really proposing that once a GP gains a licence to practice they should then be allowed to continue doing so indefinitely without these regular checks on their ability and knowledge?
Bours suggests such a change would allow GPs’ surgeries to open one night a week and one weekend a month – but I’m not sure patients will view a trade-off between opening hours and medical skill as a good deal. Even if it did prove acceptable, the question of how to renegotiate GP contracts remains open.
Notably, Bours has changed UKIP’s core statement on the NHS. In the Autumn it was:
“UKIP will ensure the NHS is free at the point of delivery and time of need for all UK residents”
Spot the difference with today’s speech:
“The NHS will remain free at the point of delivery and in time of need for all British citizens and qualifying foreign nationals.”
That’s quite an important change – apparently in response to our original criticism that requiring foreign nationals to hold health insurance for the first five years of their residence in the UK before being allowed to access NHS services did not equal “free at the point of delivery…for all UK residents” (though bizarrely the original statement still appears on the policy section of their website).
One of Bours’ pledges may sound familiar:
“UKIP will integrate health and social care, bringing both back under the control of the NHS with funding merged into one ‘social care fund.’”
Yes, it’s, er, a straight-out filch of Andy Burnham’s policy on the same question. While Labour have been struggling to come up with a viable way to fund such a huge change (Miliband vetoed a massive cash transfer, Balls vetoed a death tax, and now they’ve shunted it into a Commission in the hope that everyone will stop asking about it), UKIP claim that “merging these funds will reduce bureaucracy and administration costs”. Really? It isn’t hard to imagine the propensity for extra bureaucracy in an effective merger of local government and the health service. Incidentally, wouldn’t this also be just another of the “endless top-down reorganisations” that Bours blasted elsewhere in her speech?
“Loneliness is also a big problem for many old people, and one we want to tackle, so we will fund a ‘Coordinating Service for Older People’ unit in every local authority. This service will cross the boundaries between the NHS, Social Services, Community Agents and the voluntary sector. It will be responsible for ensuring that these organisations work together effectively…”
It isn’t necessarily a bad idea, but it’s worth noting that funding hundreds of new units does sound an awful lot like the creation of a new group of managers, the breed which Bours supposedly wants to reduce.
“UKIP will also insist that any foreign health professionals working in the health and social care system must hold appropriate qualifications and speak and write English to a level that is acceptable to the profession.”
As previously noted, this is already NHS policy – for UKIP to keep repeating it as a supposedly new pledge is simply misleading.
County Health Boards
It seems that the CHB’s, which in the 2010 manifesto were meant to be in charge of the NHS, have finally settled into an elected oversight role:
“The Care Quality Commission, the organisation that’s supposed to scrutinise care for the elderly and put right any wrongs, just isn’t working…We will scrap this organisation and put its remit into local County Health Boards with the power to do unannounced, spot checks across all local NHS and social care services.”
As ever in politics, it can pay dividends to look at what isn’t said as well as what is:
- Twin pledges to stop further use of PFI and seek to buy out PFI contracts early, which were made in the Autumn, strangely got no mention. In their place was a woolly reference to “tackling PFI debts”.
- Bours’ attack, launched at the UKIP conference, on “a two tier national health service, where those with money can opt to pay for enhanced services” wasn’t repeated. Given that in 2010 her party’s policy was to facilitate people opting to top up their care through NHS vouchers, might she perhaps have been told to tone it down a bit?
As I noted at the start of this article, while UKIP denounce the use of the NHS as “a vote generator”, this was a speech aimed at doing exactly that – with the aid of a promised £3 billion. Leaving aside the overblown rhetoric, the internal inconsistencies and the somewhat worrying plan to remove clinical quality control and scrutiny of GPs, the whole scheme will ultimately come down to that money. Where exactly will it come from? We’ll report back when their explanation is launched.