How does a political party stand out from the crowd in relation to the NHS in the lead up to a UK general election? Typically, they attack the prevailing government’s strategy and track record. Commit to loads more of everything: money, shiny buildings, doctors and nurses. Set themselves out as different, with new, bigger and better ideas.
And how does this compare with the approach in Scotland in their forthcoming parliamentary elections? Not all that closely.
Reading through the manifestos of five of the main parties – the Scottish National Party (SNP), Scottish Conservative and Unionist Party, Scottish Liberal Democrats, the Scottish Green Party and Scottish Labour Party - the tone is far less mudslinging and commitment-trumping and far more, well, consistent.
Here is an overview of the key NHS-related themes.
The Scottish Conservatives and Scottish Labour do draw attention to the ‘cuts’ that have taken place under the SNP – health spending per person in Scotland has reduced in real terms over the last five years. But this is skillfully dealt with by the SNP manifesto, which commits to raising the NHS revenue budget by ‘£500 million more than inflation by the end of the next parliament – which means that it will increase by almost £2 billion in total’.
The Scottish Conservatives are similarly specific, with their manifesto committing ‘an additional £1.5 billion for our health service by the end of the Parliament, with the budget reaching £14.5bn by 2021/22’. The Scottish Liberal Democrats and Scottish Labour are also signed up to protecting NHS funding, albeit without mentioning any specific figures. The Scottish Greens call for NHS funding to be increased to take account of ‘austerity measures and welfare reform’.
Mental health emerges clearly as an issue of major importance, with all manifestos providing varying degrees of detail on how they would improve the mental health of the nation. Scotland faces many of the same issues highlighted in the Health Foundation’s briefing on the state of mental health services in England.
The SNP, Scottish Conservatives and Scottish Labour all agree that Scotland needs a 10-year strategy. While the Scottish Liberal Democrats flag that the country’s recently expired mental health strategy needs to be updated.
The SNP and Scottish Liberal Democrats both agree that an increasing share of the NHS budget needs to be directed towards mental health. The SNP have committed to invest at least £150m more over the next five years. The Scottish Liberal Democrats have committed to double the funding available for children and young people. The Scottish Greens ‘will fight for more resources’, and the Scottish Conservatives plan to provide an additional £3m over the course of the parliament.
Another major theme across the manifestos is how to stave off the crisis being faced in general practice – a topic explored by the Health Foundation in our analysis of the Commonwealth International Survey of Primary Care Doctors published earlier this year.
The SNP, Scottish Conservatives and Scottish Liberal Democrats all agree that the share of the NHS budget directed towards primary care should increase. The Scottish Liberal Democrats plan to treble the allocation to the Primary Care Fund, which when announced in June 2015 was £60m over 3 years. Scottish Greens ‘will seek to ensure that all primary care services… have the resources to reduce waiting times… to ensure provision is equitable’.
Scottish Labour and the Scottish Conservatives both plan to expand the existing Minor Ailment Service which was established in 2006 to allow eligible patients (about half of the population at present) to register to see a community pharmacist as their first point of contact with the NHS. The Scottish Conservatives would do this with £10m extra funding per year. And Scottish Labour would extend the service to the entire Scottish population.
The SNP plans to increase GP training places from 300 to 400 and to train an additional 500 advanced nurse practitioners. The Scottish Liberal Democrats commit to train and recruit ‘more’ GPs and increase the number of support staff. Labour plan to increase both medical student and GP training places as well as invest in ‘more’ advanced nurse practitioners.
The manifestos (bar Scottish Labour and Scottish Greens’) also commit to making social prescribing a reality, to help people access a much wider network of support in the community than the NHS can offer.
The SNP manifesto refers to the 31 new local integration boards which have been in operation since April 2016, and which join the planning responsibilities of the NHS and local government for health and social care services. The SNP also hints at a possible reorganisation to streamline the resulting array of boards and bodies now in place.
Integration is usually the place where the new, bigger and better ideas emerge: but not in Scotland. In their place, simply a gentle nod of approval from the Conservatives, Liberal Democrats and the Labour Party for the SNP’s progress so far.
So how should we make sense of the general consistency between the various manifestos in Scotland- a ‘manifesto blur’ - when it comes to the NHS? And is this is a good or a bad thing for the NHS, its staff and patients in Scotland?
From talking with colleagues working in policy and practising medicine in Scotland this doesn’t come as much of a surprise to me. The history of partnership and collaborative working runs much deeper in Scotland compared to other parts of the UK.
Whichever party wins the election next week, the NHS in Scotland can expect to be run with a fairly steady and consistent hand over the next four years, if not much longer.
There’s no indication of a ‘Lansley moment’ where what voters think they signed up for bears no resemblance to what then takes place. And any major reversals of policy and strategy are also unlikely.
Instead, the NHS in Scotland is likely to enjoy relative stability, which - apart from unlimited cash - is possibly the best prescription that could be hoped for.
A full list of all Scottish Parliament candidates and links to all the parties’ manifestos is available on the BBC website.
Sally Al-Zaidy is a Senior Policy Fellow at the Health Foundation