Political profiles: Politics of health

The starter pistol has not even have been fired, but already the main political parties are gearing themselves up for a general election, widely expected to be held in May.

Just last month, Conservative leader Michael Howard and Liberal Democrat leader Charles Kennedy announced what amounted to pre-election election manifestos. Prime Minister Tony Blair and Chancellor Gordon Brown have also made a series of keynote speeches.

Much as OH practitioners might wish it otherwise, being realistic, OH is unlikely to be a central battleground for the main parties. If their most recent pronouncements are anything to go by, the economy, taxes, the state of public services, Iraq, and the NHS are all, inevitably, going to be much more prominent.

But that’s not to say workplace health will not get a look in. All three main parties have, for instance, outlined plans to cut back on Whitehall ‘waste’, including slashing the numbers of civil servants and improving efficiencies. Tackling civil service sickness and absence rates is a key part of this equation.

Similarly, public health – obesity, smoking, stress and so on – is likely to be an important issue, both in terms of how the health of the nation can be improved and how people can better access health provision.

Labour

While Labour has yet to publish a formal election manifesto, it is pretty clear from recent policy documents where, as the governing party, it is likely to head on workplace health should it win the next election.

In a major speech in January, Blair set out his vision for a third Labour term, putting the focus firmly on the economy and the need to increase “personal prosperity and well-being, not just for a few but for all”.

He said: “There is a huge programme of change still to be carried through in the NHS. But we have got the strategic reform direction right; and prosperity – a health service delivering for the individual, and a health system which maximises our economic potential as a nation – is rising in consequence.”

Also last month, Labour election chief Alan Milburn, speaking on the BBC’s Today programme, gave an insight into the party’s current thinking on the long-term sick. While he stressed the party had no intention of “driving people into work”, he spoke of the tax and welfare system needing to “provide the right incentives to people”.

He said: “What we do know is there are one million people on incapacity benefit who want the opportunity to work, providing the right level of support is there for them.”

It is evident then that should Labour be victorious, its general direction on OH is unlikely to be radically different from what has gone before.

Examining the Government’s most recent policy documents in this area, the focus will continue to be on prevention and rehabilitation rather than just treatment. As last summer’s Department of Health NHS Improvement Plan – effectively, its five-year plan for the future – put it, the NHS will concentrate now on “transforming itself from a sickness service to a health service”. Disease and illness prevention, tackling health inequalities and encouraging healthier lifestyles across the board will all be central to this.

A good snapshot of the role OH is likely to play going forward was outlined in the Government’s public health White Paper Choosing Health, published last autumn.

The White Paper says OH is seen as central to improving the health of the nation’s workforce, including an expansion of NHS Plus, more consistency in OH services and more OH-based rehabilitation.

Under a future Labour Government, OH, both NHS and commercial, is therefore likely to have an increasingly high profile role, particularly if it gradually starts to take over sickness certification from GPs, as is intended from April 2006.

When it comes to long-term sickness, the Department for Work and Pensions’ (DWP) Job Retention and Rehabilitation Pilots are probably one to watch. Currently being piloted in six parts of the country, they are testing new ways of getting sick workers back to work.

Methods being examined include using physiotherapy, occupational therapy, and looking at cognitive behaviour to help people back into work, as well as making changes to the workplace, such as ergonomic assessments, mediation and adjustments to equipment or duties.

More detail should be added to the Government’s plans on rehabilitation later this month, when Sir Liam Donaldson, chief medical officer for England, publishes a report on the economic benefits of NHS-provided rehabilitation.

Also during February, a DWP-led group should be publishing its recommendations on how to improve earlier access to rehabilitation.

Conservatives

Bringing a wasteful, bloated government firmly into line was at the heart of a pre-election campaign speech by Conservative leader Michael Howard in January.

While the focus was very much on the economy and taxes, Howard also pledged to reduce public spending by £35bn by cutting waste, including losing 235,000 civil service jobs.

A total of £107m would be saved by cutting civil servants’ absenteeism, and £109m by reducing staff costs at the Department of Health. Strategic health authorities would also be abolished.

“Conservatives will give choice to parents and patients. Choice drives up standards in every field of human endeavour,” Howard said.

“It is monopoly run by bureaucrats that is their enemy. And Conservatives will give power to local professionals – teachers, doctors and nurses. They know better than bureaucrats in Whitehall how to provide good local services,” he added.

Howard has also pledged that, in its first month, a future Conservative Government would introduce legislation to give patients the right to choose “cleaner, better hospitals”.

What this means for OH in practical terms is somewhat less clear. Similar to Labour, public health is set to be a priority under the Conservatives – “the first pillar of our health policy”, as the party’s Health of the Nation policy document outlined last June.

At the launch of the document, shadow health minister, Andrew Lansley, gave his vision for the NHS of the future.

“It will be a service where resources reach the front line and where bureaucracy is minimised; where resources are increasingly matched to need and where choice, competition and payment by results create incentives for efficiency, quality and service development; where public health is given the priority and focus it requires, and consistent, effective campaigning necessary to secure public understanding by those whom the public trust,” he said.

In practice, this would entail the establishment of a Public Health Commission to promote “effective evidence-based improvements in public health”. Public health directors – joint appointments between primary care trusts and local authorities – would be given powers to target funds to meet public health objectives.

“While central government should play a part in communicating key health messages across the population, on a micro-level, it is workplaces which have the resources, the contact time and the incentive to promote health improvement ideas to individuals,” the document recommends. “Therefore, we need to encourage them to be partners in occupational health and health prevention.”

As part of this, a Conservative Government would develop an Investors in Health Standard, similar to the existing Investors in People Standard. This would be designed to encourage businesses and employers to take more responsibility for improving the health of their employees and reduce the burden on the NHS.

The Conservatives would also develop national health-screening programmes and offer ‘health MOTs’ every three to five years to everyone registered with a GP, based on National Institute for Clinical Excellence recommendations.

Public health would no longer be covered by a junior minister at the Department of Health, but upgraded to be part of the brief of the health minister.

On rehabilitation of the long-term sick, GPs and health professionals would be tasked with encouraging people, where possible, back into work as a key to long-term recovery, with the Public Health Commission directing research in this area.

“In addition, a Conservative Government will work with family doctors, social services and local health practitioners to identify where work is the problem or cause of ill health and to find ways of resolving this issue in partnership with employers,” the Health of the Nation document concludes.

Liberal Democrats

On the same day that Michael Howard was outlining his tax cuts message, Liberal Democrat leader Charles Kennedy was making his first keynote pre-election speech of 2005.

While, again, much of the focus was on the economy and presenting the party as the radical alternative to either of the other two big hitters, Kennedy did begin to flesh out some of the Liberal Democrats’ ideas on health.

He said the NHS needed to become a “quality local health service”. This meant a service that was “putting patients first and freeing doctors and nurses from Whitehall meddling so they can get on with giving patients the first-class attention they deserve”.

While he also pledged to create £5bn of savings from cutting Whitehall waste, this needed to be “not just cutting civil servants and promising ‘efficiency’ gains”, he said.

A good picture of where the Liberal Democrats are likely to be going regarding workplace health can be gleaned from the party’s pre-manifesto document Freedom, Fairness, Trust, published last August.

It says that if elected, the party would ring-fence guaranteed funding for the NHS through the creation of an ‘NHS Contribution’ taken out of existing taxes.

On ill health, the focus would be on tackling the root causes of ill-health as well as curing people once they had fallen ill, the document says.
“We will cut money wasted in government NHS bureaucracy and recruit more community nurses; develop more preventative medicine and screening; and promote education about issues like smoking, healthy eating and the need for physical activity. We will also reduce the social causes of ill health such as poverty, pollution and poor housing,” it says.

Other initiatives would include promoting walking and cycling, with more cycle routes, and a reform of planning laws to make sure key services are more easily accessible by foot or bicycle.

“After five years in government, money would be more focused on helping people stay healthy and fit, through better screening programmes and health education – rather than only waiting until doctors have to operate or prescribe medicines when people get ill,” it concludes.

According to Paul Holmes, the party’s shadow work and disability spokesman, tackling stress in the public sector would also be a key priority were the party to be elected.

“When employees are off sick, we are keen to have greater intervention from employers. We will be trying to encourage employers to be more proactive. That would benefit both employees and employers,” he told Occupational Health.

Another possible key area of party policy either side of the election may be older workers. A policy paper published in September proposed the creation of a “flexible decade” of retirement, where people could be gradually eased from work into retirement rather than the current “shutting-the-door” approach.

More flexible- and part-time working would be an important element of this, while, from the health perspective, the key areas would be to encourage better health advice for older people, to make preventative healthcare a priority throughout life, and to support carers better, the party argues.

What the other parties say

Along with the big three, there will be an array of smaller and regional parties contesting the election whenever it comes, including:

Plaid Cymru
Earlier this year, the party’s shadow health minister, Rhodri Glyn Thomas, accused Labour of having “no strategy, poor management and financial incompetence in its administration of the health service”. From the health perspective, its 2003 manifesto focused closely on public health issues, reducing health inequalities, greater investment and reduction of bureaucracy.

Scottish Nationalist Party
Key points include a call for greater investment in the NHS in Scotland and an end to ‘postcode’ treatment. The party is also calling for more investment in community services, to free NHS beds and reduce bed-blocking.

UK Independence Party
Perhaps unsurprisingly, the party’s focus is very much on reducing “needless” European regulations on health and safety that are strangling. “We do not want to roll back any legislation that may mean people being harmed, but there needs to be a balance,” argues a UKIP spokesman.

Green Party
Under the slogan “Real Progress: food we can trust”, the party’s focus is on “healthcare that aims not just to cure but also to prevent illness”, and local services that “make our cities, towns and villages wonderful places to live”. It is calling for a partnership approach on health and more services, such as eye tests and dentistry, to be free at the point of delivery.

Respect
Traditionally socialist, Respect – ‘the unity coalition’ – argues there has been “next to no” progress on health and safety under Labour. “The escalating epidemic of health problems – musculoskeletal disorders and stress in particular – is not being adequately tackled,” it says. The party is calling for “a step change in policy and resources committed to health and safety regulation and a challenge to the neo-liberal agenda”, including a doubling in the number of Health & Safety Executive inspectors.

Monster Raving Loony Party
With the slogan “Vote for insanity, you know it makes sense”, the party has yet to publish its election manifesto. But its alternative Queen’s Speech last autumn did have a vague health feel to it – arguing for an improvement in the standard of cooking in the UK. As such, it consisted solely of a recipe for Victoria sponge cake.


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