5 May is a significant date. Millions of people will be heading to the polling stations across the UK to vote in a host of important elections including local elections, London Mayor and Assembly elections and national elections in Scotland, Wales and Northern Ireland.
As well as 10 million people deciding which party will control their health services, as the first major vote since the General Election it will also be an important barometer of politics as a whole.
Cut through provides your analysis of the political state of play, as well as the health issues at stake up to and beyond 5 May.
State of the polls
With just one week to go, what are the polls predicting?
Proportion of the vote in Scotland
Ipsos-MORI research for STV – 18-25 April 2016
With the political dominance of the SNP set to continue, the closest race in Holyrood is for second place. The margin between support for Scottish Labour and Scottish Conservatives is extremely tight, with the latest poll indicating that the Conservatives have opened up a small lead. With nearly one in five voters undecided, there is still scope for change. A second place victory for the Conservatives in Scotland would be momentous and a disaster for Labour.
Any change in Opposition could shift the focus of health policy scrutiny, due to different perspective on key issues such as NHS funding and prescription charges.
Proportion of the vote in Wales
YouGov for ITV / Cardiff University 19-22 April 2016
The Labour Party's grip on power in Wales could be weakened on 5 May. As the polls currently stand, the Welsh Labour Party is set to win 28 seats, 2 fewer than in 2011, a result likely to lead to complex coalition negotiations.
With all parties campaigning on similar issues it will be interesting to watch what negotiations and trading will take place, particularly on healthcare issues.
Proportion of the vote in Northern Ireland
Lucid Talk opinion panel 30 March-1 April 2016
The polls indicate that the make up of the Assembly will not radically shift. However an additional factor is the rise of the TUV, a new unionist party, whose popularity is being led by their charismatic leader Jim Allister - the party is only projected to double its number of seats. The TUV has called for cancer care to be made the top NHS priority in the region.
The pattern of recent instability at Stormont, with health minister Simon Hamilton having repeatedly temporarily resigned due to disagreements with other members of the Executive, could be set to continue. In light of the pressures facing the NHS in Northern Ireland the Health Ministry maybe seen as a poisoned chalice and not a priority position for parties to bid for when deciding cabinet positions.
Access to medicines: a single diagnosis, many remedies
Funding. Waiting times. Cancer care. Mental health services. Familiar themes for health watchers feature in prominently in the manifestos of many of the parties competing for power in Scotland, Wales and Northern Ireland.
Surprisingly, another issue on which most of the parties have made commitments, has yet to become a flashpoint, despite never being far from the headlines over the past five years.
Access to medicines has rarely been out of the spotlight. From campaigns on the elimination of postcode lotteries led by charities in Northern Ireland, ongoing controversies in Scotland to David Cameron’s comments regarding Offa’s Dyke forming a “line between life and death".
Variations in healthcare are an inevitable consequence of devolution and inequalities in access to drugs have been one of the most visible – and resonant – forms of variation to occur. The parties have lined up to set out their competing visions for access to treatments – so why hasn’t the issue flared in the media?
The truth is that, in each of the nations, the parties may have fought themselves to a standstill.
The debate in Wales around the right mechanism for providing access to cancer treatment has been particularly fraught. Extensive media coverage of patients seeking cancer treatment in England resulted in strong public support for action. In February Carwyn Jones surprisingly announced that if the party was elected in May, Labour would introduce a ‘New Treatment Fund’ to increase the availability of medicines for life-threatening illnesses. With the Conservatives and Plaid Cymru having already announced plans for medicines funds of their own, it is possible that Jones’ announcement was made in part to blunt opposition attacks. On current evidence, this strategy would seem to have largely paid off. However, during last night's leaders' debate, which was dominated by the NHS, Jones came under repeated pressure from the audience and other parties on access to cancer treatment. This could be a sign that the issue will become more prominent over the next week of campaigning. Whatever the shape of the debate in the run up to polling day and regardless of the result, the consensus among the three main parties in Wales means that significant changes in the Welsh access landscape lie ahead.
It is likely that the pledges made in Wales by Labour and Plaid were influenced to some extent by the success of the New Medicines Fund (NMF) introduced by the Scottish Government in 2014. In combination with changes to the medicines appraisal system, the NMF has facilitated improvements in access to treatment and it is telling that there has been no significant political opposition to it since its introduction. However, the new system has not been without problems and the Scottish Government has commissioned an independent review of progress. Two of the SNP’s manifesto commitments seem to pre-empt the findings of the review, with a commitment to introduce a “pause” in the appraisal process to allow for extended negotiations with industry and the introduction of a new national drugs formulary. The absence of opposition to the Government’s reforms go some way to explaining the lack of focus on access issues in the Scottish campaigns to date. However, the Scottish Conservatives’ manifesto does include a pledge to reintroduce prescription charges in order to fund improvements in access to new medicines. This is controversial territory, so it is possible that the proposal will receive some attention in the next week, including at the next leaders’ debate on 1 May.
The degree of consensus in Scotland and Wales is not matched in Northern Ireland. The DUP, which under the terms of the power-sharing agreement was responsible for the Department of Health, Social Services and Public Safety during the last Assembly, does not include any pledges on access in its manifesto. By contrast, the SDLP’s manifesto contains a specific call for the introduction of a cancer drugs fund. The Ulster Unionists’ and TUV's focus is on the adoption of NICE approved drugs and the Alliance Party’s proposal is a halfway house, supporting the introduction of a “small” prescription charge to fund increased access to treatment to deliver parity with the rest of the UK. That these differences have not received much airtime is probably a reflection of the dominance of long waiting times as a political issue.
Lack of political debate does not mean that difficult discussions do not lie ahead. With coalitions needing to be negotiated in Northern Ireland and possibly Wales, expect plenty of horse trading to come.
Health in the London mayoral campaign
The NHS is a strange issue in London elections. The Mayor doesn’t have much power over health, but always hopes to exercise plenty of influence. And, for Labour, the issue is seen as a key dividing line.
So far, the 2016 race has followed a predictable patterns. Sadiq Khan has made action to improve London’s health services central to his campaign. His Conservative opponent, Zac Goldsmith, has stayed largely quiet on the issue. With health services being seen as particularly important to women voters, a demographic with which Khan has a bit of ground to make up, the dichotomy between the two campaigns’ treatment of health issues is perhaps even more pronounced than in previous elections.
It is difficult to say with any certainty how influential Khan’s campaign on the NHS has been in helping him open up his 16 point lead in the polls, however, it is clear that Goldsmith has a mountain to climb as we enter the final week of the campaign. With odds overwhelmingly in Khan’s favour (as low as 1/16 with some bookies), it is perhaps a good time to explore Khan’s position on health in greater detail and examine what his Mayoralty could mean for the capital’s health service provision.
Khan has pulled no punches in his analysis of the current state of London’s NHS, describing it as facing an “imminent collapse”. However, recognising the limited power that City Hall currently has to influence service delivery, Khan has been choosing his language rather carefully, stopping short of identifying measurable commitments and opting instead to “to argue for the resources the NHS needs” and “campaigning alongside patients, health workers and all NHS supporters”.
Currently, the Mayor of London does not have control over the policy levers necessary to influence those issues where Khan feels action is most urgently needed. City Hall does not directly fund, commission or design NHS services in the capital. Will Khan succeed in delivering on his manifesto commitment to win the “new powers to plan and coordinate services across the city”?
The dynamic between a Labour Mayor and a Conservative Government would be interesting. However, George Osborne has shown himself to be willing to devolve power – including on health – to political opponents. With the NHS in London facing some tough decisions, perhaps Khan should be careful what he wishes for.