Health divide at the polls
Authors: J. Warden
Journal: BMJ (1987)

truth is an early casualty in every general election campaign, and it is not one that the health service can do much about?being itself one of the worst victims of political overkill.  reason is not hard to find. According to th? Gallup poll, the health service ranks second only to unemployment as the most important issue of the 1987 election. Compared with 1983, and especially since 1979, the National Health Service has displaced inflation and strikes as the issue that people tell pollsters will be most important in deciding their vote. And when they were asked which party had the best policies to deal with the problems of the health service 41% said Labour and 24% Conservative. That difference in perception in Labour's favour is twice as large as it was in 1983. It was no surprise, therefore, that Labour should focus attention on an issue judged so important by the voters and on which it was held to have the best policies.  surprising aspect is the uninspired way in which the subject is treated in the Labour manifesto. Far from driving home its advantage on a potentially election winning issue with radical and coherent proposals, Labour's section on the health service is the thinnest of the three main party manifestos. In the second week of the campaign Labour did produce a supplementary manifesto, Restoring the National Health, which adds a few details. Thus Labour would have a bed manager in every district to allocate hospital beds. It would monitor the performance of consultants to maximise their NHS workload. Patients would have a guaranteed right to a second medical opinion. A fairer system would be introduced to decide NHS pay. And there would be more provision for alternative medicine on the NHS. Yet even in this second attempt the same element is missing as in the first. Quite simply, the omission is the ? symbol. Nowhere does it intrude to show even roughly how much more a Labour government would spend beyond the ?21 billion presently com? mitted to the NHS. No more elucidation was forthcoming when questions were put directly to Labour's health spokesman, Michael Meacher. He insisted that Labour would spend more on the health service than the Conservatives and the Alliance (which pledges ?1 billion more in five years). But instead of a figure Mr Meacher goes for a formula. This is to increase NHS spending by 3% a year in  terms. Mr Meacher also has a rather more ambitious target, which is to raise the proportion of the gross domestic product spent on health from Britain's 5*5% to nearer the 8% or 9% in France and Germany. On present calculations that might amount to an extra ?10 billion a year, so Labour is quick to add that the difference can be made up only gradually. Examined on Labour's proposals to abolish prescription charges and phase out NHS pay beds, Mr Meacher could not be precise on timing, even within five years. He said: We will increase resources in health approximately in line with economic growth and within that we can make a significant reduction in prescription charges. At the final reckoning Labour may regret that its disappointingly superficial policies on health do not withstand rigorous examination in terms of costs and resources. For what it is worth, the Conservatives obliged when the Chancellor of the Exchequer, Nigel Lawson, estimated a loss of revenue of ?630m on charges and a cost of ?400m a year on extra resources.  debate, so far, has been almost entirely on the government's record, with predictable contributions from both sides. So we have Mr Meacher proclaiming: The health service is on a remorseless treadmill of decline, and will not survive a third Thatcher term. While declaring that Labour is committed to a real boost in health spending and services, the aim is to highlight existing deficiencies to the point of exaggeration and distortion. All's fair in war and elections, perhaps, but there is a danger that ill founded criticism and denigration of the health service, whether by politicians or professionals, can not only affect morale within the NHS but cause distress to patients and their relatives.  government for its part is content to stand by its record, which it confidently projects also in a supplement to its manifesto, under the title Health into the Nineties.