Page last updated at 11:53 GMT, Monday, 10 May 2010 12:53 UK

Would coalition government mean stalemate for the NHS?

By Nick Triggle
Health reporter, BBC News

Hospital ward
The NHS has been told to make savings

While the differences in health policy are not what they were a decade or so ago, there would still be a number of plans in England that could become casualties in a coalition government.

To put it simply, much of the reform programme would be put on the backburner.

Instead, it is likely the only issues that future ministers would spend time hammering out would be those that affect the budget.

The NHS is responsible for nearly a fifth of government spending - and so cuts and savings would have to be made to help the wider economy.

The Conservatives were actually the only party to promise to increase the NHS budget above inflation.

However, in reality any increase would be small.

Cost savings

Indeed, none of the parties have disagreed with the head of the NHS, Sir David Nicholson, who has asked the service to make up to £20bn of savings by 2014 to help keep pace with the rising demands from new drugs, the ageing population and lifestyle changes such as obesity.

The economy is clearly the crucial issue and so how the NHS affects that will be the priority
Professor John Appleby of the King's Fund

That is about 5% of the yearly budget - quite a challenge for a service that has seen productivity fall each year over the past decade.

Michael Sobanja, chief executive of the NHS Alliance, which represents NHS staff who work outside hospitals, says: "It is the case that whatever government gets in the challenge on money remains the same.

"The most significant area that affects this is staff - headcount, pay and pensions. There is no getting away from it."

Professor John Appleby, chief economist at the King's Fund health think tank, agrees.

"The economy is clearly the crucial issue and so how the NHS affects that will be the priority.

"As for everything else, rather than create opportunities for disagreement they will just keep to the basics. The NHS will just trundle on."

If the experts are right, that would mean a host of eye-catching initiatives being punted into the long grass particularly if it is the Tories and Liberal Democrats who reach an agreement this week.

Proposals and promises

The Tories wanted to create an independent NHS board to run the health service and change the Department of Health into the Department of Public Health.

But that is at odds with the Lib Dem vision of putting the power into the hands of local people through directly-elected health boards.

Meanwhile, the Lib Dems have supported minimum pricing for alcohol. The Tories are, however, implacably opposed.

On targets, there is disagreement too. The Lib Dems, like Labour, back the idea of creating patient guarantees for cancer treatment and hospital operations.

Andrew Lansley, the Tory shadow health secretary, spent much of the election campaign criticising them as "damaging and perverse" and promising to abolish them.

Perhaps the biggest casualty - and probably most far-reaching - will be social care. Lib Dem health spokesman Norman Lamb has worked hard in recent months to try to build consensus over the issue of funding.

His team indicated he had been willing to support the Labour plan for a compulsory levy to create a National Care Service.

But the Tories have made it clear, particularly in recent weeks, that they were opposed.

They want to see a voluntary insurance scheme despite Lib Dem insistences that such models never get high enough take-up to work.

The result could be that the status-quo - the means-tested system - remains in place.

Jeremy Taylor, of National Voices, a coalition of charities and patient groups, says that would be a disastrous situation for some of the most vulnerable people in society.

"The system is unfair and chaotic. People can't get access. But it is a difficult, expensive and politically sensitive issue and the danger now is that the momentum gets lost."

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