“David Cameron delivers five pledges to protect the NHS - but has already broken three.” Daily Mirror, 7 June 2011

“David Cameron is the first PM in history to set out five pledges to protect the NHS from his own policies, yet he has already broken two of them.” Ed Miliband, 7 June 2011

With Parliament returning from Whitsun recess today, David Cameron and Ed Miliband have wasted little time in renewing hostilities over the Government's controversial proposals for the NHS.

The Prime Minister pointed to polling suggesting popular support for the principle of health service reform, while also setting out five 'guarantees' to the public on the limits of his proposed measures.

He promised: “We will not endanger universal coverage, we will make sure it remains a National Health Service. We will not break up or hinder efficient and integrated care – we will improve it. We will not lose control of waiting times – we will ensure they are kept low. We will not cut spending on the NHS – we will increase it. And if you’re worried that we are going to sell off the NHS and create some American-style private system – we will not.”

However the Labour Leader, delivering his own speech on healthcare this morning, argued that Mr Cameron had already broken two of these pledges, before they had even been announced.

Mr Miliband said: “The number of people waiting 18 weeks for treatment has gone up. He has not protected the health service budget.”

The Daily Mirror went even further, arguing that three of Mr Cameron's promises had already been breached, adding doubts about whether or not the Prime Minister was protecting a 'national' service to those raised by Ed Miliband.

The paper argued: “The PM’s cancer drugs fund has also introduced a postcode lottery for those needing services not automatically provided by the NHS.”

So how many of these health pledges – if any – were dead on arrival?

Waiting times:

The trajectory of waiting times under the Coalition’s stewardship has been a matter of fierce debate recently.

David Cameron and Ed Miliband clashed on the issue at Prime Minister's Questions in April, with the PM rebuffing the accusation from Mr Miliband that waiting times had risen over the past year, and instead labelling them “stable.”

When we looked into the figures, we found that both arguments could be substantiated, albeit with different data.

Mr Miliband points to the “number of people waiting 18 weeks for treatment,” and within this frame of reference he is correct to say that waiting times are rising. In May 2010 the proportion of patients waiting more than 18 weeks for treatment stood at approximately 7 per cent, while in February of this year it was 10 per cent.

However the Prime Minister and his Health Secretary Andrew Lansley point to alternative data. They argue that median referral to treatment times – the average period that all patients have to wait – have been flat since they assumed office.

And indeed a look at this dataset does show that median waiting times have remained stable at around eight to nine weeks since last May, where they have been since March 2008.

For Ed Miliband's claim that the Prime Minister has broken his pledge on waiting times to stand up, one must accept the 18 week target as the best way of measuring them. Whether or not it is is a matter of some contention, however it certainly isn't the only way of looking at the issue.

Furthermore it is important to note that Mr Cameron pledged only to keep waiting times 'under control', and does not absolutely rule out the possibility of some rises.

Funding the NHS:

The Prime Minister's pledge to increase real term funding for the NHS is one which his party has campaigned on during and since the election.

Again however, the Government's prospects for meeting this pledge have been the source of much consternation.

When it set out its funding plans in the October Spending Review, the Government committed to provide approximately £1 billion in extra cash each year to 2015, which it anticipated would translate into an annual 0.1 per cent real terms rise.

However revisions in growth and inflation projections since then have cast doubt on whether the provisions will actually constitute a real terms rise. By the time of March's Budget, Ed Miliband's party were claiming that Mr Cameron had “broken his promise” on NHS funding.

Expert opinion on who is right has been divided. Head of the IFS, Paul Johnson, has said that so far as the years 2010-11 and 2011-12 were concerned, the Government's flagship pledge “is now only expected to be barely met”.

This was, he said: “only because of a possible underspend and the fact that they are comparing to actual spending in 2010-11 rather than a figure which takes account of temporary measures.”

He added: “At the time of the Spending Review the Government used this figure including temporary measures as the comparator for all departments. If the 2010-11 spending had been in line with the spending review baseline, then there would have been a small real terms cut in 2011-12.

“The government is meeting its pledge but it is sailing perilously close to the wind.”

Health body the King's Fund has gone one step further, arguing that the present spending plans and economic environment mean that “the small real-terms increase of 0.34 per cent over four years is now forecast to be a small real cut of around 0.25 per cent.”

Again therefore, while the positions of both Mr Miliband and Mr Cameron can be supported, neither can claim a monopoly on accuracy, and the matter is unlikely to be settled until the economic data presents a clearer and more consistent picture. Also, it is worth bearing in mind that the Government is of course free to announce extra funding for the NHS should inflation place the pledge an immediate risk.

'Postcode lottery'

The third 'breach' posited by the Mirror relates to whether or not the Government is retaining a 'national' health service. The paper suggests that the “PM’s cancer drugs fund has also introduced a postcode lottery for those needing services not automatically provided by the NHS.”

The concern about uneven distribution of the £200 million Cancer Drugs Fund stems from a Macmillan Cancer Support press release back in April.

The cancer charity argues that while the Fund was broadly positive for patients, there had been “sadly considerable variation in the way that it has been administered between regions.”

It argued that better guidance is needed in order to avoid a “postcode lottery” as the scheme was rolled out in full.

Whether the uneven distribution of the new Cancer Drugs Fund in its initial period is tantamount to a breach of the Prime Minister's pledge to protect “universal coverage” is a matter of interpretation.

Conclusion

As with many issues surrounding the ongoing Health and Social Care Bill reforms, there is a good deal of often contradictory information, providing plenty of scope for competing claims.

While it would appear that there isn't enough evidence yet to say conclusively that any of the Prime Minister's guarantees have already been breached, on some issues, particularly funding, there are some indications that the Government is already “sailing close to the wind”.

On most of these issues however, only time will tell whether Mr Cameron or Mr Miliband has the better analysis of the current direction of travel.