As the dust settles after the first of the leaders’ debates, did it tell us any more about the parties’ approach to health?

For health aficionados, the debate was perhaps as notable for what the leaders didn’t say, as what they did. There was no discussion about the Conservative proposal for an independent NHS board or the Lib Dem commitment to local elected health boards, for example, although it would hardly be surprising if party strategists judged these issues too prosaic for the viewers. It was also short on definitive commitments, although David Cameron appeared to write a blank cheque for at least one cancer drug, albeit one that has already been approved by NICE.

Instead, the leaders’ pitches reflected their overall approach to the debate. Gordon Brown concentrated on policy commitments, especially Labour’s personal guarantees – which he challenged the Conservative leader to match. David Cameron didn’t rise to the bait, despite Brown returning to this a number of times.

Cameron’s pitch was a personal one, focusing on his experience of the NHS during his son’s illness – his message was that the NHS is safe in his hands. Meanwhile, Nick Clegg called on the other two to be honest about the difficulty of protecting NHS services in the current economic climate, taking a swipe at the number of NHS managers.

The Conservative leader successfully shifted the debate on to the dominant issue of the campaign so far – Labour’s planned increase in National Insurance – and the Tory proposal to spend the £200 million this would cost the NHS on cancer drugs. This is where things got more interesting. The most eye-catching statement of the evening was David Cameron’s assertion that death rates from cancer in the UK are worse than those of Bulgaria.

The truth? Yes they are. But comparisons of this sort are notoriously difficult to make as the data on which they are based is often unreliable and the picture is complex. For example, Bulgaria has historically had much lower rates of smoking than the UK – something which is now changing. And, while death rates from cancer in Bulgaria are rising, the UK’s are falling, at least in part due to reductions in waiting times for screening and treatment and to other improvements in cancer services.

On social care, the leaders were keen to avoid the recriminations of recent weeks, with no mention of the ‘death tax’ row which has dominated the recent debate. All the leaders talked about the unfairness of people having to sell their home to pay for their care and the need for political consensus going forward, with Gordon Brown and Nick Clegg playing up their proposals for a commission to resolve the thorny question of how to fund social care.

However, although Gordon Brown outlined the proposals in Labour’s recent White Paper, it seemed all three preferred to kick this issue into touch rather than debate concrete proposals for reform. With Labour holding an 11-point lead on this issue according to ICM, it was perhaps surprising that the Prime Minister did not challenge his Conservative counterpart more strongly.

Many watching will have felt a sense of déjà vu. Back in 1997, Tony Blair famously said that he didn’t want his children to be brought up in a country where people are forced to sell their home to pay for their care. His solution? To set up a Royal Commission. Thirteen years later, we appear to have come full circle. Patrick South