Unpicking the general election manifestos on health and care

Conservatives

The Conservatives’ manifesto Secure Britain’s Future describes itself as a “clear plan,” but the health and care section occupies just three of the document’s 80 pages. It offers to “increase NHS spending above inflation every year, recruiting 92 000 more nurses and 28 000 more doctors, driving up productivity in the NHS, and moving care closer to people’s homes through Pharmacy First, new and modernised GP surgeries and more community diagnostic centres.”

The plan also says it will “return performance to the levels set out in the NHS Constitution by the end of the next parliament” but gives no explanation as to how this will be achieved. Nor is there much clarity on social care, apart from a commitment to “supporting a high quality and sustainable social care system, building on our additional investment of up to £8.6bn over the last two years.” The imprecise number here relies on local governments putting up council tax. They also laud their dental recovery plan, which has widely been regarded as a costly failure.

The Conservatives also offer to “build or modernise 250 GP surgeries, focused on areas of new housing growth, and build 50 more community diagnostic centres, including in underserved areas, resulting in an additional 2.5 million checks a year.” These are funded by their pledge to “cut waste and bureaucracy in the NHS, reducing the number of managers by 5500, releasing £550m for frontline services, and simplifying and streamlining oversight and accountability.”

However, by international standards the NHS is undermanaged,[4] with former health secretary Andrew Lansley’s 2011 reforms having cut management by 45% from the 2008-9 level.

The pledge to increase community care capacity also has echoes of the 2020 new hospitals programme, the delivery of which has faced criticism from the House of Commons Public Accounts Committee and the National Audit Office.

Labour

Labour’s planned spending restraint shapes the party’s manifesto commitments on health and care, limiting promises.

Labour’s manifesto, Change, promises to get a grip on the record waiting list.[8] “We will return to meeting NHS performance standards,” it says. “That means patients should expect to wait no longer than 18 weeks from referral for consultant-led treatment of non-urgent health conditions.”

The manifesto doesn’t give a date by which this will happen, although shadow health secretary Wes Streeting has repeatedly said that he wants this done by the end of their first term.

Labour aims to create 40 000 more appointments a week, funded by a tax crackdown and new non-domicile tax measures and delivered by incentivising existing NHS staff to work extra sessions at evenings and weekends.

The party pledges to use spare private sector capacity, of which there is little.[10] The practicality of its idea to “pool resources across neighbouring hospitals to introduce shared waiting lists to allow patients to be treated quicker” is also yet to be proved to work at scale.

The Labour manifesto also describes a new “Fit For the Future” fund to double the number of CT and MRI scanners, allowing the NHS to catch cancer and other conditions earlier and saving lives.

Labour also says it is committed to delivering the new hospitals programme. It is worth noting, however, that this is not the same as tackling the £12bn capital and maintenance backlog.

Another pledge offers more power to patients. Labour’s plan is to transform the NHS app, putting patients in control. “This will include giving performance information on local services and notifications of vaccinations and health checks. Patients will be able to see the medical guidelines for the treatment they should get, to hold health services to account and understand what their choices are.” This sounds good, but the track record on the real impact of patient choice is underwhelming.

The manifesto goes on to talk about patient safety and modernising the NHS to become a “neighbourhood health service.” There is a mention of shifting resources to primary and community care, but there are no numbers or timelines. There’s also an interesting aim to take the pressure off GP surgeries by improving access to services and treatment through new routes. The manifesto says, “We will create a community pharmacist prescribing service, granting more pharmacists independent prescribing rights where clinically appropriate. We will allow other professionals, such as opticians, to make direct referrals to specialist services or tests, as well as expanding self-referral routes where appropriate.”

There are commitments on dental contract reform, mental health, and social care: it is not clear in the manifesto, but Labour has since pledged to match the Conservatives’ plan to introduce the £86 000 lifetime personal care cap by 2025. There is also a pledge to “build consensus for the longer term reform needed to create a sustainable National Care Service.”

Liberal Democrats

The title of the Liberal Democrats’ manifesto, For a Fair Deal, hints at the party’s likely best case scenario: returning as a top three Westminster party and influencing the national debate.

The Liberal Democrats’ care offer is significant, which is unsurprising given that the party’s leader, Ed Davey, has spoken publicly about his experience of caring for family members.

They pledge to introduce free personal care, based on the model introduced in Scotland in 2002, whereby provision is based on need, not ability to pay. They also pledge to create a social care workforce plan, establish a Royal College of Care Workers to improve recognition and career progression, and introduce a higher minimum wage for carers.

They pledge to establish a cross party commission to forge a long term agreement on sustainable funding for social care and to give unpaid carers a “fair deal,” including paid carer’s leave and a statutory guarantee of regular respite breaks.

The Liberal Democrats’ headline health pledges include giving everyone the right to see a GP within seven days or within 24 hours if their need is urgent, with 8000 more GPs to deliver on that. They will also guarantee access to an NHS dentist for everyone needing urgent and emergency care, to end DIY dentistry and “dental deserts.”

The party also pledges to improve early access to mental health services by establishing mental health hubs for young people in every community and introducing regular mental health checkups at key points in people’s lives when they are most vulnerable to mental ill health.

Cancer survival will be boosted, and the party says it will introduce a guarantee for 100% of patients to start treatment for cancer within 62 days of urgent referral.

They will also help people to spend five more years of their life in good health by investing in public health.

The Liberal Democrats’ offer is the most generous of the three national parties, although there is scant detail how they plan to deliver their pledges. They also have plans for the NHS estate: to “implement a 10 year plan to invest in hospitals and the primary care estate to end the scandal of crumbling roofs, dangerous concrete, and life-expired buildings.” However, there is little clarity on how they’d deal with the more than half of the current £12bn NHS capital and maintenance backlog that is already posing risks to the safety of patients and staff.