Against a backdrop of chronic underfunding, longer A&E waiting times, and restrictive thresholds on new medicine uptake, health and social care has emerged as one of the dominant talking points in the election race. The three main parties have all pledged to invest billions in the NHS, yet independent health experts still suggest these promised cash injections are insufficient to plug the gap.
Despite talk of a cross-party approach earlier this year, the party political battle lines have been drawn once again over how social care is funded. All of the major parties have acknowledged the need for additional social care funding, but their manifestos offer varying solutions.
Earlier this year, in the midst of the A&E winter crisis, a cross-party group led by Norman Lamb MP put pressure on Government to establish an NHS and Care Convention to find a long-term solution to health and social care funding. Despite warm words from the Prime Minister at the time, this cross-party approach has been adopted in by the Liberal Democrats and, to an extent Labour’s but not by May’s Conservative Party.
The Conservative manifesto instead outlines a set of ‘hands-off’ policies to fund social care, giving councils the ability to raise additional funds and offering continued support for Sustainability and Transformation Plans (STPs). Of course Labour came out early with a commitment to halt and review all STPs, playing the NHS card early on in the election campaign.
Since its conception, the NHS has played a divisive role during election campaigns. Despite David Cameron’s commitment in 2010 to “cut the deficit not the NHS”, the Conservative-led Government has seen the health service slowly buckle under the pressure of being under-resourced.
The Conservatives under May have committed to give the service the “resources it needs” – interpreting this as a minimum £8 billion in real term spending over the next five years. However it is still unclear on whether this is new money or transferred from the Spring Budget. In contrast, Labour and the Liberal Democrats are committed to raising additional revenues for the health service through explicit and dedicated taxes. Labour will commit over £30 billion in extra funding over the next Parliament through increasing tax for the highest 5% of earners and by increasing tax on private medical insurance. The Liberal Democrats have promised to provide £6 billion of funding for the NHS through an extra one penny to every pound of income tax.
Amidst nurse shortages and changes to nursing bursaries, the Government has responded to calls for certainty over the NHS’s EU workforce, promising to prioritise the working rights of 140,000 NHS staff from the EU. Labour and the Liberal Democrats have pledged to do the same.
But are these promises of additional spending enough and is more money the answer to the NHS’s problems? Theresa May and NHS England’s Simon Stevens have already locked horns over funding in the last Parliament, with the Chief Executive calling the Prime Minister’s claims to have given the health service more money than it had asked for ‘a stretch’. Many would argue that political parties’ obsession with short-term funding commitments fails to address the root cause of NHS pressures, namely an ageing population living with complex co-morbidities, entering into a healthcare system rife with management silos, perverse incentives and a fundamental lack of integration.
In 2014, the newly appointed NHS England Chief Executive set out his plans to reform frontline NHS services by joining up health and social care; moving care out of hospitals and into the community; and engaging in preventive care. Exalted as the mechanism for closing the funding gap and improving local health care through local partnerships, Simon Stevens’ STPs have remained a point of contention between the Conservatives and the Labour party.
The shift towards joined up health and social care at a local level dominates the Conservative manifesto promises, from police commissioners sitting on local health and wellbeing boards to an independent healthcare safety body covering local health-related services.
Conversely, Labour has vowed to halt the progression of STPs, condemning them as a smokescreen, established solely to mask cuts to frontline services.
For May, the continuation of locally driven health policy is fundamental to her ‘country and community’ manifesto promises, not least because this places the responsibility and accountability for delivery firmly with Simon Stevens and his NHS colleagues. The Conservative pledge to hold NHS leaders to account for driving reform is a fairly pointed reminder to Stevens that Number 10 and the Prime Minister won’t be the ones taking the heat if he fails to address the funding gap.
Stevens therefore needs local NHS leaders across England to make STPs work. Yet, even if Stevens is successful in bringing local leaders together, the real sticking point is in the legislation, or lack of – without which STP leaders are essentially powerless to intervene.
In the wake of Brexit, investment in the UK’s science and innovation base has been a matter of much debate. Government has accepted that investment is essential if the UK is to remain attractive to pharmaceutical companies and med-tech companies alike. The Conservative Party’s manifesto focuses on how to make access pathways more streamlined and cost-effective, with a promise to implement the recommendations of the Accelerated Access Review (AAR). This independent review made recommendations on how NICE might accelerate patient access to drugs devices and diagnostics; deliver the NHS’s Five Year Forward View; and provide patients with definitive cancer diagnosis within 28 days by 2020. Whilst this is a seemingly straightforward commitment, and one that Government probably considers a ‘quick win’, the signals are in fact mixed. This desire to allow for more agile processes and rapid access appears to be in direct contravention with the recently tightened NICE Highly Specialised Technologies (HST) budget and QALY thresholds, which will likely delay or even block patient access to transformative, innovative treatments.
Labour’s manifesto does not refer to the AAR but to its own Industrial Strategy which would include extra investment in research. Labour further pledges to create an ‘innovation nation’ with the highest proportion of high-skilled jobs in the Organisation for Economic Co-operation and Development (OECD) by 2030 and to meet their target of 3% of GDP spend on research and development in the same year. The Liberal Democrats, however, pledge to build on the existing Industrial Strategy by creating more ‘catapult’ innovation and technology centres. Both Labour and the Liberal Democrats pledge to eliminate preventable diseases like TB, HIV and malaria and explore new ways to support research and development into vaccinations.
Whilst the three main political parties differ on spending plans, they are all in agreement that reform of mental health provision should be at the heart of any future NHS reform to achieve parity of esteem with physical health. Theresa May placed mental health at the centre of her health manifesto promises, illustrating her desire to ‘transform’ attitudes to mental health, with a focus on children and young people. The introduction of a new Mental Health Bill seeks to reduce unnecessary detentions and discrimination by reforming the Mental Health Act.
Although the Prime Minister’s plans have been welcomed by mental health campaigning groups, the true test will be whether the commitment to new mental health training, awareness and national and local health services will be properly resourced. Labour and the Liberal Democrats have also focused on children’s mental health, with Labour promising to extend schools-based counselling to all schools and the Liberal Democrats guaranteeing that children won’t have to wait more than two weeks for treatment when they experience a first episode of psychosis. For the Liberal Democrats, mental health funding will be ring-fenced within the one penny income tax rise.
Perhaps surprisingly, cancer is not given much attention in the parties’ manifestos. The Conservatives promise to give patients a definitive cancer diagnosis within 28 days by 2020 and to continue to support research into the diagnosis and treatment of rare cancers. Labour promise to deliver the Cancer Strategy in full (all 96 recommendations) by 2020 and the Liberal Democrats state that they will support public awareness campaigns such as ‘Be Clear on Cancer’. It is interesting to note that the Conservative Party have focused on the early part of the care pathway, for example diagnostic times and radiotherapy equipment.
With the World Health Organisation reporting that no country has managed to turn around the obesity epidemic in all age groups, all three parties have pledged to take action to tackle childhood obesity. Labour promise to implement a Soft Drinks Industry Levy or ‘sugar tax’ to reduce obesity, the Liberal Democrats would go one step further and restrict TV advertising on certain foods before the watershed.
Following the Conservative Party’s Spring Budget pledge to put £2 billion into the social care system and allow councils to raise more money through council tax, the Conservatives have further promised to publish a green paper to examine the quality of social care provision. The central tenet of the Conservatives’ plan to fund social care was a single capital floor, set at £100,000, to ensure that people would retain at least £100,000 of their savings and assets, including value in the family home. However, anyone over this threshold would have to pay for their care. Dubbed as the ‘Dementia Tax’, the Conservatives later announced that the amount people would have to pay would be capped and, if the Conservatives win, considered after the Government forms.
In contrast, Labour promises to increase the social care budget by a further £8 billion over the lifetime of the next Parliament, including an additional £1 billion for the first year and the creation of a National Care Service. The Liberal Democrats would add one pence on income tax to raise £6 billion to be spent on NHS and social care services, and to limit the amount older people have to pay for social care services.
See who has pledged what in our go-to health manifesto guide here.
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