This is the first in a series of posts looking at what the three main parties’ manifestos have to say about key policy issues. According to polling by YouGov, health is the second most important issue at this election (after Brexit). There are a lot of statistics thrown around in this area, and a lot of claims and accusations; many of these are true, but at least as many are false – perhaps even slanderous.
One such accusation, consistently made against the Conservative Party, is that NHS funding will be cut as it supposedly has been in government. The truth is that funding really is at record monetary levels, but has fallen as a percentage of GDP. The reason for this is that we had the highest growth in the EU with sustained low inflation up until Brexit, thanks to our long term economic plan, but we still have a huge budget deficit to eliminate with rising debt to pay off.
Under the Coalition government, the NHS budget was maintained at or above inflation throughout the Parliament. The Labour opposition called this irresponsible in the wake of the financial crisis, and cut funding for NHS Wales where they were (and still are) in power. David Cameron’s majority government committed to the NHS’s own ‘five year forward view’ plan, with a budget increase of £8bn by 2020 plus an extra £2bn up front.
“The Conservative Party believes in the founding principles of the NHS. First, that the service should meet the needs of everyone, no matter who they are or where they live. Second, that care should be based on clinical need, not the ability to pay. Third, that care should be free at the point of use. As the NHS enters its eighth decade, the next Conservative government will hold fast to these principles by providing the NHS with the resources it needs and holding it accountable for delivering exceptional care to patients wherever and whenever they need it.”
Conservative Party Manifesto, 2017
Admittedly, the current budget plan is near the bottom end of what was outlined in the forward view, but is more than the minimum necessary to continue operating effectively under increasing demand. The new Conservative manifesto makes the same financial commitment, along with a pledge for a variety of reforms. Beyond the core question of funding, many of the peripheral issues are covered in a similar way by each of the parties, and there is a consensus that “our National Health Service is the essence of solidarity in our United Kingdom”.
Labour’s manifesto promises to increase the NHS budget by £30bn over the next Parliament, with the intention of funding it through tax rises. While this would likely solve all of the immediate problems in the health service, it could have unintended consequences. We can’t just keep throwing money at the problem; I believe high ‘current’ spending with reliance on a large tax take is inherently unstable. I set out my arguments for a lower tax economy in a previous post, and as we all remember, you can’t have a strong NHS without a strong economy.
To their credit, Labour do seem to set out more effective action to tackle childhood problems which go on to pervade and perturb the NHS such as nutrition, exercise, and obesity, as well as tackling awareness of developmental issues related to smoking and alcohol. However, they also want to reverse the localisation of control over NHS services, recentralising power into the hands of the Secretary of State and returning to a wasteful, unpragmatic monolith.
They go on to repeat their most effective lie: “the next Labour government will reverse privatisation of our NHS and return our health service into expert public control”. The NHS has not been, is not being, and will not be privatised. Nevertheless, private sector involvement in the system has increased through contracts for the provision of services on behalf of the NHS. The amount spent on these contracts increased by roughly the same percentage under the last Labour government and the Coalition/Conservative governments, although it was slightly higher under Labour. I don’t see this as a problem; it is often more efficient to pay a private provider to perform a highly specialised task than to invest in facilities which would go unused most of the time.
“Our longer-term objective will be to bring together NHS and social care into one seamless service – pooling budgets in every area by 2020 and developing integrated care organisations.”
Liberal Democrat Manifesto, 2017
The Liberal Democrats have pledged a much more modest 1% rise in income tax, dedicated to funding health and social care. It is expected to raise £6bn, presumably as a supplement to the £8bn increase currently planned, and is intended to eventually transform into its own bespoke tax based on (much-needed) reform of National Insurance. They are also calling for a full cross-party review of the long-term sustainability of the health service, involving professionals and the public.
According to the Lib Dem manifesto, 40% of NHS spending is on preventable diseases. I very much agree that “we need to do more to promote healthy eating and exercise, making people aware of the dangers of smoking and excessive consumption of alcohol and other drugs”. However, seemingly contradicting the latter aim is the commitment elsewhere in the manifesto to legalise cannabis and lessen the penalties for the use of other drugs.
I expected the lens of Brexit to feature most prominently in the Lib Dems’ health plans, but I was surprised that they had very little more on the topic than the other two. All three manifestos acknowledge the NHS’s reliance on EU migrants, and place a high priority on securing their rights in negotiations. The Conservative manifesto goes further, asserting that “we cannot continue to rely on bringing in clinical staff instead of training sufficient numbers ourselves”.
My preferred plan for health comes from the Liberal Democrats. While there are details I disagree with, some quite strongly, a temporary levy to relieve services would be welcomed by most people. Investing in preventative measures and incorporating wider care could bring down the total cost of the NHS over time, but I am also relying on the assumption that a proper review will result in some of the positive reforms proposed in the Conservative manifesto being put into practice.
Andrew Bulman 