What do the party manifestos mean for the NHS? | Richard Vize

19 May

Labour’s election manifesto offers confused plans for the NHS, while the Conservatives have admitted there are serious problems with existing legislation.

The Tory manifesto says that if the “current legislative landscape” – dominated by the government’s own health reforms – is hampering the Five Year Forward View or undermining local or national accountability they will fix it, as well as do what they can in the meantime to remove barriers to care integration.

It identifies the internal market as the key problem, because it is too expensive to run and can fail to work in patients’ interests.

This is a significant move. It had been assumed that Theresa May would avoid reopening the issue of NHS reform at the same time as navigating Brexit. But she has clearly been persuaded that the benefits of cutting running costs and making it easier to join up services outweigh the risks.

One of the weaknesses in Labour’s proposals is muddled thinking about the organisational building blocks of the health service. It promises to repeal the Health and Social Care Act 2012, which imposed Andrew Lansley’s dysfunctional NHS reforms, and to “halt and review” sustainability and transformation plans (STPs).

So instead of trying to fix problems introduced by the reforms, such as endless competitive tendering, Labour holds out the prospect of wholesale change, including wrenching public health back out of local government and scrapping NHS England.

Labour has always been uneasy at the reduction in central political control of the health service, and the Tory promise to “hold NHS England’s leaders to account for delivering their plan” shows how the government is trying to wriggle out of responsibility. But the inevitable upheaval caused by pulling the NHS back inside the Department Health would be an serious distraction.

Labour’s portrayal of STPs as “looking at closing health services across England” is a gross misrepresentation of the efforts of local leaders to implement the Forward View within severe funding restraints. It also wilfully conflates changes driven by affordability with those intended to improve quality and save lives by concentrating some services in specialist centres. Delaying those changes would put patients at risk.

Stoking up public fear of anything that looks like change is cheap politics.

Labour’s promise to create yet another regulator – NHS Excellence – is baffling. No detail is given.

The manifesto promises to reverse privatisation of the NHS. With the failure of several high-profile private sector contracts in recent years, notably in community services, this is comfortable territory for Labour. But, despite claims of excessive profits, there is still the risk that scrapping some contracts will drive up costs.

NHS staff are promised an end to the NHS pay cap, with control put back in the hands of independent pay review bodies.

Labour is promising £30bn in extra funding over the next parliament, which is modest compared with its £48.6bn of additional annual spending commitments. The Liberal Democrats are proposing £6bn a year extra for health and social care, paid for by a 1p rise in all rates of income tax, while the Tories are pledging an £8bn real terms increase over five years.

All three are likely to prove inadequate. The Health Foundation said that on current cost projections, the manifestos would all leave a significant funding gap by 2020-21, varying between £7bn for Labour and £12bn under the Tories.

The Conservatives are promising “the most ambitious programme of investment in buildings and technology the NHS has ever seen”. With the health service’s capital budget frozen and raided to support revenue spending, this commitment is hard to believe, and it certainly will not match the wishlists of the STPs.

But the NHS England chief executive, Simon Stevens, has identified capital spending as a priority for the coming months, and there have been indications that the Treasury position on this funding stream is softening.

So far the election campaign has been quietly helpful to the NHS. It is opening up debate around some of the legal barriers to better care, forcing a discussion on social care funding and creating a focus on the need for investment in mental health, particularly in the Lib Dem manifesto.

But not even Labour is offering a solution to the funding problems.

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