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Election 2017: Party policies and the future of the NHS

The political parties have set out their plans for the health service ahead of the 8 June election. But are they facing up to the real challenges or just chasing your vote? And what will it mean for nurses if, as polls predict, the Conservatives win an increased majority?
election moore

The political parties have set out their plans for the health service ahead of the 8 June election. But are they facing up to the real challenges or just chasing your vote? And what will it mean for nurses if, as polls predict, the Conservatives win an increased majority?

Isnt this meant to be the Brexit election? Where does health fit in?

Polls suggest the NHS is one of the key areas of concern for voters possibly even more than Brexit. Labour would love this election to be all about the NHS, and has produced a raft of policies that should appeal to people working in it, including free car parking and an end to pay restraint. Labour leader Jeremy Corbyn has put

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The political parties have set out their plans for the health service ahead of the 8 June election. But are they facing up to the real challenges or just chasing your vote? And what will it mean for nurses if, as polls predict, the Conservatives win an increased majority?

election moore
Whoever wins the general election, there is a mountain to climb to resolve challenges facing the NHS.
Picture: iStock

Isn’t this meant to be the Brexit election? Where does health fit in?

Polls suggest the NHS is one of the key areas of concern for voters – possibly even more than Brexit. Labour would love this election to be all about the NHS, and has produced a raft of policies that should appeal to people working in it, including free car parking and an end to pay restraint. Labour leader Jeremy Corbyn has put the NHS at the heart of his campaign, promising an extra £37 billion for it by 2022.

The Liberal Democrats have also committed to more spending – £6 billion a year over five years to be funded by an extra 1p on income tax – and to an independent body to monitor health spending and make recommendations to parliament. Lib Dems leader Tim Farron told RCN congress: ‘The time to invest in health and care has come, and not a moment too soon.’

What’s not to like?

Promises of more money for health are not the whole story. The Conservatives, whose NHS funding proposals are not greatly different from those of the other parties, argue that their record on economic stability means the NHS would do better with them than under other parties.

60,000

Around 60,000 NHS staff are citizens of other EU countries whose right to remain in the UK is unresolved

The deal Britain negotiates as it leaves the EU will be important for the NHS, and prime minister Theresa May is pitching herself as the person most likely to obtain a good settlement that will boost the UK’s economy. A crucial point for the NHS will be whether the 60,000 or so NHS staff who are citizens of other EU countries are able to stay and work here – and how quickly that is resolved.
Polls can be wrong, of course, but at the moment a Labour government – or even a broad left coalition – looks unlikely to happen.

If the Conservatives win what will it mean for health?

To some extent, more of the same. There is no sign of a massive change in direction, certainly not in funding, where commentators have said the promised extra £8 billion in real terms by the end of the next parliament is actually a very tight settlement – as all the three main parties’ proposals would be. This is because demand for NHS services continues to rise, with factors such as an ageing population with more co-morbidities, and the cost of providing those services will rise by more than the rate of inflation due to, for example, expensive new medicines. One plus point is the promise of more money upfront in 2018-19, which had previously looked particularly difficult.

There are also hints of more capital spending – something the NHS desperately needs and where budgets have been raided to support revenue over the past few years. No figure has yet been put on this.

One plus point is the promise of more money upfront in 2018-19, which had previously looked particularly difficult

The manifesto also commits to sustainability and transformation plans (STPs) – the NHS blueprints for the future – as long as they are ‘clinically led and locally approved’. With a new mandate and potentially a big majority, a Conservative government might be happy to support controversial reconfigurations. NHS England chief executive Simon Stevens has already talked of the NHS ‘rolling up its sleeves’ on service reform after the election.

But a Tory victory would also be likely to mean that pay restraint remains across the public sector – and this might be even more likely if the economy continues to show worrying signs of slowing down.

The Conservatives are making some promises on health, including keeping people with mental health problems out of police custody, where possible, and more preventive care and early intervention such as mental health first aiders in schools.

Will Jeremy Hunt survive as health secretary?

Jeremy Hunt is Britain’s longest-serving health secretary, and it is possible he will be reshuffled away from health. Whoever gets the post might see their main job as bringing NHS spending under control – something the Treasury is thought to favour. That would bode ill for NHS wages and spending more generally over the next few years. One knock-on effect could be at the top of the NHS – would Simon Stevens still want to continue at NHS England if a new health secretary saw the need for cuts but not the need for funded transformation?

Mr Stevens’ relationship with Theresa May and the Treasury is not as close as it was under David Cameron, and the Conservative manifesto includes a comment about holding NHS England’s leaders to account for delivering their plan to improve patient care. 

Do any of the parties making these promises really grasp the nature of the challenges the NHS is facing?

Possibly not – or they don’t want to admit how difficult much of this will be to achieve. Some of the promises make good sound bites but don’t recognise the underlying reality.

Workforce, for example, is identified by many inside the NHS as its major challenge. Yet there is little detail in the manifestos of how this will be tackled – though there are a few promises about extra staff. Manifestos are of necessity fairly brief, but it is sometimes hard to see whether there is deeper thinking about the problems of demand, cost and workforce. The Conservative manifesto is largely silent on the nursing workforce outside mental health, for example, despite the huge nurse shortfall the NHS is facing.

Workforce is identified by many inside the NHS as its major challenge. Yet there is little detail in the manifestos of how this will be tackled

The Health Foundation charity’s director of research and economics Anita Charlesworth says social care will need immediate attention, and spending on the NHS needs to increase in the next two years. Looking beyond 2020, the rate of funding growth for both will need to accelerate so they take a bigger share of the UK’s gross domestic product to cope with growing demand and costs.  ‘Short-term funding is necessary, but not sufficient,’ she adds.

The Health Foundation’s calculations show that funding needs to increase by 4% above inflation each year to keep up with these pressures, and every party’s proposals would still be billions of pounds short of what is needed.

Chief economist at the Nuffield Trust John Appleby says: ‘It is crucial that the health service can plan for steady funding increases which are in line with what experts recommend, rather than the current regime of feast and famine.’

At a deeper level there seems to be little willingness to ask what kind of NHS we are prepared to pay for, given the pressure increasing demand is putting on the current model. ‘The big questions are yet to be debated,’ says RCN lead pay negotiator Josie Irwin.

Are there opportunities for health in this election?

One positive might be clarity on the road ahead. If Theresa May is returned with a firm majority, as seems likely, then STPs – designed to help ensure that health and social care services in England meet the needs of local populations – and new models of care are probably here to stay.

There would be five years until the next election to take some hard decisions relating to them and start to deliver the benefits. There would be an unparalleled opportunity to push forward with some of the changes in care which many professionals feel are necessary, without worrying about the short-term political ramifications.

Many commentators say money being committed to the NHS by all parties is still inadequate

Another positive is that the election campaign is bringing the NHS’s problems out into the open and raising public awareness of the desperate position it is in. NHS Providers, for example, has called for an end to pay restraint in the NHS because of recruitment and retention issues. Ms Irwin says: ‘This means that the issues which are of concern to us and our members are being debated and discussed in the media and social media.’

‘From our point of view it is very helpful that the spotlight is shining on the impact of public sector pay restraint, and on recruitment and retention.’

She also highlights the reliance of the NHS on the goodwill of staff, and suggests this is reaching a tipping point.

And the same is true of social care, where the Conservatives have been forced to bring forward proposals for long-term funding after the issue had been parked for several years. These would see more care in the home being means-tested, as the value of people’s homes would be included as part of their assets in their assessment.

It also seems likely that either a Labour or a Conservative government would make changes to the Health and Social Care Act 2012. This could enable new models of delivering care – such as accountable care organisations – to be trialled and could also mean a lessening of the NHS’s ‘internal market’.

And, should the gap between the parties seem close in the final few days before polling, there is always the possibility of parties starting to promise more money for the NHS in the belief that it might be a vote winner. However, whichever party wins the election will find there is a mountain to climb to overcome the challenges the NHS faces.

Election manifestos: what the parties are promising

Conservatives
  • Additional funding for 2018-19 and a commitment to continue a real-terms increase in funding throughout the next parliament.
  • More money for capital projects, though this is not quantified.
  • The position of EU staff to be ‘a priority’ in Brexit negotiations.
  • Increasing charges for non-UK residents to cover their use of the NHS.
  • Potential changes to the regulation of doctors and nurses.
  • A promise to add 10,000 mental health professionals to the workforce by 2020.
  • Further commitments to a ‘seven day’ NHS in and out of hospital.
  • Increased ‘skills charges’ for organisations hiring non-EU workers.
Labour
  • Restoring bursaries for health-related degrees and abolishing tuition fees.
  • Pay decisions to be made by an independent pay review body.
  • Free car parking for NHS staff and patients.
  • ‘Right to work’ guarantees for EU staff.
  • Over £30 billion in extra funding for the NHS over the five-year parliament.
  • A review of STPs with more public engagement.
  • ‘Reversing’ privatisation of the NHS and a ban on companies making ‘excess profits’ from NHS work.
  • A re-commitment to the 18-week wait for elective treatment, delivering the cancer strategy by 2020.
  • An end to postcode lotteries for treatment.
Liberal Democrats
  • Re-introduction of bursaries for student nurses, but tuition fees seem likely to remain.
  • 1p on income tax to raise extra funds for the NHS and, longer-term, a dedicated health and care tax.
  • Guarantees for EU NHS staff.
  • An end to the public sector pay freeze.
  • A national workforce strategy.
  • A patient premium to encourage staff to work in deprived areas.
  • Joint ‘place-based’ budgets for health and social care by 2020.

Alison Moore is a freelance health writer

 

 

 

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