Healthcare Leader takes a look at the health pledges from the three main political parties in the UK, ahead of the general election on 4 July, and how health leaders are responding.
Conservatives
Since the election was announced on May 22, the party which has held office since 2010 has pledged to boost community services, including Pharmacy First and to build new GP practices, backed by £1bn per year by 2029/30. They have also promised to amend the equality act to define sex as ‘biological’ (see box).
The boost to primary and community services has been welcomed by The King’s Fund, but the think tank has said the party’s way of funding this – through cutting NHS managers – would ‘risk sabotaging’ the goals of the policy.
‘A refocusing of the NHS towards primary and community services will free up stretched hospitals to treat the patients they are best placed to treat, thanks to many more people being diagnosed and cared for in the community,’ said Sarah Woolnough, chief executive of The King’s Fund.
However, she said: ‘This announcement does come with a considerable sting in the tail. Funding these pledges by making cuts to NHS managers risks sabotaging the goals of the policy.
‘The NHS already has a lower ratio of managers compared to other industries and a smaller administrative spend compared to other health systems globally. Achieving an efficient and productive health service requires experts who can streamline processes, align incentives, and create the environments for clinicians to focus on what they do best – delivering patient care.’
She added that the pledge for £1bn a year by 2029/30 for the community services boost would only deliver ‘limited changes’ and must be ‘just a first step’ if the party is serious about implementing the shift to primary and community health services.
The Nuffield Trust added that moving care closer to people’s homes was ‘the right aspiration’, but that the proposals were ‘small-scale’.
‘Funding growth for acute hospital health services hugely outpaced growth in funding for services provided closer to home. Spending on community services – which covers health visiting, district nursing and school nursing – was cut in real terms in three out of the six years to 2022/23 – and spend per person fell by 4.2% when patient need is included,’ said chief executive Thea Stein.
‘Moving care closer to home should not be a “pick and mix” of different proposals, however laudable they might be individually. It’s about sustained, holistic investment in and support for a range of services that provide most of the healthcare in this country.’
NHS Confederation also welcomed the primary and community focus of the pledge, saying there must be increased investment in community services to deliver the change to health and wellbeing that the country needs.
However, chief executive Matthew Taylor said that more resources were needed in primary, community and social care.
‘As our survey of NHS leaders this week revealed, many NHS organisations are having to make short term cuts to their clinical and administrative staff to balance their books. We can’t let our long term ambitions to expand the NHS workforce and shift more care into the community be derailed by short term cost pressures,’ he said.
Though he welcomed the proposals to extend Pharmacy First, he warned that the sector was also facing the same staffing and estate issues as general practice.
‘Any expansion of the scheme would need to consider how best to address that capacity crunch,’ he said.
‘Overall, this is the right direction of travel but it requires more support and investment for primary care, community and social care services – and successive governments have rarely delivered on this ambition. We have an ageing, increasingly sicker, population but with only flat funding to deal with rising demand for care, public spending plans for 2025 onwards are looking perilous. The Conservatives proposals to fund their plans by further cutting NHS management costs needs to be considered carefully against the fact that the NHS is already under-managed, and with managers playing a key role in efforts to improve NHS productivity.’
On amending the equality act, NHS Providers’ deputy chief executive, Saffron Cordery, said: ‘It is essential that any healthcare reforms have inclusivity and eliminating discrimination at their heart while also considering the practical implications for those tasked with delivering frontline services.’
Conservative pledges on health so far:
- To expand Pharmacy First to free up a total of 20 million GP appointments.
- To build 50 new community diagnostic centres.
- To build 100 new GP surgeries and modernise 150 others
- The plans would be backed by £1bn per year by 2029/30. This would be funded by cutting the number of NHS managers and halving spend on consultants in the public sector.
- To amend the equality act to define sex as ‘biological’.
Labour
The Labour party has promised it will reduce the NHS waiting backlog over the next five years, trial a ‘neighbourhood’ health service and get more people with health conditions and disabilities into work (see box).
NHS Providers said if these pledges were to become a reality, then they would need to commit to ‘sustained investment’ in both capital and digital infrastructure, as well as staffing, social care reform and resolving any outstanding pay disputes and industrial action.
‘Trust leaders and their teams know they need to go further and faster to cut waiting times. But rising demand, squeezed NHS funding, the fallout from the pandemic and severe workforce shortages have all taken their toll,’ said Saffron Cordery, deputy chief executive at NHS Providers.
NHS Confederation added that teams have been doing ‘all they can’, but they ‘cannot escape’ the pressures the service is under, including rising demand, industrial action and a financial crisis in social care. They called for an additional £6.4bn of capital investment per year.
Matthew Taylor, chief executive of the NHS Confederation said: ‘While the priority for staff as always is to treat patients and keep them safe, the backlog still looms over the NHS with the IFS reporting that it’s unlikely waiting lists will reach pre-pandemic levels over the next four years.
‘Every penny counts in the service, and we welcome the promises set out. To make inroads in tackling the waiting list we need long term planning which means the right support and resources to ensure the extra beds opened this winter continue to be staffed, as well as opening new theatres to keep tackling the backlog.
‘This will mean they can start to address the repairs backlog and invest in new technology and equipment, which directly effects productivity in the service. NHS leaders also want to see a promise to fund the existing NHS workforce plan, so we have enough staff to treat patients.’
On the work and health plan to get more people with health conditions back to work, Mr Taylor said this was addressing a ‘critical challenge’.
‘The health of the country and the health of our economy are inextricably linked, and we know from our research that investing in health is a key driver of economic activity. We are making strides in this area, with 15 local integrated care systems having been selected as WorkWell pilot sites. These pilots will help to expand the employment support and treatment available to people who need it, but there’s an opportunity to build on this and widen access to all parts of the country in time.’
Labour’s pledges so far:
- Delivering two million more NHS appointments per year, by paying NHS staff extra to work evenings and weekends to reduce the backlog.
- Recruiting 8,500 more NHS mental health staff.
- Committing to a ‘neighbourhood health service’, including ensuring patients can see the same GP each appointment if they choose to, and a trial of neighbourhood health centres bringing together family doctors, district nurses, care workers, physiotherapists, and mental health specialists.
- 700,000 more urgent dental appointments.
- A plan on ‘work and health’, including local plans for support to get more people with health conditions and disabilities into work.
Liberal Democrats:
The Lib Dem party has plans to provide £1bn a year to restore the public health grant, give patients the right to see a GP within seven days and introduce free personal care (see box).
The £1bn plan to restore the grant to previous levels has been ‘warmly welcomed’ by The King’s Fund.
Sarah Woolnough, chief executive of The King’s Fund said: ‘The evidence shows that investing in public health at a local level is a highly cost-effective use of public spending and reduces use of higher acuity health services.
‘Cuts made to the public health grant since 2015/16 have had a major impact on local services – such as sexual health clinics, smoking cessation services and children’s health visitors – which play a key role in protecting and improving people’s health.’
However, she added: ‘Although local government leaders will welcome this increase to an individual funding grant, local authorities provide a huge range of services that support health and wellbeing in our local communities. It is therefore crucial that all parties present a credible plan to properly fund local government.’
NHS Confederation’s chief executive Matthew Taylor said any proposals to reverse the ‘damaging cuts’ that the public health grant has seen over the last decade would be welcomed.
‘We will await further detail on which services this additional funding would be invested in,’ he said.
On free personal care, Ms Woolnough from The King’s Fund added that it was ‘heartening’ to see this pledge.
‘Funding free personal care would be a significant step forward from the current social care offer in England. Providing increased levels of support to many more people would also help reduce the burden of millions of unpaid carers who often have to support their loved ones without the professional help they need (in England, unpaid carers deliver care equivalent to that delivered by 4 million paid care workers). Free personal care already exists in Scotland so there is experience to learn from.’
However, she added the ‘devil will be in the detail’ of how far the commitment will go.
‘Social care services don’t only support older people; about half of the social care budget in England goes on supporting working-age adults living with disabilities and it’s not clear whether they are covered by this proposal.
‘And we caution that while this is a good first step, free personal care is not a panacea and will not cover everything that is needed to put social care back on a sustainable footing so it can support people to live good-quality lives in their communities.’
She added there must be bold action to tackle workforce gaps, to support providers to be financial sustainable and to improve the quality of services.
Nuffield Trust fellow, Camille Oung, said free personal care was ‘only a small subset of what social care can offer’, and that it would risk reducing the flexibility of tailoring care for individuals.
‘Without adequate funding stretched local authorities would struggle to deal with an increase in demand for personal care, as was seen in the early years of implementation in Scotland. We want to see a social care system that enables people to make choices to live their lives, and it’s unlikely this will be achieved by defining a narrow package of care that appears only focused on older people.’
Liberal Democrats pledges so far:
- Provide £1bn a year to restore the public health grant which will help fund health checks for 40–74-year-olds, health visits for infants and their mothers and wider access to blood pressure tests.
- The right to see a GP within seven days or 24 hours if in urgent need.
- Introduce free personal care like in Scotland, which would cover the cost of nursing care, hygiene and medication for older and disabled people with high needs.
