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The pledges of the two main opposition parties prompt as many questions as they provide answers.

The spectre of an election once again stalks the nation. Pledges on the NHS and social care have bubbled out of the Labour and Liberal Democrat conferences. Conservatives gather this weekend: the Johnson government has already made voter-friendly announcements on hospital upgrades, AI and tech, and cash for social care.

The NHS is important to voters, and they are increasingly aware of the problems with social care. Although we’re yet to see full blown manifestos, the main opposition parties are jostling for position.

For the biggest difference between the Lib and Labour, look no further than the titles of the two publications released at their respective conferences. The Liberal Democrats produced a detailed 50-page policy paper: Save the NHS and Social Care by Stopping Brexit, while Labour have (so far) only published details of their vision for social care: Towards a National Care Service. The Liberal Democrats’ message is simple: it’s Brexit, stupid. Brexit in whatever form, is damaging to staffing and funding for the NHS and social care, so stop it.

Labour, with its own Brexit territory so muddy, is choosing instead to give a push to social care, stealing a march on Boris Johnson, who announced on the steps of Downing Street that he would ‘fix social care once and for all,’ but has yet to say how he intends to do this.

Labour say their vision for a National Care Service will be similar to the ‘free personal care’ provided in Scotland: the state provides funding for everyone over the age of 65 to get help with the basics, such as getting out of bed or going to the toilet. This will probably land well with the public, many of whom believe that social care is free at the point of use until they or a relative need care, and they learn the cruel truth. If their proposed model is similar to Scotland, it should more appropriately be called ‘some free personal care.’ Care home residents in Scotland receive £177 a week from the state, and a further £80 a week if they need nursing care. Actual care home fees are higher than this (average residential care home costs £798 a week) and there is still a means test to establish whether the state or individual picks up the shortfall. Bills can mount up catastrophically if people need care for many years. Labour acknowledges that there will have to be some sort of lifetime limit on care costs under their model. More detail is promised.

The ‘universal and free’ theme has popped up again in relation to prescription charges, with both opposition parties making pledges. Labour promise to scrap prescription charges in England: Shadow Secretary of State Jon Ashworth calls them a ‘tax on illness.’ The vast majority (just under 90%) of the 1 billion prescriptions dispensed each year go to patients who are exempt from the £9 charge. Nevertheless, the charges paid by those of working age generate more than £500 million a year: not insignificant. Opponents of prescription charges argue some people with chronic illnesses struggle to pay for regular medications, and cite modelling which shows that the cost of removing charges for certain conditions would be more than offset by savings to the NHS, which otherwise has to treat the effects of missed medication.

The Liberal Democrats believe that prescriptions should be free for all those with chronic conditions, including mental health, but stop short of promising free for all. This pledge is just one of many from the Liberal Democrats, none costed so far, that range from more upstream prevention, better mental health services, maximum waiting times for children’s mental health services, statutory respite breaks for carers, better care for long-term service users and more support for NHS and social care staff. Many of these proposals are hard to argue with. To fund these pledges the Liberal Democrats propose to increase income tax by 1p on the pound, which will raise £6 billion. This will have to stretch a long way: to fix the immediate crisis in social care, reverse the cuts to public health and more mental health services beyond what is already planned. Significantly, the Liberal Democrats provide no big proposals for fixing social care, a system widely acknowledged to be profoundly broken.

Both parties make promises to fix the workforce. Labour want to expand GP training places to 5,000 a year but as yet don’t have the detail on filling GP numbers while new GPs are being trained. Both parties want to reinstate nursing bursaries: Labour for all nurses; the Liberal Democrats for nursing specialties where there are shortages, such as mental health.

What is welcome is that both parties also flag their commitment to creating a healthier society. Labour want health in all policies, and action to reduce the conditions which condemn people ‘to becoming ill quicker and dying sooner,’ as Jon Ashworth put it. The Liberal Democrats also promise a cross-government target to reduce health inequalities and tackle the ‘social and economic drivers of poor health.’

Eyes will be on Manchester this weekend to see if the Conservatives wheel out more vote-pleasers on health and social care. Will their grand plan for social care be revealed? Will they pick up the opposition gauntlet on improving health or is the underwhelming prevention green paper it? Maybe don’t hold your breath too long…

Ruth Thorlby (@RThorlby) is Assistant Director of Policy at the Health Foundation.

This article was originally published in the HSJ on 24 September 2019.

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