Election fever has well and truly set in and political parties are hastily preparing their manifestos. In the scramble to see what these shiny, new documents are promising, it’ll be easy to forget about what’s gone before. So – with new pledges due to arrive in full in the coming weeks – this is a good moment to recall previous manifestos and see what did and didn’t get done after the winning party got into Number 10.
Looking back at the health care pledges from the most recent election, some specific commitments from the 2017 Conservative manifesto have been realised: for example, a new GP contract, expanded GP seven day services and a green paper on young people’s mental health. But, how much progress have we seen on the central promise of ‘exceptional health care, whenever, wherever, delivered by an NHS with the money, buildings and people it needs’? Let’s see.
Progress on money
It wasn’t until June 2018 that action was taken on the Conservatives’ specific manifesto commitment to a real terms funding increase. As a 70th birthday present to the NHS, Theresa May announced an NHS funding boost for the following five years, at 3.4% a year on average. Current plans now imply much higher Department of Health and Social Care spending than originally promised in the 2017 election. However, according to Health Foundation analysis, this will, at most, only help keep up with rising demand for care for our growing, ageing population, and won’t be enough to improve quality of care.
Progress on buildings
Giving the NHS the buildings and equipment it needs requires investment in ‘capital spend’. The 2019/20 capital budget of £7bn for the Department of Health and Social Care is larger than in any year since 2010/11. But, as we highlighted earlier this year, significant underinvestment in buildings, equipment and technology in recent years means this doesn’t go far enough. To bring capital spending in England up to the level of comparable countries would take a further £2.5bn in the 2019/20 budget. In recent months – perhaps mindful of an election on the horizon – the government has announced further investment in building projects and equipment, but the amount promised is still some way off what’s needed to fix the backlog.
Progress on people
Similarly, the NHS still faces critical workforce shortages and is far from having all the people it needs. Vacancies exist across staff groups and the situation hasn’t improved in the past two years. For example, advertised full-time equivalent vacancies in NHS hospital and community services increased from 78,051 in Q1 2015/16 to 90,992 in Q1 2019/20. With 37,357 vacancies in Q1 2019/20, ‘nursing and midwifery’ is the most affected. To address problems with retaining the existing workforce, the 2019 Spending Round announced investments in staff professional development, but this won’t improve nursing student dropout rates. Since August 2017, nursing, midwifery and most allied health students stopped receiving NHS bursaries and 1 in 4 nursing students are now leaving before completing their courses.
More of the same
Governments failing to live up to all their manifestos is nothing new. Labour’s 1997 manifesto committed to ending the internal market in health care and criticised private sector involvement in clinical services. Once in government, it retained the split between purchasers and providers of services and, three years later, embraced private sector provision of operations in the NHS Plan 2000. While New Labour did achieve many of its targets on waiting times and NHS funding, they were operating under different circumstances, with a majority government and a more stable political and economic context.
Equally though, we can’t entirely blame a minority government or Brexit for stasis in recent years. Among the most tragic past manifesto failures, many concern social care reform, where government after government have failed in their promises to deliver a sustainable funding system. In their 1997 manifesto, Labour promised ‘a fair system for funding long-term care for the elderly’. Two decades on, the Conservatives made a familiar commitment to ‘the first ever proper plan to pay for – and provide – social care’. Between 1997 and now, we’ve seen two commissions, two green papers, four white papers and, more recently, another eternally-promised green paper: yet, five prime ministers later, we’re still no closer to a solution. Politicians not doing what they say they will is a problem that transcends party lines and political context.
We’ve already heard bold promises about the NHS on the campaign trail so far – and we can certainly expect more of these when manifestos are published. These documents are intended to be vote-winners, after all. But the health and care sector is in a very fragile state, with NHS England data out last week showing that pressure is continuing to build on services as people wait even longer in A&E and for planned surgery. Although voters can’t bank on any party meeting all their manifesto promises, we’re going to have to hope that this time round health and especially social care are priorities in reality as well as rhetoric.