Yesterday, the Liberal Democrats fired the starting gun on the next phase of the general election campaign by becoming the first of the three main parties to publish their manifesto. This is the time when debates on policy start to get a bit more serious – or, at least, a little more specific.
The core message of the manifesto – helpfully summarised in its title – is to ‘stop Brexit’. The nature of the UK’s future relationship with the EU will affect our health. A no-deal Brexit, for example, could cause significant harm to NHS and social care services and the people who rely on them.
But the Liberal Democrats also propose a long list of specific policies on health and care.
The headline pledge is for £7bn additional annual investment in health and social care over the next parliament (covering the whole UK – more like £6bn for England), paid for through a penny on income tax. This would see the health budget grow at around 3.8% a year over the next four years – broadly in line with the long run average and more than double the growth over the last decade. According to our projections, this would be enough to maintain quality of care and support some care improvements. The manifesto sets out a range of commitments to improve mental health services.
While a clear improvement on current spending plans, the money pledged doesn’t quite go far enough in key areas of the health budget – including training for new doctors and nurses, capital spending on new buildings and equipment, and public health. The capital investment promised, for instance, would still see England trailing behind comparable European countries on spend as a share of GDP. And the investment pledged for public health falls just short of the minimum needed to address past cuts.
Staffing, as much as money, is the major issue facing the NHS and social care in the short term. The workforce crisis is chronic: the NHS is currently down around 100,000 staff. The gap in social care is more like 120,000. The Liberal Democrats’ manifesto is strong on describing these issues – and rightly points to the need for ethical recruitment from overseas to help fill staffing gaps. But the document is less strong on describing the package of policies that will be introduced to close them.
The proposal to fund new health spending commitments through increases in income tax makes sense. Overall tax revenue in the UK as a share of national income is lower than most other OECD and EU15 countries. And people at the median and top of the UK income distribution pay less income tax than they would if they lived in many other European countries.
But the idea of a dedicated health and care tax may be less clever. The manifesto proposes the ‘development of a dedicated, progressive Health and Care Tax’, which would ‘bring together spending on both services into a collective budget and set out transparently, on people’s payslips, what the government is spending on health and social care.’ Some form of new hypothecated tax might generate support from the public. But the risk is that extra spending for a particular service – here, health and care – is determined by changes in the tax take, not health and social care needs.
The manifesto includes a wide range of policies aimed at preventing ill-health, tackling poverty, and reducing inequalities. This is welcome and much needed: long-term improvements in life expectancy and mortality in the UK have stalled, and – for under 50s – are falling behind comparable countries. The gap in health between the best and worst off is growing. Addressing these issues requires long term policy action on the wider determinants of health, such as education and housing, not just investment in health care.
Proposals include boosting funding for children’s centres, extending the Soft Drinks Industry Levy, tackling air pollution, action to reduce homelessness and food insecurity, and more. These measures would be supported by a national wellbeing strategy and a health in all policies approach in central government. These are all the right words – the question will be how to turn the rhetoric into reality.
The most obvious gap in the manifesto is on social care. NHS leaders can breathe a sigh of relief, as no major reorganisation of the health system is proposed. But much needed reform of social care is not one of the main priorities set out by the Liberal Democrats for this parliament.
The social care system in England is currently failing some of the most vulnerable people in society. The Liberal Democrats’ pledge to establish a cross-party convention on social care funding could help generate consensus behind reform – and it is good to see that the party would back a cap on care costs as their preferred option. This would provide protection against catastrophic care costs, and already lies on the statute book. But we’ve been here before. There has been a long line of government reviews, commissions, and policy papers on adult social care dating back decades – yet there has been no solution to the crisis. What the system needs now is firm action, not just a plan for another plan.