Intended for healthcare professionals

Observations Health Policy

Surreal, unlikely, curious: the voters’ choice on health

BMJ 2019; 367 doi: (Published 27 November 2019) Cite this as: BMJ 2019;367:l6673
  1. Andy Cowper, editor
  1. Health Policy Insight, London, UK
  1. andycowper{at}

Andy Cowper examines the Conservative, Labour, and Liberal Democrat manifestos for the 2019 general election


The Tory manifesto has an air of the surreal, and it’s hard to know where to even start with such a blatant cocktail of the misleading and the untrue: it promises “40 new hospitals, while delivering 50 000 more nurses and 6000 more doctors.”1 These pledges imply that there is a magical warehouse of doctors, nurses, and GP appointments. The reality is that the NHS has a longstanding workforce crisis,2 and solving it will be expensive, take years, and probably require significant immigration.

It is clear that just six hospitals have actually been promised money for significant redevelopment by 2025, with another 38 pledged “seed funding” sums of money to plan for redevelopment.3 Yet Boris Johnson has repeated his claim of “40 new hospitals,”45 though the party’s costings document gets the numbers correct, referring only to “20 hospital upgrades” rather than new hospitals.6

The costings document also makes a pledge to “reduce the incidence of ‘health tourism.’” The notion of the NHS suffering from too much health tourism is one of the classic health policy zombies: …

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