Intended for healthcare professionals

Feature UK General Election 2019

The main parties’ pledges on health

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6702 (Published 27 November 2019) Cite this as: BMJ 2019;367:l6702
  1. Gareth Iacobucci
  1. The BMJ

The manifestos of the Conservatives,1 Labour,2 and the Liberal Democrats3 contain many promises aimed at improving health and social care. Gareth Iacobucci picks out the highlights

Funding

Conservatives

  • Increase NHS funding by £34bn a year by the end of the parliament (£20.5bn in real terms, a 3.4% rise)

  • £1bn extra a year for social care in every year of the new parliament

  • Build and fund 40 new hospitals over the next 10 years, and make 20 hospital upgrades

  • £74m over three years for extra capacity in community care settings for people with learning disabilities and autism

  • £25m (pledged in August 2019) for hospice care

Labour

  • Increase expenditure across health sector by an average 4.3% a year (£26bn increase by end of the parliament)

  • Provide an extra £1.6bn a year to ensure that new standards for mental health are enshrined in the NHS Constitution, ensuring that access to treatment is on a par with that for physical health conditions

  • Invest £2bn to modernise hospital facilities and end the use of inappropriate out-of-area placements

  • Return NHS England to the international average level of capital investment (£15bn increase over parliament)

  • Invest more than £1bn in public health

  • Allocate a greater proportion of overall funding to health services close to patients' homes and build interdisciplinary, patient focused services across primary care, mental health, and social care

Liberal Democrats

  • Raise £7bn a year from a 1p in the pound rise in income tax. Money will be ringfenced for social care, staffing, and mental health and prevention services

  • £10bn capital investment in equipment and buildings

  • Reinstate funding that was cut from public health budgets by the Conservatives

  • Increase government spending on climate and environmental objectives to at least 5% of the total within five years

  • Develop a dedicated, progressive Health and Care Tax, offset by other tax reductions, after consultation with the public

  • Introduce a statutory and independent budget monitoring body for health and care, similar to the Office for Budget Responsibility

Staffing

Conservatives

  • Recruit and retain 6000 more GPs, 6000 more primary care professionals such as physiotherapists and pharmacists (in addition to 7500 extra nurse associates and 20 000 primary care professionals already announced), and 50 000 more nurses

  • Reinstate previously scrapped nursing bursary, giving students an annual maintenance grant of £5000 to £8000 during their course

  • Within first 30 days of parliament, hold an urgent review, working with the BMA and Academy of Medical Royal Colleges, to solve the “taper” problem in doctors’ pensions

  • End freedom of movement when UK leaves the EU. Create a new “NHS visa” exclusively for skilled overseas staff who apply to work in the NHS

Labour

  • Expand GP training places from 3500 to 5000 a year by 2023-24 to create 27 million more appointments

  • Put Agenda for Change terms and conditions into law alongside safe staffing limits for all staff

  • Reintroduce nurse training bursary

  • Recruit 4500 more health visitors and school nurses

  • Review current tax and pension changes to ensure workforce is fairly rewarded and that services are not adversely affected

  • If UK remains in the EU, freedom of movement would continue; if UK leaves, it would be subject to negotiations. Labour would recognise social and economic benefits of free movement and would seek to protect rights

Liberal Democrats

  • End GP shortfall by 2025 by training more GPs and making more use of other healthcare staff and digital appointments where appropriate

  • Produce a national workforce strategy

  • Seek to attract staff from EU member states by making current registration process more flexible and accessible without lowering standards

  • Encourage healthcare staff to work in areas of shortage, especially inner city and remote rural areas, through incentive payments

  • Implement recommendations of Roger Kline’s report into lack of diversity in NHS senior management and commission a strategic analysis of racial discrimination in NHS

Access

Conservatives

  • Boost early cancer diagnosis across 78 hospital trusts

  • Create 50 million extra general practice appointments a year (increase of more than 15%) and shorten GP waiting times

  • Make car parking free for people in greatest need, such as disabled people, frequent users of outpatient clinics, parents of sick children staying overnight, and staff on night shifts

  • Clamp down on “health tourism” and increase the NHS surcharge paid by patients from overseas

Labour

  • Abolish prescription charges in England

  • Make basic dentistry free

  • Make hospital parking free for patients, staff, and visitors

  • Establish a generic drug company. If fair prices are rejected for patented drugs, use Patents Act provisions, compulsory licences, and research exemptions to secure access to generic versions. Aim to increase number of pharmaceutical jobs in UK. Will play an active role in the medical innovation model, ensuring that rewards and incentives match areas of greatest health need

  • Introduce mandatory standards for NHS inpatient food

Liberal Democrats

  • Introduce further maximum waiting time standards on mental healthcare, starting with children’s services, services for people with eating disorders, and severe and enduring conditions. Ensure that all young people with a diagnosable condition get NHS treatment

  • Increase access to clinically effective talking therapies

  • Make prescriptions for people with chronic mental health conditions available for free on NHS

  • Decriminalise abortion across the UK while retaining the existing 24 week limit, and legislate for access to abortion facilities in Northern Ireland. Fund abortion clinics to provide services free of charge to people regardless of nationality or residency

  • Ensure that HIV pre-exposure prophylaxis is fully available to all who need it on NHS

Public health

Conservatives

  • Invest in preventing disease as well as curing it

  • Uphold commitment to extend healthy life expectancy by five years by 2035

  • Continue to promote uptake of vaccines through national vaccination strategy

  • Continue to take action to tackle gambling addiction

  • Extend social prescribing

  • Overhaul NHS screening and use new technology and mobile screening services to prevent ill health

  • Improve hospital food alongside a wider national food strategy

  • Take a new approach to treatment to reduce drug deaths and “break the cycle” of crime linked to addiction

Labour

  • Reduce health inequalities through a comprehensive children’s health strategy

  • Introduce new legislation to enshrine health aims in all policies and bring in a new duty for NHS agencies to collaborate with directors of public health

  • Invest in children’s oral health, tackle childhood obesity, and extend sugar tax to milk drinks

  • Ban fast food outlets near schools and enforce stricter rules on advertising of junk food and on salt levels in food

  • Urgently put in place a vaccination action plan to regain WHO measles-free status

  • Fully fund sexual health services and roll out PrEP medication

  • Tackle drug related deaths, alcohol related health problems, and adverse effects of gambling as public health matters, treated accordingly in expanded addiction support services

  • Label alcoholic drinks with clear health warnings

  • Review the evidence on minimum pricing of alcohol

  • Implement a tobacco control plan

  • Establish a royal commission to develop a public health approach to substance misuse, focusing on harm reduction rather than criminalisation

Liberal Democrats

  • Publish a national wellbeing strategy that puts better health at heart of all government policy

  • Keep public health within local government

  • Introduce new statutory requirement for public health interventions that NICE evaluates as cost effective to be available to qualifying people within three months of NICE guidance

  • Restrict marketing of junk food to children. Close loopholes in the soft drinks industry levy and extend it to include juice and milk drinks that are high in added sugar

  • Introduce new levy on tobacco companies to contribute to costs of healthcare and smoking cessation services

  • Introduce minimum unit pricing for alcohol in England

  • Introduce compulsory levy on gambling companies to fund research, education, and treatment of problem gambling. Ban use of credit cards for gambling and restrict gambling advertising. Establish a gambling ombudsman

Social care

Conservatives

  • Seek a cross party consensus to bring forward necessary proposals and legislation for long term reform

  • Guarantee that no one needing care has to sell their home to pay for it

  • Extend the entitlement to leave for unpaid carers to one week

Labour

  • Build a comprehensive national care service for England, focusing on ethical delivery of care that ensures growing provision by public sector and providers that meet standards of transparency, compliance, and profit capping

  • Provide free personal care for older people, beginning with investments to ensure that they have their personal care needs met, with the ambition to extend this provision to all working age adults

  • More than double the number of people receiving publicly funded care packages

  • Introduce a lifetime cap on personal contributions to care costs

  • Develop eligibility criteria that ensure the service works for everyone

  • End 15 minute care visits and provide care workers with paid travel time, access to training, and an option to choose regular hours.

  • Increase the Carer’s Allowance for unpaid full-time carers to the level of the Jobseeker’s Allowance

Liberal Democrats

  • Establish cross party convention to reach agreement on sustainable, long term funding of a joined-up health and social care system

  • Create new professional body for care workers to promote clear career pathways, ongoing training and development, and improved pay structures

  • Introduce professional regulation of all care home managers, who would be have to have a relevant qualification. Set a target that 70% of care home staff should have an NVQ level 2 or equivalent (current level is around 50%)

  • Provide more choice at the end of life and move towards free social care at end of life, whether people are at home or in a hospice

  • Introduce a statutory guarantee of regular respite breaks for unpaid carers, and require councils to make regular contact with carers to offer support

  • Provide package of carer benefits, such as free leisure centre use, free bus travel for young carers, and self referral to socially prescribed activities and courses

  • Raise the amount people can earn before losing their Carer’s Allowance from £123 to £150 a week, and reduce the number of hours’ care per week required to qualify for it

Climate

Conservatives

  • Lead the global fight against climate change by delivering net zero greenhouse gas emissions by 2050

  • First budget will prioritise the environment: investing in R&D; decarbonisation schemes; new flood defences that will receive £4bn in new funding over the coming years; electric vehicle infrastructure, including a national plug-in network and gigafactory; and clean energy

  • Use £1bn Ayrton Fund to develop affordable and accessible clean energy

  • Support clean transport to ensure clean air

  • Set strict new laws on air quality

Labour

  • Develop recommendations of “30 by 2030” report to put UK on track for a net zero carbon energy system within the 2030s, with faster progress if credible pathways can be found

  • Deliver nearly 90% of electricity and 50% of heat from renewable and low carbon sources by 2030

  • Aim to achieve net zero carbon food production in Britain by 2040

  • Launch national transformation fund of £400bn and rewrite Treasury’s investment rules to make them compatible with climate and environmental targets

  • Target science, research, and innovation to tackle the climate crisis, plastic waste, and other societal challenges such as the ageing population and antibiotic resistance. Set a target for 3% of GDP to be spent on R&D by 2030

  • Ensure NHS becomes a net zero carbon service with an “NHS Forest” of a million trees, more efficient heating and insulation systems, greater reliance on renewable energy, and a transition to electric vehicles

Liberal Democrats

  • Set a new legally binding target to reduce net greenhouse gas emissions to zero by 2045 at the latest

  • Implement the UK’s G7 pledge to end fossil fuel subsidies by 2025, and provide Just Transition funding for areas and communities negatively affected by the transition to net zero greenhouse gas emissions

  • Establish a Department for Climate Change and Natural Resources, appoint a cabinet level chief secretary for sustainability in the treasury to coordinate government-wide action

  • Create a statutory duty on all local authorities to produce a zero carbon strategy

Other pledges

Conservatives

  • Keep the price the NHS pays for drugs and the services the NHS provides off the table when negotiating trade deals

  • Enshrine the NHS long term plan in law

  • Legislate so that patients with mental health conditions such as anxiety and depression have greater control over their treatment

  • Make it easier for people with learning disabilities and autism to be discharged from hospital and improve how they are treated in law

  • Extend Cancer Drugs Fund into an Innovative Medicines Fund

  • Improve early diagnosis and treatment of all major conditions

Labour

  • Ensure that all parts of NHS, treatment of patients, employment of staff, and drug pricing are fully excluded and protected from any international trade deals

  • End and reverse privatisation in the NHS in next parliament, by repealing the 2012 Health and Social Care Act and ending requirements to put services out to competitive tender

  • Join up, integrate, and coordinate care through public bodies

  • Implement all recommendations from the independent review of the Mental Health Act

  • Improve stroke, heart disease, and cancer survival rates by providing earlier diagnosis and improved screening rates

  • Call a moratorium on bed cuts

  • Progress clinically appropriate prescription of medical cannabis

  • Promote fairer international patent regimes that do not prevent countries accessing essential medicines and support efforts to increase price transparency so governments can negotiate fair prices

  • In the long term, ensure all medicines developed with the support of UK taxpayer money are accessible to people in poor countries

Liberal Democrats

  • Stop Brexit and prevent increased access by US corporations to services currently provided by NHS and to the UK drug market

  • Support changes to the Health and Social Care Act proposed by NHS England

  • Move towards single, place based budgets for health and social care, encouraging greater collaboration between NHS and local authorities in commissioning

  • Implement all recommendations of the Wessely review of the Mental Health Act, including bringing forward investment to modernise and improve inpatient settings and ambulances

  • Review, on the basis of evidence, any unscientific and discriminatory practices aimed solely at LGBT+people, such as around blood donations

  • Introduce a legal, regulated market for cannabis, permitting it to be sold through licensed outlets to adults aged over 18 (with limits on potency levels)

References

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