Intended for healthcare professionals

Opinion

What are the early election promises on health?

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1258 (Published 07 June 2024) Cite this as: BMJ 2024;385:q1258
  1. Richard Vize,
  2. public policy journalist and analyst

The early promises on health in the election campaign head in different directions. The Conservatives are focusing on community services, Labour aims to slash the elective care backlog, and the Liberal Democrats want to strengthen prevention. All the plans are built on financial quicksand.

The Conservative offer revolves around moving care “closer to home” by building 100 general practice surgeries, modernising 150 more, shifting some primary care work to pharmacies to free up general practice appointments and building more community diagnostic centres.1

Just as the party’s increase in defence spending is, implausibly, to be funded by cutting civil servants,2 the £1.2 billion annual cost would be funded by cutting 5,500 NHS managers and halving government consultancy spending.3

The pledge to build surgeries would have more credibility if tangible progress had been made on the 2019 manifesto pledge to build 40 new hospitals, now mired in design and funding problems.4

Promising to move care closer to home contrasts with the Tories’ record. Nuffield Trust analysis reveals that NHS community services in England were cut in real terms in three out of the six years between 2016/17 and 2022/23, while GPs’ share of total funding was unchanged.5

Labour’s big pledge is to clear the backlog of NHS patients waiting more than 18 weeks for treatment by the end of its first five-year term.6 At present about 3.2 million of the 7.5 million cases on the waiting list (about 6.3 million people) have been there longer than 18 weeks, and the current target of treating 92% of cases within 18 weeks has not been hit since 2015.7 The Institute for Fiscal Studies (IFS) dismissed Labour’s claim that the list would hit 10 million under the Tories.8 Labour would need to clear the 3.2 million and keep on top of new cases.

Labour’s 1997 government used substantial funding increases to cut waiting lists. This time the party would use evening and weekend working and the private sector, funded by closing “tax loopholes.” While the funding is tenuous, the plan for the work is plausible—it represents a small increase on NHS England’s plan for the current year.9 But with many staff complaining of burnout10 there are no guarantees that enough will sign up for extra shifts.

The Liberal Democrats’ health priorities have a local government focus, with free personal social care—covering basics such as washing and dressing—for older or disabled people living at home, alongside higher pay for care workers to plug staffing gaps.11 The Health Foundation says a Scottish-style model of free personal care in England could cost £6bn extra, more than double the Liberal Democrat’s budget.12

The Liberal Democrats have also promised to reverse the 28% real terms cut per person to the public health grant since 201513 and increase GP numbers by 8000—more than 20%.14

The impact of the BMA’s five-day junior doctors’ strike, currently timed for just before polling day,15 is unpredictable. Health secretary Victoria Atkins tried to raise the spectre of Keir Starmer being in the pocket of the unions with a “vote Labour, get strikes” accusation,16 but since the Tories have presided over a 15-month dispute that attack looks desperate.

If Wes Streeting becomes the Secretary of State for Health and Social Care, he would need to bring the dispute to a rapid end, to avoid haemorrhaging the time and goodwill needed to fulfil Labour’s 18-week pledge and to demonstrate grip on NHS issues. That might entail a hefty price tag before a single additional appointment has been secured.

Footnotes

  • Competing interests: none declared.

  • Provenance and peer review: commissioned, not externally peer reviewed.

References