This general election was supposed to be all about Brexit. But the NHS has emerged as a key battleground in England. Which party will best serve patients, service users, and carers?
First, the good news. The three main manifestos reveal more consensus than the parties would probably want to admit. They are all committed to sustaining the NHS model: comprehensive, paid for out of taxes, and free at the point of use. (It was not always so). They all promise more money and staff to deal with the growing gap between capacity and demand. They all acknowledge the need to sort out social care and do more on mental health. They all have things to say about prevention, health inequalities, people with long term conditions, and more joined up care. They don’t put it this way, but all to a considerable extent build on the cross-party consensus that was crystallised in the 2014 NHS Five Year Forward View and then developed in the 2019 NHS Long Term Plan.
The bad news is that none of the plans are convincing.
The Conservative health offer is undermined by their own track record. After nearly ten years in office they can’t dodge responsibility for the fragile state of the NHS and social care. Why expect any better next time? Brexit—their number one priority—will make implementation harder, particularly when it comes to workforce. The lack of new thinking is also striking. It’s as if, after the horrors of the 2012 Lansley reorganisation, they now shy away from any radical reform. In some ways that is a relief, but the decision to kick social care into the long grass yet again is inexcusable.
Labour’s plan is undermined by a lack of realism. The language of priorities is the religion of socialism said Aneurin Bevan. But Labour have not prioritised. They offer more of everything at vast and possibly unfeasible expense. Their obsession with the bogeyman of NHS privatisation is a distraction. It may be good knock-about politics, but it betokens a certain absence of seriousness.
The Liberal Democrat proposals are undercut by the unlikelihood of a LibDem-dominated government and by their own ducking of a solution to social care. That is a shame, since the LibDems’ manifesto is the best of the three main parties on health: detailed, thoughtful, and holistic. They also have some credentials, having been responsible in the 2010 Conservative and Liberal Democrat coalition government for the 2014 Care Act, health and wellbeing boards, and much reforming energy in the areas of mental health, autism, and learning disability.
Regardless of who is in power, Brexit will be a dominant and constraining factor. Finding the money and staff and implementing improvements will be far more challenging than the breezy manifesto assurances. In that context, patients and voters have a right to expect a few key things—not all of which can be gleaned from the manifestos. I suggest four:
Firstly, the next government requires competence, integrity and an overall economic and political strategy which provides a feasible basis for their specific health and care plans. This shouldn’t need spelling out, but sadly it does.
Secondly, the health of the nation is not just about the NHS and social care. When lack of decent housing, secure work, or affordable food are harming health, new hospitals and nurses, however welcome, are not the solution. Ten years of austerity leave a big question mark over the Conservative’s credibility in this sphere, and their manifesto is sketchy. Both Labour and LibDems promise to be more holistic about health and wellbeing and to adopt a “health in all policies” approach.
Thirdly, health and social care require sustained, intelligent, stewardship. Since 2010, health ministers have governed in two styles—arrogantly driving through pet projects, or else outsourcing all the hard thinking to officials, and quite often both at the same time. Political leadership of substance and subtlety is required, getting a sensible balance between policy and implementation, and between national and local decisions.
Finally, there is something depressingly retro about parties competing on how many pounds, staff, and new machines they can throw at the NHS. Resources are important, but health is also vitally about relationships, models of care, and outcomes that matter. Improvement requires the active involvement of staff, patients, and citizens. The manifestos make some references to these matters, but the Conservatives have shown a tin ear to co-production and Labour’s statism is the kind that could easily end up being imposed without listening to people.
No government can afford to let the NHS fail, nor to continue to duck social care reform. Whatever the election result it is likely that our new rulers will do what is necessary to keep the show on the road. It might be wise to avoid nurturing any more ambitious hopes, however.
Jeremy Taylor is an independent consultant and former CEO of National Voices. He is a member of the BMJ patient panel.
Competing interests: None declared.