In light of alarming news about Elon Musk and Nigel Farage, a reminder of the terrible ideas that the Reform Party has for the NHS...

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In a way, it feels unbelievable to see polling results showing the Reform Party gaining ground, and yet in another sense there’s nothing surprising about this at all. A huge number of people feel incredibly let down, and a lot of them are feeling politically homeless. Now Nigel Farage is swooping in with his particular brand of charisma; anecdotes and pints and harking back to a time which was dreadful for many, and a false memory for others. Rule Brittania! We were great ‘back then’, weren’t we? No one would be able to pin-point exactly when, or exactly how, but there is nostalgia and the cosy superiority of nationalism to nestle back into when the facts are hazy. Who needs facts anyway, after all, when we have union jacks?

There are flags a-plenty - flags, and bonhomie and the worst political manifesto I think I’ve ever read. It’s not even being described as a ‘manifesto’, in fact. As inews recently reported about Farage at its launch:

“He stressed that the document he was releasing was not a manifesto but a ‘contract’ with voters, arguing there had been a breakdown of trust in politics where manifesto pledges were frequently broken.”

This makes no sense of course, because this ‘contract’ is a document released by a political party during an election period to tell voters what that party stands for and pledges to deliver if they are elected into power. But Farage is clever; he’s pitching himself and his party as the party of true change. Unlike Keir Starmer, who has seemingly printed the word ‘change’ on a million red placards and stood beside them one by one, Farage is ripping up the rule-book.

Some journalists haven’t been taking any of this seriously enough, because while Farage may play the jester, he means business and a lot of people are listening to him now. If we don’t scrutinise his ‘contract’ properly and hold him to account, just like all other political leaders, he will be dealt an unfair advantage on July 4th and we should be really worried about that. Farage is alarming, and a real threat, and should be taken seriously.

So I’ve gone through this manifesto just as I’m going through the manifestos of all the main political parties; taking a look at the details and highlighting some of the key points to tell you what I think about their pledges for the NHS. I probably don’t need to stress to you how important this election is for the NHS; the service is in the worst state it’s ever been in, and millions cannot access the healthcare they need. The NHS is one of the most important issues for the public right now, and the next government is going to have their work cut out if they want to turn the situation around.

OK... so let’s talk about this ‘contract’ from the Reform Party.

The first thing to note is that it’s quite short, and the bits about the NHS don’t have an awful lot of detail, but there are some extremely bold statements. Farage hasn’t promised to tackle dozens of things in the NHS; instead, he seems to have written the document almost like a press release - each of the bullet points could be turned into a punchy headline, the sentences short and memorable.

The other thing to note is that the Reform Party is pledging an enormous amount of money for their dubious plans. As the BBC said:

“The party sets out an extra £17bn a year for the NHS. That’s significantly higher spending than any of the three main parties. By 2028/29, the Conservative Party is pledging around £1bn extra in cash terms for the NHS, Labour around £2bn extra, and the Lib Dems £5.8bn extra.”

The opening pages contain this quote, which I thought I’d share with you:

“Our Contract with You is not just another party manifesto. It sets out the reforms that Britain needs in the first 100 days following a general election and thereafter. It has been produced with advice from a range of independent economists, think tanks and advisors…”

One wonders, uneasily, who these independent advisors and others might be.

You have to scroll through various pages of rhetoric about borders and immigration before you reach the section about the NHS. It is actually only a single page in length, and starts with a few sentences about how they’ll reduce the tax and financial burdens absorbed by NHS staff, in order to increase retention and recruitment. Here’s the actual quote:

“All frontline NHS and social care staff to pay zero basic rate tax for 3 years. This will help retain existing staff and attract many who have left to return. End training caps for all UK medical students. Write off student fees pro rata per year over 10 years of NHS service for all doctors, nurses and medical staff.”

On the face of it, this looks like an attractive proposal, especially at a time when we are missing 121,000 full-time NHS staff. However, given the amount of work Reform is expecting these staff members to do, you might expect them to offer a significant pay rise instead. That’s because the stand-out policy; the one that has attracted a great deal of attention in the UK media over the past few days, is that the Reform Party claim that they will reduce the NHS waiting lists to zero.

As the BBC reported: “Reform UK says its policies would eradicate NHS waiting lists in two years.”

It is hard to state how ludicrous and unachievable this pledge is. Since waiting times have been measured, the NHS has never had a waiting list of zero, and the odds of bringing the waiting list down significantly are stacked against any group of politicians willing to take on the challenge now, because the service is in such a terrible state. The Reform Party make vague, sweeping claims about how this great goal will be achieved, like “operating theatres must be open on weekends” (many already are), and “Rotas must be planned further in advance”. But speaking as a former NHS doctor who has organised multiple NHS doctor rotas in my time, it doesn’t matter how far in advance you put together that spreadsheet if you don’t have enough staff members to fill the shifts. NHS staff need proper support and better pay, not a more efficient rota co-ordinator.

The key to the Reform party’s pledges for the NHS mostly boil down to privatisation, which they’re very keen on. As their “contract” says:

“We will harness independent and not-for-profit health provision in the UK and overseas…

Tax Relief of 20% on all Private Healthcare and Insurance…

This will improve care for all by relieving pressure on the NHS. Those who rely on the NHS will enjoy faster, better care. Independent healthcare capacity will grow rapidly, providing competition and reducing costs.”

We need to be really clear about what a plan like this would mean for the NHS, if it was successfully enacted. If the private healthcare sector proliferates, and the NHS is turned into a healthcare service which people only use as a last resort because they cannot afford to “go private”, a two-tier healthcare system will develop in the UK.

There is also no evidence to suggest that costs would be reduced by rapidly increasing the size of private healthcare, despite the Reform Party’s claims. People in the US, who have a system similar to the one Reform is proposing, do not enjoy cheap healthcare. On the contrary; over half a million families go bankrupt every single year due to health-related costs.

Even if Reform did attempt to pursue this plan, it would simply not be achievable in the short term. Despite what politicians (including Wes Streeting) have been saying about utilising “spare capacity” within the private healthcare sector to bring down waiting lists, this spare capacity simply does not exist in any meaningful way.

It is difficult to establish the exact capacity of our private healthcare sector, but here are the best figures I have found to illustrate the private sector’s reliance on NHS staff. They come from a letter sent from Chris Wormald, Permanent Secretary at the Department of Health and Social Care, to Meg Hillier MP (Chair of the Public Accounts Committee) in Jan 2022. The letter suggests that 90% of the consultant doctors working in the private sector also work within the NHS, and that only 2% of consultants in the UK work exclusively privately. Therefore, if the NHS expects private healthcare companies to take on additional staff, they will simply poach NHS staff to do this work. Even a private healthcare CEO, Justin Ash, recently spoke to The Times to explain that private hospitals didn’t have the capacity to bring down waiting lists quickly. The independent sector simply does not have the ability to swoop in and save the NHS, regardless of what the Reform Party might like us to believe.

There’s a final, bizarre caveat to these pledges about bringing down the waiting lists, where Reform claim that:

“NHS Patients will receive a voucher for private treatment if they can’t see a GP within 3 days. For a consultant it would be 3 weeks. For an operation, 9 weeks.”

This makes absolutely no sense. If the Reform Party have enacted their own plan and are maximising the private sector to bring down NHS waiting lists, and then a patient fails to receive treatment within these stipulated time frames within that system, the voucher seems pointless. Millions of people on waiting lists would just be sent vouchers which they wouldn’t be able to “cash in” anywhere?

But Reform wouldn’t be Reform if they hadn’t managed to throw in some policies which negatively impact vulnerable people or attempt to inflame some iteration of the culture wars, and they haven’t missed an opportunity here either. We’re told that the NHS Race and Health Observatory will be scrapped. In case you hadn’t heard about this project, it is described like this on the NHS Confederation’s website:

“The NHS Race and Health Observatory works to identify and tackle ethnic inequalities in health and care by facilitating research, making health policy recommendations and enabling long-term transformational change.”

This work is enormously important and there is no way that any group of politicians should be stopping it. Finally, predictably, depressingly, we’re told that they’ll charge people for missed NHS appointments, despite analysis showing it won’t save the NHS much money, and even the money it would save would mostly be charged to people who struggle to access healthcare or are vulnerable in other ways. Setting up a system like this would also cost the NHS, in admin costs and the associated bureaucracy it would generate.

Let’s face it, charging patients for missing appointments is also at odds with the foundations of the NHS altogether. The service exists to provide equal, comprehensive care for all. It should provide a safety net for vulnerable people to provide holistic care. How on earth can we expect to improve the health and lives of the population, if the system itself exerts draconian rules on many of those who are struggling to access the healthcare they need?

This plan from The Reform Party, is not a good plan, it’s not a fair plan, and it’s not a plan that is going to work. In 2024, with the NHS in the worst state it's ever been, we need bold, transformational ideas which will care for every member of the public, not treat everyone like customers in a barely-functioning system.

Verdict: A terrible, unworkable plan for the NHS.