Manifestos Unwrapped - The Round-Up: All You Need To Know About NHS Policies Before You Vote.
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The Conservative Party - a terrible manifesto for the NHS.
The first thing you notice when you open the Conservative Party manifesto is that they’re very keen on flags, and the second thing is the tone of the messaging. It has that specific essence of condescension and abrasiveness that Rishi Sunak has brought to UK politics in recent years. This manifesto attempts to convince us that the UK’s problems are down to the pandemic and the war in Ukraine, whilst also telling us that their plan is working, and that we should stick with it.
There are 3 pages dedicated to the NHS in this document, which seems extraordinarily short given the service is in the worst state of its entire 75-year history and the solution is incredibly complex. In fact, they have written less than one page of information for every 2 million people currently sitting on an NHS waiting list. Still, I thought, let’s focus on the content and see what they have to say…
The first statement about the NHS, their opening gambit, tells us that:
“Since 2010, we have invested more in the NHS than at any other point in its history.”
…which is incredibly misleading.
Healthcare does become more expensive every single year; because as advances happen in medicine and science, things become pricier and our expectations increase too. This is to be expected, and it’s actually a good thing! It’s a mark of progress. But if you look at the real-terms growth in investment into the NHS, the period 2010-2020 had the smallest % increase since the NHS first started. The bar chart of annual spending in this BBC article says it all (click and scroll down).
The Conservatives are also keen to highlight the NHS workforce plan. Here’s what they say about it:
“We have taken the long-term decision to train the staff the NHS needs, by backing the NHS’s first ever Long-Term Workforce Plan. By the end of the next Parliament, there will be 92,000 more nurses and 28,000 more doctors in the NHS than in 2023. We are also delivering record increases in training places for other clinicians”
The NHS has suffered from chronic understaffing for many years now, and it’s undeniable that a robust workforce plan was sorely needed, but this one has glaring errors that have been pointed out by many experts. For a start, the doctors I speak to aren’t sure how all of these new staff are going to be trained in NHS workplaces. The pressure upon NHS staff now is enormous, and there isn't enough viable capacity for senior clinicians to train these new staff. Many doctors explain that training staff becomes an additional burden, adding to their workload and taking time away from their patients. If the Conservatives are serious about bolstering staff numbers, they need a more solid plan about how to train them all.
There are also huge concerns about the non-doctor staff who are being recruited in large numbers to take on roles traditionally done by doctors (like physician associates and anaesthesia associates). The concern from medics is so great that a group of anaesthetists called “Anaesthetists United” are currently raising a legal challenge against the GMC about the way they are handling the regulation of these staff members.
Concerns continue to grow that flooding the NHS with lower-skilled workers is being done by the government to intentionally downgrade the level of care provided by the NHS, turn the NHS into a second-rate system, and pave the way for an expansion of the private healthcare sector, both within the NHS, and outside it too.
The manifesto goes on to tell us that the Conservatives plan to:
“Build or modernise 250 GP surgeries, focused on areas of new housing growth. …Build 50 more Community Diagnostic Centres, including in underserved areas, resulting in an additional 2.5 million checks a year.”
There won’t be many people reading this who will have forgotten the Conservatives’ pledge in 2019, to provide 40 new NHS hospitals. They have failed to deliver, and I’m not sure if they’d achieve this new goal either. But even if they manage to build these new facilities, there’s no guarantee they’ll be able to staff them. Many GPs are currently losing their jobs because the government has not provided sufficient funding to GP practices, and we are facing a staff exodus abroad. Just today I saw some messages between GPs who were talking about the desperate situation, and their reluctant plans to leave the NHS and move to Australia. If the government really wants to tackle the crisis in General Practice, then they need to start by pledging to support the staff.
The final few notable pledges feel like they’ve been thrown in just to fill up the bucket.
We’re told:
“We will grow opportunities for all types of providers - NHS, charity or independent sector - to offer services free of charge to NHS patients, where these meet NHS costs and standards.”
…which is simply code for more NHS privatisation.
We’re told they’ll get rid of some NHS managers - it’s unclear if this will actually improve anything, but attacking NHS management has been a tried-and-tested formula for politicians for many years now. And, finally, we’re told that they’ll tackle mental health, which again feels like a tired promise that they’ve been pledging for many years. Who can forget David Cameron’s bold claim in 2016 that they’d create a “revolution” in mental health care? That didn’t happen, did it?
To be honest, all in all, the NHS promises within the Conservative manifesto feel like too little, too late, from a party that has trashed the public healthcare system for the past 14 years. The only one that doesn’t feel like too little, too late, in fact, is the one about outsourcing, which definitely feels like too much. We don’t need more privatisation. If we want to restore the NHS to its previous functioning, we need it to be eliminated entirely by the next government.
My verdict? This is a terrible manifesto for the NHS.
The Liberal Democrats: Can we trust politicians who are failing to focus on NHS privatisation?
The first thing to say is that the Liberal Democrats have an extremely high opinion of their plans for the NHS. In fact, at their manifesto launch Ed Davey stated:
“This is a manifesto to save the NHS”
Of course, this is music to my ears, so I opened up their manifesto website with trepidation, hoping to find an ambitious plan which would reverse the relentless degradation of our public healthcare system which politicians have conducted over the past 40 years. “Saving the NHS” after all doesn’t just involve pumping in more funding, or managing to recruit more staff. It would require an elimination of the corporate elements that have been allowed to infiltrate this public service and use it for their own gains, it would require a proper across-the-board pay rise for all NHS staff, and it would require an overhaul of the facilities (many of which weren’t fit for purpose 30 years ago, let alone now).
In short, I was disappointed. This is a manifesto of many, many bullet points, some of which sound thoughtful, and hopeful, and a real step forward. But ultimately the plan is missing some key things, and many of the proposals feel impractical.
Unbelievably - and I was so staggered by this that I re-read the manifesto points three times in case I had missed something - NHS outsourcing of patient services is not mentioned once. Not once! Alarmingly, it is as if they don’t realise the extent of NHS privatisation that is already embedded within the system…
Unlike Labour, the Conservatives and the Green Party, the Lib Dems seem to have completely disregarded the existence of thousands of outsourced services across England. They don’t mention the existence of the many private companies already working within the NHS, and there is no mention in their manifesto of what the future relationship with these organisations might be.
The question of whether or not the NHS embraces profit creation within public healthcare is a fundamental decision the UK must face up to. Interestingly, I haven’t seen any media outlet comment on this omission from the manifesto, but it’s crucial,and can’t be ignored.
I’ve pulled out the bits of the (long) manifesto document which I think are the most interesting, to let you know what I think:
GP services
The manifesto prioritises primary care, which many people will welcome because the system is now completely overloaded.
The Lib Dems say they’ll improve things by: “Increasing the number of full-time equivalent GPs by 8,000, half by boosting recruitment and half from retaining more experienced GPs.”
It’s refreshing to see a political party focus on retention; as the NHS faces the realistic prospect of a mass exodus of staff who are moving to abroad or even to different careers, as their working lives have become intolerably stressful.
I think a lot of people will be wary about the “8000 GPs” figure though; it takes ten years to fully-train a GP and, without a clear plan, it’s difficult to see how the numbers could expand by thousands in the next 5.
Dentists
Their plan for dentists looks excellent on the face of it, and I expect it will be very popular with voters. They say they’ll be: “Bringing dentists back to the NHS from the private sector by fixing the broken NHS dental contract and using flexible commissioning to meet patient needs.”
However, I don’t understand what they mean by “flexible commissioning”, to be honest. If I don’t understand it (and I spend a lot of time campaigning against privatisation) then I’m not sure what the public will make of it either.
Mental Health
There’s a big section focusing on improving mental healthcare provision. The Lib Dems say they want to provide wider access to early diagnostic assessments, provide additional support to various vulnerable patient groups, and work on public awareness campaigns to de-stigmatise mental health.
All of this sounds well thought-through in terms of priorities, and is extremely important. But there is a glaring omission when it comes to these services, and that is the in-patient mental health bed crisis. There have been aggressive bed cuts, and the NHS now has far too few, which has led to a situation where there is widespread reliance on private hospitals. This desperately needs to be tackled, and I don’t think the Lib Dem policies go far enough to address this.
Fixing the buildings
In recent years, the extent of underfunding in NHS buildings and facilities has finally come to light, and the Lib Dems have actually done a lot of work to highlight this in the media. This has been impressive and much-needed, and their manifesto prioritises fixing the NHS infrastructure. They say they will: “Implement a ten-year plan to invest in hospitals and the primary care estate to end the scandal of crumbling roofs, dangerous concrete and life-expired buildings.”
Even back in 2019 when the NHS Confederation’s briefing document about the Lib Dem proposals looked at their plans, the healthcare leaders who make up this organisation identified this situation as a key priority:
“Capital investment ranked as the third most pressing priority identified by health leaders… spending on capital investment in the NHS has fallen by 7 per cent in real terms from 2010/11 (£5.8 billion) to 2017/18 (£5.3 billion) according to research carried out by the Health Foundation. The UK currently has one of the lowest levels of healthcare capital funding in the Organisation for Economic Cooperation Development (OECD) countries.”
…and in the intervening years, the state of the NHS estate has significantly worsened.
A better deal for carers
Finally, and probably most impressively given how this situation has been woefully ignored in recent years, the Liberal Democrats are pledging to improve things significantly for carers.
It’s an ambitious plan and includes these quotes among other areas of improvement: “Give unpaid carers a fair deal so they get the support they so desperately need, including paid carer’s leave and a statutory guarantee of regular respite breaks… Creating a new Carer’s Minimum Wage, boosting the minimum wage for care workers by £2 an hour, as a starting point for improved pay across the sector.”
I hear from carers almost every day about their experiences, and I cannot stress enough that they deserve more support to do their valuable and tireless work. These policies have probably been put together so cohesively and thoughtfully because Ed Davey is himself a carer to his son and grew up caring for his Mum; he knows what he’s talking about.
But most importantly, we need to consider with all of these policies is whether they’re actually workable, and unfortunately the Lib Dem policies fall down here.
As the Health Foundation have said:
'While the commitment to a ten-year capital investment plan is welcome, overall, the funding promised by the Liberal Democrats for the NHS is not enough to provide the stable, long-term investment needed to keep pace with demand and improve services for the future.”
…and the Nuffield Trust have made this statement:
“The real sting in the tail of this manifesto is that the sums to support these worthwhile aspirations simply don’t add up. It’s unclear from the costings document exactly what the £8.35 billion pledged to cover the NHS and care pledges is based on.”
The Liberal Democrats are using big words, big promises, and big stunts, but it’s not enough. They say in their manifesto that they want “a fair deal where everyone can get the high-quality healthcare they need, when they need it and where they need it”. But their plans disregard the relentless infiltration of privatisation within the NHS, the costings haven’t been properly thought through, and all in all, this isn’t a plan that will save the NHS.
Verdict: The Liberal Democrats had an opportunity to offer a real alternative, but Ed Davey has fallen short.
The Reform Party: Pledges for the NHS that should alarm us all.
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 Timesto 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.
The Green Party: A Compassionate Manifesto that Focuses on the Fundamental Cause of the NHS's Collapse.
With a growing role in national politics, it’s important to scrutinise the plans they’ve made for the NHS, and so this newsletter is about their key manifesto pledges, and their merits and drawbacks. Let’s get into it…
I always find it interesting to listen to what politicians are saying about their own policies. It tells you a lot about the mood within their party, and how they’re trying to position themselves politically. The Guardian covered their manifesto launch and wrote an article about what co-leaders Adrian Ramsay and Carla Denyer had to say. It contains this quote from Ramsay:
“We reject the pessimism of the other parties who don’t believe we can safeguard our publicly funded health system, [who think] that we can’t provide warm and secure homes for everyone, that tackling the climate crisis is too challenging for us”... And this about Denyer: “She accused the Conservatives and Labour of “a race to the bottom on tax”. She said: “They think that people don’t cotton on that this means even more devastating cuts to public services, like the NHS, that we rely on every day.”
They sound confident. I’ve been impressed with the interviews I’ve seen from their spokespeople too; there’s a fluency in the way they explain their ideas, and they have responded thoughtfully when asked the difficult questions. This in itself is refreshing when we’ve endured many years of Tory ministers on morning talk shows, watching as they look shifty and awkward, giving clear signals to all that they don’t want to be there at all.
The Green Party manifesto isn’t long, and the section about the NHS is a single page. This surprised me, because I had been expecting more detail, but the things they have included are really important. Crucially, their manifesto, unlike the Conservative Party, Labour, the Liberal Democrats and the Reform Party focuses on NHS privatisation. That alone marks out this manifesto as different, because it demonstrates that the Green Party is keen to tackle the fundamental reason that the NHS is collapsing…
The manifesto says:
“The Green Party is committed to a fully public, properly funded health and social care system, and to keeping the profit motive well away from the NHS.”
…and if you take one thing away from their manifesto, this should be it. The main reason that the NHS is falling apart is that politicians have been introducing new layers of privatisation and corporatisation into the service for the past 4 decades. Every single time the service has undergone a “reform”, politicians have used that opportunity to create new ways for private interests to infiltrate the service. We now have a situation where thousands of NHS services in England are run by external organisations, some NHS trusts are in enormous debt because of building projects which were completed several decades ago, and private companies are even working in NHS facilities out of hours, hiring NHS staff to work evenings or weekend shifts to bring down NHS waiting lists (and create profit in the process).
If we want to restore the NHS’s functioning, make things more efficient and create a public healthcare system fit for the 21st century, we are going to have to remove profit creation from the delivery of public healthcare. The Green Party know that, and they’re definitive in their opposition to NHS privatisation.
They also want to inject a lot of funding into the NHS. As the BBC reported:
“The cash injection being promised by the Greens into the NHS is huge. In the first year, they say they will increase the budget in England by £8bn. It is currently £165bn. And by 2030 there will be £28bn more. There will be more for public health too, delivered by councils … To put that into context, the Liberal Democrats are only promising £8bn a year more for health by the end of the Parliament, while the Conservatives have limited their promises to above inflation increases.”
They have big plans for this money too. They want to invest it into primary care where it is sorely needed due to the extraordinary strain on GP services, into public health, to focus on prevention of illness as well as treating disease, and into fixing the crumbling NHS buildings. This is absolutely essential; things are so bad that there is an almost £12 billion unmet repair bill in the NHS in England alone. I’m genuinely concerned that we could see an incident similar to the Grenfell catastrophe because of this situation. The Conservative government should have tackled the problems many years ago, and because they haven’t done so, the buildings in which we are cared for when we are sick and vulnerable deteriorate every year.
The Green Party has also pledged to offer “an immediate boost to the pay of NHS staff, including the restoration of junior doctors’ pay, to help with staff retention”
I can’t stress how important this is. Other political parties are creating impressive pledges about increasing the staff numbers through recruitment drives, but the NHS has a wealth of talent and experience which is now being rapidly lost as staff leave for other countries or even other careers, due to a lack of support. Just this morning I saw a tweet about a GP who could not find work in the NHS and so was working as a taxi driver instead.
A public healthcare system with too few staff, who have been shown too little care is not a public healthcare system which will function properly for its patients. We must care for the carers, and speaking of carers, the Green Party have great pledges for the social care sector too. They want to improve the situation for those requiring personal care (an area that has been woefully neglected for a very long time), and they want to “introduce a career structure for carers to rebuild the care workforce”. This sounds brilliant and is much-needed.
I’m sure there’ll be people reading this and wondering “what’s the catch?”. The catch, of course, is that big plans like this require a lot of money, and the Green Party is taking a different approach to other political parties. The Institute for Fiscal Studies describe it like this:
“The Green Party has set out a vision which would see the size of the state increase on an unprecedented scale: by the end of the next parliament, they want to increase taxes by over £170 billion per year to fund a £160 billion boost to day-to-day public spending … They also plan to spend an additional £90 billion a year on capital spending, which would be a particularly big increase. Even taking their figures at face value, overall borrowing would end up around £80 billion a year higher and we could expect debt to be rising throughout the next Parliament.”
This is unpalatable for those who think big spending is a bad idea when the economy is in such a mess. Others are questioning the way they’re hoping to raise the funds. As The Guardian explained:
“The plans would be financed by tax changes, including a wealth levy of 1% on individual taxpayers with assets worth £10m or more, rising to 2% for those with assets above £1bn. Capital gains tax would be aligned with income tax, and higher earners would pay more national insurance … In a post-speech Q&A, Ramsay was asked if the party was comfortable asking people to pay more national insurance on incomes above £50,000. He said someone on £55,000 would pay an extra £5 a week, calling this “a modest amount that’s affordable”.
I’ve seen some concerns from very wise folk, who wonder why the Green Party are proposing to raise a wealth tax in this particular way. There are other methods which could be used instead, methods that would see the wealthiest in our society pay their bit, and wouldn’t create an additional burden for people like teachers and senior nurses too. If nothing else, it seems politically unwise to create a plan for a “wealth tax” which includes people who aren’t wealthy, and who have endured a very difficult few years. It feels like they’re giving a gift to those who are already rubbishing their plans or calling them unrealistic.
The challenges facing the Green Party are seismic, because, at the moment, the Conservatives and Labour align on a number of key issues around spending. The two main parties are proposing smaller ideas and smaller plans beyond the election – in comparison the Green Party appear radical. They’re also offered less attention by the mainstream media, and this is a frustration which is regularly expressed by key figures within the party on social media.
Byline Times wrote about this back in February, saying:
“There have been around 43,000 media mentions of the Green Party (in England, Wales, or UK-wide) over the past year, according to Google News analytics. But there have been nearly 88,000 media mentions for Reform UK in that time. While it is not a comprehensive metric, it offers an indication of the different levels of attention.”
They’re the underdogs on the political scene, and any seat won at the General Election will be a huge victory for the Green Party. While their representation in Parliament might be small, there is a growing number of people who are dissatisfied with the lack of ambition and transformative ideas offered by the other political parties, and I wouldn’t be surprised if we see the Green Party’s influence continue to grow in the coming years.
Verdict: Ambitious ideas for the NHS, focusing on the fundamental reasons that the service is failing. Hopefully the Green Party will provide effective political opposition in Parliament, fighting for the NHS!
The Labour Party: Our Next Government Needs Pressure to Fix The NHS
During an election campaign, a lot of the media coverage is swallowed up discussing gaffes, pitfalls, personality politics, or the jibes that individual politicians make towards one another as they try to build their own political appeal and diminish that of their opponents. This can be compelling, even entertaining, but if we want to gain an understanding about the political candidates and what they stand for, then we need to pay close attention to their manifestos.
So far, I have looked at the Conservative Party manifesto for the NHS, the Liberal Democrats, the Green Party and Reform, pulling out the most important points, providing critique on whether they’re focusing on the right priorities, and discussing whether these plans are achievable at all. Now I’m turning my attention to the Labour Party. Given they’re likely to form our next government, their manifesto for the NHS is arguably the most important of all.
There was a huge amount of speculation at the beginning of this election campaign season about whether the Conservatives would close the enormous lead that Labour has in the polls, but as the Guardian described a few days ago, Starmer is still holding strong:
“The Tories’ disastrous election campaign has propelled Labour to a near-record poll lead with just 11 days to go until election day. The latest Opinium poll for the Observer puts Labour on 40% (unchanged compared with a week ago), with the Tories languishing on just 20% (down three on the week). The 20-point figure equals the highest Labour lead under Keir Starmer other than during the catastrophic and short-lived premiership of Liz Truss.”
This gives the impression of solid support for Labour, but a recent survey from Ipsos shows that there has actually been a lot of movement, with a large number of people changing their voting intentions over the past few months.
“... a new Ipsos survey on the Ipsos online random probability UK KnowledgePanel reveals a notable degree of voter volatility. The survey, which tracked the voting intentions of the same group of over 15,000 British adults between January and June, found that while the overall percentage of the population who planned to vote for most parties remained relatively stable, underneath the surface 30% of the total voting age population had changed their vote intentions in some way by June.”
Labour is losing voters to the Green Party, but picking up others who had previously planned to vote Conservative, and overall, projections still point to a hefty 20 point lead. If you’re interested in keeping an eye on the state of the polls as the election draws closer, this poll tracker from Labour List combines the results and is updated regularly.
The way things currently stand, Starmer will be our next Prime Minister, and it looks like he’ll also command a huge majority. That matters, because it means he’d be able to turn many of his manifesto plans into reality. It also matters because we are facing a polycrisis of epic proportions within our society; we need action to tackle the climate emergency, to fund schools properly, and to tackle the state of emergency in the NHS. If Starmer does become Prime Minister, he has his work cut out.
Many people were horrified earlier this week to see the reality of the situation during a Channel 4 “Dispatches” programme. An undercover reporter worked in the A& E department at Royal Shrewsbury Hospital for 3 months and filmed what was going on. He saw patients suffer the effects of an NHS which has been underfunded for many years. Channel 4 also conducted some research, which showed that:
“Almost 19,000 NHS patients were left waiting in A&E for three days over a 12-month period, an investigation has revealed. Between April 2023 and March 2024, nearly 400,000 people were left waiting more than 24 hours across A&E departments, a 5% rise on the previous year. Channel 4’s Dispatches programme also found that 54,000 people had to wait more than two days, a freedom of information request to NHS England found.”
But while the documentary was illuminating, many didn’t need a television programme to show them how bad things have become in our public healthcare system. After all, millions are on NHS waiting lists at present, unable to access the treatment they need and which they pay for through their taxes. If Starmer wins the majority that is currently being forecast, all eyes will be on his next moves, and I suspect many people will be watching him with caution. After all, he pledged to remove NHS outsourcing during his bid for the leadership of the Labour Party, and then dropped this pledge in the Summer of 2022. His shadow health secretary Wes Streeting has caused repeated controversies and widespread anger when he has attacked trade unions and “middle class lefties” who oppose NHS privatisation. Both Starmer and Streeting have also ignited significant concern because of donations they received from those associated with the private healthcare sector.
The Labour party has traditionally been known as the “party of the NHS”, but many people are struggling to align Streeting and Starmer’s attitudes with the expectations they usually have of Labour. We will need to watch their behaviour and plans very closely, and keep them accountable for the decisions they make. And so this is why it’s important to scrutinise their plan for the NHS, so let’s get started! I’ll pull out some of the key points to discuss their merits, their drawbacks, and whether the plans are practical in financial terms…
The first thing you notice when opening the Labour Party’s manifesto is that they really want you to think that they represent change. At the top of the document Keir Starmer is pictured, just as he is in many social media posts and recent interviews, next to placards emblazoned with the word “change”. When you read on, to the content of the manifesto itself, it feels like someone opened up a thesaurus to find other words which also mean “change”, and they absolutely went to town. Here are two sentences from the opening section:
“A moment where we can turn the page on a set of ideas that, over 14 years, have consistently left us more vulnerable in an increasingly volatile world. And an opportunity to begin the work of national renewal. A rebuilding of our country, so that it once again serves the interests of working people.”
So that’s the first key point - Keir Starmer wants to impress upon you that he is the change candidate, and that he will bring about an end to the chaos of the Conservative government. The second key point is that The Labour Party manifesto is jarring and dissonant - Keir Starmer’s vision and his plans simply don’t stack up.
The style of writing within this manifesto makes it very difficult to grasp onto any policy points, because the whole document is written in sweeping statements and bold proclamations. This is then compounded by the structure of the document; it comprises “6 first steps for change” and then “five missions to rebuild Britain” before explaining the policies in different sections. Reading this through, one gets the impression that one team was in charge of the “steps” and another the “missions”, and the Party couldn’t decide which to stick with, so threw both of them in. It’s difficult to see where Starmer’s priorities really lie.
When you get to the section about the NHS, he includes these bullet points:
How Labour will build an NHS fit for the future:
Cut NHS waiting times with 40,000 more appointments every week
Double the number of cancer scanners
A new Dentistry Rescue Plan
8,500 additional mental health staff
Return of the family doctor
…and these are all important areas. It’s clear, reading through, that a Labour government would like to focus on improving public health and preventative medicine, reducing inequality and improving community access to services. All of this would be welcomed, and there are some good points. We’re told that a Labour government would buy more scanners, would regulate NHS managers, and start to fix the dental crisis.
There are glaring omissions too though. Any new government should be prioritising the support and retention of current NHS staff who have endured terrible treatment for a long time. We’re told that 40,000 extra appointments will be provided per week by asking NHS staff to work extra hours. From speaking to many NHS doctors about this, I know they think this plan is unrealistic; the workforce is exhausted and morale is at an all time low. Why would the staff want to do yet more work, unless they receive a significant pay rise from the new government?
There is insufficient focus on the non-doctors, like physician associates, taking on roles in the NHS traditionally fulfilled by doctors - a huge and legitimate concern for many people at the moment. There is also insufficient focus on the situation in A&Es which prompted this week’s Dispatches programme, with overcrowding and long waits now a normality of in every department. There is some mention of investing in the service, but not enough; if the Labour Party wants to rebuild the NHS, they are going to have to work a lot harder than this.
If Labour really do, as his manifesto tells us, want to rebuild the NHS, even the country, then Starmer needs to think a lot bigger in terms of the investment his government will make into the NHS. And this, really, is the crucial point; big words don’t add up, because the sums they are offering do not add up in a way that will create the radical transformation and change so many people are desperate for.
As the Institute for Fiscal Studies (IFS) explained recently:
“Beyond some small amounts of ‘additional’ funding, the Labour manifesto provides no detail about the overall funding the NHS will receive in the next parliament … New Labour governments improved NHS performance dramatically in the 2000s, but this was alongside rapid funding growth, of about 7% per year in real terms, delivered in a very different fiscal climate.”
..in another statement the IFS said this:
“One public service where there are big promises is on the NHS. Labour has recommitted to the workforce plan, to getting rid of all waiting times more than 18 weeks, and to more hospitals. Big promises, but that will require big spending too. All that will leave Labour with a problem. On current forecasts, and especially with an extra £17.5 billion borrowing over five years to fund the green prosperity plan, this leaves literally no room – within the fiscal rule that Labour has signed up to – for any more spending than planned by the current government. And those plans do involve cuts both to investment spending and to spending on unprotected public services. Yet Sir Keir Starmer effectively ruled out such cuts. How they will square the circle in government we do not know.”
This is worrying. Millions want to believe that the Labour Party represents change, and will rebuild the NHS and our wider society, so things feel functional again, and so we can start to achieve progress once more. But it doesn’t feel like this manifesto has the substance to achieve what we need. Starmer isn’t committing to enough investment, he isn’t committing to eliminate NHS privatisation, and he isn’t committing to support the current NHS workforce in the proper, meaningful way that would restore the morale and confidence for the healthcare staff who have been holding the NHS together for years.
Excellent summary. Thank you. I am opting for Green, who I believe offer the best for our NHS. I know that Labour will most likely get in but they seem to support privatisation. We can only hope the Greens will get some seats to hold Labour to account.
Thank you for this exceptional summary. I was looking at vote for Policies the other day and the Green Party certainly stood head above the crowd on the NHS front. I'm glad I've also been able to read your analysis and perspective given your personal knowledge of the NHS.