Dr Sally Ruane looks in depth at what's being offered for the NHS at the general election

Although the NHS remains a key issue for voters, a clear picture of what parties will offer to resolve the current crisis have not yet been published.

Patients are experiencing difficulty in access to both hospital care and GPs. Before the pandemic, austerity had already almost doubled the waiting list for elective (planned) care and once the pandemic hit, the need to focus on Covid-19 patients combined with advice to patients not to consult GPs led to a rapidly growing backlog of patient care, with around 6.3 million currently on waiting lists.

Unsurprisingly, public satisfaction with the NHS is at an all-time low. Staff shortages are evident everywhere with the NHS struggling to recruit and to retain those staff it has. High workload and poor work-life balance, lack of support and loss of real terms value in pay have all contributed to this, as has the failure to undertake long-term workforce planning. Resources that are inadequate to provide good quality care commensurate with one of the world’s richest nations contribute to stress, poor morale and moral injury to staff.

So what are the parties offering to expand the capacity of the NHS, speed up access to good quality treatment and care for the staff without whom there is no service?

Both Labour and Conservatives promise a recruitment drive through expanded training places (Conservatives plan roughly a third increase to10,000 medical and 40,000 nurse training places by 2028) and the use of alternative routes into the professions, including apprenticeships. More radical are changes in the workforce mix to include new roles with typically, less trained, lower paid staff (such as Medical Associate Professionals) to supplement – or even replace – more highly trained professionals.

The Conservatives promise an extra 12,500 doctors and nurses by 2028. Labour promise 8,500 new mental health staff, double the number of district nurses and training 5,000 more health visitors. The Lib Dems are promising to recruit 8,000 more GPs, although recruiting extra GPs is much easier than securing an increase of full-time equivalent GPs especially given retention problems. Reform UK believe a zero basic rate income tax for frontline health and social care staff will improve retention and attract others back into the service.

What isn’t clear is whether the resources needed to implement much needed expansion will be in place. The government is spending £5bn less on health in England than promised in 2019 and now offering only very small increases in day-to-day funding. £730m per year has been promised to fund additional mental health services, paid for out of cuts to other services, in order to keep more people in work.

Faced with the fact the NHS cannot be restored without significant additional funding, Starmer insists that the NHS “is always better funded under Labour”. However, Labour has not so far added substance by telling people what the improved level of funding will be. Having supported cuts in National Insurance Contributions, Labour are trying to find revenues for health through taxing the non-domiciled and tackling tax avoidance. Welcome though these may be, they will not raise the funds needed to restore the NHS. With the Conservatives and Labour not differing enormously on their tax policies and fiscal rules, voters will be sceptical that the necessary expansion in NHS capacity will be delivered.

The Green Party is the first to make a bold spending pledge. Through requiring “the very richest” to pay more tax, it promises over £50bn of extra spending a year by 2030 on health and social care with a further £20bn for capital investment. Labour has yet to commit itself on the Conservative’s hospital building plan to build “40 new hospitals by 2030” which has not gone ahead and lacks sufficient funding.

Labour propose to clear waiting times of more than 18 weeks – currently over 3 million – within five years, partly by paying staff to work overtime. The shadow health secretary also plans to use the private sector to help achieve this goal, ignoring the lack of evidence for such a policy and the many valid objections. The Conservatives and UK Reform also promise an increasing role for the private sector, in the latter case supported through tax relief on private health care insurance. By contrast, the Green Party offer a ‘cast iron guarantee’ that they will fight privatisation at every stage.

The worrying state of maternity services has barely featured in general election campaigning and is not mentioned in Labour’s NHS Fit for the Future policy outline. Prevention, too, has received scant attention although Labour’s promise to embed prevention in government departments goes further than the Conservatives.

The LibDems have been emphasising social care much more than the other parties, promising free personal care at a cost of £2.7bn funded through reversing tax cuts given to the banking sector, hoping to free up NHS beds and saving the NHS £3bn. How this would increase capacity in a social care sector ravaged by staff shortages is unclear. Labour propose a National Care Service but are not prioritising it and what it will look like remains unclear.

Dr Sally Ruane is Reader in Social Policy, Director of Health Policy Research Unit at De Montford University and a member of Keep Our NHS Public

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