David Oliver: Will the actions pledged in Labour’s election manifesto save health and social care?

Broad brush ambition

There’s talk of “taking the pressure off GPs” by allowing more community pharmacists to prescribe, more community health staff to refer directly to hospital specialists, and a trial of neighbourhood health teams where district nurses, allied health professionals, GPs, and mental health, social care, and end-of-life care teams can be “under one roof.”

Mental health services, funding, and staffing—too often an afterthought in health policy priorities—are given their own section: “Improving mental health,” with a promise to recruit an extra 8500 staff in Labour’s first term, modernise mental health legislation, improve patient rights, and tackle discrimination in services. And there’s a particular focus on children and young people and on suicide prevention.

In terms of the workforce to deliver all of this, Labour commits to regular publication of “independent workforce planning across health and social care,” implementing the workforce plan (presumably, but not explicitly, last year’s long term plan from NHS England7), and ending industrial disputes. Although the manifesto makes a nod to the current pressures, overcrowding, and waiting times in urgent and acute care, as well as the impact of the many patients currently stuck in hospital beds, it sets out no major actions to tackle either—and, unlike a pledge to restore the 18 week target for elective care, it mentions no numerical ambition. In fact, timescales, targets, and numbers linked to most of the pledges are notably scant.

The section on “social care reform”—an issue ducked by successive governments for two decades or more, which significantly affects millions of people, their carers, and the NHS—offers thin gruel. There’s a lot of rhetoric, comforting platitudes, and broad brush ambition about enhancing support and improving lives and care close to home, but is there any substance? The plan for a “national care service” isn’t defined. There’s mention of “national care standards,” but the Care Act 2014 already set out a whole set of criteria and entitlements,8 which were never followed with the resources or oversight to deliver them and with access to social care worsening.9

There’s a pledge on a “fair pay deal” for staff. Yet—with no mention of how to reverse the reduced funding to local government, or how to increase funding for adult social care to restore provision to historical levels, let alone improve access; nothing on the payment mechanisms or thresholds, and nothing on the current reliance on international recruitment to help fill workforce gaps—the words don’t convince. Indeed, there’s little in the other parts of the manifesto on positive immigration policy to continue the ethical recruitment to health and social care through visas, which we still rely on.1011

Measurable commitments

There’s a welcome “public health” section that restates some existing pledges on online safety, gambling, smoking cessation, and childhood obesity. And a section on “health inequality” makes some broad promises to “halve the gap in life expectancy between the richest and poorest areas of England,” to “tackle the social determinants of health,” and to “prioritise women’s health.”

But there are no detailed policy proposals on any of these. Considering that “wider determinants”1213 encompass inequalities in housing, education, transport, wealth, access to leisure and recreation, and pricing and regulatory policy on smoking, food, alcohol, and drugs, this was disappointing. “Health in all policies” is a concept that matters,14 and it’s not adequately reflected in the rest of the manifesto. Nor is there any pledge to redress serious reductions in the public health grant since 201515 or to support national public health agencies.

The manifesto does contain a welcome focus on improving patient safety in the wake of recent reports and inquiries, including a pledge on regulating NHS managers and improving safety in maternity services, with “1000s” of extra midwives. It promises to “modernise the NHS” and “give power to patients” by increasing the number of scanners, upgrading IT and digital health, making greater use of the NHS app and patient held records or self-directed care, and boosting public-private partnerships in innovation and clinical trials.

With the notable exception of urgent and acute care, I think this manifesto covers the key areas. But very few are backed by measurable commitments and timescales. And, despite Labour’s repeated assertion that all its commitments are fully costed, it’s not clear how much money will be invested or where it will come from: money is barely mentioned, and the spending pledged across the entire manifesto is only about £10bn, when the NHS budget alone is £180bn.16 Let’s hope that it’s only a starting point for a more ambitious programme of government in the longer term.