How do the political promises for health and social care stack up?

The government is about to announce its legislative agenda. The political uncertainty is immense and no one knows if anything in the Queen’s speech will be implemented. But giventhe NHS comes a constant second to Brexit in the list of public concerns, what might be the priorities for health and social care for this government? Or a new one following a general election?

Some clues come from the recent party conferences. For the Conservatives the main pledge was to “build 40 new hospitals” in England over the next decade costing a cool £13bn—although the reality was that the funding was mainly earmarked for six hospitals with seed-funding for the remainder. These and other commitments to public services would be met by “growing the UK economy” by “raising the productivity of the whole of the UK,” and “not with socialism” as the prime minister made clear. There was nothing specific on fixing social care, but merely another pledge to, in Boris Johnson’s words “solve the problem of social care and end the injustice that means people have to sell their home to pay for their old age.”

For Labour the key commitments were to abolish NHS prescription charges in England (as in the rest of the UK), and end the “scandal” of social care for older people by making personal care free (as in Scotland). In another proposal described as radical in parts of the press, a public sector medicines company would be set up to manufacture cheaper drugs, and compulsory licensing for some new medicines would be introduced to secure cheaper generic versions of patented medicines. These and other commitments weren’t costed but the top 5 per cent of earners would face higher taxes to pay for them.

The Liberal Democrats have published a 50 page policy document detailing how Brexit would damage the NHS and social care services and why it should be stopped. A specific pledge to raise 1p extra in the pound via general taxation would bring in £6bn to spend on a set of priorities: top of the Lib Dem pile is mental health services. There was also a proposal to establish a commission to set a “realistic” funding settlement for the NHS and social care.

All parties would increase the number of NHS staff, currently running at 100,000 vacancies. Labour and the Liberal Democrats propose to improve public health in part by reversing recent cuts to the public health budget. Labour would enact a new law to ensure action to reduce inequalities in health between the most and least well off, and rejuvenate the Sure Start programme for the under-fives. The Lib Dems would set a wellbeing budget, which would in part focus on the health of future generations, and introduce a cross-government target to reduce health inequalities. The Conservatives and Labour are specific about raising the living wage.

The most obvious feature in all the offerings is spending, a lot of it. Where the funds will come from is murky, but austerity is clearly unfashionable.

Yet there is no defining reform agenda to improve care at the front line, other than investment. Labour promises to repeal the 2012 Health and Social Care Act, and the Liberal Democrats to move some commissioning of NHS care to local authorities. Both are radical but largely administrative changes.

And despite the promised spending, there are structural questions of funding left unaddressed, such as the real lack of detail on funding social care properly—an issue which is currently crippling the NHS. Labour comes closest with the free personal care pledge. But as we know from Scotland, personal care isn’t free but merely subsidised, with some users still facing significant costs. Funding an adequate offer in England, as well as the state covering catastrophic costs for the most needy, would total somewhere in the region of £15bn by 2023/24.

Then there’s the acute staff shortage, aggravated by Brexit, a legacy of inadequate funding of training places, and a failure to solve the huge problem of pension tax liability which forces some NHS consultants to turn down work. All are resulting in wholly avoidable shortages, including in highly trained staff needed to keep waiting times down.

What is encouraging is the emphasis, mainly seen in proposals from Labour and the Lib Dems, on improving wellbeing and health for the whole population. Only about 20 per cent of the impact on our health is down to health care, the rest down to wider factors such as family, education, employment and housing. Addressing these areas is the right thing to do, plus there will be a good return on any investment. The Conservatives do pledge to raise the living wage to £10.50 an hour to match two thirds of median earnings. But the emphasis in their recent Green Paper on preventing ill health is predictably on the individual, for example using technology to help people at high risk of ill health.

How will all this land with the public amid the Brexit storm? The spending spree is largely on guaranteed crowd-pleasers, some radical. On other critical issues—a long term solution for social care, a credible workforce plan, investment in population health and how these will be funded—no party provides all the answers. Change is required. But given the distraction of Brexit, there is no guarantee it is coming.