Welcome to The Conversation’s Manifesto Check, where academic experts scrutinise the party manifestos.
Health
Andrew Street, Professor of Health Economics at University of York
The Conservatives recognise that the electorate is suspicious about their guardianship of the National Health Service. Prior to the last election, they promised that there would be “no top-down reorganisation of the NHS”, only for Andrew Lansley to embark on a reorganisation of such scale that the NHS chief executive of the time described it as “so big you can see it from space”.
In the party manifesto, the Conservatives seek to put this behind them, by pointing to their triumphs over the past five years. But not all of their claims about health policy match up with the evidence.
The party claims to have “cleared out bureaucracy” and, indeed, there are 20,000 fewer managers and support staff now than in May 2010. NHS productivity has improved year-on-year, mainly due to slower recruitment of staff. And the manifesto correctly claims that The Commonwealth Fund has ranked the UK as having the best health system among 11 countries.
But other statements don’t stand up to scrutiny. The official statistics contradict claims that fewer patients are waiting longer than target times. In February 2015, although 194 fewer patients were waiting more than 52 weeks, 18,804 more patients were waiting longer than 18 weeks – and 6,019 more than 26 weeks – for hospital admission, compared with May 2010. And many more patients were also waiting longer for outpatient care.
I’ve been unable to verify the claim that those waiting over a year for cancer treatment has fallen from over 18,000 to under 500 is correct, but the evidence shows that achievement against all cancer waiting time standards has deteriorated over the parliamentary term.
And the statement that “patients are reporting the highest levels of satisfaction for years” is true if compared to 2011, when 58% reported being at least “quite satisfied” with the NHS, which has risen to 65% in the most recent survey. But satisfaction remains below the all-time high of 70% recorded in 2010, prior to the re-organisation.
If their past record is patchy and claims are questionable, what of the promises for the future? The manifesto offers five highlights.
First, the Conservatives promise to increase spending on the NHS, so that it remains free at the point of use, and continue to back Simon Steven’s action plan for the NHS, much of which is reflected in the manifesto.
Second, the action plan calls for increased NHS spending to help close a funding gap that is otherwise projected to widen to £30 billion by 2021. To fill this gap, they promise to spend “at least an additional £8 billion by 2020 over and above inflation”. It remains unclear how this will be funded, despite Andrew Marr’s best efforts to secure clarity from George Osborne, but the manifesto pins its hopes on increased tax returns from a stronger economy.
Third, reiterating a similar promise from the 2010 manifesto, the Conservatives pledge that people will be able to see a GP and receive hospital care seven days a week by 2020, and all those older than 75 will get a same-day appointment if needed. The costs of this were not factored into the action plan, so even more money might be required above the promised additional £8 billion.
What’s more, the Conservatives will have to convince the medical profession of the necessity of a 24/7 NHS, as the British Medical Association claims that the proposals “lack credible evidence and risk wasting resources and endangering patient safety”.
Fourth, recognising that people are living longer with multiple long-term conditions, the Conservatives promise to strengthen integration of health and social care. These include initiatives such as the Better Care Fund, the pooling of health and social care funding in Greater Manchester and the trialling of new approaches.
It will be a bigger challenge, though, to address reductions in social care funding, with around 320,000 fewer people receiving local authority supported social care in 2012/13 than in 2005/06, despite the number in need increasing.
Fifth, the Conservatives plan “to lead the world in fighting cancer and finding a cure for dementia”. Like Labour, the Conservatives will maintain support for the controversial Cancer Drugs Fund, which gives priority to cancer patients at the expense of those with other conditions. Cameron has personally prioritised improving care for those with dementia, and the manifesto reminds the electorate of this commitment.
After reneging on their “no top-down re-organisation” promise after the last election, the Conservatives will need to reassure the electorate that they can be trusted with the NHS. It remains to be seen whether the 2015 manifesto will succeed in doing this.
Mental health
Richard Slinger, Clinical Psychologist at Lancaster University
The Conservative manifesto, as with the Labour equivalent, makes broad and positive recommendations about the future of mental health care. It continues to highlight the aim for parity of esteem for mental and physical health, promises to increase funding for mental health care, promises to tackle waiting times and access to therapeutic support.
These are positive intentions, and will be supported by most people accessing and working within mental health services. But the manifesto also suffers from a conspicuous lack of detailed and clear plans. There is little explanation of how its objectives will be met or what they will look like in practice for users of mental health services. And this is badly needed.
The last five years have seen considerable disinvestment in some areas of mental health such as child and adolescent services and many services are deemed to be at breaking point. More money, or at least less disinvestment, is clearly needed – but so is a fresh look at how we address mental health difficulties and how we can achieve better wellbeing for everyone.
But there’s still no consensus on whether we should do more of the same, or try a whole new tack.
There are plenty of ideas out there, from professional bodies, the third sector and from within the government itself around what could be done.
It is a shame that given the chance to go beyond vague promises and stake out a radical or at least innovative new approach, the Conservatives did not take it.