Tory manifesto’s NHS and social care promises – do they add up?

Andy Rain/EPA

Having presided over annual funding increases that are among the lowest in the history of the English NHS, the Conservative manifesto offers less generous funding increases over the next five years than the other parties. Even this offer should not be taken at face value.

Just as in their 2015 manifesto, the Conservatives are promising to increase spending by £8 billion on the English NHS over the parliamentary term. But, once elected in 2015, the Conservatives committed to increase the health budget by only £4.5 billion, making up the difference by reducing spending on health education and training, public health grants and capital.

They’ll have less wriggle room to pull the same trick if re-elected. This is partly because they’ve reduced the education budget as far as they can by introducing nursing bursaries, which both the Liberal Democrats and Labour have promised to reinstate. And the Conservatives won’t be able to raid the capital budget, because they’re now promising the “most ambitious programme of investment in buildings and technology the NHS has ever seen”. Unlike the other parties, the Conservative manifesto provides no indication of where the extra funding is to come from.

Sticking to their plans

Unsurprisingly, given that they’re in power, the Conservatives aren’t promising radical change to the NHS, committing to the action plan known as the “five-year forward view” and to the so-called “sustainability and transformation plans”, which have been drawn up by the NHS and local authorities to cover 44 geographical areas. These are set to evolve into Accountable Care Organisations, the latest in a never-ending sequence of new organisations to grace the English NHS, but which may quietly lead to the end of the internal market introduced in 1990 by Margaret Thatcher.

The manifesto also restates existing policy commitments, including the controversial promise to provide a “truly seven-day healthcare service”. They also plan to retain the target that 95% of people attending A&E should be dealt with in less than four hours. This target has not been met since July 2015.

The manifesto also commits to the 18-week elective care target, which the NHS has threatened to abandon. The Conservatives aren’t going to allow the NHS to do this. Indeed, one of the subheadings of this section of the manifesto boldly states that they’ll be “holding NHS leaders to account”, which can be interpreted as a veiled threat to Simon Stevens, the chief of the NHS, to toe the political line.

Manifesto may contain a veiled threat to Simon Stevens, head of NHS England. Twocoms/Shutterstock

No concrete details are given about how the Conservatives hope to turn round increasingly poor waiting-time performance, but they seem to expect that better information will help improve the quality and safety of care. The NHS already leads the world in publishing outcomes data for individual doctors and, following initiatives introduced in 2013 when the Conservatives were in coalition with the Liberal Democrats, the manifesto promises to continue to make “clinical outcomes more transparent”.

Replacing migrant staff

Probably in a bid to lure UKIP sympathisers, the Conservatives are laying claim to being the “nasty” party when it comes to dealing with the impact of immigration on the NHS. The annual health surcharge on migrant workers that they introduced in April 2015 is to increase from £200 to £600 a year.

And, unlike the other parties, the Conservatives make no firm commitment to protecting the right to stay in the UK for the 140,000 health and care staff from other EU countries, merely saying they will be a “priority in our negotiations with the European Union”. The long-term ambition is to reduce reliance on overseas labour as more home-trained doctors, nurses, carers and other types of staff enter the workforce. To this end, the Conservatives have repeated their commitment to training 1,500 doctors annually, and also aim to recruit 10,000 more mental health professionals, presumably by the end of the parliamentary term.

They also intend to get more from the existing workforce. Following bitter negotiations, the Conservative government imposed a new contract on junior doctors, phased in from October 2016. If re-elected, they plan to introduce a new contract for GPs, which was agreed in February 2017, and to conclude ongoing contract negotiations with senior hospital doctors.

But they also say the NHS will become a better employer, offering more flexible working conditions, more training opportunities, a greater diversity of career paths and protection against bullying. Given the criticisms that the government has received about NHS workforce planning, it is critical that better workforce plans are developed if any of the manifesto promises are to be delivered.

Dementia tax

Within days of the manifesto launch the Conservatives had back-tracked on their plan on how to fund care of the elderly, which was quickly dubbed a “dementia tax” because it would hit people with long-term care needs, such as those with dementia, particularly hard. Instead Theresa May said the issue would be put to consultation.

The manifesto had dismissed the previous consultation, the Commission on Funding of Care and Support led by Sir Andrew Dilnot, which was set up by the coalition government in July 2010 and reported the following year. The manifesto claimed Dilnot’s proposals “mostly benefited a small number of wealthier people”. But this isn’t true: Dilnot recommended that a person’s lifetime contributions to their social-care costs should be capped at £35,000. The Conservatives intended to drop this cap, implying that many people would continue to face potentially unlimited costs. Theresa May has since said that a cap will be set, but not at what level.

Dilnot also recommended that the means-tested limit for home care should be raised from £23,250 to £100,000, meaning that people with assets below the threshold would have their costs covered by the state. The manifesto also promises to set the threshold at £100,000, but, unlike Dilnot, says that the value of the person’s home will be included in the calculation. If this becomes policy many people with long-term health problems, such as dementia, won’t be able to pass on their houses to their family when they die. This, coupled with the lack of an overall cap, caused an outcry, and May’s rapid U-turn.

The manifesto also promises that winter fuel payments to the elderly are to be means tested. One way or another, many pensioners will be made worse off if these promises become policy.