UKIP manifesto pledges for the NHS don’t add up

Time to get serious. Gareth Fuller/PA

UKIP has announced its health policies ahead of May’s general election. The NHS is an important issue with voters, but it’s also economically important. The NHS costs more than £110 billion a year – or around 10% of our GDP. It employs more than 1.3m people and treats a million patients every 36 hours.

Yet despite constant criticism it is thought to be one of [the most efficient health care systems in the world]((http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror). So what do UKIP’s manifesto pledges on health look like under an economic microscope?

Health tourism – ripped off numbers

With so little detail available at present it is difficult to fully assess their policies but several of them stand out as requiring further attention. For instance, their claim that £2 billion can be saved from preventing “health tourism” is simply a fiction.

There are three problems with this claim. First is the real scale of the problem. The £2 billion figure is ripped straight from a Daily Mail headline, which in turn misquoted a government report and ignores the fact that £430m is accounted for by student residents in the UK who provide a considerable net benefit to the economy. A further £520m is accounted for by migrants in the UK for more than 12 months who could not be said to be deliberately targeting the NHS.

In fact, the government’s own report estimates that actual “health tourism” is likely to amount to a cost of between £60m and £80m – but could be anywhere from £20m to £200m – only 10% of UKIP’s £2bn.

The £2 billion figure is also made up of numerous types of temporary visitor using the NHS including £260m from European Economic Area visitors that the NHS can already reclaim through EU regulations, and almost £100m from UK expats.

In many cases it is in our own interest to treat people, irrespective of their ability to pay for treatment. This arises where there are benefits from treatment for everyone, as is the case with communicable diseases. If a tourist who does not have health insurance presents with Ebola surely we want to treat them, even for free.

Speaking on the Today Programme on February 23, Louise Bours, UKIP’s health spokesperson, said this was still to be worked out but that those without insurance would be turned away at the border. However, there are no clear and costed mechanisms for implementing these border checks. A laborious and costly check at entry to determine whether somebody has valid health insurance (as opposed to a piece of paper which claims to be an insurance document) would likely be more expensive to implement than it would save. To put this in perspective, the voluntary additional Ebola screening checks on a few thousand individuals were expected to cost £9m over six months.

Hospital parking – or saving lives?

According to UKIP, savings from this would be spent on providing free hospital parking.

Hospital parking seems to get some people hot under the collar, but the £200m earmarked for parking could have funded 20,000 cataract operations allowing people to see properly again, 7,000 cochlear implants giving people the gift of hearing or perhaps saving 2,000 lives through heart bypass procedures. What all taxpayers and policymakers must appreciate is the opportunity cost of any money spent in the public sector.

Parking issues. Bay by Shutterstock

Charging, sometimes high fees, for parking is not about the revenue it makes for a hospital. While in a cash-strapped NHS every penny is useful, parking charges are used to ration an incredibly scarce resource. Unless there is a plan to build additional parking capacity, which would only be possible at huge cost, there will still be a shortage of parking spaces, with or without a charge.

Charging for parking sends a signal about the scarcity of the resource and allows people to make an informed choice about the value of driving to the hospital against alternatives such as taxis, public transport or arranging for a lift from friends or family. If you live particularly far from the hospital or not close to public transport then driving may be a cost-effective choice for you.

The law of demand tells us that lowering the cost of parking will encourage even more people to drive to the hospital. People will therefore not be complaining about the cost of parking but about the inability to park at all, or having to wait hours to enter the car park and perhaps missing their appointment.

More staff – from abroad?

UKIP also made some large financial pledges including £130m a year to fight dementia and £1 billion per year for elderly social care and an extra £3 billion for the NHS. They write:

We will insist this money goes into frontline resources, yes that’s real doctors, nurses and care, not middle management or expensive spin doctors. This money will provide 20,000 new nurses, 3,000 midwives and 8,000 GPs.

At present these are unfunded pledges with short-term savings to be identified elsewhere in the manifesto. However, setting aside the funding, it isn’t clear how quickly the NHS could recruit or train this number of additional staff, and who would fund that training. The obvious solution for most NHS providers is to recruit from overseas, although I’m not sure how this would fit with UKIP’s immigration policy.

At present there are only 20,000 people starting nursing training and around 8,000 starting medical training each year. Expanding this quickly is difficult and very costly.

NHS managers – costing up

The attack on management is a continuing theme in their policy statement. UKIP promises to reduce the number of managers and to regulate managers like clinicians through a “licence to manage”. The cost of regulating managers isn’t calculated, nor is the scale of the proposed cuts to management but it’s worth remembering that less than 3% of the NHS’ 1.3m workforce are managers or senior managers.

Their commitment to fund medical education is also unfunded – and it won’t be cheap. If we estimate that there are around 8,000 students in each of three pre-clinical years of education this would cost over £200m a year to fund. Or about the same as their car parking pledge.

Whether or not these policies will appeal to voters is unclear. But one thing is certain, the central place the NHS will play in the election coverage. And as with any other party, UKIP’s policies need close scrutiny.