In his first 100 days as prime minister, Boris Johnson made several pledges and confirmed those of the former PM Theresa May to support the NHS. Many of these feature in the Conservative Party manifesto, even though they have been shown to be false promises – not unlike the infamous Brexit bus, which promised that leaving the EU would mean an extra £350 million a week for the NHS.
The Conservative Party is continuing with its rhetoric that an “increase in the NHS of £34 billion per year is the biggest cash boost in its history”, despite the Nuffield Trust, a thinktank, suggesting late in 2018 that part of this money is actually from savings that hospitals have been required to deliver.
Regardless of whether this is the biggest increase in history or not, two other thinktanks, the Health Foundation and the Institute for Fiscal Studies, have shown this amounts to a 3.3% increase in spending, which falls well short of the 4% needed to address waiting times and the under-provision of much needed mental health services.
The Conservatives are also continuing with their pursuit to “upgrade 20 hospitals and build 40 new ones”. This was previously pledged at the Conservative Party annual conference, but was fact checked (by the independent fact-checking charity rather than the Conservative press office) and found to be the refurbishment of six hospitals only.
Staffing the frontline
The Tories recognise that doctors and nurses are key resources to the NHS, promising 6,000 more general practitioners (GPs) and 6,000 more primary care professionals, such as physiotherapists and pharmacists, as well as an extra 50,000 nurses, incentivising them with a maintenance grant – although this latter figure has been disputed.
Some of these extra nurses include migrant staff, and the Conservatives have pledged an NHS visa to fast track entry for appropriately trained health professionals from overseas. But given a large number of key NHS and social care staff fall under the increased immigration salary threshold, attracting and retaining staff will be difficult.
They do, however, have plans to address retention by improving staff morale by providing funding for professional training. But this may not be immediate as the current staff shortage means staff cannot spare the time for training.
At the other end of the scale, they will address the NHS pension issue – where perverse pension tax rules mean experienced senior staff in the NHS are turning down shifts for fear of excessive tax bills – by holding an urgent review with the British Medical Association and Academy of Medical Royal Colleges. Given the health secretary just rejected a vote by GPs to reduce home visits, these discussions could be interesting.
This is not to deny that the promised 50 million extra GP appointments are much needed. Likewise, this increase in staff could address the worst waiting times since they started recording them. But what is missing from the manifesto is how much these extra doctors, nurses and allied health professionals will cost the NHS and if they are included in their spending estimates, and importantly, when they will materialise.
It takes around ten years to train a GP and four years to train a nurse. There are already concerns that the medical profession is no longer attractive, with several medical schools opening their places to clearing (this is where universities open places to students often with lower grades who may not have received offers at other universities). Despite this, the Tories previously pledged to open five new medical schools.
As well as funding more frontline staff, the Conservative Party manifesto pledges to invest in preventing and curing disease, although without detailed spending estimates. They refer to improving “the early diagnosis and treatment of all major conditions”. They also refer to, without spending estimates, “developing new treatments for serious disease”, and specifically doubling research funding into dementia.
They are pledging an extra £83 million a year for dementia research, which would be spent on increasing the number of clinical research academics and researchers studying the disease. This will be welcomed by dementia researchers, but it is unclear how this will “speed up trials for new treatments”, particularly given the fear that “getting Brexit done” threatens most medical research, including dementia research.
Notably, the Tories wish to “extend the successful Cancer Drugs Fund into an Innovative Medicines Fund”, although there is no evidence of the success of the current Cancer Drugs Fund as it has only been running for three years. It is also working from a very low baseline, given the failure of the first iteration of the Cancer Drugs Fund, which significantly overspent.
The Innovative Medicines Fund would ringfence £500 million to give patients quicker access to the most cutting-edge medicines for cancer and other diseases. Quicker access to medicines often comes at greater cost, which is already a possibility with Brexit.
Brexit and trade deals
Although Johnson has been elusive when questioned in public debates, the manifesto explicitly states that when “negotiating trade deals, the NHS will not be on the table. The price the NHS pays for drugs will not be on the table. The services the NHS provides will not be on the table”. This has been refuted and other US trade deals have included medicine prices.
Brexit is the cornerstone of the Conservative manifesto, but given the NHS is the cornerstone of British society the Tories appear to have paid mere lip service to an institution British people hold dear. It is not clear that their spending plans will save the healthcare system from years of under-spending and an uncertain future with the UK outside of the European Union.