The main English party manifestos on health

Here is information (not intended to be impartial) about the manifestos of four parties as they relate to health. The Conservatives are mentioned only in passing. After 2010 who is to believe them, especially now they are plucking billions of pounds for health out of thin air.

Labour's Health Manifesto is a mixed bag. The promise to repeal the 2012 Health and Social Care Act seems to be presented almost as an unimportant afterthought. Nonetheless several of the specific undertakings we have been looking for are there - restoration of accountability; repeal of the competition framework; some promised security against TTIP; some control of the private sector, plus a number of positive measures. There are promises of moves towards devolution (which some people may read as threats to the NHS) and Labour is now expressing doubt about the Manchester proposals as they stand.

Funding remains an issue although Labour obviously thinks that what can be saved from marketisation red tape (£100m) is considerably less than the much higher and pretty unrealistic figure of well over £5 billion being quoted by some campaigners. This may lead people to suspect that Labour's commitment to reduce the market is weaker than it appears; certainly they do not appear to be abolishing the commissioning approach and nothing is said about the impending privatisation of the Commissioning Support Organisations. The NHS Reinstatement Bill is not mentioned. Labour also steps back here from explicitly endorsing the Five Year Forward Look (again by not mentioning it – though Andy Burnham has said subsequently that it would need adaptation since Labour will be starting from a different place), thus freeing itself from endorsing the financial package of £8 billion extra before 2020 and the further £22 billion of efficiency and other savings which Stevens says are also required if there is to be zero growth. There are also doubts about how quickly Labour's promised extra funding will kick in. Money has to be found for the NHS during 2015-16.

What the manifesto does evidence is some very real thought about the NHS, about integration of services, the impact of cuts elsewhere, and in particular in social care, on the NHS and, to some extent about public health. The promised figures for increases in staffing seem plucked out of the air, but the focus on improving access to primary care is more realistic than Cameron's unfunded and overambitious promise of 7 day working. "The next Labour Government will guarantee the right to a same-day consultation with a doctor or a nurse at your GP surgery, and the right to a GP appointment within 48 hours. We will also ensure patients have the right to book more than 48 hours ahead with the GP of their choice."

Certainly the manifesto is by far the most detailed approach to securing the NHS of any of the parties so far and contrasts with the rose-coloured haze cast over the current working of the NHS by the Conservatives and their apparently unfunded promise of the £8 billion over 5 years requested by Simon Stevens has to be linked with the £22 billion 'efficiency savings' mentioned above. Be sure that this will mean further radical changes.

Undecided voters should seriously consider that Conservative promises on the NHS cannot be trusted. Last time we had 'no top down reorganisation'; this time we have a conjuring promise of extra money with no indication where it will come from nor of how the £12 billion welfare cuts will affect people with severe health needs. Cameron parrots the current fashionable demand for 7 day working, without helping us to any real understanding about what this means, which services it will affect, and how it will be achieved. The apparent commitment to the 5 year forward view suggests that parcelling up of the NHS can be expected to proceed apace. For instance the Wirral which has a privatising CCG has just announced that its vanguard partnership will consist of the hospital trust, other local public sector health providers, Wirral Council and three outside bodies: Cerner UK Ltd - (informatic solutions and population health management) Advocate Physician Partners ACO (USA) - (modelled Accountable Care Organisation deployment and learning" and the King's Fund - (research, learning, evaluation and dissemination).

The Green Party Manifesto has also been launched, with a significant section on health, (pp31-35) https://www.greenparty.org.uk/we-stand-for/2015-manifesto.html some of it written by Sheffield Green Party parliamentary candidate Jillian Creasy. The programme is much clearer in its attack on the market and calls for an end to the commissioning mechanism and to the blanket use of 'commercial confidentiality'. It is specific about PFI (not even mentioned by Labour) and contains a number of brave promises - including bringing addiction services across to the Department of Health. On p74 the Greens confirm opposition to TTIP. There is mention of transferring hospital services to the community without it being clear how this will be done (Labour envisages a continuous institution, which may or may not prove to be a good idea.) Jillian's section on a 'person-centred' NHS is particularly interesting for its intent to enable the time and opportunity for staff to care effectively by being able to respond more directly to patient needs. The manifesto supports the NHS Reinstatement Bill, already introduced to Parliament by Caroline Lucas, but rather glosses over its application. Critics will probably say that it is strong on good intentions but much weaker on delivery, both in terms of structures and the rather optimistic funding mechanisms.

The Lib Dem manifesto contains a lot of fine intentions, but, given that the Lib Dems are not going to lead a government, they have two purposes - one to attract/retain voters in marginal constituencies, the other to act as bargaining points in any sort of coalition or hung parliament.

The Lib Dems say (p73) they will repeal parts of the Health and Social Care Act “which make NHS services vulnerable to forced privatisation through international agreements on free markets in goods and services - so the TTIP pressure is getting through to Clegg. What he won't admit is that it's not just 'parts' of the Act. They don't admit their responsibility for putting the NHS in this situation in the first place. They are more careful about specific promises around staff recruitment - preferring to talk about different ways of accessing GPs rather than 7 day working or unrealistic estimates of GP numbers. They also have specific and often welcome proposals on social care and public health and have clearly majored on mental health. This contrasts with the Tories - whose manifesto is now discovered to contain the threat of benefit sanctions against people who refuse medical treatment.

UKIP's manifesto is a hotchpotch of opportunist and populist proposals designed to reassure prospective UKIP voters that it cares about the NHS whose ills it puts down to demographic change, immigration and the EU. The proposals are, in our view, little more than pub speeches. It contains promises to rebalance funding away from Scotland and towards Wales and England, to insist on health insurance for all migrants, and to increase some GP availability. It enters the staff number lottery by promising 8000 more GPs, 20,000 nurses and 3,000 midwives and will, from somewhere, put a GP in every A&E (presumably paid at extravagant locum rates and deflecting GPs from local practices although they do say they will pay for additional consultants by preventing the current reliance on locums). UKIP claims commitment to the founding principles of the NHS. It will increase funding for mental health, end hospital parking charges and build a new specialist military hospital. Obviously it opposes TTIP as an EU initiative and wants to demand specific exclusion of the NHS. However UKIP will pursue a separate trade deal with the USA.

UKIP will finance improvements in social care (including the end of zero hours contracts for care workers) through a sovereign wealth fund financed by taxes on fracking (assuming any fracking takes place!). So that’s social care down the sinkhole then.