Health December 11, 2019
General Election 2019: Voting for the NHS

By Ben Howlett - Accountable Care Journal

This guide is not about Brexit. A refreshing change, perhaps, given that the 2019 General Election was called because the Prime Minister could not settle a timetable with Parliament on his Brexit legislation. However, as the weeks have progressed, the NHS has become one of the most important issues for electors as they ready themselves to hit polling stations.

With less than 24 hours to go before the polls open on the first General Election to be held in December since 1923, Public Policy Projects offers its assessment of the various positions on the NHS.

From commitments to substantially increase spending, reinvigorate hospital building, and recruit thousands of new nurses, this election campaign has raised the electoral profile of the NHS. Some argue this is clear and damaging politicisation of the health service. However, these commentators are often the same ones shouting the loudest for additional funding. If the NHS was devoid of politics, it would not receive the attention it deserves.


Have the big parties “ducked” the big issues?

Most voters never read the glossy manifestos and therefore political parties do not take them as seriously as we may like. However, the launch of the 2017 Conservative manifesto changed all that. Theresa May’s disastrous social care announcement saw the hopes of a majority crushed at a single press conference.

Given the context of 2017, commentators have read through this year’s commitments line by line, looking for every loophole. Overall, some of the announcements can be described as “lacking detail” or “empty promises”. The head of NHS Providers made this case earlier this week.

There is already plenty of information in the public domain. For those brave enough, they can always read the various manifestos for themselves before they decide how to vote. However, for those without hours-on-end to spare, Public Policy Projects has compiled some of the key analysis.


Spending:

The major parties have certainly not ducked this issue. Austerity is definitely over in terms of macro-spending decisions. In the context of Brexit, the question instead is whether the commitments are affordable without serious tax or borrowing increases. It does not take extensive analysis to realise that they are not. Therefore, the question for voters is whether they believe the promises from each of the main parties.

 

Party pledges for NHS spending. NHS England budget (£bn) Source: BBC News

The Kings Fund analysis:

The Kings Fund has produced a comprehensive assessment of all health and care promises made by the Conservatives, Labour and the Liberal Democrats, which is well worth a read before voters put their cross in a box tomorrow. However, the core highlights from each of the parties include; the Conservative plan to increase the Cancer Drugs Fund and double the investment in dementia research; Labour’s pursuit of a 'health in all policies' approach and a clear focus on preventative care; and the Liberal Democrats agenda to re-introduce bursaries for student nurses.

 

Source: The Kings Fund

 

Clangers:

Manifestos aside, this campaign has not been without its political clangers – some of which have been very difficult for candidates to answer. The most notable of these was the Culture Secretary’s inability to grasp that the Conservative pledge for 50,000 more nurses included the current cohort of 19,000 in an interview with Good Morning Britain. For those in the innumerate government, that equals 31,000 more nurses, not 50,000. Furthermore, discussions continue to surround the 40 new hospitals promised by Boris Johnson and Matt Hancock, only six of which have received firm funding commitments, the remaining 34 receiving just seed funding.

The image of four-year-old Jack lying on a hospital floor in Leeds caused serious pressure in an otherwise featureless election campaign, threatening to derail Boris Johnson’s chances of securing an overall majority. Empathy is key in politics and the Prime Minister failed to show any as he refused numerous times to look at images of the little boy. This is likely to make a significant dent in the Conservative’s poll ratings on the NHS.

On the other side, Labour’s health and care spokesman went one step further, suggesting that Jeremy Corbyn would never lead the UK in a leaked recording to the press. They have also suggested that they would do what the Soviet Union failed to achieve and make their own drugs. The Liberal Democrats have also faltered heavily in the polls, promising that a reversal of Brexit will produce a dividend to keep the NHS funded for years to come. The public are clearly not as interested as the Liberal Democrats had thought they would be.


A matter of trust

Trust in politics is already at the lowest levels since the financial crash in 2008. With so many promises made for an institution that is religious in status, it will be extremely important for the winning party to deliver on its promises. This will certainly be a challenge given the unachievable promises offered in this election. Spin is often unravelled over time, and in several years, it will be interesting to review the pledges made to see if they have been implemented. Will the billions of extra funding become a reality? Will there be 40 new hospitals built? And will there be 50,000 more nurses recruited (excluding the current 19,000 of course)?

The results of this election may not be felt for years to come. It takes about as long to build a new hospital as it does to recruit and train a new clinician. A week is a long time in politics and 5 years may seem like an eternity. Priorities and even leaders can change over this time. After the election, it will either be for the Conservatives to deliver on their promises or for Labour to find the money to fund theirs. The Liberal Democrats, meanwhile, must choose whether to support the new government on its manifesto commitments or not.


Voting tactically or tactical accountability?

Tomorrow, the electorate may choose to vote tactically on the NHS. A significant proportion of the population will do just that on other issues. However, it is rare to hear this argument made in terms of health and care. It may be hard to see the benefit as each party has promised that the NHS is the most important issue for them at a domestic level. Therefore, the suggestion is that voters support the party they believe will deliver on its promises and ensure it is held to account.

In five years’ time (or less) voters will once again have the chance to review these promises and oust the elected Government should it have failed to deliver. Fanciful accounting and broken promises will further erode trust. Therefore, It is of utmost importance that the electorate continues to hold politicians to account for their General Election promises for years to come.


[1] Department of Health/Conservatives/Labour/Liberal Democrats https://www.bbc.co.uk/news/election-2019-50690908

[2] The Kings Fund Analysis https://www.kingsfund.org.uk/publications/parties-pledges-health-care-2019

[3] The Kings Fund Analysis https://www.kingsfund.org.uk/publications/parties-pledges-health-care-2019


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