Polls say the NHS is the issue of most concern to voters, but it is little talked about by the main parties. Margery Thorogood explains what they really think

As the media hustings continue, more statements are being made about the NHS and its future. The underlying thrust is more relevant than the vagaries contained within the slanging matches. The NHS is under threat and its future is in crisis. The recent Nuffield Trust assessment of the costed NHS policies of Tory, Labour and Lib Dem parties reports a financial squeeze that the planned funding increases would ‘make the next few years the tightest period of funding in NHS history’.

So, the ‘main’ political parties have constructed their manifestos for the future. These will remain as reference points for future debate and challenge. The ten pledges from Starmer are always useful to see how things can be dropped once in office. In relation to the NHS, Starmer had pledged (when he was standing for leadership) to ‘defend our NHS’, and to ‘end outsourcing’. Both gone, along with the rest.

So where do the main parties stand on our NHS?

Labour Manifesto: main points

(Note author comments are in italic.)

How Labour will build an NHS fit for the future:

• Cut NHS waiting times with 40,000 more appointments every week
• Double the number of cancer scanners
• A new Dentistry Rescue Plan
• 8,500 additional mental health staff
• Return of the family doctor

Some additional points:

• Labour has promised to clear the waiting list within 5 years with more evening and weekend appointments and using the private sector, paid for by a crackdown on tax avoiders
• It will create 7500 more medical school places and 10k more nursing and midwifery clinical places a year. (This will be difficult with staff shortages and no mention of pay, T and C etc.)  
• It will deliver 700k extra dentistry appointments a year. (Set in a dentistry crisis context where NHS dentists are non-existent in many places and tooth decay is the main reason for child hospital admissions, this seems to be missing the point.)

For more detail, see here.

Wes Streeting has stated clearly that NHS spending would go up ‘if conditions allow’ in the next parliament, reiterating that: ‘We’ve got to get the economy back to growth.’ (Little different from the Tories then. As workers create growth, don’t we need to think about them first?)

Conservative Manifesto: main points

• 25 million more NHS dental appointments
• Cut NHS managers by 5500
• Increase NHS spending above inflation every year
• Recruit 92,000 nurses, 28,000 doctors
• Specialists to issue sick notes, not GPs
• Build/modernize 250 GP surgeries

Sunak has repeatedly promised to cut waiting lists, stating that the backlog has fallen by 200k since September 2023 even though it remains higher now than when he made that pledge.

The actual content of the Conservative manifesto is breathtaking in its descriptions and promises. Reference is made to the present with its ‘record funding’, having ‘more doctors and nurses than ever before’ and ‘delivering record numbers of appointments’. Promises made to backing the NHS Long Term Workforce Plan, to ‘record increases in training places … such as midwives and paramedics’, to ‘cap social care costs by 2025’, etc.

(Pages of it. People would be right to think it should have all happened before. It also praises the ‘extraordinary acts of service and sacrifice from health and care professionals’ during Covid which is unlikely to be received well by staff. At a time when there are staff shortages of 100k in unfilled jobs and the RCN says almost half of its members are currently planning or considering quitting, Sunak is missing the point. Any promises made are in a context of distrust with ongoing industrial action. Junior doctors are due to strike just before the election.)

Lib Dems manifesto: main points

• Give everyone the right to see a GP or the most appropriate practice staff member within seven days, or within 24 hours if they urgently need to
• Guarantee access to an NHS dentist for everyone needing urgent and emergency care by
• Take action to prevent tooth decay by
• Work towards a fairer and more sustainable long-term funding model for pharmacies, and build on the Pharmacy First approach to give patients more accessible routine services and ease the pressure on GPs
• Improve early access to mental health services by
• Boost cancer survival rates by
• Help people spend more years of their life in good health by
• Train, recruit and retain the doctors, nurses and other NHS staff we need, including by
• Fix the life-threatening crisis in our ambulance services by
• Harness the benefits of new technology and digital tools for patients by
• Implement a ten-year plan to invest in hospitals and the primary care estate to end the scandal of crumbling roofs, dangerous concrete and life-expired buildings
• Create a new ‘Patients Charter’ to harness lived experience of patients and embed patient voice, partnership and safety standards across health and care settings, including

(There are more pledges, all with detail provided, much of which relates to situations to which people can relate, e.g. extending young people’s mental-health services up to the age of 25 to end the drop-off experienced by young people transitioning to adult services; modernising the Mental Health Act to strengthen people’s rights, give them more choice and control over their treatment and prevent inappropriate detentions;  establishing a properly independent pay review body. But, as we know, the party has history.)

See the link: https://www.libdems.org.uk/manifesto

Greens Manifesto: main points

The Green Party is committed to a fully public, properly funded health and social care system, and to keeping the profit motive well away from the NHS.

Green MPs will push for:

• A year-on-year reduction in waiting lists.
• Guaranteed access to an NHS dentist.
• Guaranteed rapid access to a GP and same day access in case of urgent need.
• An immediate boost to the pay of NHS staff, including the restoration of junior doctors’ pay, to help with staff retention.

To meet these aims, we estimate that the NHS in England will require additional annual expenditure of £8bn in the first full year of the next Parliament, rising to £28bn in total by 2030. Additional capital spending of at least £20bn is needed over the next five years for hospital building and repair.

Investing in GPs and public health is key to prevention, early diagnosis and improving our quality of life, while also reducing the burden on the NHS. Green MPs will push for:

• Increasing the allocation of funding to primary medical care, with additional annual spending reaching £1.5bn by 2030.
• Restoring public health budgets to 2015/16 levels with an immediate annual increase of £1.5bn. Smoking cessation, drug and alcohol treatment and sexual health services all need to be properly funded.
• A National Commission to agree an evidenced-based approach to reform of the UK’s counter-productive drugs laws.

NHS dentistry

Green MPs will end the systematic underfunding of dentistry and the scandal of dental treatment deserts by pushing for:

• A new NHS dentists’ contract so that dentists are properly rewarded for taking on NHS patients
• Additional investment in NHS dentistry reaching £3bn a year by 2030.
• Funding for community hubs and primary care to roll-out free dental nursing for children and those on low incomes.

Mental health and neurodiversity

There’s been a dramatic rise in mental health problems in recent years, particularly among young people, with far too many unable to access help when they need it.

Elected Greens will press for:

• A legal framework that supports the rights of those struggling with their mental health to be respected and to live fulfilling lives.
• Increased funding for mental health care, putting it on an equal footing with physical health care and enabling people to access evidence-based mental health therapies within 28 days.
• A trained and paid counsellor in every school and sixth-form college.
• Readily available tailored provision to meet the needs of communities of colour, children and adolescents, older people and LGBTIQA+ communities.
• Adequate support in the school system for neurodivergent children and children with special educational needs.

Assisted dying

Elected Greens will support a change in the law to legalise assisted dying for people suffering from terminal disease who wish to avoid prolonged unnecessary suffering, if this is their clear and settled will. Proper safeguards would be put in place.

End new cases of HIV by 2030

Green MPs will work towards no more HIV transmissions by 2030, advocating for a joined-up evidence-based approach, including access to the HIV prevention pill online, in pharmacies and from GP services, and renewing successful opt-out HIV testing programmes in A&Es in all areas with a high prevalence of HIV.

See the link: https://greenparty.org.uk/about/our-manifesto/

Reform UK manifesto: main points

This appears to be the manifesto although more detail might be added. It opens with a statement:

‘Imagine No NHS Waiting Lists Still free at the point of delivery, healthcare needs reform to improve outcomes and enjoy zero NHS waiting lists. Cut back office waste to spend more money on the frontline. Tax breaks for doctors and nurses to tackle the staffing crisis.”

Main points:

Our contract with you despite record extra funding in recent years, NHS healthcare outcomes have declined. While still free at the point of delivery, our healthcare needs major reforms to improve results and enjoy zero waiting lists.

CRITICAL REFORMS NEEDED IN THE FIRST 100 DAYS:

• End Doctor and Nurse Shortages. All frontline NHS and social care staff to pay zero basic rate tax for 3 years. This will help retain existing staff and attract many who have left to return.
• End training caps for all UK medical students. Write off student fees pro rata per year over 10 years of NHS service for all doctors, nurses and medical staff.
• Use Independent Healthcare Capacity. We will harness independent and not-for-profit health provision in the UK and overseas. Tax Relief of 20% on all Private Healthcare and Insurance This will improve care for all by relieving pressure on the NHS. Those who rely on the NHS will enjoy faster, better care. Independent healthcare capacity will grow rapidly, providing competition and reducing costs.

Thereafter:

• Put Patients in Charge With a New NHS Voucher Scheme. NHS Patients will receive a voucher for private treatment if they can’t see a GP within 3 days. For a consultant it would be 3 weeks. For an operation, 9 weeks. Services will always be free at the point of use.
• Improve Efficiency. Cut Waste and Unnecessary Managers Operating theatres must be open on weekends. Rotas must be planned further in advance. Nail down better prices using economies of scale. Review all NHS Private Finance Contracts for significant savings potential. Charge those who fail to attend medical appointments without notice. Abolish the NHS Race and Health Observatory. Save A&E Cut waiting times with a campaign of ‘Pharmacy First, GP Second, A&E Last’. We will offer tax incentives for new pharmacies and those who employ more staff to assist in relieving pressure on A&E. Excess Deaths and Vaccine Harms Public Inquiry Excess deaths are nearly as high as they were during the Covid pandemic. Young people are over-represented

We are familiar with the names of these parties which reinforce the status quo and exclude others. One such group is the Independents; possibly because they represent different aims (data unavailable).

Interestingly, and according to the BBC, the list of parties and the number of candidates standing for each is as follows: Conservative (635), Labour (631), Lib.Dems (630), Reform UK (609), Green Party (585), Workers Party of Britain (152), Social Democratic Party (122), Scottish National Party (57), Scottish Green Party (44), Heritage Party (41), TUSC (40), Plaid Cymru (32), Yorkshire Party (27), Rejoin EU (26) plus a small tail of parties with less than 20.

However, another list (by Wikipedia) is much longer, including every single party there is taking part in the GE. Noticeable for its absence in the BBC data is the Independents which according to the second list, has 459 candidates, thus a significant group. Other examples included are the Cooperative Party (48), the Communist Party of Britain (14) and the Workers Revolutionary Party (5) trailing down to People Before Profit (1).  

Independents are a varied group but their role is significant. We know that their numbers have increased at council elections with many successes and that now, their role has become increasingly important. Research by Alistair Clark (local democracy expert from Newcastle University) states that support for Independents tends to go up when voters are disillusioned with the ‘mainstream’ parties. Certainly, we have seen evidence for this across the board with most recently, a falling out in the community with Labour over Gaza and the stance taken over a ceasefire or lack of. Then there are the candidates who are standing as Independents, largely due to their appalling treatment by the Labour leadership, and include Jeremy Corbyn, Faisa Shaheen and Andrew Feinstein.

Knowing the background context is important. The dominant parties will be in the media more and the lesser parties not heard unless hustings are organised locally and then the focus might well be on Palestine at the exclusion of all else. Many of us have been thinking ‘Palestine’ non-stop since October 2023 and we will be expanding out to all the issues facing people: the cost-of-living crisis, lack of genuinely affordable housing, education cuts, child poverty at 4m children in the population, energy prices, the increase in homelessness, etc.

So where to go from here on our NHS? Speeches are being made, data thrown around and stories presented to candidates to, first, get their answers and second, keep reminding the population what a perilous state out NHS is in which further undermines the NHS and pushes people into thinking an alternative system of health care is the only way forward. In this respect, the two main parties are almost identical, which is nothing short of dangerous.

Several campaign groups continue to work hard in warning the public how crucial this election is going to be for our NHS. Street stalls and conferences are taking place and, with reference to KONP-HCT, their thrust is as follows – ‘VOTE TO RESCUE OUR NHS’. 

On a personal note, I will add the NHS manifesto commitments from Jeremy Corbyn (Independent candidate for Islington North) which state as follows:

DEFEND OUR NHS
End privatisation
Support our doctors and nurses
Mental health
A National Care Service
Reproductive health

Vague and brief but sincere and with the backing of his constituents, they would together work hard to make it – and more – happen.

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