The NHS has been central to Labour’s election campaign so far. But the arrival of the party’s manifesto gives us a clearer picture of what a Labour government would mean for health and care.
The most eye-catching pledge is for more cash – and lots of it. The manifesto promises a 4.3% real terms annual increase in the health budget over the next parliament. If delivered, this would see spending on health services increase at a faster rate than the average for most previous governments over the NHS’ history. The exception is the New Labour years, when health spending grew by 6% annually. This spending would unambiguously be a good thing: the NHS needs investment, and Labour promises it.
What would the new money buy? According to our projections, this investment would be enough to maintain NHS quality in the face of growing demand, and support care improvements. It would cover improvements in day-to-day NHS spending, investment in buildings and equipment, and training for new doctors and nurses. It would also reverse cuts to the public health grant seen over recent years – though wouldn’t be enough to then keep public health spending growing as fast as NHS services.
Turning the cash into tangible care changes won’t be easy. The system is playing catch up after a decade of austerity, so a chunk of the new money will need to go towards getting the system back on track. Take capital investment. While Labour has promised a spending boost that would bring investment up to the OECD average, the NHS faces a capital maintenance backlog worth £6.6bn.
Crucially, the extra money needs to translate into extra people. The NHS is currently short of around 100,000 staff. Social care is down 120,000. Like the Liberal Democrats’, Labour’s manifesto acknowledges these issues, but is light on detail about how chronic staff shortages will be addressed.
Any credible manifesto needs to include a plan for reforming social care. The Labour Party proposal is to introduce ‘free personal care’ for older people and a lifetime cap on care costs.
Before you get too excited: free personal care isn’t the same thing as free social care. Under the same model already in place in Scotland, people over 65 (and now working-age adults too) receive free personal care – including personal hygiene, continence, diet, mobility, counselling, simple treatments and other services – in their own homes, if their needs are deemed eligible. But individuals still need to cover their additional social care costs, such as housework, laundry and wider social activities, as well as contributing to living costs in residential care (subject to a means test). Free personal care allowances in Scotland only meet around 25 per cent of the weekly costs of a residential care home.
This would be an improvement on the current system, which is failing some of the most vulnerable people in society. But individuals with persistent and severe care needs – for example, a person with dementia – could still face high costs. The proposals also don’t include younger disabled adults, who make up around half the cost of the adult social care system.
The second half of the policy is a cap on lifetime care costs. Under this model, people with the means would pay for their own social care – presumably on top of whatever is covered under ‘free personal care’ – up to a limit. After that, the state picks up the bill. The inclusion of the cap is welcome: around one in 10 people aged 65 currently face future lifetime care costs of over £100,000. But there’s little detail on what the policy would look like and where the cap would be set. These details will be important for people and their families.
Improving the nation’s health is about more than the NHS and social care. Labour’s manifesto also includes ambitions to reduce inequalities, eradicate in-work poverty, and tackle hunger and homelessness. This includes reversing some of the harshest cuts to social security – like the two-child limit – reinvesting in Sure Start, and restoring local government spending power to 2010 levels. In the context of stalling life expectancy and widening health inequalities, these are much-needed policies to help improve the social and economic conditions that shape our health. Legislation is also proposed – à la Wales – to ensure governments consider the wellbeing of future generations in their policymaking. But it’s not clear how politicians would be held to account in practice. The risk is that warm words don’t translate into workable policy. And all this needs to be considered in the context of Labour’s whole manifesto, which would see the biggest increase in state spending since the Wilson government of the 1960s. The IFS has questioned how far this expansion could be funded.
There are other risks too. While Labour offers the NHS a welcome boost in funding, it raises the unwelcome spectre of another major NHS reorganisation. Labour’s ambitions to end the use of private providers in the NHS – itself a problem oversimplified in the manifesto – and repeal the Health and Social Care Act risk being a distraction from far bigger issues, like staffing shortages or gaps in mental health care. The Health and Social Care Act 2012 was damaging and distracting. Another restructure risks yet more damage and distraction – and could eat up valuable resources that the NHS could have redirected towards patient care instead.
This blog previously featured in Prospect.