14 Apr 2015

Few surprises on health in today’s Conservative manifesto

And here we are again, back to this £8bn extra for the NHS by the end of the decade. Without wanting to sound like a stuck record, this £8bn that the Conservatives have today pledged to meet and that Labour has steadfastly refused to guarantee, is increasingly meaningless.

Firstly, both the Health Foundation and the King’s Fund say it is a bare minimum.  It is not where the parties should stop, it is where they should begin.

Secondly, it is predicated on the Five Year Forward View making the savings of £22bn through system changes and better prevention.

Thirdly, it is based on a level of productivity that the NHS has not been able to meet in recent years.  According to recent analysis from the Health Foundation, NHS hospitals have only improved their productivity at an average rate of 0.4 per cent over this parliament.

The Five Year Forward View, from Simon Stevens at NHS England, suggests productivity improvements at 2-3 per cent.

As for the rest of today’s health pledges from the Conservatives, there are no surprises. Again, as with Labour, everything has been trailed endlessly.

Seven-days hospital services, a guaranteed same-day GP appointment for those aged over 75 if they need one, and improved integration of health and social care – though not under the same budgets.


The seven-day pledge, which has long been called for by the likes of the Royal College of Physicians, is widely welcomed in the face of figures which show far higher death rates at the weekends when there are no consultants around and vastly reduced diagnostic facilities.

But again, the King’s Fund, the Health Foundation, and the Nuffield Trust say that this would require funding over and above that £8bn.

The same goes for seven-day GP working, which has been trialled in parts of the country but is far from universal.

Recently, I have been wondering why David Cameron has not made more of the lead he took on dementia. The dementia summit was deeply impressive, and although it has been shown today that funding for the disease massively trails the spending on cancer and heart disease, it was the first time there has been such political will to find a cure.

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And so, finally, it was here in the manifesto. A wee bit buried, but there is a pledge to “ensure the UK leads the world in fighting cancer and finding a cure for dementia”.

​That will also undoubtedly need over and above the £8bn extra by 2020 as well, but it is a worthwhile ambition indeed.

What is most noteworthy, however, is the contrast between the last manifesto and this one. Then we were given a hint of what Andrew Lansley had in mind for the NHS:  family doctors to be given the power to hold budgets and to commission care; an independent NHS board to be created to deal with political interference in the health service; and the Department of Health to become the Department of Public Health, with a new funding system ensuring more money goes towards the poorest areas with the worst health outcomes.

Of course, what it didn’t say was that there would be a reorganisation “so big you can see it from outer space”. And we all now know what happened next.

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