Election '97: Year-on-year pledge to raise spending on NHS

The manifesto recipe for the NHS is a careful mixture of basic populist ingredients - more money, more doctors, more nurses, more health - topped off with some ideological icing, in the shape of more hospital league tables and more private investment in capital schemes.

The party does not quantify its promise to increase spending, it just says it will increase resources "in real terms" year on year. It does specify, however, that the intake of students into medical schools will go up to 5,000 by the year 2000 (it now stands at 4,740) and the number of nurses qualifying each year will increase by 2,500.

The Conservatives claimed that spending on the health service had been increased since 1979 by nearly 75 per cent more than inflation to almost pounds 43bn, and boasted that the number of patients being treated had risen from 5.1 million in 1979 to 9.2 million today. Such claims, however, take little account of the fact that the method by which such numbers are collected has been changed several times during the intervening years and that numbers were already rising before Margaret Thatcher came to power.

The manifesto shows sensitivity to two criticisms - that the number of bureaucrats has increased at the expense of front-line staff and that the closure of many mental hospitals has led to vulnerable people being released into inadequate community care. It counters the first by claiming that for every senior NHS manager, there are now 77 front-line staff (no comparison is made for 1979, however), and the second, by promising: "We will not close any long-stay mental hospitals unless it can be shown that adequate care services exist in the community".

The promise to promote the Private Finance Initiative "which will unleash a new flow of investment funds into the modernisation of the NHS", would carry more weight if the Government had managed to get any substantial schemes under way before the election was called. At present, three PFI hospital projects - in Norfolk, Kent, and Buckinghamshire - are in limbo because bankers investing in the schemes recently became worried that hospital trusts did not have the right to enter into such deals with the private sector. A new government will have to introduce legislation to clarify the legal powers of all hospital trusts.