“We are the party of the NHS.” Philip Hammond’s claim may have rung hollow for the more than 100,000 patients who were made to wait longer than 12 hours in A&E last year, but with the release of their manifesto, the Conservatives are again hoping to convince voters the health service is safe in their hands.
However this phrase – coined by the Chancellor in March as he announced the Budget – has not been repeated incessantly by Theresa May and her party, unlike other Tory mottos “strong and stable” and, in 2015, “long-term economic plan”.
Health Secretary Jeremy Hunt is perhaps better known for silence than soundbites. It took him three days to respond to the devastating cyber attack that hit the NHS last week, and last winter, when ambulances were queuing outside hospitals, causing the Red Cross to declare a “humanitarian crisis”, he bolted down the street rather than take questions from a reporter.
The Conservatives know voters care about the NHS, which consistently tops polls on what makes people most proud to be British. But years of austerity, pay freezes and the threat of hospital closures makes it a thorny issue the party would often prefer to avoid mentioning altogether.
A recent poll for The Independent found three in four people believe the NHS is in a bad condition, with 51 per cent of people saying the Tories bear the most responsibility for the current problems facing the NHS.
With this in mind, they have promised an extra £8bn over the next five years for the health service. While some might point out this falls well short of the £350m a week promised by the Leave Campaign, it’s a clear attempt to woo back voters from Labour, who have pledged a real-terms spending increase of £11.6bn by 2022-23, a reduction of one million from waiting lists, and a pay rise for NHS staff.
The Liberal Democrats have said they will raise income tax by 1p to fund a real-terms increase in health spending of £8.5bn in the same time period, according to analysis by health think thank the Nuffield Trust.
Health experts have called the Conservative manifesto – which, if you believe the polls, could soon become policy – “deeply disappointing”, with the Health Foundation predicting it will create a funding gap of £12bn in the next four years.
“The £8 billion in additional funding over the next five years does little more than extend the squeeze on NHS finances for another two years and will not be enough to meet rising demand for services and maintain current standards of care,” said Chris Ham, Chief Executive of The King’s Fund.
The manifesto says important targets such as 95 per cent of A&E patients being seen in four hours, and no waits of longer than 18 weeks for non-urgent surgery, will be retained if the Conservatives win – but this may prove a challenge without a funding hike, Mr Ham told The Independent.
“It’s likely to be a real struggle for the NHS to deliver on key targets,” he said. “We welcome funding, it will help the NHS to maintain existing services, but it leaves no margin. There’s very little money left over to invest in other priorities like parity of esteem for mental health or giving support to GP practices struggling under the strain of rising patient demand.”
The British Medical Association (BMA) has accused the Government of using “smoke and mirrors” to extend current levels of funding, which were set out in a 2015 spending review.
Back then, the Department of Health promised a real-terms funding increase of £10bn by 2020-21 – along with £22bn of savings made through “efficiencies”, which have proved contentious as they translate into cuts to services and ward closures.
“The Conservatives have been in power for the last seven years, yet this manifesto will do nothing to reassure patients and NHS staff that they have the vision the NHS needs or will deliver the funding to ensure its survival, said Dr Mark Porter, the BMA’s council chair.
“The extra £8bn touted in this manifesto for the NHS is smoke and mirrors – rather than extra money, this essentially extends the funding already promised in the 2015 spending review for another two years and falls far short of what is needed.
“The NHS is already at breaking point, and without the necessary investment patients will face longer delays, care will be compromised and services will struggle to keep up.”
These so-called ‘illusions’ are nothing new, according to Sally Gainsbury, senior policy analyst at the Nuffield Trust. Firstly, the promise of an extra £10bn made in 2015 measures the increase from the previous year, so the true figure is actually £8bn, she says.
Secondly, Jeremy Hunt has managed to fund this increase in spending to the quango known as ‘NHS England’ partly through cuts to Department of health spending by £3bn, impacting other important aspects of healthcare such as doctor training and public health initiatives.
This clever wordplay has been employed again this time round, she told The Independent. “As expected, the Conservative’s £8bn extra pledge only refers to spending defined as ‘NHS England’, meaning there is 10 per cent of the Department of Health (DH)’s budget which is unknown.”
“At the Spending Review in 2015, the Conservatives made a similar pledge to increase NHS spending by £8bn but it turned out that £3.5bn of that was actually funded through cuts to the £15bn worth of the DH’s budget that sat outside NHS England.”
Doctors have warned deep cuts to public health budgets, enabled by this change in terminology, mean the NHS faces a “ticking time bomb” unless funding is drastically increased.
The BMA said swingeing cuts of £400m by 2020-21 and failure to curb persistently high levels of obesity, smoking and binge drinking will plunge the NHS further into the red, while condemning patients to suffer from preventable diseases.
Gainsbury added that the overall figure the health service receives may also turn out to be be lower than expected.
“The Conservatives are saying that details on the remaining 10 per cent of the DH’s budget would only be set out in a spending review after the election. So this leaves some uncertainty. It means that at the most, total DH spending, in real terms, will be £8bn higher in 2022-23,” she said.
“But if, for example, a Conservative government chose to freeze spending on the remaining 10 per cent of the DH budget, then the over real terms increase for the DH could be nearer £7bn.”
The manifesto promises to “make it a priority” that the 140,000 staff from EU countries are able to continue to work in the NHS after Brexit – but many have already decided to leave, health bodies report, while low pay and morale fuelling staff shortages and the possibility of the first nursing strike in history.
The party is also proposing a new GP contract, with family doctors expected to “come together to provide greater access, more innovative services, share data and offer better facilities, which ensuring care remains personal”.
Shadow Health Secretary Jonathan Ashworth has said Tory claims on money they allocated to the NHS has been “blown apart by independent experts”.
However, Labour’s promises to fund the health service by taxing the rich may not have convinced everyone, said Mr Ham. “If they aren’t persuaded by what the Conservatives are saying, would they be persuaded by what the other major parties are saying?”
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