David Oliver: What the party manifestos should cover on health and social care but probably won’t

Training and retention

Key to all of this is the workforce. Unsurprisingly, staff satisfaction scores mirror those of the public using the services: by 2010 the NHS staff survey showed record high scores, which have recently hit record lows.10 Those same public surveys and focus groups show that people blame short staffing for many of the NHS’s problems, rather than the individual clinicians who support them when they do manage to access care.

To my mind, any credible manifesto must contain commitments on workforce training, recruitment, and retention to provide more homegrown workers, continue ethical overseas recruitment, and do more to stem attrition and improve morale. I’ve been critical of aspects of NHS England’s workforce plan,11 as has the National Audit Office12—but since this plan took years to lobby for, develop, and deliver, a good start would be to support its principles, commit to long term funding, and agree to consult on some of the contentious or missing aspects, reviewing and updating the plan rather than starting from scratch.

There’s also the issue of long term adult social care: its funding, eligibility, and provision. The past 25 years have seen too many false dawns, broken commitments, and more recently serious cuts to local government budgets and social care provision, even as need has risen.1314 Even respected legislation such as the 2014 Care Act wasn’t backed by funding. Immigration rules have damaged the supply of social care workers in a sector already struggling to compete with others on terms and conditions. To attract or retain staff, this has to be tackled.15

Next is population and public health. Life expectancy has stalled in recent years, healthy life expectancy has declined, and health inequalities have grown.16 This isn’t just about good healthcare but about effective public policy on the wider socioeconomic determinants of non-communicable diseases and ill health: action on housing, poverty, air quality, smoking, obesity, food environments, and unequal access to healthcare.1718 We need to restore the local public health funding that’s been cut in recent years,19 but we also need cross cutting solutions across all government departments and agencies, with the principle of “health in all policies.”2021

Funding and investment

The NHS, in comparison with health systems in other industrialised nations, has underinvested in capital expenditure on buildings, facilities, equipment, and technology.22 This affects our ability to deliver good and timely care, as capital budgets are repeatedly raided for running costs. And we need some concrete commitments on ringfencing this expenditure, not just magical thinking about digitally enabled care or discredited promises of new hospitals.23

Underpinning all of this, we need commitments on NHS funding. You’ll hear Conservative spokespeople say that the NHS is receiving record levels of absolute funding. This may be true, but it’s also disingenuous. After record average annual real terms funding uplifts during the Blair-Brown government, the years from 2010 to 2019 saw the lowest real terms annual increase in NHS history.6824 If we’d kept up with the average across 14 EU nations from 2010 to 2019, when we spent around 20% less, it would have meant an additional £40bn a year in the UK’s total healthcare budget, according to a Health Foundation analysis in 2022.25

The economy is in much worse health than when Labour won in 1997, 2001, or even 2005—and NHS funding will be tighter this time, whoever wins. But we need some explicit commitments on funding and preferably a multiyear settlement to allow predictability and planning. Finally, we need the politicians to level with us about what can be realistically achieved and how quickly—and to be honest about what cannot. I’m not holding my breath.