With the annual party conference season providing a useful pre-election platform, both Labour and the Conservatives were keen to underline their commitment to investing in health and social care.
But while the two parties pledged to increase spending in these areas, piecemeal policy proposals still leave fundamental questions unaddressed – and betray a lack of joined-up thinking.
Labour has promised to increase GP numbers by expanding trainee places by 50% a year. These extra 1,500 places would bring the total number of new GP trainees up to 5,000 a year, which is in line with calls from the Royal College of General Practitioners. The policy is designed to address the longstanding shortfall in GP numbers, which have fallen by 858 since September 2015 – despite David Cameron’s 2015 pledge to increase the number of GPs by 5,000 by 2020.
However, the shortfall in GPs has occurred despite the number of trainees increasing by a quarter over the last seven years. Sample surveys from The King’s Fund in 2018 show that only 21.7% of GP trainees intend to be in full-time clinical work a year after qualifying, with this figure falling further – to 5.4% – 10 years after qualifying.
Any government would therefore have to improve retention – by addressing issues such as GP workload – to boost GP numbers. This could be through greater support for primary care networks – which redistribute workloads among interdisciplinary teams of healthcare professionals within the community, of which GPs are just a part.
The Conservatives’ Health Infrastructure Plan promises to spend £13 billion on 40 hospitals – consisting of a combination of "entirely new buildings or gutting existing structures to create state of the art facilities". As part of this outlay, the government has confirmed £2.7bn for six schemes to be built between 2020 and 2025.
Many hospitals need the investment. Following a number of years in which capital budgets were transferred to frontline services, the backlog of hospital building maintenance stood at £6bn in 2017/18. Of this maintenance bill, £1bn is considered ‘high-risk’ – where building repairs need to be an urgent priority so as not to compromise patient safety.
But the Health Infrastructure Plan also emphasises the need to modernise the primary care estate. This would relieve the burden on acute hospitals and fulfil the NHS Long Term Plan’s objective to prioritise preventative, community-based care that treats people’s conditions before they require hospital treatment. Despite this, all six of the hospitals for which funding has been allocated provide acute and/or specialist care. By failing to prioritise investment in the primary care estate, the Conservatives’ proposals could undermine the aleady-existing NHS Long Term Plan.
Wage increases may not reduce vacancies in social care – but will increase cost pressures for providers
Both Labour and the Conservatives have pledged to increase the national living wage. This will increase the wages of care workers on the minimum wage, but it will also increase the cost of care for providers – who may pass on the costs to councils and those who self-fund their care. A higher national living wage will apply to all workers – not just those working in social care. Consequently, sectors that traditionally compete with social care for staff – such as retail – will pay more, so rising wages may not make social care a more attractive career option. After the national living wage was introduced in April 2016, for example, vacancies and turnover in social care continued to rise.
Labour has pledged to provide free personal care, estimated to cost £6bn a year by The King’s Fund (rising to £8bn by 2030), with the aim of doubling the number of people who do not have to pay for help at home to 400,000 – but this does not include those who need to go into a care home. And no proposals on social care emerged from the Conservative conference – not surprisingly, perhaps, given the repeated delays to the social care green paper.
The party conference spending announcements were built on promises of big sums of money. They created positive headlines for the Conservatives and Labour. But short-term headlines are not necessarily built on long-term thinking – a lack of which will continue to create real challenges for health and social care.