The NHS is once again front and centre of a general election campaign. The televised leaders’ debate between Boris Johnson and Jeremy Corbyn saw the Labour leader repeatedly reiterate his party’s commitment to the NHS. Johnson then used the launch of the Conservative manifesto to highlight the party’s pledge to fund 50,000 new nurses. And the Liberal Democrats insist that they are the only party with a credible plan to fund the NHS. The truth, however, is that no party is focusing on the workforce problems which will hamper any attempts to improve services.
After a decade of spending restraint, there is increasing evidence of pressure on staff and performance in hospitals.
Labour has now promised to increase funding for NHS England (alongside the rest of the Department of Health and Social Care) to £143.5bn by 2023/24, an 22.9% increase on spending compared to 2018/19, while the Conservatives have pledged to increase funding for NHS England to £140.3bn by 2023/24, a 20.1% increase on spending compared to 2018/19. The Liberal Democrats have promised to increase funding more than the Conservatives, but slightly less than Labour.
All parties’ spending pledges would be more than enough to keep up with demographic pressures and maintain current standards. But all have gone further. The Conservatives, through the NHS England 10-year plan, have pledged to improve care for cancer patients, while Labour has also pledged to improve cancer care as well as expand counselling services in schools and community mental health hubs. The Liberal Democrats have made additional pledges to improve mental health services.
Regardless of the amount of money committed, improving hospital performance or expanding services will require recruiting and retaining staff to deliver care.
This is now a major challenge: NHS trusts currently have over 96,000 vacancies. Nursing is a particular problem, with vacancies rising from 36,000 to 40,000 between 2017/18 and 2018/19. Retention is a growing concern, with the number of voluntary resignations – staff leaving before retirement – more than doubling between 2011/12 and 2018/19.
There are some signs that the parties are tackling these problems. All three parties have pledged to restore at least some support for undergraduate nurses. With applications for UK nursing courses having fallen dramatically after the bursary was removed, this should help in the medium term – though this will not address the immediate shortage.
And neither party has set out proposals to address the most immediate staff problem facing the NHS – the 2016 pension allowance reforms, which resulted in some doctors refusing extra shifts for fear of triggering large tax bills. As a short-term fix, the government has allowed senior doctors early access to their pensions to cover extra bills – with NHS England making up the difference at retirement so that no-one will be left worse off – but this will only apply this year. Labour and the Conservatives have both only committed to reviewing the changes; the Liberal Democrats are silent on the problem.
The NHS will welcome the increased spending commitments, but no amount of extra money will be spent effectively unless the government puts forward plans to retain and recruit staff to work in the health service. All three parties have found a magic money tree, but none of them have focused on the roots of the NHS’s problems.