19 May 2017

Dr Emily Andrews says that Labour’s manifesto promises big change with big spending increases, while the Conservatives are doubling-down on their current plans.

The Labour Party pledges to save public services from crisis; the Conservative Party believes it already has.

The Labour Party manifesto pledges injections of cash or staff for all major public services: £6 billion a year for the NHS, £8 billion for social care to stabilise the system, 3,000 extra prison officers, and a “properly resourced” education system. Under Labour, the short-term efficiency tactics employed over the last seven years – public sector pay freezes and staff cuts – would be mostly reversed. This includes the much discussed 10,000 extra police officers, replacing staff that – our analysis suggests – the police service has managed well without.

The Conservative manifesto does pledge more money for the NHS: £8 billion additional funding over the next five years (so an average of £2 billion a year). This more modest sum is not coupled with new ambitions for the scope and quality of services: the manifesto re-commits to a “seven-day NHS” and to the existing targets for A&E and elective waiting times. 

This is significant. The most recent NHS plans included an admission that, “given multiple calls on the constrained NHS funding growth”, the current elective waiting times target was unlikely to be consistently met. The Conservatives’ message to NHS England, and to its Chief Executive Simon Stevens, is: we will give you a bit more cash, and we expect you to deliver.

On stabilising the social care system and prisons in the short term, the message of the Conservative manifesto appears to be “job done”. There are no explicit plans for new government cash injections for prison staff or social care beyond that already pledged in recent fiscal events. Money gained from means testing the winter fuel allowance is, more vaguely, promised to “health and social care”.  However, there are new plans to address recruitment and retention pressures in schools: the pay freeze will remain in place, but teachers will be “forgiven” their student loan repayments while teaching.

Labour sets out vague but ambitious-sounding reform plans, while the Conservatives back the current system.

Both main parties have promised to continue the beleaguered NHS Sustainability and Transformation Plans (STPs), but in very different forms. Under Labour they would cease to be an instrument of spending control, but will be refocused on “patient need”. It is not clear exactly what this means, but it is probably true that any plan to transform the NHS will only succeed if it is seen as being good for patients, rather than good for NHS financial managers.

The Conservative manifesto frames the STPs in their current form as an NHS England initiative that they are happy to “support”. This includes an offer to make changes “if the current legislative landscape is slowing implementation”, signalling a willingness to unpick some of the competitive elements of the 2012 Health and Social Care Act which have hindered collaboration within STPs. 

Unsurprisingly, the proposed schools “national funding formula” – a re-distribution of schools’ funding – has not survived the campaign. All parties committed to a “fairer” funding formula where schools that are relatively underfunded would receive more money, but no schools would lose out. Whoever wins this election, it appears that schools’ budgets will remain broadly protected compared to other services.

Social care has received the most headlines over the last couple of days. The Conservatives’ plan is effectively a move to prop up the system in its current form. People with assets over £100,000 – including their home – will be expected to pay for the care they receive, both at home and in residential care (under the present system, the bar is set at a lower £23,250, but home value is only considered for those in residential care). This is in marked contrast with Labour’s implication of a greater role for state funding, through a new “National Care Service”.

The Conservative plan provides a politically bold answer to the question of how to manage the growing bill for state-funded social care. What it does not address – in spite of the extra £2 billion pledged in the budget – is the long-term existential risk of large numbers of struggling private providers of social care leaving the market

Tackling wishful thinking

Both manifestos are bold in their own ways: the Labour Party promises large programmes of public service reform and investment, the Conservatives promise to maintain or increase the scope and quality of public services within a context of ongoing financial constraint.

The truth is that the public, or indeed our politicians, don't know whether either sets of plans amount to wishful thinking. Whoever the next government is, it is vital that they can prove – to themselves, to Parliament, and the public – that their plans for public services are realistic. Everyone will benefit from independent scrutiny of the assumptions underlying these plans.

Both Labour and the Liberal Democrats have signed up to an ‘Office for Budget Responsibility for health’, an idea originally put forward by the Lords’ Committee on the long-term sustainability of health and social care. This body would – much like the National Infrastructure Commission – provide its own forecasts of future demand, cost and workforce needs of health and social care to government and the public.

But there is a strong case for going further. We need a body to verify the next government’s spending plans across the piece, and expand the scrutiny that the Office for Budget Responsibility provides on tax and benefit spending to the whole of government spending on services.

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