A CRITIQUE OF THE MAIN PARTY MANIFESTOS

 FOR HEALTH AND SOCIAL CARE

 The political party manifesto pledges for health and social care cannot be judged on spending promises. Apart from the fact that both Labour and Liberal Democrat manifestos are not costed, Labour’s includes extremely high spending on setting up a completely new National Social Care Service, bringing services provided by private and third sector ‘in-house’ and dismantling current health and care provider networks and setting up new ones.  Their reason for doing this is the left-wing belief that the public sector is better, but in reality, it will increase costs considerably and delay improvements in care.  The three main party’s manifesto pledges are considered here.

 The major issues for health and social in the general election and manifesto are arguably -

 ·         The funding and provision of social care and Integration with healthcare

 o   There is an immediate funding increase from all parties of £0.5 billion, with Conservatives pledging the same amount for children, but the actual amount needed is estimated to be £2.2-2.5 bn.

 o   There needs to be a cross-party consensus on future funding, but while the Conservatives and Lib Dems [and Greens] are willing to take part, Labour is not.

 o   Labour plans to set up a completely new National Care Service and scrap the current Integrated Care System.  This will make integration of health and care more difficult and costly and delay implementation.

 o   Labour’s aspiration is to fund free social care for all, sometime in the future

 ·         Future Staffing of the NHS

 o   Current NHS vacancies stand at ~96,000, but 90-95% of these are filled by temporary staff

 o   All parties will increase the numbers of GPs and thus the number of appointments

 o   All will offer bursaries for nurses, but only the Conservatives pledge to increase the number of nurses, while Labour will increase counsellors

 o   Labour will bring all services in-house and increase public sector pay by 5%, probably wiping out their proposed 4.3% annual increase in NHS funding

 o   Labour’s pledge to have a 4-day working week will increase staffing costs by 20% when there is already a shortage.

 ·         Patient Access to New and Existing Treatments

 o   All parties will fund more medical equipment such as MRI and CT scanners

 o   The Conservative pledge to make new treatments more available

 o   Labour’s plans for pharmaceuticals will reduce access to new medicines for patients

 o   The Conservatives have pledged to build 40 new hospitals and 20 upgrades with additional funding for hospices, while Labour will fund “confirmed hospital rebuilds”

 o   All parties will invest more in mental health and Labour will abolish prescription charges

 ·         Public Health and Preventable Disease

 o   All the manifestos are disappointing on public health

 o   All mention tackling obesity, particularly in childhood

 o   Labour and the Lib Dems mention additional issues such as alcohol, smoking, drugs and gambling

 o   Conservatives mention improved screening and vaccination programmes

     ·         How Much Will It Cost?

 o   Only the Conservatives have produced costings

 o   Labour will increase funding to the NHS by 4.3%, but also increase staff pay by 5%.  They will also incur considerable new re-organisation costs for a new Social Care Service and community care.  This will be funded by increasing corporation tax and income tax for those earning more than £80 k p.a.

 o   The Lib Dems will raise £7 bn from a 1p rise in income tax which will be ring-fenced for the NHS and social care and have a £10 bn capital fund

 o   The Conservatives have pledged a cash increase for the NHS of £33.9 billion a year by 2023-24 compared to 2018-19 budgets, and an extra £1 billion a year for social care, to be delivered in every year of this parliament.

 ·         IFS analysis of the manifestos does not take into account considerable reorganisation costs from Labour but show –

 o   Social Care - All parties propose more funding for adult social care system

 •     Conservatives: ~£0.5bn (£1bn split between children and adults)

 •     Lib Dems: ~£0.5bn + £2.2bn by 2023-24

 •     Labour: ~£0.5bn + ~£4bn by 2023-24 for the current system Labour also plans £7bn to bring in universal free personal care for over-65s

 o   Real growth in health spending between 2019−20 and 2023−24:

 •     Conservatives: 3.1% per year

 •     Liberal Democrats: 3.8% per year

 •     Labour: 4.3% per year

 

1.     The Funding and Provision of Social Care and Integration with Healthcare

 This has been a very significant issue in the last and previous general elections with past proposals, the Conservative ‘dementia tax’ and the Labour ‘death tax’ both proving very unpopular.

 Most agree that social care and healthcare need to be integrated to provide seamless care for patients and their families, whether this be temporary acute care such as post-operative recovery or long-term such as for dementia.  The current Government move to Integrated Care Systems is welcome and also supported by the Lib Dems.  Labour will abolish this move and set up a completely new system which appears not to be integrated at all and if anything, would exacerbate the different silos of health and social care.

 Both the Conservative and Liberal Democrat Parties have called for a cross-Party discussions and agreement on a long-term solution for the future of social care.  The Conservatives pledge “The prerequisite of any solution will be a guarantee that no one needing care has to sell their home to pay for it.” The Labour Party has refused to join in, preferring instead to pledge that they will set up a new National Care Service as they did originally for the NHS.   They also state that they will “introduce a presumption in favour of insourcing” in the public sector, but as most social care is provided by private care companies the re-organisation may be very disruptive. In addition, their pledge for a 4-day working week will increasing staffing requirements by 20% and there are already significant vacancies.

 These Labour proposals are likely to mean a new, very expensive and cumbersome bureaucracy.  It is difficult to see the advantage of this to care users and taxpayers.  We have existing structures and systems for delivering care and it would be much more efficient and effective to improve, integrate and evolve the current system, where necessary, rather than set up a new one.  Evolution could also be implemented much more rapidly. Most thought that the lessons had been learned about NHS reorganisations, how costly, ineffective and disruptive they are, apart apparently from the Labour Party.

 Labour and the Lib Dems do not give costs for what they pledge, but according to IFS analysis all parties have proposed increased funding for adult social care –

 ·         “Conservatives: ~£0.5bn (£1bn split between children and adults)

 ·         Lib Dems: ~£0.5bn + £2.2bn by 2023-24

 ·         Labour: ~£0.5bn + ~£4bn by 2023-24 for the current system [1]

 In addition, the Conservatives “will also provide £74 million over three years for additional capacity in community care settings for those with learning disabilities and autism”.

 The IFS states that Labour also plans £7bn to bring in universal free personal care for over-65s,¹ although the cost is not mentioned in their manifesto. Close scrutiny shows that it has “an ambition to be universal”at some point.  It will start with older people and “develop eligibility criteria” …” with the ambition to extend this provision to all working-age adults”.

 The immediate amount pledged by each main party is similar and insufficient in the short-term.  The issue of funding of social care has been on the political agenda for many years.  The Dilnot Commission reported their recommendations in 2011.  These welcomed “the prospect of cross-party talks – previous attempts at reform have failed due to lack of political consensus” The Labour Party has refused to take part in these, while the other major parties, including The Greens have all agreed.

 Earlier this year another report on funding social care by Damian Green for the Centre for Policy Studies was published “Fixing the Care Crisis”.  This stated there was an immediate need for an additional £2.2-2.5 billion a year - “Currently, Government spends £11 billion on social care for the elderly across the UK, though roughly £2.5 billion of this is recouped through user charges. Another £7 billion or so goes into the system in private funding, giving a total of £18 billion. A joint report by the House of Commons Health and Local Government Select Committees last year estimated that in 2019-20, there will be a funding gap of £2.2 to £2.5 billion.”[2]

 In the longer-term there must be an early decision and consensus about the funding of care-homes and care at home.  This is needed urgently.

 

2.     Future Staffing of the NHS

 According to “Full Fact”[3] with information obtained from NHS Improvement there were approximately 96,000 staff whole-time equivalent (WTE) vacancies in NHS trusts in England between January and March 2019.  However, between 90-95% of these vacancies were being filled by temporary staff.  Of the vacancies approximately 39,500 WTE were in nursing. ³

 All three of the main parties will recruit more GPs to provide more appointments -

 •                    Labour pledges “we will expand GP training places to provide resources for 27 million more appointments each year and ensure community pharmacy is supported.”

 •                    Lib Dems will “End the GP shortfall by 2025 by both training more GPs and making greater appropriate use of nurses, physiotherapists and pharmacists, and also phone or video appointments, where clinically suitable.”

 •                    The Conservatives will recruit “6,000 more doctors in general practice and 6,000 more primary care professionals, such as physiotherapists and pharmacists. This is on top of the 7,500 extra nurse associates and 20,000 primary care professionals that we have already announced. Our new funding will deliver 50 million extra general practice appointments a year”

 Nursing –

 •                    Labour will “introduce a training bursary for nurses, midwives and allied health professionals. We will remove the obstacles to ethical international recruitment…. and recruit 4,500 more health visitors and school nurses.”   There is no target for additional nurse recruitment.

 •                    The Lib Dems have no nursing targets but will “Target extra help for nursing students, starting with bursaries for specialties where shortages” and attract healthcare professionals from overseas.

 •                    The Conservatives will recruit “50,000 more nurses, with students receiving a £5,000-£8,000 annual maintenance grant”.

 Both Labour and the Conservatives promise to “address the ‘taper problem’ [tax and pension changes] in doctors’ pensions”.

 Other healthcare professionals -

 •        Labourwill “recruit almost 3,500 qualified counsellors to guarantee every child access to school counsellors.”

 Other issues affecting staffing –

 Labour will “ensure services are delivered in-house and also bring subsidiary companies back in-house.” This will add to public sector staffing requirements and overheads.   Labour will also introduce a 4-day week increasing staffing requirements by 20% when there are already significant vacancies.

 

 3.     Patient Access to New and Existing Treatments

 •         Currently 15 million in England live with a long-term condition

 •         30 million people in the UK are forecast to be diagnosed with long-term conditions by 2050  

 Patient access to beneficial treatments should include –

 •         Timely access to appropriate medical professionals

 •         Access to innovative and beneficial new technologies and medicines, for diagnosis and treatment, which have been formally reviewed for safety and efficacy

 •         The infrastructure, staffing and funding to make access possible

 According to the Medical Technology Group “Uptake of medical technology in the UK is not as good as it should be, given its great potential to provide value for money to the NHS, patients and taxpayers.”[4]  The same is true of medicines.

 Staffing of the NHS and social care has been covered previously.

 “The only way the NHS is going to cope, particularly with an ageing population in coming years is by making use of new technologies.” Dr Richard Torbett ABPI

 Access to medical technologies –

 •         for diagnosis (a few examples) –

 o   blood tests in pathology and scans such as ultrasound, CT, MRI, PET etc

 

•         for treatments (a few examples) –

 o   hip and knee replacements,

 o   heart disease - stents, heart valves, implantable cardioverter-defibrillator (ICDs), angioplasty

 o   tumours (cancerous and benign including fibroids) - embolisation

 o   diabetes – insulin pumps, continuous glucose monitoring

 o   3D printing, robotics

 The Medical Technology Group’s Ration Watch shows that currently patient access is rationed by many CCGs, contrary to evidence based NICE guidelines and patients deteriorate and are eventually treated as an emergency or a more complex and expensive case.[5]

 According to Medical Technology Group -

 •         “£476 million in savings could be generated from the use of eight technologies in reduced long-term health costs and benefit payments”[6]

 o   In 2017 implantable cardioverter-defibrillator (ICDs) were implanted in Germany at over three times the UK rate (Source: EHRA White book 2017)

 o   The UK has lower levels of pacemaker use than every country in Western Europe except Norway and Ireland (Source: Eucomed)[7]

 There is a similar story for medicines in the UK – “For every 100 patients that get a new medicine in its 1st year of launch in other parts of the EU – including France and Germany – just 21 patients in the UK get access”[8]

 There have been many initiatives in the NHS to embrace and take up beneficial new technologies quicker, but success has been very limited. [9]^, [10] So how will each Party improve this, if at all?

 •         Labour will invest more in “state-of-the-art medical equipment, including more MRI and CT scanners.”

 •         Lib Dems will “use £10 billion of our capital fund to make necessary investments in equipment, hospitals, community, ambulance and mental health services buildings, to bring them into the 21st century”.

 •         The Conservatives will –

 o   “roll out cancer diagnostic machines across 78 hospital trusts to boost early diagnosis” ….

 o   “We will develop new treatments for serious diseases. We will extend the successful Cancer Drugs Fund into an Innovative Medicines Fund so that doctors can use the most advanced, life-saving treatments for conditions” and

 o   “we will use frontline technology to improve patients’ experience”

 Reduced Access to Medicines Under Labour

 However, under Labour patient access to new medicines is likely to be severely reduced, potentially adversely affecting patient outcomes and in some cases survival.  The NHS has some of the least expensive medicines in developed countries, a very efficient generic drug industry, and an effective NHS medicines procurement process.  Recently the Government had to legislate to stop parallel exporting of some medicines to other countries where they are more expensive, to stop shortages here.  These included drugs for HRT and vaccines. [11] Despite this the Labour Party pledges to “establish a generic drug company.”  This is likely to be a substantial waste of tax-payers money, since NHS prices are already very low. 

 Labour further pledges “If fair prices are rejected for patented drugs, we will use the Patents Act provisions, compulsory licences and research exemptions to secure access to generic versions”. As pharmaceutical companies are unlikely to be compensated for their research and development costs for new patented medicines their reaction is likely to be that new medicines will be licensed and marketed last in the UK, after other EU and developed countries, to the detriment of patients. 

 Surprisingly Labour also aims “to increase the number of pharmaceutical jobs in the UK.” It is hard to imagine how pharmaceutical companies would be attracted to increase jobs in UK with Labour’s promises to –

 •         Increase corporation tax

 •         Reduce the working week to 4-days, increasing staffing by 20%

 •         Setting up a tax-payer funded generics company to compete with efficient private sector ones

 •         Flout international patent laws so it is not cost effective for pharmaceutical companies to launch new medicines in the UK

 Funding Infrastructure

 •         Labour – “We will complete the confirmed hospital rebuilds and invest more in primary care settings, modern AI, cyber technology “…… “and a planned model of joined-up community care” …. “join up, integrate and co-ordinate care through public bodies”.

 •         Lib Dems – “Also use £10 billion of our capital fund to make necessary investments in equipment, hospitals, community, ambulance and mental health services buildings, to bring them into the 21st century.”

 •         Conservatives - We will build and fund 40 new hospitals over the next 10 years. This is on top of the 20 hospital upgrades announced in the summer. We will roll out cancer diagnostic machines across 78 hospital trusts to boost early diagnosis” and

 We will support our precious hospices….., with a £25 million cash injection

 Mental Health

 This had become a Cinderella service and all parties pledge to give it the same ‘parity of esteem’ as physical health.

 •         Labour pledges “additional £1.6 billion a year to ensure new standards for mental health” and to “improve access to psychological therapies to ensure they deliver the quality care patients deserve. We will ensure provision of 24/7 crisis services” and “£845 million plan for Healthy Young Minds will more than double the annual spending on children and adolescent mental health services”

 •         Lib Dems will use part of their “£10 billion of our capital fund to make necessary investments in equipment, hospitals, community, ambulance and mental health services buildings, to bring them into the 21st century”

 “Introduce further mental health maximum waiting time standards, starting with children’s services, services for people with eating disorders, and severe and enduring conditions. Better access to talking therapies”

 •         Conservatives will“ treat mental health with the same urgency as physical health” and

 “We will continue to take action to tackle gambling addiction” and

 “will also provide £74 million over three years for additional capacity in community care settings for those with learning disabilities and autism”

 In addition, Lib Dems state – “We need services that fit around people’s lives, not ones that force them to fit their lives around the care they need” this is very welcome as the NHS often forgets people have jobs, families and other commitments.

 Labour will “abolish prescription charges”.

 Public Health and Preventable Disease

 Proper investment and delivery of a comprehensive public health programme which educates us to live healthy lives, eat a healthy balanced diet, take plenty of exercise, not to smoke and take part in screening and vaccination programmes is vital.  Also, we need to understand the importance of monitoring our bodies and accessing a diagnosis early if something is wrong.  The fact that we are living longer is to be celebrated, but rising obesity rates with the resultant rise in type II diabetes and avoidable diseases caused by smoking and drinking alcohol threaten to overload the NHS and care systems.

 Public Health funding as taken second place to the urgent need to treat ill people now. Separate ring-fenced and substantial funding and effective programmes where outcomes are monitored are required to help prevent avoidable disease.

 •         Labour will “invest more than £1 billion in public health and recruit 4,500 more health visitors and school nurses”

 •         Lib Dems will “Keep public health within local government, where it is effectively joined-up with preventive community services…. “re-instate the funding that was cut from public health budgets by the Conservatives” and importantly it will

 “Introduce a new statutory requirement for public health interventions evaluated as cost effective by NICE to be available to qualifying people, within three months of publication of guidance.”

 ·         Conservatives – “We will invest in preventing disease as well as curing it”; “empowering people with lifestyle-related conditions such as obesity to live healthier lives, as well as tackling childhood obesity, heart disease and diabetes”; “overhaul NHS screening”

 In addition –

•  Labour - “free annual NHS dental check-ups”; “a vaccination action plan”; “fully fund sexual health services and roll out PrEP medication”; ” reduce infant deaths”
•  Lib Dems – “ensure Pre-Exposure Prophylaxis (PrEP) for HIV prevention is fully available to all who need it on the NHS”
•  Conservatives - “will continue to promote the uptake of vaccines” and “extend social prescribing”

 Childhood Obesity

•  Labour – “extend the sugar tax to milk drinks”;  “ban fast-food restaurants near schools; stricter rules around the advertising of junk food and levels of salt in food”
•  Lib Dems – “restricting the marketing of junk food to children…. extend it to include juice- and milk-based drinks “; “Improve labelling for food products and restrict advertising of unhealthy foods”
•  Conservatives - “empowering people with lifestyle-related conditions such as obesity to live healthier lives, as well as tackling childhood obesity”

 Alcohol

•  Labour – more support services and “Alcoholic drinks will be labelled with clear health warnings. We will review the evidence on minimum pricing.”
•  Lib Dems - “Introduce minimum unit pricing for alcohol, taking note of the impact of the policy in Scotland. We will also ensure universal access to addiction treatment”

 Smoking

•  Labour – “We will implement a Tobacco Control Plan and fund smoking cessation services.”
•  Lib Dem – “Reduce smoking rates by introducing a new levy on tobacco companies”

 Drugs

•  Labour– will provide “expanded addiction- support services
•  Lib Dems – “Move the departmental lead on drugs policy to the Department of Health and Social Care,.. invest in more addiction services; imposing civil penalties rather than imprisonment; introducing a legal, regulated market for cannabis”

 Gambling

•  Labour – “expanded addiction- support services”
•  Lib Dem – “Introduce a compulsory levy on gambling companies to fund research, education and treatment of problem gambling; Ban the use of credit cards for gambling; Restrict gambling advertising; Establish a Gambling Ombudsman.”

 4.     How Much Will It Cost?

 Currently the expenditure on the NHS and Department of Health in England alone is estimated to be £129 bn last year (18/19) rising to £134 bn in this financial year (19/20).   The £20bn additional announced by the Theresa May Government for NHS England will be spread over 5 years and amount to a 3.4% increase a year in real terms (i.e. taking inflation into account).

 Labour

 The Labour Manifesto does not tell us how much their pledges will cost, but states there will “a £150 billion Social Transformation”. This is not broken down in any way and is probably across many ministries.  

 They state that they will give the NHS an annual increase in funding of 4.3%.  However, they also promise to give all public sector workers a 5% increase and will bring more providers into direct employment i.e. stop contracting out services to the private and third sector.  This could easily cancel out any increase in funding.

 They will also bring back all PFI contracts over time, which the Blair Government were so fond of, as a way of funding capital expenditure.

 Instead of using the existing network for delivery of social care they will set up a National Social Care Service, like the NHS.  This has not been costed, will be very expensive and bureaucratic, but more importantly will delay any changes in care delivery to the people and their families who need it.  In a similar way they will also introduce another unnecessary and possibly costly reorganisation of primary and community care, while scrapping Integrated Care Plans.

 In ensuring that “services are delivered in-house and also bring subsidiary companies back in-house”costs will increase and care will be disrupted.  Their further pledge to “halt the fire sale of NHS land and assets” will result in a significantly increased need for capital expenditure since the sales of NHS land has helped to fund capital expenditure such as their investment of  “£2 billion to modernise hospital facilities”

 This will be funded by –

•  Increasing corporation tax
•  Increasing income tax for those who earn more than £80,000 a year to pay a little more income tax, while freezing National Insurance and income tax rates for everyone else.
•  We will end the unfairness that sees income from wealth taxed at lower rates than income from work. VAT is a regressive tax that hits the poorest hardest and we guarantee no increases in VAT.

 Liberal Democrats

 Again, their proposals are not costed, but they state how it will be funded.

 They will raise “£7 billion a year in additional revenue by putting 1p on Income Tax, with this money to be ringfenced for spending on the NHS and social care.”…. “Commission the development of a dedicated, progressive Health and Care Tax …. set out transparently, on people’s payslips, what the Government is spending on health and social care.”  This is similar to the hypothecated health tax they have in France.

 They will “Also use £10 billion of our capital fund to make necessary investments in equipment, hospitals, community, ambulance and mental health services buildings, to bring them into the 21st century.”

 In addition, they will “Introduce a statutory independent budget monitoring body for health and care, similar to the Office for Budget Responsibility. This would report every three years on how much money the system needs to deliver safe and sustainable treatment and care, and how much is needed to meet the costs of projected increases in demand and any new initiatives – to ensure any changes in services are properly costed and affordable.”  This should be carried out by NHS England and the Department of Health.

 Conservatives

 Only the Conservatives actually attempt to inform us of the costs, with a separate costing document, although this has been criticised by IFS.  

 Health: a cash increase for the NHS of £33.9 billion a year by 2023-24 compared to 2018-19 budgets, and an extra £1 billion a year for social care, to be delivered in every year of this parliament.

 NHS: nurse recruitment, training & retention   - '20-21 £759 - '23-24 £879 million

 NHS: 50m more appointments in GP surgeries - '20-21 £399 -'23-24 £695 million
 Hospital car parking                                      - '20-21 £93 - '23-24 £99 million

 

In addition, they “will support our precious hospices, developing the plans already announced by Boris Johnson to secure their future, with a £25 million cash injection”.

 

Analysis by IFS[1]

 Social Care

 All parties propose more funding for adult social care system

 • Conservatives: ~£0.5bn (£1bn split between children and adults)

 • Lib Dems: ~£0.5bn + £2.2bn by 2023-24

 • Labour: ~£0.5bn + ~£4bn by 2023-24 for the current system Labour also plans £7bn to bring in universal free personal care for over-65s

 But questions remain about other commitments

 • Conservatives’ promised plans to “fix” social care are still unclear; pledge to exempt housing from means test – even after death – is a big unfunded giveaway

 • Labour and the Lib Dems’ proposal to cap overall costs would add insurance, but these commitments are also currently unfunded

 NHS

 Real terms Department of Health and Social Care spending plans –

 Real growth in health spending between 2019−20 and 2023−24:

 ·         Conservatives: 3.1% per year

 ·         Liberal Democrats: 3.8% per year

 ·         Labour: 4.3% per year

 

 

 

 

 

Ginette Camps-Walsh 12.19

 

Medical Marketing Consultants

 

Ginette has worked in all sectors of health including the NHS, private sector, pharmaceuticals, medical devices and co-ordinates a  voluntary independent patient group

 

 

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