Richard Murray is the Chief Executive of The King's Fund.
If you think that comparing the funding commitments of the different political parties is a job for statisticians, think again. Admittedly, to make sense of the different offers does require the skills of a Gertrude Cox (the First Lady of Statistics, in case you didn’t know), but they must be leavened with a healthy dose of Miss Marple. As we are often asked which manifesto is the most generous to health and social care, I am channelling both to help answer the question.
I should say that I am only looking at the offers of money – i.e, I am not looking at the costs imposed on the NHS or social care by the manifesto promises. Also, analysts differ in whether they include (or not) the various ‘extras’ offered over and above the main promises; I have used headline announcements here and then noted the other add-ons.
Health spending
The most irritating and often misleading innovation of recent years has been to limit health funding commitments to the NHS England budget, excluding capital, workforce training and public health funding to local authorities. As a result of being outside the NHS ringfence, these areas were left unprotected from the cuts that followed, with the three Peters being robbed to pay the NHS Paul; this has had damaging consequences that the system is now trying to reverse.
Starting with this narrow focus on NHS England, the Conservatives, Labour and the Liberal Democrats have all made commitments to increase funding by an average of 3.2 per cent, 3.8 per cent and 3.7 per cent a year respectively (using 2019/20 as the baseline) until the end of the parliament. The figure for the Liberal Democrats is a share of their headline commitment of an extra £7 billion for health and social care, and is based on based on their briefings to the media rather than in formal party publications. So there are differences among the three parties, but not blinding ones.
Labour and the Liberal Democrats go further and make commitments across the entire Department of Health and Social Care budget. This is important as it shows how these two parties intend to provide additional resources to pay for their commitments on capital spending, workforce (e.g, bursaries) and public health (see below). These commitments lift the Labour offer to an increase of 4.3 per cent a year and nudges the Liberal Democrats to 3.8 per cent. If they deliver on these promises, this would mean no robbing of Peter to pay Paul, at least in so far as the total sum provided to health covers all these commitments.
The Conservatives have not offered clarity on their intentions for the whole of the Department of Health and Social Care budget. They have pledged some extra funding over and above the 3.2 per cent for NHS England. This includes (costed) promises of funding for new maintenance grants for nurses, money for extra GPs and for removing car parking charges for some users. They have also made commitments on elements of the capital budget – some hospital rebuilds (although only 6, not the 40 claimed), some new scanners, some new multi-storey car parks. However, as they have not made a commitment for the entire budget, we cannot directly compare the overall impact of these extra pledges to those of the other two parties – because we cannot know what this money is additional to. More significantly perhaps, it leaves open the risk that Peter will lose out to Paul as the rest of the health budget falls outside the NHS ring fence and is therefore unprotected. For example, the new-build hospitals could be funded instead of – rather than as well as – a sufficient capital budget for maintenance.
At this point, Miss Marple pops in to point out that Labour has made additional commitments. Free prescriptions and dental check-ups and the wholesale abolition of car parking fees all add up to something around an additional £1.5 billion. They have also committed to raising NHS pay, which is even harder to cost. But we know that these commitments will not come at the expense of other health spend as they are on top of their overall headline funding offer.
Public health funding – via the ringfenced public health grant to local authorities – sits within the overall Department of Health and Social Care budget. Labour’s 4.3 per cent increase in the overall health budget includes a £1 billion increase in public health spending, while the 3.8 per cent increase pledged by the Liberal Democrats includes a promise to reverse the cuts made to public health spending in recent years. An equivalent pledge from the Conservatives is conspicuous by its absence – they simply promise to invest in preventing diseases as well as curing them.
Social care spending
On adult social care, there is a clear difference between the offers.
Repeating their Spending Round commitment, the Conservatives have committed to £1 billion per annum, to be shared between children’s and adult’s social care. The precise split is for local authorities to determine, but an assumption of a 50/50 is seen to be broadly fair. So from the Conservatives, £500 million per annum from 2020, with no increase in future years and therefore not enough to maintain services in the face of increasing demand. There is, of course, no money linked to broader reform because the Conservatives have not committed to any particular option.
Meanwhile, the Liberal Democrats have committed more funding for the current system as the extra £7 billion is to be shared across health and social care. Like the Conservatives they do not offer a sum for longer-term reform because they do not commit to any specific model.
Labour also commit more money to the current system, but are the only one of the three main parties to go further by proposing a funding reform model for the over 65s – in total they are committing to more than £10 billion in 2023/24 to meet the costs of the current system and to deliver a new offer of a National Care Service, free personal care for the over 65s and a cap (at a level yet to be determined) on the costs of care so that no-one faces ‘catastrophic’ costs.
Conclusion
On health-related spend, while the core offers for NHS England are not dramatically different, the Conservatives’ failure to provide certainty over the entire Department of Health and Social Care budget leaves a clear hole in their offer. It is social care with Labour’s offer of both funding and long term reform, that really represents the clearest dividing line between the parties.
This blog is part of the IPR 'General Election 2019' blog series. Visit the IPR blog to read more.
This blog was originally posted via The King's Fund on 6 December 2019. You can read the original post here.
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