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Health experts’ reaction to the Tory manifesto pledges on NHS and social care

Nigel Edwards, Chief Executive, Nuffield Trust

“We welcome this manifesto’s commitment to the principles of a comprehensive National Health Service. But the pledge of a further £8 billion by 2022/23, above 2017/18 spending, does not get us to a long term funding settlement to support this. It is unclear how much new money this represents, or exactly when it would come onstream. We do not yet know whether promises of upgrades for buildings and IT will be backed by new spending: the pledge does not apply to the £13.5bn of health funding not held by NHS England.

“Even under a generous interpretation of what will happen to these other budgets, the share of Britain’s national income going to the NHS will continue to shrink, from 7.3% to 7%. The same is the case for the other parties’ proposals as well: we are on course for more than a decade of unprecedented austerity.

“The approach to new legislation for the NHS is sensible: no plans for another big reorganisation while remaining open to changing provisions like the internal market if they are getting in the way.

“The manifesto is right to focus on the NHS workforce as a pressing issue, and the intention to allow NHS staff from the EU to stay in Britain is vital. However, this must be accompanied by a plan to allow continued migration after 2019 or to replace these workers.

“Our social care system is underfunded and people face a lottery where a minority are hit with disproportionately high costs. Unfortunately, the proposals in this manifesto will do nothing to solve these problems. This is not a long term solution, and the next Government will have to continue to look for one.”

Dr Mark Porter, BMA council chair

“The Conservatives have been in power for the last seven years, yet this manifesto will do nothing to reassure patients and NHS staff that they have the vision the NHS needs or will deliver the funding to ensure its survival.

“The extra £8bn touted in this manifesto for the NHS is smoke and mirrors – rather than extra money, this essentially extends the funding already promised in the 2015 spending review for another two years and falls far short of what is needed. The NHS is already at breaking point1, and without the necessary investment patients will face longer delays, care will be compromised and services will struggle to keep up. Providing additional care across the week requires not just more funding, but more doctors, nurses, diagnostic and community care staff, otherwise exiting staff will be stretched even more thinly than they already are.

“It is encouraging to see that the party will seek assurances for EU staff working in the NHS as part of Brexit negotiations2, but the emphasis on training future doctors in the UK will not solve the current workforce crisis. Any future government must address the reasons why so many UK-trained doctors are considering leaving the NHS rather than forcing doctors to stay in the health service. Demotivated, burnt-out doctors who don’t want to be in their jobs, will not be good for patients.

“We warned politicians3 that introducing the immigration skills charge for overseas NHS workers could take desperately needed money from our already under-funded health service, worsen the current staffing issues, and impact the level of care that hospitals are able to provide to patients. Rather than heeding our concerns the Conservative party is increasing this risk by doubling the charges, which will take around £7 million a year from the NHS frontline4, and charging overseas doctors three times the amount they already pay to use a health service they help to run. As overseas staff can only be employed if recruitment from the UK and EU has been unsuccessful, it is completely unacceptable for the Conservatives to pledge what is in effect a penalty against trusts for trying to fill staff shortages and maintain safe patient care.

“Public health is the ticking time bomb facing the UK5 yet there is no mention of preventative measures in this manifesto. In England, successive governments have failed to deliver a long-term plan to improve public health, and too often evidence-based public health measures have been kicked into the long grass. We need tighter regulation of the food and soft drinks industry, a minimum unit price on alcohol and support for people to quit smoking but these are notably absent from this manifesto.

“Addressing the crisis in our health service must be a priority for the next government, but based on today’s proposals it looks as though the NHS is facing more of the same. The question is how long the NHS can survive ongoing, chronic underfunding and at what point services are simply no longer able to cope.”

Chris Ham, Chief Executive of The King’s Fund

“Having raised expectations of major changes to social care funding, the Conservative Party’s manifesto is deeply disappointing. Instead of fundamental reform, these proposals involve tinkering with a broken system and do not provide the sustainable solution that is desperately needed.

“Raising the means test threshold to £100,000 will provide some protection for people with modest assets. However, including the value of people’s properties in the means test for social care provided in their homes is likely to mean more people end up paying for these services. Abandoning the cap on care costs – a manifesto commitment just two years ago – will fail to help most of those unfortunate enough to face catastrophic costs.

“Means testing the winter fuel allowance and diverting the money saved to health and social care will provide some additional funding but the Conservatives are the only one of the three main parties not to have made a major commitment to increase public funding for social care.

“Failure to tackle the growing gap in local authority-funded care, which will reach £2.1billion by 2019/20, will leave more of our poorest and most vulnerable citizens without access to the services they need. It will also further undermine a social care system that in the words of the Care Quality Commission is already at a tipping point.

“We welcome the commitment to back the NHS five year forward view and sustainability and transformation plans and to legislate, if necessary, to speed up implementation of essential changes to NHS services. The pledge to review the internal market is a significant acknowledgement that collaboration rather than competition offers the best way of sustaining and transforming services. This pledge needs to be acted on urgently if the Conservative party forms the next government.

“Plans to increase capital spending are also welcome given the cuts in the capital budget in recent years, but we need to see more detail on this.

“The £8 billion in additional funding over the next five years does little more than extend the squeeze on NHS finances for another two years and will not be enough to meet rising demand for services and maintain current standards of care. The Conservatives need to be honest with the public about the consequences for patients and their care.”

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