NHS funding in the general election 2024 manifestos: what was said and what does it mean?

Most election manifestos contain funding pledges for the NHS. But, unfortunately, many of these pledges need a lot of decoding and cobbling together from private briefings, press releases, speeches and the manifestos themselves. Our separate handy manifesto guide lists all the spending pledges in one place, so instead of a party-by-party run-through, let’s focus here on some of the issues the NHS spending pledges present.

The manifestos from the three main parties are, on the face of it, a strange mix of vaulting ambition in words and lower ambition in numbers. Add up all the costed commitments from the major parties (see figure below) and they amount to the sort of funding boosts you would expect in an annual budget announcement, rather than a generation-defining election. As a former boss of mine would say, it’s hardly a bonanza.

But money isn’t everything when it comes to manifestos. Some changes to health policy, like the smoke-free generation legislation (which both Labour and the Conservatives commit to), can deliver large health gains without a large sticker price. And manifestos are often not the final word – they are not legally binding and, of course, plans can change over time in response to things like pandemics and economic shocks.

For these reasons, manifestos often resemble an anthology of smallish-but-costed policy announcements, rather than a comprehensive plan for future government spending. So that is why – as frustrating as it is – a manifesto can reveal there will be £180 million of funding in 2028/29 to modernise 250 of the 6,300 GP practices in England, without mentioning the £20 billion that would be needed to build 40 new hospitals.

And perhaps the lack of new manifesto announcements and fiscal fireworks is partly a consequence of the stability and long-term planning many of us have been calling for. The Conservative and Labour parties have essentially recommitted themselves to the long-term policy programmes that have the single biggest impact on future day-to-day NHS spending (ie, the NHS Long Term Workforce Plan) and capital investment (ie, the 40 New Hospital Programme). Those commitments already leave little room for manoeuvre when future budgets are set.

But manifestos can still use money to signal intent. The current public health grant is £3.6 billion, so the Liberal Democrats’ pledge of an extra £1 billion a year would help salve some of the sustained cuts over the past decade while also being a statement that prevention would be prioritised. Based on recent polls, the Liberal Democrats are unlikely to form a majority government. But they can use their manifesto to throw down a gauntlet to those that will. By making eye-catching pledges on public health (and free personal care) they have tried to do exactly that.

The manifestos also include some technocratic-sounding pledges that bear a second reading. For example, the Conservatives plan to invest proportionately more in out-of-hospital health services over time, which would substantially change the shape of health spending (an issue which Labour has also shown an interest in). And their manifesto also proposed the removal of the NHS budget impact test, which allows NHS England to negotiate with drug companies to mitigate the financial impact of new cost-effective medicines on the NHS.

Stepping back and looking at the packages overall, the 2024 manifestos are altogether more muted on NHS spending pledges than their 2017 and 2019 predecessors, which brought promises of £30 billion funding boosts, ring-fenced taxes for the NHS and social care, and abolishing everything from prescription charges to hospital car parking charges.

So where does that all leave us? If the manifestos are not the full story on NHS spending, then we should turn our eyes to the rest of the year to see what choices the next government will face.

What a task awaits them.

The next six months will bring significant challenges and choices in almost every area of focus for the next Secretary of State for Health and Social Care. Pledges to increase the number of staff will meet industrial action and the Pay Review Body process. Pledges to meet NHS performance targets will meet the annual winter crisis and calls for additional funding to keep services running. Restraint in public finances will meet calls to turbo-charge hospital building programmes and increase day-to-day spending on staff. So, although the manifestos were not silent on NHS funding, even after all the promises and commitments, some big questions remain – for now – unanswered.