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Not just the NHS: manifestos need to consider other health and care priorities too


Election season is finally upon us. As campaigns are launched and politicians begin knocking doors up and down the country, it is clear that the NHS is going to feature heavily in the next six weeks.

Ahead of seeing the detail of what the parties are proposing in their manifestos, what do I hope to see from a health and care perspective? There are five things I will be looking out for: health is more than the NHS; social care reform; mental health; a workforce strategy; and clarity on funding and capital investment.

First, a recognition that health is more than the NHS. With improvements in life expectancy flatlining and health inequalities widening, improving public health and prevention should be a high priority. As a first step, any government that is serious about improving health would prioritise the public health grant, and reverse recent cuts, starting with an additional £1 billion next year. But genuinely supporting population health and wellbeing requires more. If a government wants to see people’s health improve, we need to see bold action, using all the levers government has at its disposal to improve the health and wellbeing of the population. This means government should not shy away from specific measures – including taxation and regulation – where the evidence suggests it can help support health and wellbeing. To really shift the dial, manifestos could exemplify a ‘health in all policies’ approach – look out for commitments to improve housing, supporting the best start in life for our children and more besides.

'If a government wants to see people’s health improve, we need to see bold action, using all the levers government has at its disposal to improve the health and wellbeing of the population.'

Every day, the 1.4 million people working in social care provide critical support that touches the lives of more than a million people, their carers, friends and families. Social care can be transformative for the older people and those with disabilities who rely on it. But for too long the system has struggled with a funding system that is not fit for purpose and with political leaders who have shied away from much needed, bold reform. The system is failing people, with high levels of unmet need and providers struggling to deliver the quality of care that we expect. If a prospective government wants to improve quality and fairness, its manifesto should include immediate plans for significant additional investment to support quality and reduce unmet need, and firm plans for how it will introduce a new funding system, which tackles the problems of the unfair divide between a free NHS and a paid-for social care system, with more risk-pooling to remove the fear of being one of the unlucky ones who face catastrophic care costs. Vague promises to fix social care will not suffice.

Turning to mental health and wellbeing there are a number of areas parties need to consider. They should be clear about how they will improve support for children and young people experiencing mental health problems. For people with severe and enduring mental illness, action to close the mortality gap and to see a step change in the quality of specialist care is needed. If a prospective government is serious about providing high-quality care that meets people’s needs, it should support expansion of high-quality mental health services in the community, as well as ensuring that inpatient specialist care – for those who really need to be looked after in those settings – is compassionate, dignified and good quality. To support that, all the parties should commit to implementing the findings of the review of the Mental Health Act.

The staff who work in the NHS, social care, public health and the voluntary sector are the systems’ greatest assets. They are working under enormous strain with the systems struggling to recruit, train and retain enough staff. The Kings Fund, The Health Foundation and the Nuffield Trust set out the comprehensive actions that are required to tackle the workforce crisis. Concerted efforts to train more staff, to support ethical international recruitment, and to create better working lives to improve retention must be at the heart of all the manifestos’ visions for health and care. The workforce is the key to delivering any new commitments, so alongside expecting fully costed and fully funded commitments, I’ll be looking for credible plans to increase the size of the workforce across health and care. Without the right numbers of staff, with the right skills, in the right place, any other new commitments will be meaningless.

'Without the right numbers of staff, with the right skills, in the right place, any other new commitments will be meaningless.'

Finally, the health and care systems need clarity and certainty on funding, and it is important that all the parties are clear about how much money they will provide for the NHS, social care, public health, the workforce and capital budgets. It’s right that the public should be able to understand and compare these commitments. The NHS needs modern buildings and equipment that can support high-quality, effective care – to create an environment that is fit for staff to work in, and to improve patient outcomes and experience. While this should include replacing old hospitals that are in poor repair and better maintaining existing hospitals, manifestos must go further – to include improving the estate for primary, community and specialist services too and ensure that everyone benefits from new equipment and technology.

And finally, what do I hope doesn’t feature? The resurrection of any long-standing policy zombies, including any top-down re-organisation of the health and care systems which would be a massive distraction at a time when the focus needs to be on supporting delivery in health, care and wellbeing.