Progress on the government's 2019 manifesto commitments on health and social care
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In 2019, the Conservatives made a series of health and care-related commitments in their election manifesto. They went on to win the election and form the government. Five years on, and with the current parliament coming to an end, we look at whether those commitments have been met.
It is important to acknowledge the context in which progress has been made (or not). Since the publication of the manifesto, the Covid-19 pandemic has consumed significant NHS, social care and government resource. The cost-of-living crisis, fuelled by high inflation and low wage growth (which has been driven in-part by international factors – surging energy prices following Russia’s invasion of Ukraine and supply shortages as economies opened up after the pandemic), has led to further strain on health and care spending and staff wellbeing.
Following the publication of the 2019 manifesto, commentators argued whether the Conservatives’ commitments were the right priorities for health and social care. We do not seek to reopen those debates here but instead use the best available evidence to assess whether the commitments have been met.
Commitments and progress
Below we list 14 of the most specific, prominent, quantifiable, or timestamped commitments made on health and social care, and what has been delivered.
Workforce
50,000 more full-time equivalent (FTE) nurses working in the NHS in England (includes nurses working in general practice)
Yes. The 2019 commitment to recruit 50,000 more nurses to the NHS in England has been met. In November 2023, the government cited the workforce data for August 2023 that indicated there were 51,245 additional nurses working in the NHS in August 2023 compared with September 2019 (the baseline on which the target was set).
6,000 more FTE fully qualified GPs working in general practice by 2025
No. There are fewer FTE fully qualified GPs working in the NHS as of January 2024 than there were in December 2019, when the commitment was made.
26,000 more primary care professionals working in primary care by March 2024
Yes. Primary care workforce data for March 2023 demonstrates that there are 29,103 more direct patient care staff – such as pharmacists, dietitians, paramedics and physician associates – working in primary care compared with March 2019.
Finances
£1 billion more funding every year for more social care staff and better infrastructure, technology and facilities
Partially. The government has stated that creating the Social Care Grant in 2020–21 fulfilled this manifesto commitment, as the grant provides at least £1 billion extra funding each year until 2024/25. However, the House of Commons Health and Social Care Committee’s expert panel evaluation of the government’s health and social care workforce commitments concluded that the government’s progress on this commitment had been inadequate on all its benchmarks for evaluation, stating the government’s commitment is too vague on what it will deliver. Therefore, it is challenging to evaluate whether the commitment has been met and what effect it has had.
The expert panel argues that the £1 billion extra funding every year has not delivered what was pledged – more staff, and better infrastructure, technology and facilities. Following a sustained period of very high inflation, £1 billion does not go as far now as it would have when the commitment was made.
Increase spending on the NHS by £34 billion per year by the end of the parliament
Yes, in cash terms but not in real terms. The March 2020 NHS Funding Act enshrined in law the pledge to increase NHS spending to £34 billion more per year by 2023/24 than was spent in 2018/19. The planned increases were in cash terms, so are not adjusted for inflation, which has been much higher than expected when the commitment was made in 2019.
The Covid-19 pandemic and rising inflation significantly affected NHS spending plans over the period covered by the commitment, meaning the funding has not made as significant an impact as anticipated when it was promised in 2019. Using data from the Public Expenditure Statistical Analyses, between 2018/19 and 2022/23 total NHS England spending increased by £43 billion in cash terms (ie, not accounting for inflation) – the real terms increase is £25 billion.
Increase the surcharge foreign users pay for the NHS
Yes. From 6 February 2024, the standard surcharge rate for temporary migrants rose from £624 per year to £1,035 per year, paid in advance.
NHS estate
Build 40 new hospitals across the country
No. To date, the government has not delivered on the ’40 new hospitals’ target – however, the end date for this target is 2030.
A National Audit Office report on progress with the New Hospital Programme concluded that by the definition of ‘new hospital’ used by the government in 2020, there will not be 40 ‘new hospitals’ by 2030. Instead, according to its original definition, the government now plans to build 32 ‘new hospitals’ in England by 2030, with a further eight to be completed after 2030. Of the 32 schemes, fewer than half can be categorised as complete rebuilds or completely new hospitals.
An inquiry by the House of Commons Public Accounts Committee in 2023 reported no confidence that the government would deliver its 40 ‘new hospitals’ manifesto promise. The report warned it is also highly unlikely that the government will deliver its amended aim to construct 32 new hospitals by 2030.
The Department of Health and Social Care’s New Hospital Programme factsheet stated that three new hospitals are now open to patients; another two are complete and due to open shortly; and five more are under construction.
Abolish hospital car park charges for Blue Badge holders and the gravely ill
Yes. Current guidance, updated in March 2022, states that disabled people holding a valid Blue Badge, frequent outpatient attenders, parents staying overnight with sick children, and staff working night shifts should receive free hospital car parking. However, although this guidance exists, there is no data to confirm whether all hospitals are implementing it.
Social care
Urgently seek a cross-party consensus in order to legislate for long-term reform of social care
No. Despite writing to parliamentarians in 2020 to initiate cross-party talks, there has been no progress. In September 2021, the government announced proposals for social care funding reform. However, in November 2022, the Chancellor announced the reforms would be delayed for two years to October 2025, with the funding instead allocated to deal with existing cost pressures and to ‘allow local authorities to provide more care packages’. The government has not announced any plans for implementing changes in October 2025.
Performance
Deliver 50 million extra general practice appointments a year by 2024–25 (compared with October 2019)
Yes. NHS Digital data on appointments in general practice shows that in the year to January 2024, there were more than 50 million more appointments than in the year to October 2019.
Improve NHS performance, using our record funding settlement to bring down operating waiting times, improve A&E performance and increase cancer survival rates
No. The 2019 manifesto references three separate metrics as indicators of NHS performance.
‘Operating waiting times’
The manifesto did not make the metric for measuring this commitment clear. One metric to assess this commitment is data on consultant-led referral-to-treatment waiting times for primary surgical treatments such as general surgery (eg, hip replacement surgery, transplants, tumour removal). In September 2019, the average waiting time for these types of treatment was 6.5 weeks, but by January 2024 the average waiting time has risen to 12.4 weeks.
‘Improve A&E performance’
A&E performance has not improved – the proportion of patients waiting less than four hours from arrival to admission, transfer or discharge has decreased from 85.2% in September 2019 to 70.9% in February 2024. In January 2023, the government’s delivery plan for recovering services committed to improving the proportion of A&E patients being admitted, transferred or discharged within four hours to 76% by March 2024, with further improvement throughout 2024/25.
'Cancer survival rates’
It is difficult to determine whether overall cancer survival rates have increased, as NHS data on survival rates breaks down into specific cancer type, sex, age and length of survival from one to five years – metrics that are not specified by the commitment. However, overall one-year survival rates for cancer in England increased from 65.6% in 2005 to 74.1% in 2019 and 74.6% in 2020.
Life expectancy
Extend healthy life expectancy by five years by 2035
Inconclusive. The most recent Office for National Statistics data on healthy life expectancy in the UK covers 2018–20, too soon after the commitment was made to draw a conclusion. The data showed no significant change in healthy life expectancy at birth between 2015–17 and 2018–20.
Dementia
Make finding a cure for dementia a priority, doubling funding for research
No. In December 2023, Health and Social Care Minister Helen Whately said the government would double funding for dementia research to £160 million per year by 2024/25. In the 2024 spring Budget, the government committed to spending an additional £45 million to support research by voluntary and community sector organisations in the life sciences sector (including but not ringfenced for dementia), but it is not clear when this funding will be received by the relevant research projects and for which conditions.
Maternal health
Make the NHS the best place in the world to give birth
No. Metrics for measuring whether the NHS is ‘the best place in the world to give birth’ are not set out in this commitment. However, the UK has relatively high infant and neonatal mortality rates – common measures of the safety and performance of maternity services – compared with other OECD countries, with England placed 30th, of 48 countries.
Conclusion
So far, the government’s progress on its 2019 manifesto commitments has been mixed. Of the 14 commitments we assessed, six have been met, six have not been met, and two have been partially met or the evidence is inconclusive.
A common criticism of the UK’s political system is that it incentivises short-term thinking driven by electoral cycles rather than long-term improvement. It is interesting to note that less progress has been made on commitments with a deadline beyond the next general election (January 2025 at the latest) – for example, building 40 new hospitals by 2030 and extending healthy life expectancy by five years by 2035. Those commitments with less-specific aims have also not been met, such as seeking cross-party support for long-term social care reform or doubling dementia research funding, a figure that is hard to quantify.
Importantly, this assessment does not tell us everything about this government’s progress relating to health and social care policy aims. Nor does it take account of other health and social care commitments that have been made since the current government came into office in 2019. The most high profile of these was the current Prime Minister Rishi Sunak’s commitment to cut NHS waiting lists by the end of 2023, which he has admitted has not been delivered.
As a general election approaches, progress – or a lack of it – towards the current government’s manifesto commitments may hold some lessons for political leaders now finalising their next manifestos.
General election priorities
The King’s Fund has identified three priorities where national action from a future government will help ‘fix’ the NHS and social care and improve people’s health.
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