The elections have happened, Brexit is a maybe, and here is your NHS 

by James Maxwell

The UK will head to the polls tomorrow to decide which party will be entrusted to lead the country over the next five years, a period which could either see the healing of national wounds inflicted from the 2016 referendum or the deepening of divisions leading to the breakup of the Union. In an election which is supposed to be about Brexit, the health service has taken centre stage and has consistently polled as the most important priority among the voting public. With the parties vying to be the most trusted on health, pledging ambitious-sounding policies – we explore what would the health sector look like under the different administrations; which Britain can only focus on, of course, if it gets Brexit done and ends the dither and delay of the past 9 years.

Conservative Party’s success in genomics

The year is 2029, the United Kingdom is finalising draft trade agreements with its North American and Australasian allies and the forty new hospitals promised under Boris Johnson’s government are still nowhere to be seen. Over the past decade, the UK has become a world leader in personalised medicines and genomics which has led to a booming innovative domestic medical sector and has recently been commended for its leadership in almost eradicating the threat posed by antimicrobial resistance (AMR) through its multilateral approach. Although the UK leads on the international stage, the National Health Service (NHS) is performing badly with continuously increasing patient waiting times in A&E and cancer, hospitals are struggling due to the pressures of accumulated debt, and the workforce is severely under strain. In the past year, four NHS Trusts have gone into special measures due to their inability to match key national targets with the resources they have been provided, and General Practices are restricting in-person appointments due to the reliance on digitally provided services. For the first time since the inception of the NHS, public opinion is slowly shifting in favour of opening services to competition with the successes of Europe’s insurance-based systems, shifting perceptions over American involvement with the impending free trade agreement. Calls for the government to publish its long-awaited social green paper have still not yet been answered, with the Conservative government insisting it is a completely new administration to that under the last five Conservative Prime Ministers.

Labour Party’s focus on mental health

Two years into its new administration, Labour’s minority government is on track to delivering its £26 billion rescue package for the NHS which has significantly reduced pressure on the workforce leading to vast improvements in waiting times and community-based care. There has been significant progress on filling the workforce shortfall due to the reintroduction of the nursing bursary, improvement in morale, and a commitment to maintaining free movement of labour. With the second referendum campaign well underway, the Health Secretary has promised a surplus package to eradicate health inequalities comprised of funding from a ‘remain dividend’. As a result of a rather unusual alliance between industry, patient groups, and healthcare representatives, Labour has dropped its most radical proposals for a four-day working week and state-run generics drug company, with the costs for such plans ballooning even before a white paper was released. The industry has worked hard to ensure the government’s approach does not put innovation at risk and has recently secured concessions over proposals which would restrict the pharmaceutical market from developing new drugs. Delivering on its manifesto commitments, the party has scrapped the 2012 Health and Social Care Act and ended privatisation, introduced modern legislation on mental health detentions and brought mental health care and facilities into the 21st century, and has achieved a long-lasting cross-party consensus on social care. Healthcare professionals applaud progress over recent years despite the plethora of plans that did not come to fruition, and similarly, MPs applaud Jeremy Corbyn for surviving eight fresh leadership contests.

Liberal Democrats Party’s championing of early childhood health development

In a surprising turn of events, the Liberal Democrats performed much better than expected, swiping votes from the Conservative and Labour parties in both remain and leave seats. In a hung parliament, Jo Swinson was invited to form a minority government after both main parties declined to do so given the humiliating results leading to internal squabbling and disarray. Unable to find enough political capital to either revoke Article 50 or call a People’s Vote, the government has agreed to an indefinite extension to the UK’s membership of the EU and has unilaterally introduced measures to protect the supply of medicines and research should withdrawal proceed. Recognising the most pressing issues facing the health service the party has set up no less than fourteen reviews and inquiries into how best to solve the issues surrounding the workforce, delivery of public health, and rising demands and costs. Having entered the 2019 General Election with an approach to healthcare welcomed by leading think tanks, the party’s broad-brush policies soon faced difficulty in their infancy stages and the Cabinet chose to deflect the blame on the lack of coalition-building in the country’s electoral system, pointing to the advantage of cross-party commissions in making recommendations. Despite the delay and indecision, this approach is proving to be effective in creating a long-lasting and sustainable model for social care, furthermore, their focus on education and providing the best start if life has led to measurable decreases in health inequalities, lower childhood obesity rates, and healthier and happier pupils.

Back to reality

This election could be a defining moment for the UK’s health service, with a stark choice facing voters over the future of their NHS. While the Conservatives focus on innovative research and leadership in global policy, their lack of regard for key components such as the workforce, resourced community care, and hospital financing has the ability to undermine the health service and lead to distrust over what appears to be headline-grabbing, empty announcements. Labour meanwhile has set out a clear agenda on restoring the health service, balancing a sensible plan for the NHS with scope for Bevanite reform, meanwhile committing the party to more unrealistic ideals which seem more like a box-ticking exercise to appease the leadership of the party. The Liberal Democrats’ acknowledgement of the most pressing issues facing the NHS, including the risks of Brexit, should be welcomed, however, evident by the lack of detail, the party is without a central vision for the health service which results in voters having to draw their own conclusions about the future of the NHS under their leadership.

Although the Conservatives are on track to become the largest party in the next Parliament, the results of the 12th December may just create the conditions where the government must cooperate with opposition parties to pass its legislative agenda, allowing for both Labour and the Liberal Democrats to influence policy in the committees and chambers. As Britain’s most entrusted institution, there is a new consensus among the main parties over the importance of delivering for the NHS and improving the capabilities and morale of the workforce. However, by setting out ambitious plans for the healthcare sector, the next government may have just set themselves to commitments which cannot realistically be delivered through budgetary means alone. Moreover, the parties’ commitments on social care are considerably lacking, symbolic of the need to avoid controversial commitments such as that which led to the reverse of fortunes for Theresa May in the 2017 snap election.