The United Kingdom is staring down the prospect of a general election, set to take place at some stage in 2024, with the state of healthcare and the National Health Service’s (NHS) future taking centre stage.

Polling by YouGov details how healthcare and the NHS is the second most important issue for all voters across the UK with 46% of respondents indicating that it was their top priority when the general election is eventually called, lagging behind only the economy in terms of greater concerns.

At the same time, research conducted by The Health Foundation last year was similarly stark. Looking ahead to this year (2024) around half predicted that the general standard of NHS (54%) and social care (52%) services are going to get worse. Around half (50%) think the public’s overall health and well-being will get worse. The same poll also found people’s top priorities for the health service remain expanding and supporting the NHS workforce, followed by reducing waiting times for hospital care and improving GP access.

This is not a good diagnosis for the current ruling Conservative Party and  Prime Minister, Rishi Sunak, who is hoping to regain control of the UK’s Parliament and ultimately its health system following nearly fifteen years of conservative rule. The election has not yet been called as the UK’s Prime Minister reserves the right to decide when a general election is called, and it is unprecedented that an election more than five years following the last. The last general election was in 2019.

Tensions have been rising among the NHS’s workforce and the current governments amid unprecedented walk-outs and strikes covering almost all sectors of the body’s workforce from joint action between junior doctors and consultants, as well as separate strikes from midwives and nurses. At the same time, the NHS has been rocked by aggressive new immigration laws that sought to significantly heighten the amount of money a new migrant would need to earn to be considered for a visa.

The stage is set for an election in which the NHS is going to play a significant role, given that it is no wonder each of the UK’s major political parties has made it a focal point of recent healthcare-specific manifestos. To that end, Hospital Management is examining the healthcare manifestos of the UK’s Conservative and Labour parties to see what could change across the UK and its healthcare market.

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The Labour Party

Polling carried out by Statista in April 2024 details that 38% of people in the UK thought that the Labour Party would be the best at taking care of the NHS, whilst only 10% of those polled thought the Conservative Party would do a good job in the future. Only 5% thought the Liberal Democrats would handle it better.

Led by current leader, Keir Starmer, Labour’s manifesto of healthcare policy, dubbed “Build an NHS Fit for the Future” leads with a commitment to “change so that more people get care at home in their community.” Pointing out the UK’s ageing population, the Labour manifesto argues that the NHS is overburdened by patients remaining in hospital when they do not need to be there, leaving others unable to access care.

Whilst the manifesto makes no mention of any specific financial pledge to back this initiative, the drive towards telehealth and remote monitoring, cumulatively known as hospital from home, comes as research conducted by GlobalData details how in 2020 the overall market for telehealth stood at around $2bn, with that figure is estimated to rise to $5bn by the end of this year, with further growth projected into 2030 where it’s estimated to hit a value of $12bn dollars.

At the same time, the market of remote patient monitoring sat at a value of around $600m by the end of 2020, with that value estimated to rise to $760m by 2030.There have already been several remote pilot schemes carried out across various NHS regional trusts into the use of hospital-at-home methods that have seen some positive results. One trial conducted by internet company, British Telecom (BT), alongside the NHS saw at-risk patients provided with an app that would allow them to upload their vitals and biometrics from anywhere, with that data delivered to clinicians, allowing them to track nearly real-time biometric data from patients as they continue their daily routines. BT claims the service has already prevented an estimated 30 potential cardiac events from 1,090 patients across seven GP surgeries, covering 228,000 patients across the North of England.

As part of the plan, the Labour Party is proposing a plan to “join up community health and social care services”, with an aim to drop overall waiting and admission times. The manifesto reads: “Labour will encourage Integrated Care Systems (ICSs) to identify opportunities to join up services, including by co-locating them on a single site where existing estate capacity allows and capitalising on the opportunity of closer working with voluntary organisations that are embedded in communities.

“The aim will be for more patients to have one point of contact for appointments with a range of professionals and services working together as part of a neighbourhood team, including their family doctor, carer, health visitor, physiotherapist, dentist, social prescriber, or mental health specialist.

“This will make a particular difference to patients who have more than one condition, who often attend several very different clinics that each prescribe different medication or lifestyle changes, without coordination.”

Elsewhere in the manifesto, the party put out a plan for the procurement, adoption and spread of new technologies so medical device firms have a clearer route to get their product into the NHS andidentify which goods and services should be procured centrally at volume, to get the best value for the taxpayer.

Whilst this may be welcomed by some UK-based medical device firms it makes no mention of issues surrounding the UK’s abandonment of the European Union standard CE mark in favour of its own UKCA system set to take over in June of this year.

Lastly, the Labour manifesto also contains a pledge to “put Britain at the front of the queue for new medicines and vaccines”, with a focus on expanding the UK’s clinical trial scene. The manifesto adds pledges to enhance the UK’s clinical trials space by reducing unnecessary bureaucracy which means it takes too long for trials to be set up in the UK versus other countries.

It also includes minimising the number of contracts and bespoke agreements that need to be signed to deliver a clinical trial and promising to speed up and diversify clinical trial recruitment. However, the manifesto again makes no mention of investment. It follows after it was revealed by the UK’s Northern Health and Science Alliance (NHSA) that two research centres in London and Cambridge received as much government investment in 2022 as the whole of the UK’s north.

The Conservative Party

The Conservative Party is facing a considerably tougher challenge when it comes to their perceived ability to handle the UK’s healthcare systems given that they have presided over the last nearly 15 years of healthcare policy. Whilst the Conservative party has not released a full and expansive manifesto for the future of UK healthcare like Labour has, they have published a roadmap titled “Strengthening our NHS” which pledges an overall expansion of the UK’s hospital infrastructure as well as pledging that the NHS’s budget will rise to £33.9bn by the end of 2024.

Key to the Conservative’s current strategy for the NHS is the promise to build 40 new hospitals across the country and upgrade a further 20. The party say that they have already greenlit funds providing £850m for 20 hospital upgrades, £2.7bn for the first six new hospitals, and seed funding so that work on 34 more can make progress. It also promises an additional plan to provide 78 hospital trusts with state-of-the-art MRI, CT, and mammography screening machines in a bid to raise cancer detection rates.

When it comes to staffing, the Conservatives have not been the most popular among NHS workers, but on 5 April 2024,  the government and British Medical Association (BMA) were finally able to strike a pay deal with striking senior consultants, agreeing a 2.85% (£3,000) consolidated uplift for those who have been consultants between four and seven years. In addition, the Conservative party promises a further pay rise of at least 6.5% per cent for nurses, midwives and cleaners.

The plan also lays out a pledge intended to help correct some of the damage done by the Conservative’s earlier move in terms of immigration, laying out plans for an NHS-specific visa aimed at encouraging specific overseas workers to fill gaps in the NHS’ workforce.

Previously on 4 December, the UK government announced plans to significantly cut immigration by upping the minimum amount a foreign worker can be paid before they are eligible to enter the UK from £26,200 to £38,700. This saw a significant amount of pushback from UK industry groups such as NHS Employers who said that the plan caused “deep concern across social care and health.”

At the same time, the initiative also significantly limited a new migrant’s ability to bring their family with them. Now, the Conservative party is rolling back its plans when it comes to NHS staff, by creating a bespoke visa system just for them.

The Conservative plan reads: “Our NHS People Plan will ensure that we train and employ tens of thousands more NHS professionals here in the UK. But we also want to make sure that those from overseas who want to work in and support our NHS are encouraged to do so.

“That is why overseas qualified doctors, nurses and allied health professionals with a job offer from the NHS, who have been trained to a recognised standard, and who have good working English, will be offered fast-track entry, reduced visa fees and dedicated support to come to the UK with their families.”

The Liberal Democrat Party

Britain’s third party, the Liberal Democrat party as led by MP Ed Davey, for its part focuses heavily on sickness prevention and lifestyle as key areas to its “Transforming the Nation’s Health” policy. Key to the policy is the philosophy that the government should actively support its citizens to lead healthy lives by empowering individuals to improve their own health, creating healthier environments and better funding regional communities to decide their own health directives.

To that effect the first aim of the party’s policy calls for a major shift in focus towards preventing ill health, tackling health inequalities as well as adopting what they call an “invest to save” funding model. It also calls for the restoration of the UK’s Public Health Grant, provided to councils and local authorities annually to fund community care initiatives, to be restored to 2015 levels.

Additionally, the Liberal Democrat policy calls for an expansion of social prescribing by sharing best practices across the NHS Primary Care sector. The NHS’ current form of social prescribing works through a Social Prescribing Link Worker who engages with a patient to support them with a treatment plan. This can come in the form of a series of signposts or referrals to support the community and can involve activities ranging from volunteering and group learning to gardening, and healthy eating advice.

The policy reads: “The United Kingdom is lagging behind its peers when it comes to people’s health – it is 29th in the Global obesity rankings, has the worst healthy life expectancy in Western Europe, and according to one study has the worst mental health in the world.

“A quarter of a million more Britons died sooner than expected compared to our European peers between 2012 and 2022. More than 7 million people are currently waiting for treatment on the NHS, cancer wait time targets continue to be missed across the board, and demand for GP services continues to outstrip supply.

“A key way to improve people’s health and wellbeing, alleviate the pressure on NHS services and spend tax-payers money more effectively, both now and in the future, is to invest in prevention by expanding public health initiatives and primary care.”

Regardless of which party is actively able to take control of the UK parliament in this upcoming and still presumptive general election, significant change is both needed and eventual for the NHS. The outlook of all three major parties presents different value propositions for the UK’s healthcare workers and healthcare stakeholders.

The Conservatives are not offering any change in policy but are keen to invest more money in infrastructure. However, Labour is keen to offer new policies with no mention of investment or commitment to roll back previous unpopular policies.

The Liberal Democrats to date are prioritising prevention and public health overall. Given the rising tension among the UK’s current healthcare and cost of living crisis it is inevitable that the fate of the UK’s NHS and greater healthcare market rests on the outcome of this election.