Lib Dem manifesto: worthwhile aspirations on health and care not matched with funding needed

Responding to the Liberal Democrat manifesto for government, Nuffield Trust Chief Executive Thea Stein said:

“The measures in the Liberal Democrat party manifesto outlined today are ambitious and show that in some important areas the party has taken good calls on difficult issues about what to prioritise. There is an impressive detail of commitment, picking out neglected areas like the mental health of new mothers and the dysfunctional pay review system for NHS staff. However, the funding proposed appears insufficient, and social care proposals would not achieve the goal of coverage that is equivalent to the NHS.

“It is great to see a chapter dedicated to the crisis in our adult social care system, and this must be a model for the other parties to show equal seriousness. The emphasis on unpaid carers is long, long overdue and action on care worker pay, status and conditions welcome. Free personal care, while helpful to some, is a narrow set of services to help with the basics of living and is not equivalent to free social care which encompasses broader support. The costs previously announced for a policy like free personal care for adults in England look to be an underestimate. Proposing a cross-party commission for sustainable funding kicks this thorny issue firmly into the long grass. The options for funding are clear and what is needed now is political willpower to enact bold reform.

“The real sting in the tail of this manifesto is that the sums to support these worthwhile aspirations simply don’t add up. It’s unclear from the costings document exactly what the £8.35 billion pledged to cover the NHS and care pledges is based on. Just freezing the NHS budget in real terms would require more money than this by 2028/29. Even in the most generous interpretation, a real-terms £8.35 billion increase above the planned budget for this year would result in annual increases in the region of 2.8% in cash-terms, or 1.1% in real-terms. This is lower than over the last decade, lower than the long-term average of 3.6% and would not meet the OBR’s estimates of the funding needed to pay for the existing NHS long-term workforce plan.

“Given the mismatch between the money available to pay for health care and the level of need out there, it is positive to see the Lib Dems begin – very cautiously – to recognise that this means that in some circumstances care may need to be prioritised for those most in need. Their pledges on dentistry and general practice suggest they are open to making these kinds of difficult decisions, with dental check-ups offered to the most vulnerable and access to a named GP for the over 70s or those with long-term conditions.

“This is brave policy-making and should be applauded in the context of straitened finances. But the target of 8,000 GPs is very stretching, and the party must not fall into the trap of expecting dental contract reform to be a silver bullet or be able to attract dentists back from the private sector quickly."