What to look out for in a campaign speech about health and care

We are going to have an election. The NHS, and social care to a lesser extent, will be significant issues in the campaign. All parties will raise similar issues, all parties will hope that their promises will offer them a winning platform.

Here is how to listen to a campaign speech on health policy – and some particular statements and soundbites to look out for.

“We will bring waiting lists down by x by y date” – this would be great news, but there are some things to look out for in terms of how this might be achieved: "Staff need to work harder, smarter, more efficiently” (this is hugely complex – and staff are burnt out, unwell and, increasingly, leaving); “more efficient processes will solve this” (they could, but this will take time); “we will recruit more staff” (this is a great idea, but it would be useful to ask about how services will focus on the retention of the staff they have).

“There will be more GPs” – hurrah, this would be fantastic news, but it’s worth querying how the approach will be different from the many we’ve already seen (remember the 6,000 more GPs pledged in 2019)? We currently have thousands fewer GPs than were promised by all parties in the past, and for every two individuals who enter GP training we only have one qualified GP at the end of it.

“AI will save money and improve care” – this would be great but again, and sorry for being a misery, it’s more complicated than that. Really good digital infrastructure may help – having a patient record that is coordinated and accessible across settings so patients don’t have to repeat their stories many times, and staff don’t have to search or input the same data many times, may make a huge difference. But AI won’t save us yet. What staff want is often quite simple.

“Our staff are our greatest asset” – this is true, they are. So how will they be recruited and retained? Is a loans forgiveness policy on the agenda? Are there real plans to implement the long-term workforce plan with appropriate provision for education and training? What is planned to deal with the concerning amount of staff sickness and burnout in the NHS?

“We will learn from *insert name of country that is completely unlike us*” – we won’t be able to replicate what is happening in *insert country name*, because we are not them. There are lessons to learn from other countries, as our work has shown, but overly simple claims of being able to copy and paste success stories from other countries will fall short.

“The health service needs to be more productive and we will ensure that it is” – this is complicated. It’s a nuanced issue and it’s long term, without a quick fix. Tackling the drivers of low productivity – whether addressing poor capital investment, changes in patient need, high staff turnover – require thoughtful and careful policy responses in their own right. And even fully understanding this complex picture is not straightforward. I’ve written about this.

“There will be no more money” – but why won’t there be? It’s not all about money, I absolutely agree, but we need to have a debate about what we are prepared to pay for through taxation when NHS funding is not growing in real terms, there have been huge underlying deficits affecting NHS organisations for years, and health care is still funded at a lower level than comparable countries. Meanwhile social care spending has barely grown in a decade. We have to acknowledge the wider context of economic stagnation, that all public services have been wrung dry and the fact that there are no easy choices. The core debate we need to have should be about how we sustainably fund public services for the long term.

“There will be quick and efficient spread of innovation across the NHS” – but will there? How? There is research stretching back over decades demonstrating the complexities and challenges inherent in this. The NHS cannot be managed from the centre with identikit models lifted and dropped. It won’t work, it hasn’t worked. Innovation is more organic. Best practice spreads through rigorous application of innovation methodology and local leadership, and that takes investment in management.

“We will deliver new NHS buildings/tech/kit” – good, as investing in capital is essential to the success and sustainability of both health and care. But NHS capital is too often raided to shore up day-to-day spending on services. A better pledge to look out for is “we will invest sustainably, predictably, relentlessly and for the long term in capital. NHS capital infrastructure is crucial to its productivity, and we will protect it.”

“We will restore NHS dentistry” – but for whom? For all, or for all children? Or all those in need? Will it quietly become means tested or is NHS dentistry gone for good? Our recent report offered a comprehensive review of the state of NHS dentistry and future policy actions. 

“There will be a social care settlement” – good! There’s no need for a commission, as there have been several. There’s no need for good practice research, just ask the Nuffield Trust as we have lots of evidence to tell any political party what good looks like. So, excellent news, don’t delay, this is crucial.

“We will bring care closer to home – investing in and organising care around the individual through neighbourhood teams” – excellent, this is what we all want, and what has been described for years and years. What’s going to be different this time? Will there be a relentless focus on making this happen? Will there be enough investment? And as it’s an election campaign, the optics matter: will the first photo of the new health team be in a community setting or at a hospital? Will the policy speech be delivered from a hospital setting?

“There will be no top-down restructuring of the health service” – pin this pledge to your notice board.

We have six weeks.

*Read our briefing series ahead of the election on what health and care need from the next government, with briefings already published on NHS staffing and adult social care, with more to follow.