How much spending on the NHS have the major parties committed to in their election manifestos?

With election manifestos from the three largest parties in England now published, the electorate, not unreasonably, would like to know how the parties compare on funding the NHS.

Sadly, none of the parties have thus far chosen to be transparent on this matter. Instead, each has published costings documents alongside their manifestos purporting to set out planned "extra" funding for health and social care by 2028/29, but without any information on the baseline spending level this “extra” would come on top of.

To help inform the election debate, we have tried to fill this void with some informed assumptions to allow like-for-like comparisons.

Our core assumption is that all three parties accept as their baseline that total spending by the Department of Health and Social Care will increase by at least a real terms 0.8% each year between 2024/25 and 2028/29. That figure stems from the Office for Budget Responsibility’s base case for the next Parliament which assumes day-to-day spending across all government departments increases by a real terms 1% each year, while capital spending (on longer-term investments such as buildings and equipment) is frozen in cash terms. Applied to the DHSC, that assumption results in real terms annual increases of 0.8%, and forms the funding baseline, on top of which we can compare each party’s pledged “extra”.

It is worth noting that without this assumption, the “extra” spending by 2028/29 pledged by each of the three largest parties would be insufficient to allow NHS spending to keep up with inflation. We have discounted that as a possibility, because it is both implausible and also at odds with the explicit statement in at least one manifesto (the Conservatives’) that funding will increase at above-inflation levels.

Applying the listed “extra” spending pledged by each party to a real terms base case for total health spending annual growth of 0.8% would result in the next four years being the tightest in NHS history under the Conservative and Labour pledges – tighter even than the coalition government’s “austerity” period, which saw funding grow by just 1.4% real terms a year between 2010/11 and 2014/15.

The Liberal Democrats’ pledge on health spending would take real terms annual increases marginally higher than the austerity low point, with average increases of 1.5%, while the Conservatives would offer annual increases of 0.9%, and Labour would offer 1.1% per year.

Our chart below illustrates what these annual percentage increases would look like if applied to the NHS England day-to-day spending budget, setting each party’s pledge alongside actual spending levels since 2013/14. 

Our chart here is consistent with our previously published 10-year NHS finances tracker and also sets out the OBR’s estimate of the funding trajectory needed in order to fully fund the NHS’s Long Term Workforce Plan. Although each of the three parties have implied they will support that Plan, it is clear that the funding thus far committed falls very far short of it.

As illustrated by the chart, the frugal spending commitments follow three years in which NHS England’s spending has either been cut in real terms, or held close to flat. This means that, if any of the three parties’ pledges were implemented, the period 2022/23 to 2028/29 would see the tightest and most sustained NHS funding squeeze in recorded history (going back to 1979/80), resulting in annual real terms increases of just 0.4% under the Conservative pledges, 0.5% under the Labour pledges and 0.7% under the Liberal Democrat pledges: all below the most recent rate of population growth, even before adjusting for the increased health care need of an ageing population.

It is important to note that when comparing spending pledges on a like-for-like basis, we have excluded the £3.7bn in spending pledges made by the Liberal Democrats to support adult social care, which is normally funded from outside the NHS budget. Although improvements in adult social care have the ability to ease pressures on the NHS, the Liberal Democrat plan currently focuses on a pledge to fund “free personal care”. There is no good evidence that such a policy would ease pressures in the NHS and, in so far as it replaces current private household spending on social care with publicly funded spending, it is unclear what tangible net change in the volume of social care received it would have. As a point of note, however, including the Liberal Democrat pledge earmarked for social care would increase their real terms increase to 1.9% a year.

None of these pledges are plausible. Politicians – ever keen on the squaring of circles, particularly when it comes to polarised demands to both minimise taxation but improve public spending – will likely argue the £20–23bn gap this leaves with the Workforce Plan funding requirement can be filled with higher levels of productivity. With NHS productivity growth averaging around 1% a year in the decade-and-a-half before the pandemic, such magical thinking would require productivity to increase to three-to-four times that rate, over a sustained period, and result in cash savings, rather than being based on increasing the level and quality of care for patients – ­something which can also increase productivity, but not in a way that necessarily fills funding black holes.

Whichever party – or combination of parties – takes over government on July 5, they will need to set out more credible funding plans if they want the NHS to be able to retain its existing levels of service, let alone extend and improve it.