21 June 2024

More than a manifesto: funding pledges fall short of NHS needs

Two leading health think tanks say the NHS will require far more investment than outlined by any of the main political parties if they are to make their promised changes.

The Health Foundation said a £38 billion shortfall in funding is required to meet and sustain improvements until the end of the next parliament.

The Nuffield Trust has said that if any of the three main parties implemented their pledges, the next parliament would see "the tightest and most sustained NHS squeeze in recorded history", even before adjusting for the higher demands of an ageing population.

As for the parties, the Conservatives say they will provide £1.7 billion a year to expand the Pharmacy First scheme, Labour has promised £1 billion for 40,000 extra NHS appointments, operations and scans a week. In comparison, the Liberal Democrats have committed to an extra £3.7 billion a year in day-to-day NHS spending.

However, all the manifestos lack detail about how the funding will achieve its targets of cutting waiting lists.

The Institute for Fiscal Studies reported that, due to growing health needs and population sizes, "spending will need to rise just for the service to stand still. And even standing still would leave the NHS performing considerably worse than it was pre-pandemic, despite some recent progress in cutting the overall waiting list".

The Nuffield Trust's projections show very little difference in day-to-day spending figures by the end of the next parliament between Labour (£175.6 billion) and the Conservatives (£174.8 billion). The projection for the Liberal Democrats (£178.8 billion), which promises more for the health service, still falls far short of the estimated £198.3 billion required to meet the workforce plan's funding requirements.

The projections are based on the Office for Budget Responsibility (OBR) assumption that NHS spending must increase by a real-term 3.6% each year to cover the plan's workforce expansion costs.

Over the past four decades, health spending has shown a clear tendency to rise faster than planned, according to the OBR - exacerbated by poor economic growth and high inflation.

Since the pandemic, waiting lists have risen steeply, surpassing seven million waits for hospital treatment since 2022. The rise in waiting lists puts pressure on busy hospital departments and increases funding demands.

All the major parties accept that the financial and system pressures on the NHS require a re-balancing of priorities, recognising the contribution that providing care closer to home can make. The next government must invest more in primary care services - including audiology - to keep people well and out of hospital.