“The Labour Party has not set out an overall spending plan for health and social care in England. This makes it impossible to judge the plausibility of the party’s plans” (Institute for Fiscal Studies, June 13, 2024)

– so why waste a vote in Scotland on Labour?

By stewartb – a long read

In the next UK parliament when all roads are STILL leading back to Westminster what can we expect from a Labour government of benefit to health and social care in Scotland?

With Labour’s manifesto now published, It’s worth taking a look at reactions to its policy pledges. What follows are statements from sources with no particular axe to grind in terms of Scotland’s future.

Context

When reading of the reactions, its worth recalling how Labour’s leadership in Scotland conducts its politics with regard to NHS Scotland: (i) it berates and denigrates at every opportunity what is on many metrics the best performing NHS in the UK; (ii) it demonstrates crass hypocrisy in attacking the Scottish Government over the NHS here whilst in denial of Labour’s very much worse record in government in Wales over the performance of its NHS.

And after years of context- and perspective-free negativity from Labour in Scotland, what do we finally get when it suits Labour HQ in London? In case anyone missed it, in a TV interview with Laura Kuenssberg (BBC 1, 19 May), Wes Streeting the likely Secretary of State for Health and Social Care in the next Westminster government said: “Right across the UK every part of the NHS is in crisis and all roads do lead back to Westminster because even though this is devolved, decisions taken in Westminster have an impact on the NHS across the whole country.”

Let’s turn to the reactions from ‘credible’ sources in England.

1) ’A stunning lack of detail’ – The Nuffield Trust – https://www.nuffieldtrust.org.uk/news-item/nuffield-trust-response-to-labour-party-manifesto

“The Labour manifesto sets out commendable ambitions to drive down waiting times, improve GP access and reform social care. These are important aspirations but they are let down by a stunning lack of detail on exactly how the party intends to deliver these pledges and tackle some of the most profound problems facing our health and care services in 75 years.’ (With my emphasis)

“There is no detail on a broader funding settlement for an NHS already struggling to make ends meet, and no longer-term funding plans specified. In fact, the increases detailed in this manifesto would amount to annual real terms increases of just 1.1% if added to the 1% in extra yearly revenue spending the OBR projects – far below the historic increases the health service has had, and in effect leaving spend per head frozen in real terms when adjusted for an ageing and growing population.’

Regarding the increased funding being promised, the Nuffield Trust states:  “these increases are compatible with the tightest period of funding in NHS history – 1.5% for the Liberal Democrats, 0.9% for the Conservatives, and 1.1% for Labour.This would mark an unprecedented slowdown in NHS finances, and it is inconceivable that it would accompany the dramatic recovery all are promising.’

Of course it is through the level of funding set for health and social care in England which brings substantial consequences for the budgets of the governments in NI, Scotland and Wales.

On social care, the Nuffield Trust argues that Labour’s offer “is overshadowed by the lack of a costed plan for social care, promised by Sir Keir Starmer just two weeks ago, and a seeming lack of recognition of the need for urgent action. The ambition of a national care service has little detail, isn’t well defined and there is no mention of a credible long-term funding model for social care. Unpaid carers – who deliver high-quality compassionate care for their friends and families every day – are notable by their absence.”

On workforce matters: “The party states its intention to deliver the NHS Long-Term workforce plan but with no detail on how, and what funding will be available to do so, and a deafening silence on how to solve the retention issues that health care employers are grappling with.’

And on waiting times: “The promise of 40,000 additional appointments to improve waiting times is ambitious but getting more weekend and evenings shifts out of exhausted staff will be hard. Investment in scanners is positive, but after years of neglect on capital spending, buildings and digital technology are also in a poor state. While using the private sector more is pragmatic, there is a question over how much spare capacity there actually is.”

2) ’Dodges the issue of social care reform’ – The Kings Fund – https://www.kingsfund.org.uk/insight-and-analysis/press-releases/response-labour-party-manifesto

‘… the individual pledges in the manifesto are, at best, only a policy down-payment on achieving those longer-term reforms. In and of themselves, the specific commitments set out by Labour lack some concrete detail and are unlikely to deliver the scale of change the party is promising.  

‘The manifesto also makes a number of key commitments without clarity on the spending implications for health and care budgets.’ 

‘Refocusing the NHS towards primary and community care would lead to a more efficient and sustainable health care system, but this has been the stated policy aim of successive governments over several decades and has not been realised because ministers have not put their money where their mouth is. If Labour really want to come good on this promise and avoid repeating history, it must be more than warm words; they will need to take some tough decisions on where funding, staff and political energy are directed.’ 

On social care: ‘The Labour manifesto largely dodges the issue of social care reform. The promises on social care reform could best be described as a plan to come up with a plan. The current social care system in England is not fit for purpose and many people’s needs go unmet, yet it is one of the most overlooked and ignored policy challenges in recent decades. 

‘Labour’s plan for a fair pay agreement for care workers would help attract more people to work in the sector, but unless that increase in pay is matched with commensurate increases in local government funding, it will further squeeze already strained care provider and local council budgets.’ 

3) ’Little here to inspire confidence’ – The Health Foundation – https://www.health.org.uk/news-and-comment/news/health-foundation-response-to-the-labour-election-manifesto

‘The Labour Party has set out a bold vision for addressing some of the most pressing issues facing the UK’s health and the future of public services but lacks detail on how its goals will be delivered and paid for.’

‘Labour’s plans to drive down NHS waiting times are ambitious, but achieving this will be an extremely tall order, particularly given that they appear to rely on asking already exhausted staff to work overtime. Other measures to improve early diagnosis and treatment, expand access to general practice and deliver more NHS care in communities are welcome, but the elephant in the room is how these improvements will be funded. Delivering these improvements will require significantly more investment than has been set out so far.’

On social care: ‘there is no timetable for reform – and no recognition that these measures need to be fully funded*. The manifesto also dodges crucial questions about long overdue funding reform to protect people against the costs of care. 

‘There is little here to inspire confidence that a Labour government would bring an end to the political neglect of social care by successive governments.’

The reactions above come from specialists in the health and social care sectors. What about the reactions from the London-based, establishment endorsed economic think tanks?

4) ’Fiscal policy will not survive reality’ – The Institute for Government – https://www.instituteforgovernment.org.uk/comment/general-election-2024-labour-manifesto

The IfG’s statement is entitled ‘General election 2024: 10 things we learned from the Labour manifesto’. It is telling that the important subjects of the NHS and social care don’t figure much if at all in its ‘learning’!

‘… again like the Conservatives, it (Labour’s manifesto) does not address the issue of how it would deliver the implausibly tight public service spending plans that are already pencilled in from 2025 – which imply real-terms cuts to several key services. 

‘The party’s frontbenchers have argued that their policies would improve growth, and therefore revenues, solving this huge fiscal problem. This focus on growth is undoubtedly important, but the narrative that it will enable them to avoid tough choices on fiscal policy will not survive reality.’

‘… the manifesto largely mirrors Labour’s cautious approach in the campaign. Such evasion will not be sustainable should it enter government.’ 

5) ’‘The Labour Party has not set out an overall spending plan for health and social care in England. This makes it impossible to judge the plausibility of the party’s plans’ –  Institute for Fiscal Studies – https://ifs.org.uk/articles/labour-party-manifesto-initial-response

On health and social care pledges: ‘Beyond some small amounts of ‘additional’ funding, the Labour manifesto provides no detail about the overall funding the NHS will receive in the next parliament. This makes it impossible to judge whether meeting these commitments is credible.’

‘The Labour Party has not set out an overall spending plan for health and social care in England. This makes it impossible to judge the plausibility of the party’s plans for cutting waiting times, increasing the workforce and building new hospitals. Achieving the promises in the manifesto will require the NHS budget to grow substantially faster than inflation over the next parliament, almost certainly needing growth of upwards of 3% above inflation each year.’

‘The manifesto does set out £1.8 billion (cash terms) in additional spending per year by 2028–29 for specific pledges. This covers previously announced policies including doubling the number of CT and MRI scanners in the NHS and recruiting 8,500 new mental health staff. But this additional spending is worth less than 1% of the £192 billion spent on health and social care in England this financial year.’

‘The manifesto reiterates the commitment to return NHS waiting times to the 18 week target; in April, 3.2 million treatment pathways had already lasted longer than this. There is no deadline specified for the first step of providing 40,000 extra appointments, scans and operations each week. But if and when this is achieved, it would represent a small but noticeable increase in NHS activity (around 1.5% extra relative to NHS activity in 2023-24). Such an increase in hospital activity would be smaller than the annual growth in demand pressures forecast by the government’s Long-Term Workforce Plan (2.1% per year). As a result, it will be far from enough to achieve the target on its own.’

‘The manifesto commits to major reforms in adult social care, but provides next to no detail on how or when these would be implemented, or what final form they would take. This includes a commitment to create a “National Care Service” and to introduce a collective pay agreement in adult social care. With no specific funding set aside for these changes, paying for them would mean less for other services, unless taxes or borrowing were increased.’

More generally, the IFS states:

‘The public service spending increases promised in the “costings” table are tiny, going on trivial. The tax rises, beyond the inevitable reduced tax avoidance, even more trivial. The biggest commitment, to the much vaunted “green prosperity plan”, comes in at no more than £5 billion a year, funded in part by borrowing and in part by “a windfall tax on the oil and gas giants”.’

‘Beyond that, almost nothing in the way of definite promises on spending despite Labour diagnosing deep-seated problems across child poverty, homelessness, higher education funding, adult social care, local government finances, pensions and much more besides. Definite promises though not to do things. Not to have debt rising at the end of the forecast. Not to increase tax on working people. Not to increase rates of income tax, National Insurance, VAT or corporation tax.’

On Labour’s self-imposed fiscal constraints: ‘.. leaves literally no room – within the fiscal rule that Labour has signed up to – for any more spending than planned by the current government. And those plans do involve cuts both to investment spending and to spending on unprotected public services. Yet Sir Keir Starmer effectively ruled out such cuts. How they will square the circle in government we do not know.’

‘Like the Conservatives and the Liberal Democrats, Labour continues in a conspiracy of silence on the difficulties they would face. These challenges are already perfectly clear. The books are open. A post-election routine of shock-and-horror at the state of the public finances will not cut it.’

‘This is a manifesto that promises a dizzying number of reviews and strategies to tackle some of the challenges facing the country. That is better than a shopping list of half-baked policy announcements. But delivering genuine change will almost certainly also require putting actual resources on the table. And Labour’s manifesto offers no indication that there is a plan for where the money would come from to finance this.’

End note

Separately and even more so in aggregate, these reactions are damning assessments. Unfortunately for voters in England the other options open to them in this General Election in terms of a prospective governing party are little different and in some cases worse. Scotland has a different option!

Given that all roads lead back to Westminster, a majority Labour government – perhaps one with a ‘super majority’ – will bring little to address the challenges facing health and social care in England based on what the above analyses reveal. 

And if Labour in Westminster fails to deliver the investment needed for the failing NHS and social care systems in England, Labour will deliver little or nothing of value to the NHS and social care in Scotland – or Wales or NI!

In this situation, an enlarged and compliant group of Labour MPs from Scotland in the next Westminster parliament is the last thing Scotland’s public services need in the face of the above damning assessments of Labour’s manifesto.