Political parties have promised much on the NHS before 7 May. Nicola Merrifield runs the rule over their election pledges on nursing.
Staff numbers and training places
As predicted, the NHS has been a key battleground in the 2015 election and most parties have spied an opportunity to garner support by making promises on boosting the nursing workforce.
Labour has the most expansive plans, with a manifesto pledge to ensure 20,000 more nurses over the next five years, along with 3,000 extra midwives and 5,000 more care workers.
It has also committed to more training places – an extra 10,000 nurses above current levels by 2020, starting with 1,000 extra on courses starting this year.
“What we actually need is not random pre-election promises, but a commitment to sustained workforce planning”
Meanwhile, perhaps more surprisingly, the UK Independence Party has promised the same number of nurses and midwives as Labour, and all of the others have committed in some shape or form to increasing nurse numbers.
While the Conservative manifesto promises only to ensure there are “enough nurses to meet patients’ needs”, during its election campaign the party claimed it has committed to 5,000 extra nurses and allied health professionals in the community.
The Liberal Democrats, meanwhile, have said they will boost the community workforce – including district nurses – but have not provided specific numbers. Instead, care minister Norman Lamb said they were proposing a review of the nursing establishment.
Similarly, Plaid Cymru in Wales said it would develop a 10-year national workforce plan for healthcare staff, the Greens have said they want to see more nurses trained in the UK, and the Scottish National Party’s manifesto commits to investing more in specialist nursing care, to the tune of £2.5m.
However, no party provides detailed information on what strategies will be required to achieve their workforce goals, for example extra training places, return to practice schemes, retention of existing employees or overseas recruitment.
Professor James Buchan, a nursing workforce expert from Edinburgh’s Queen Margaret University, noted that the next government faced the “big challenge” of ensuring a rapid increase in nursing numbers in the short term.
“It’s all very well and worthy to commit to increasing the nursing workforce, but we have to recognise that our options in the short term are relatively limited,” he said.
“What we actually need is not random pre-election promises, but a commitment to sustained workforce planning,” he added.
He also pointed out that pledges to rapidly increase the community nursing workforce were particularly problematic.
“That is not an area of the workforce that lends itself easily to international recruitment, because not many others countries train nurses to function effectively in those community services compared to acute hospitals, which are easier to recruit from,” he said.
NHS pay increases and unsocial hours payments
Some parties have also targeted the growing unrest among nurses about pay freezes and a failure of wages to keep pace with inflation in recent years. Around 70% of NHS provider budgets are spent on staff pay.
The Liberal Democrats have stated they would ensure NHS pay improves at least in line with inflation from 2016 onwards and higher during later years. Similarly, the Green Party said it would bring NHS wages back in line with the cost of living.
Meanwhile, Labour shadow health secretary Andy Burnham told a recent hustings event that he agreed with no real terms wage cuts “as a principle” and that his party supported the use of the NHS Pay Review Body in the pay bargaining process.
Plaid Cymru has also said NHS pay should be determined by the review body, while the SNP said it would press the UK government to ensure all public sector workers are paid the living wage.
“You cannot grow the workforce, pay them more and live within a constrained budget. Something has to give”
However, the Conservatives have made no specific manifesto commitment to listen to the review body or increase pay. Neither has UKIP.
But the Nuffield Trust’s director of healthcare systems, Candace Imison, warned that while pledges to increase wages would be welcome to nurses, pay awards would have a “huge influence” on what could be achieved elsewhere within the NHS budget.
She agreed that real terms pay cuts were not sustainable in future, as the recovering economy gave nurses increasing options to work elsewhere.
But she noted that wage increases across the NHS would be a far greater financial challenge than any of the party proposals to increase the nursing workforce.
Ms Imison said she did not believe any party had pledged sufficient money to both pay NHS staff better wages and improve staffing levels, in light of the £22bn efficiency savings the health service was required to make by 2020.
“The maths isn’t possible,” she said. “You cannot grow the workforce, pay them more and live within a constrained budget. Something has to give.”
The overall NHS budget
According to NHS England bosses, the health service will need £8bn extra funding every year by 2020 – combined with the efficiency savings – to tackle the £30bn annual deficit that is expected to appear over the next five years as demand grows.
All of the parties have agreed to meet or go beyond this funding requirement by 2020, apart from Labour and Plaid Cymru.
“We need a bit more clarity about the money next year. It’s all very well promising £8bn for 2020”
The Liberal Democrats were the first party to confirm the £8bn – as well as promising to provide extra money for Scotland, Wales and Northern Ireland – and the Conservatives have also committed to this amount over the next five years.
UKIP has pledged to increase the NHS budget by £12bn by 2020, while the Greens have promised the same increase immediately – and a 1.2% rise annually after that. Meanwhile, the SNP said it would vote for a boost to NHS spending across the UK of £24bn by 2020.
Instead, Labour has promised an extra £2.5bn from a “Time to Care” fund, paid for by a so-called mansion tax, while claiming that an estimated £4bn savings could be made from full integration of health and social care services.
Despite the almost unanimous consensus on levels of extra funding for the NHS, the lack of detail about how the extra money will be used and whether it will be available in the short term has attracted criticism.
Beccy Baird, policy manager at the King’s Fund health think-tank, said: “We need a bit more clarity about the money next year. It’s all very well promising £8bn for 2020, but how that money is staged becomes really important.
She said: “If it’s a little bit [of money] now and lots in 2020, that is not going got help the NHS, which is looking at nearly a £1bn deficit just in the provider sector this year.”
Despite the financial question marks, Ms Baird suggested that trusts, particularly those in the acute sector, were still likely to increase their workforce next year.
“The nursing numbers are going up at the moment because a lot of hospitals particularly are trading off financial balance with quality,” she said.
She suggested that “in a post-Francis world” trusts were more likely to want to fail and “go under” because they could not control their finances than because of care quality issues like those at Mid Staffordshire.
Changes to primary and social care
In contrast to the tight financial position, the three main parties also have ambitions to improve access to services at weekends and in the evenings – hoping to appeal to voters with promise to make the NHS a “truly seven-day service”.
Labour has said it will guarantee the right to a same-day consultation with a doctor or a nurse, while the Conservatives have said they will ensure same-day GP appointments for the over 75s.
The Liberal Democrats, meanwhile, have pledged to expand evening and weekend opening and encourage phone and Skype appointments.
However, the Green Party is alone in committing to a clear increase in spending for primary care – up to 11% of the total NHS budget.
Anne Marie Rafferty, professor of nursing policy King’s College London, said there was a “gap” in the thinking across all parties about how they would ensure adequate community staffing levels to achieve the changes in services they had outlined.
“You are not going to be able to deal adequately with primary care unless you are able to produce skilled practitioners at speed,” she said.
“You’ve got to speed up and scale up the production of community nurses, district nurses and advanced nurse practitioners.”
“Pay is not proportionate to the demands that are being put on these people… This is extremely demanding and complex work”
Anne Marie Rafferty
She referred to the pledge made by the Tories before the last election to increase the health visitor workforce by 4,200, suggesting that if the parties had demonstrated “political will” to boost primary care nurses by specific numbers, then their pledges around service change could be more achievable.
Meanwhile, Professor Rafferty criticised pledges to improve pay for staff working in nursing homes and other social care settings for being “too weak”.
She said a Liberal Democrat promise to “promote” the living wage and Labour’s pledge to “incentivise” employers to provide the living wage did not go far enough.
“That sector and its wages need a serious look at,” she said. “It [pay] is not proportionate to the demands that are being put on these people…. This is extremely demanding and complex work.”
As we enter the final few days of the 2015 election campaign, some nurses will already have decided who they will vote for and others will still be undecided.
But come the 8 May, the profession must ensure that whichever party, or parties, comprise the next government stick to their promises on the NHS and nursing.
Roundup of other health election pledges made by the main political parties:
Mental health funding and targets
- Labour – will “set out a strategy and timetable” to deliver a waiting-time standard of 28 days for access to talking therapies for both adults and children. Will ensure all staff trained in mental health, in particular student midwives on perinatal mental health. Aims to increase “over time” the proportion of mental health funding spent on children.
- Conservative – more investment in mental health services, with access to therapists across the country and will enforce new access and waiting time standards. Has promised more mental health support for women during and after pregnancy.
- Lib Dem – will increase mental health spending in England by £500m a year by 2016-17 with investment in the other UK nations. Manifesto says they would change the way services are funded so they do not lose out investment decisions in future
- Green party – manifesto commits to expanding the mental health workforce, ensuring swift 24/7 access to treatment for those in crisis, 28-day waiting standard for talking therapies and investment in dementia services. Increase spending on mental health and dementia services. Raft of other changes including access to beds in local area.
- UKIP – has pledged to increase mental health funding by £170m annually, phased in during the first two years of the next parliament
- Plaid Cymru – will increase access to talking therapies, resources for young people, as well as funding support for eating disorders, and drug and alcohol treatment.
- SNP – has already committed £15 million to a mental health innovation fund and, as part of proposals for higher health spending, will seek to increase this investment to £100 million over the next 5 years
Unsocial hours payment/7seven day service
- Labour – will not cut unsocial hours payments but plans to introduce a seven-day service via funds released from reduced reliance on agency staffing bill
- Conservative – have said will introduce a seven day service by 2020 with access to both GP and hospital care. Under the previous government proposed cuts to unsocial hours pay to fund the service
- Lib Dem – minister has suggested if seven day service were introduced, the party would not cut unsocial hours payments
- Green Party – also said if seven day service plans were to go ahead, the party said it would have to include additional pay for staff for unsocial hours
- UKIP – no specific pledge
- SNP – no specific pledge
- Plaid Cymru – no specific pledge
- Labour – manifesto says will create an NHS staff champion to improve staff health and well-being, and help tackle bullying and abuse. Will help staff raise concerns and feel confident acting upon them with a clear expectation that all NHS and care staff receive training in whistleblowing
- Plaid Cymru – Anyone who raises concerns about healthcare standards will be supported and we will ensure that those responsible, whether bosses or workers, are held to account if there are failures. Want to improve Healthcare Inspectorate Wales, ensuring it has the resources and independence needed to truly identify failures in care.
- UKIP – Abolish CQC. Inspections would be taken up by local health boards, who would also be encouraged to take evidence from whistleblowers and patients with grievances.
- Conservative – the CQC has undergone a big transformation under this Government. We have a tough and transparent new inspection regime that focuses on staff and patient experiences, rather than simply ticking boxes. Since April 2014, under its new inspection methodology, the CQC always look at how an organisation handles complaints from patients and carers, and crucially, whistleblowing concerns from staff.
- SNP – no specific pledge
- Lib Dems – no specific pledge
- Green party – no specific pledge
Prevention and public health agenda
- Labour – Providers will be incentivised to focus on prevention through year-of-care budgets, which will cover all of a person’s care costs over a year, Labour will place the promotion of physical activity at the centre of public health policy with new, easily understandable recommended levels of physical activity
- Conservative – Invest more in primary care prevention work, national, evidence-based diabetes prevention programme, action to reduce childhood obesity
- Lib Dems – Would launch a “national wellbeing strategy” to cover all aspects of government policy, and a new public health campaign to promote steps people can take to improve their own mental resilience – described as “the wellbeing equivalent of the Five a Day campaign”.
- Green Party – manifesto commits to expanding primary and community health services to help prevent illness
- Plaid Cymru – We will make it easier for people to access wellbeing facilities and to get active to prevent health problems.
- UKIP – no specific pledge
- SNP – no specific pledge
Read more of our coverage on the general election and nursing by visiting the special page of the Nursing Times website