How are Boris Johnson’s manifesto pledges on the NHS holding up?

2020 was far from the year Boris thought it would be when he tweeted on 2 January that it would be a “great year for Britain”, with the newly-formed Brexit government thrown into a global pandemic that has dominated headspace across Whitehall.

Yet this time last year, the NHS played a key part in the Conservative Party’s 2019 General Election campaign and its resulting 80-seat majority. One year on, we explore how the Conservative’s pledges on the NHS are faring – in the context of a pandemic that has exacerbated health inequalities, placed unprecedented pressures on the NHS workforce and exposed the shortcomings in NHS infrastructure.

Pledge: The Conservatives promised to recruit 50,000 more nurses, as well as 6,000 more doctors in general practice

Where are we now: The Royal College of Nursing has recently warned the number of nurse vacancies in the NHS in England “remains stubbornly high”. NHS workforce data has shown over the last year the number of full time equivalent (FTE) nurses has gone up by 14,813 – driven by nurses returning, many temporarily, to the NHS during COVID-19. But Matt Hancock has said the increase shows the NHS is on track to recruit the 50,000 more nurses promised.

Meanwhile NHS Digital data on GP workforce showed an increase of only 572 FTE GPs between September 2019 and September 2020.

Pledge: New funding was promised to deliver 50 million extra GP appointments a year, an increase of over 15 per cent

Where are we now: The Government’s November spending review (SR) announced a £6.6 billion increase in the NHS’s core budget, to be used to fund the Government’s commitment on 50,000 more nurses, as well as the 50 million extra GP appointments a year.

A verdict on this commitment will have to wait, though we can expect many of these additional appointments to be virtual in light of the NHS’s COVID-19 recovery plan. Matt Hancock told the Health and Social Care Committee the current levels of 45% of appointments being delivered remotely “feels about right”.

The roll out of the COVID-19 vaccine, the largest vaccination campaign in NHS history, will also need to be measured separately to this commitment – so that the vaccine roll out is not counted towards the 50 million extra GP appointments a year.

Pledge: The Conservatives committed to build 40 new hospitals over the next 10 years, on top of the 20 hospital upgrades previously announced

Where are we now: Whilst the November SR was reduced to one year, it did provide £3.7bn in capital funding over 5 years to allow the NHS to start building. However, for the 40 new hospitals to be delivered it will require a further boost in capital spending from 2025 – with 26 of the promised new hospitals due to be built between 2025 and 2030.

Meanwhile the Government has attracted criticism as many of these new hospitals are rebuilding projects on existing sites and consolidations of other hospitals.

The SR also allocated £1.7bn until 2024/25 for over 70 hospital upgrades to improve health infrastructure across the country.

The next multi-year SR will provide a further indication on progress against the Government’s capital commitments – though it’s clear that the Government still has a long way to go with its ambitious and long-term commitments on capital.

Pledge: Legislation so that patients suffering from mental health conditions, including anxiety or depression, have greater control over their treatment and receive the dignity and respect they deserve

Where are we now: In April, DHSC wrote to Public Health England to say it expected PHE to focus on the response to COVID-19 – with other manifesto commitments, including on mental health, picked up on as part of “the recovery and renewal phase”.

But the SR did provide £500 million to support mental health services, and it also included funds to replace outdated dormitory accommodation in mental health providers. However, with the mental health charity Mind warning that the pandemic will leave a “deep and lasting scar on the mental health of millions in this country”, there will be concern that this support is too little and too late.

What next?

The Government will be forgiven for deprioritising some of its manifesto commitments on the NHS in light of the unprecedented financial and logistical challenges caused by COVID-19. Yet as a result of the deep-set challenges facing the NHS even before the start of the pandemic, the Government has made the delivery of its 2019 commitments a key part of its pandemic response – and we should expect it to play a key part in the Government’s NHS legislation expected in the Spring.

As we approach 2021 and the NHS prepares to undertake the unprecedented challenge of rolling out COVID-19 vaccines alongside growing waiting lists, elective care backlogs and widening health inequalities – the Government’s focus on delivering its manifesto commitments will become even more important, and key to its hopes of re-election in 2024.