For the winning party, manifesto commitments echo throughout their time in government, while Parliament has greater freedom to block policies not included in the document.

It is easy to be sceptical about manifestos, because they are not exciting documents.

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In today’s era of rolling news, manifestos are often shorn of more than just the one major new policy in order to avoid the danger that multiple policy announcements are burned up in one single day of an election campaign.

They are also not pristine examples of comprehensive programmes for government.

In the 2005 general election the Conservative Party manifesto was little more than a wish list of five policies – the one relating to the NHS being “cleaner hospitals” – which had been focus grouped to death and designed to appeal to a small number of swing voters in a tiny handful of Labour held Tory target seats.

But manifestos do matter.

Quite the commitment

Most obviously, they matter from a communications perspective.

They are one of the few set piece events during a general election campaign which the parties have a reasonable prospect of controlling in the violent media environment.

After then, for the winning party, manifesto commitments echo throughout their time in government.

‘Manifesto commitments echo throughout a party’s time in government’

Civil servants work to implement the manifesto of the winning party (or the blend of manifestos which forms a coalition agreement).

Ordering them to implement a policy which contradicts it gives them greater scope to “push back”.

For parties like the Liberal Democrats - with truly courageous levels of democratic participation - a failure to implement a manifesto commitment can trigger a genuine leadership crisis.

Above all, Parliament has greater freedom, by convention, to block policies not included in manifestos. 

Ministerial footsoldiers

The job of working out what policies should be included and of making it work both in a general election campaign and then in a parliamentary committee years later is a thankless one.

Charities, companies and the media all want to have their box ticked.

Arguments between competing ministers (and their entourages) can be frequent.

‘Charities and the media all want to have their box ticked’

For governing parties, government departments complicate matters further – when you have a civil service at your disposal it becomes much harder to fudge the costs of policies. Opposition manifestos almost always contain more spending commitments than government manifestos for this reason.

Trying to balance these competing interests is rarely the job of Cabinet ministers (who keep their powder dry until the very end).

The civil service (rather gleefully, if rightly) excuses itself too.

The head scratching job of working out what is possible and whether it all adds up, and then working out if what it adds up to is electorally enticing and politically feasible falls instead to the ministerial footsoldiers.

For months, it has increasingly dominated the working days of Ed Jones in Richmond House and Nick Seddon at Number 10, working hand in glove with Jo Johnson – and no doubt the days of their equivalents in other parties too.

The ultimate objectives

Right now, the final gloss is being painted onto the results of their considerable efforts.

The ultimate aim for all parties will be to arrive at a finished product that delivers as cleanly as possible on two electoral objectives:

  • carving out distinctive ground on which the party can usefully fight an election; and
  • neutralising ground on which the other party has a lead.

For the Conservative Party, how the health sections of their manifesto will deliver on their objectives is becoming clearer by the day.

Distinctive ground exists on the “culture” of the NHS.

Though the assertion may provoke strong feelings, Jeremy Hunt has proved masterly at proclaiming the Conservative Party the “patient’s champion”, and tainting the last Labour Government’s stewardship with accusations of cover-ups and of poor care.

‘Distinctive ground exists on the “culture” of the NHS’

Neutralising Labour’s attacks is more challenging.

Labour’s most potent line – on “Tory privatisation” – may be overspun, but the Conservatives will not want to fight head to head against it.

Rather, they will seek to bog Labour down in a discussion on whose vision of integration – the ground where Andy Burnham has repeatedly sought to plant his flag – is best.

Up until a few weeks ago, the Conservatives could probably have achieved this simply by plagiarising the language in the NHS Five Year Forward View for their manifesto.

Now, they can go one step further - pointing to “devo Manc” as a vision they want to realise. 

So the health sections of the Conservative Party manifesto are set to be a barely concealed replica of the forward view, politically charged with a swipe at Labour on culture.

Electoral logic

But on money – arguably the most important issue of all – it is still unclear exactly what it will say.

The decision is whether to commit to Simon Stevens’s ask of £8bn extra a year by 2020, or instead to commit more loosely to “protecting” the NHS with additional money.

That decision will be being lively debated as we speak within the walls of Number 10, although electoral logic will probably dictate that the issue is taken out of their hands.

‘We shouldn’t be too sceptical about manifestos’

The reason why is that, though the Lib Dems are the only party presently to have committed to the extra £8bn, Labour - without the discipline of a civil service to keep them honest on spending, and with an ongoing need to put the NHS front and centre of their own campaign - will eventually get there too.

Faced with their two main challengers promising to spend more on the NHS, the Conservatives would never leave this left flank exposed for long – their only headache being how they can also protect their right flank on defence spending.

It is, therefore, just a question of whether the Conservatives (and Labour) commit to the extra spending in their manifestos themselves – or later on during the campaign.

The latter would allow them to argue – at a later date – that, though unfortunate, the commitment cannot be honoured.

The former would give them much less wriggle room. And that is why manifestos matter, and why – though it is easy – we should not be too sceptical about them.

Bill Morgan is a founding partner of Incisive Health