• Lib Dems promise extra £7bn in health and social care revenue spend from 1p on income tax
  • Part of this will be ring-fenced for mental health
  • Also plans ’OBR for health’ to do three-yearly reviews on what system needs to run safely

The Liberal Democrats have set out their manifesto pledges on the health and social care system, which it said was “in a state of crisis”.

The party has pledged an extra £7bn in revenue spend for each of the next five years – meaning an extra £35bn over this period – ring-fenced for “NHS and social care services”. It would be paid for by a 1p rise on income tax.

Some of this would be ring-fenced for mental health, while payslips would show which part of somebody’s tax bill was going towards health and social care. 

The party added £10bn in capital funds would be earmarked for spend on “equipment, hospitals, community, ambulance and mental health services buildings”.

In the longer term, the party wants a dedicated health and care tax. The Nuffield Trust however warned such a policy could leave the NHS financially vulnerable if tax revenues fell during an economic downturn.

It also said it would set up a “statutory independent budget monitoring body for health and care”, similar to the Office for Budget Responsibility, that would report every three years on how much money the system required to run at a “safe and sustainable” level. Labour pledged the same idea in its 2017 manifesto.

The Liberal Democrat document said the party would implement all of the recommendations of 2018’s Wessely review of the Mental Health Act, including “ensuring an emergency bed is always available if needed”.

Other pledges included:

  • Ending the GP shortfall “by both training more GPs and making greater use of appropriate nurses, physiotherapists and pharmacists” by 2025;
  • Ending the “automatic tendering of services” and making the NHS-requested changes to the Health and Social Care Act 2012;
  • Introducing a “patient premium” to incentivise clinicians to work in regions where there are shortages;
  • Establishing a professional body for care workers;
  • Implementing the recommendations of Roger Kline’s report on diversity in the senior management of the NHS and commissioning a “strategic analysis of racial discrimination in the NHS”; and
  • Keep public health as part of local government and introducing a raft of new public health policy legislation.

Could do better?

While welcoming parts of the manifesto, think tank The Health Foundation also found it insufficiently ambitious.

Chief executive Jennifer Dixon said: “The Liberal Democrat’s manifesto plans are a welcome shot in the arm for the NHS, but don’t go far enough on fixing social care.

“The money would more than double the growth in health spending seen in the last decade — bringing growth back to the long-run average, before austerity set in. This would help the NHS improve standards in the face of rising demand, especially in mental health services.”

Dr Dixon added: “The biggest challenge facing the NHS at present is the acute workforce shortage, running at around 100,000 vacancies. The manifesto acknowledges this will require investment in recruitment, retention and making the NHS an attractive place to work.

“Yet the funding promised falls short of the amount needed for workforce training, despite chronic staffing shortages. The capital investment proposed will not be enough to upgrade the buildings and equipment needed for a modern workforce to operate effectively.”

The Nuffield Trust welcomed the extra funding but said there were “some big unanswered questions about the proposal to move to paying for care through a special health and care tax”.

The think-tank’s chief economist John Appleby added: “This idea [having a special health and care tax] puts the cart before the horse – we should decide how much we want to spend on the NHS and then raise the money, not just wait to see how much comes in. If revenues from this tax fall, in an economic downturn for example, it could mean cuts for health and care.

“Looking for cross party agreement on social care reform is a good idea and should have been done long ago. We need action on funding, staffing, and how services are run.

“The Liberal Democrats’ starting proposal of a cap on the amount people pay could help protect them against the catastrophic costs an unlucky few face today. But the crucial question will be where that cap is set.”