The Labour manifesto and its giveaways is the real threat to the NHS

There is no doubt that the Labour party is really pushing the “Trump: our NHS is not for sale” line at this election. But the big question is why is Labour investing so heavily in this flimsy idea? It does not survive the most cursory of inspections.

BBC health correspondent Nick Triggle puts his finger on the issue this morning pointing out there is not much difference in the core financial offers being made by the three main parties at this election. Labour is relying on the Trump message as its own cash offer is really not so different from the Conservatives’.

Triggle goes on to note that the gap between Labour and the Conservatives grows even smaller when you consider that the government has already promised to help with NHS pensions, and if that is included then the difference between the main parties drops to £3.5 billion or 2.3%.

But if Nick Triggle is in the business of spotting differences he has missed some huge ones. Labour’s manifesto makes some eye catching promises to British workers. Promises that have the capacity to cut huge chunks out of NHS budgets and make the whole institution unviable.

The first big promise is four extra bank holidays. Very nice you might think. A disaster for the NHS. NHS full time staff work just fractionally over 200 days a year. So four extra bank holidays represents a loss of 2% of staff time. With an annual pay bill of £60 billion in the NHS and assuming that the lost time has to be back filled at overtime rates or with locums the cost is going to be about £2 billion a year.  The promise would need to be enacted next year otherwise Labour would immediately lose credibility. The same promise was wheeled out in 2017. This loss of staff time in the NHS could not be replaced by productivity improvements that quickly. Already Labour’s manifesto has taken away £2 billion even assuming that you can find 2% more staff at a time when staff shortages in the NHS are widespread.

Next Labour’s manifesto promises “year-on-year above-inflation pay rises, starting with a 5% increase” for public service workers. This must include the NHS. Currently the benchmark CPI rate of inflation is running at 1.5% so Labour is promising to increase the NHS pay bill be 3.5% in real terms in the first year and to keep on adding above inflation rises for staff. Again, this sounds wonderful for staff, but it is simply not costed into Labour’s spending plans. In the first year they are adding £2.1 billion to the pay bill with more to come.

So our first two manifesto promises have more than wiped out Labour’s extra spending for NHS England in their first year with more damage to come with each above inflaton pay rise thereafter. It is Labour’s third promise that threatens to rip the NHS apart.

Labour promises that:

Within a decade we will reduce average full-time weekly working hours to 32 across the economy, with no loss of pay, funded by productivity increases.

The NHS’s Agenda for Change terms and conditions assume a standard working week of 37.5 hours. Getting to 32 hours requires the NHS to give up 17% of its working time. If nurses and most other clinical staff in the NHS are getting 17% of their time back everyone on other contracts will expect the same. The idea that this is going to be made up with productivity in such a short period as 10 years is laughable, especially when you are trying to cover 24 hour rotas, meet safety criteria and provide service levels for different specialities.

If you can squeeze out more productivity it is not really clear that patients will welcome the benefits being passed on to staff with no strings attached. Patients might expect the benefits to be at least shared equally. 

17% of the NHS pay bill is £10bn.

So in summary Labour is proposing to dispense with 19% of NHS staff time (2% for 4 bank holidays and 17% for 32 hour weeks) with a cost to replace of about £12bn (£2bn for 4 bank holidays and £10bn for 32 hour weeks). 

The NHS is already having to run incredibly fast to recruit and retain staff. You can’t just get hold of another 19% of staff.  If Labour’s manifesto promises become the norm for British workers NHS staff shortages will be double or triple their current levels.

Labour’s manifesto will look very attractive to NHS staff but patients should be very afraid. Labour’s election giveaways could easily make the NHS unaffordable and unviable. 

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