Manifesto Check: the Greens have detailed plans for health, but can they afford them?

The Green Party manifesto has the stated aim of creating a “national health society” and presents a picture in which employment, education, transport, housing, food and the environment all contribute towards the creation of a healthier and more equal society. The contribution their specific policies for health will make to this vision, centre around a number of main issues.

The Greens pledge that by 2020, they will be spending £20 billion more per year on health care, as well as spending an extra £9 billion to provide free social care for the elderly, along the lines suggested by the Commission for Health and Social Care set up by the King’s Fund in 2013.

Finding the funds

This is a greater sum allocated to health than the other parties have pledged to date, and raises the immediate question of how it can be afforded. The section of the manifesto on health mentions the imposition of extra taxes on alcohol and tobacco, in order to help pay for this. Elsewhere in the manifesto the party sets out tax reforms, including “wealth taxes”, which they say will allow them to spend more on the public sector overall.

In relation to health, the manifesto says that UK spending on health is low compared with other countries – at 9.6% of GDP – and that more can be afforded in order to “end austerity”.

The Greens are indeed correct that spending in some countries as a proportion of GDP is higher than the UK – they cite France (11.7%), Germany (11.5%) and the USA spending, “an astonishing 17.6%“. But what the Greens fail to note is that some of this spending is made by private individuals, rather than the government. In the UK, public expenditure as a percentage of the total expenditure on health is higher than in all the countries cited (at 84%). Whereas in the USA, it is a mere 48% of the total, which means that individuals are responsible for more than half of that spending, via insurance payments or direct payments.

The Greens also pledge to repeal the Health and Social Care Act 2012. Instead, they would introduce an NHS Reinstatement Bill, which would restore the obligation on the secretary of state to provide a comprehensive health care service, as well as ending the involvement of the private sector in the financing and delivery of care, and abolishing the purchaser/provider split. But the party would retain a role for the not-for-profit third sector.

The Greens wish to invest more in primary care, seeing a key role for GPs as well as other community-based professionals. But perhaps they have overlooked the fact that most GPs are in fact independent contractors to the NHS, rather than public employees, which has been the case since the NHS was founded.

Hitting the target?

As with most political parties, emphasis is placed on trying to prevent, rather than treat, ill-health. The Greens approach includes imposing a minimum unit price on alcohol, which has indeed been suggested as an effective policy; as well as extending VAT to less healthy food, while ring-fencing the generated income to subsidise fresh fruit and vegetables.

More controversially, the party says it will consider a regulatory framework for the right to an assisted death, as well as reviewing the approach to the classification of drugs currently banned under the current misuse of drugs act.

The Green Party manifesto focuses on local services run by health care professionals, as opposed to centralisation of care, targets, defined pathways and protocols and central regulation. But there may be some tension between their plans to drive up quality, and their criticism of the Care Quality Commission and other regulators.

While regulation should be appropriate and proportionate, and there is certainly dispute about the degree to which targets have been useful, relying on healthcare professionals to do the right thing (or even to know what is the right thing to do) using only their “individual and local knowledge”, risks throwing the baby out with the bathwater. Quality assurance and patient safety require knowledge and information about the bigger picture at a system level, as well as the local level.

Something for everyone

Mental health services also figure as a central focus of the manifesto. In this context, there is support for targets – including 28 days for access to talking therapies – as well as concerns about access to hospital beds. Mental health issues within specific vulnerable groups are highlighted, including those who often go unnoticed in major policy announcements; for instance, refugees, the LGBTIQ communities, ex-service people and their families, as well as those from black and minority ethnic groups.

The health manifesto from the Greens also includes some of the traditional “green” issues we might expect to appear. For instance, tackling air pollution is included in the list of health promoting policies, as well as systems to measure and improve the ecological impact of health care. But overall, the Greens have provided a relatively detailed account of their pledges for health and social care, focusing on a wide range of relevant issues.

The Conversation’s Manifesto Check deploys academic expertise to scrutinise the parties' plans.

Maria Goddard receives research funding from the Department of Health and NIHR. The Centre of which she is Director receives research funding from a variety of sources.