Party manifestos: What do they mean for older people’s healthcare?

Sally Greenbrook joined the BGS in April 2019 as Policy Manager. She has more than a decade of experience in the UK health policy sector, having worked for the Department of Health and, most recently, as Policy Manager for Breast Cancer Now. She has for many years had an interest in the health and care of older people, having written her MA thesis on housing for older people. She tweets at @SallyGreenbrook

Having been taken slightly by surprise on the first day of our Spring Meeting by Rishi Sunak’s announcement of a general election, we at the BGS finalised our manifesto asks in time to announce them at the policy breakfast the next day and we published our full manifesto the following week. In our manifesto, we make ten asks of the incoming Government, grouped under three themes. Meanwhile, each of the three main political parties has now published its manifesto so we've had a look to see how their commitments on healthcare measure up to our asks.

Some caveats, before we dive in.

For the sake of space, we have limited this analysis to the three biggest English parties (Conservative, Labour and Liberal Democrats). For the sake of political neutrality, we have limited our analysis to the policies themselves. We have not made a judgment around how feasible these policies are, how much they will cost or how the parties have said that they’ll pay for them. We have also limited our analysis to the three broad themes of our manifesto, rather than the ten specific asks.

1. Provision of person-centred care: before, during and after ill health.

This theme covers prevention and proactive care, services for early assessment to discharge older people as quickly as possible (on the same day, where appropriate) and rehabilitation services to support people to recover well after periods of illness. We also called upon the parties to embed the Joining the dots, the BGS Blueprint, as good practice across the NHS.

The Liberal Democrats have made a couple of commitments that are aimed at addressing this point. Their manifesto commits to everyone over 70 and everyone with a long-term condition having access to a named GP. While we haven’t called for this specifically, better access to primary care for older people will help to identify frailty and other long-term conditions earlier, preventing avoidable hospitalisation. The Liberal Democrats have also committed to extending virtual wards and investing in technologies that allow people to be treated at or closer to home. We know that for many older people with appropriate support at home, virtual ward services can be very beneficial.

The Conservatives have committed to increasing access to primary care, including building or modernising 250 GP surgeries. They have not specifically made any commitments around older people’s access to primary care. Their manifesto also commits to moving forward with the Major Conditions Strategy which aims to prevent six major conditions (cancer, heart disease, musculoskeletal disease, mental ill health, dementia and respiratory disease) and support people with those conditions to live better. While this is not specific to older people, many of the people living with the six major conditions will be older (although we have publicly said previously that we think this list should include frailty).

Labour has also made commitments around access to primary care, including guaranteeing continuity of care to support efficient treatment of ongoing or complex health needs. Again this appears not to be targeted at older people, but many of the people with long-term health conditions will be older. Labour has also committed to developing Neighbourhood Health Centres, bringing together existing services including GPs, district nursing, physiotherapy and palliative care. The manifesto also talks about the importance of prevention and the need to change the health service to meet the needs of people with multiple long-term conditions.

Perhaps unsurprisingly, we did not secure a commitment from any of the major parties to embedding our Blueprint across the NHS. However, we will be contacting the incoming Government shortly after the election to ensure they are aware of the guidance offered in the BGS Blueprint.

2. A fully trained and sustainable workforce.

This theme makes calls around recruitment and retention of the entire multidisciplinary team, including meeting our benchmark of one geriatrician per 500 people aged 85, increasing medical school places, reforming medical training, supporting the MDT to develop the skills needed and mandating frailty training across the NHS.

All of the three main parties make commitments on NHS workforce. Both the Lib Dems and the Conservatives make promises around the numbers of staff – the Lib Dems say they’ll recruit an additional 8,000 GPs and the Conservatives say that if re-elected, there will be 92,000 more nurses and 28,000 more doctors working in the NHS by the end of the next parliament. The Conservatives have also said that they’ll cut 5,500 managers. Labour have only put a number on an increase in staff working in mental health, saying they’ll recruit 8,500 new mental health staff, although they have also said that they’ll train ‘thousands’ more GPs.

In terms of other commitments on workforce, the Lib Dems say they’ll establish an independent pay review body, implement a ten-year retention plan, stop spending money on agency workers and will make changes to both flexible working and visa arrangements so that working in healthcare is more attractive for people who need more flexibility and for those coming from overseas.

The Conservatives have committed to training more staff to work in rural and coastal areas and will use AI to help free up healthcare professional time (although there is no detail of how AI would be used for this purpose). The manifesto also restates the party’s commitment to the NHS Long Term Workforce Plan.

Labour have also committed to implementing the NHS Long Term Workforce Plan. Labour is also the only party to explicitly refer to resolving the ongoing strikes with healthcare staff, saying that they will ‘reset relations with NHS staff.’

3. A long-term solution to social care

This is the big one. Social care is really outside our remit as a specialist medical society but most of our members agree that this is one of the biggest issues for older people’s healthcare. The other measures will be limited in their impact if social care is not fixed. This ask calls on parties to take both short and long-term steps to resolve the crisis in social care. In the short term, we are asking for an increase in pay, improvements in terms and conditions and ensuring visa arrangements are in place to allow care staff to come to the UK and to bring their families. In the longer term, we need an honest conversation with the public about social care and complete reform of the system.

The Liberal Democrats are the only party to have devoted an entire chapter of their manifesto to social care. They have committed to introducing free personal care and giving unpaid carers more support including paid carers’ leave and a guarantee of respite breaks. Their manifesto also commits to establishing a Royal College of Care Workers to improve recognition and career progression and to introduce a higher Carers’ Minimum Wage. Further ahead, if elected, the Lib Dems commit to establishing a cross-party commission to develop a long-term agreement on sustainable funding for social care.

In addition to their main manifesto, the Lib Dems have also published a separate manifesto on care, setting out more detail of the above commitments. They are the only party to have gone into detail about their plans on social care. Their care manifesto talks about how they will better support people to age well, including establishing a Commissioner for Older People and Ageing in England, introducing active ageing programmes to prevent falls and avoidable hospital admissions and increasing fracture liaison services.

Labour’s manifesto commits to the introduction of a National Care Service which would have national standards in order to maintain consistency in care across the country. Services within the National Care Service would be delivered under a principle of ‘home first’ with closer partnerships between local NHS and social care organisations to improve hospital discharge. The party has committed to building consensus around the National Care Service to ensure that it is sustainable and is able to support both an ageing population and working age disabled people, as well as being better integrated with the NHS. Labour have also committed to establishing a Fair Pay Agreement in adult social care to set out fair pay, terms and conditions and training standards. In the immigration section of their manifesto, Labour has named health and social care as one of the sectors in which they will look to reduce the country’s reliance on overseas labour.

The Conservative Party has said that at the next spending review, they will give local authorities a multi-year funding settlement in order to implement the proposals in the People at the heart of care White Paper (published in 2021). The manifesto also says that the Conservatives will ‘attract and retain’ a high-quality workforce, reform the older people’s housing market and support unpaid carers, although no detail is given of how. From October 2025, the Conservatives will put a cap on social care costs. It is also worth noting that the immigration section of the Conservative manifesto highlights changes that they have made during the current Parliament, meaning that care workers are unable to bring their families to the UK and that anyone coming to the UK on a family visa must be earning at least £38,700.

Hopefully this has been a helpful round-up of the three main parties’ commitments on health and social care. The manifestos themselves are hefty documents (the longest one is 136 pages long). If you fancy reading them in full they can be found at the following links:

• ‘Clear Plan, Bold Action, Secure Future’ (Conservatives)
• ‘Change’ (Labour)
• ‘For a fair deal’ (Liberal Democrats)