The Conversation’s Manifesto Check brings academic expertise to bear on the political parties’ key election pledges.
In essence, the UK Independence Party (UKIP) propose to solve the problems of the NHS by spending more money. The risk, of course, is that the NHS could swallow this extra money without delivering improved quality and outcomes for patients. UKIP do not explain how they will get value for money from this spending. And like the other parties, they do not spell out what tax increases and spending cuts in other areas of public spending will be required to accommodate the NHS’ ever increasing share of public expenditure.
The UKIP manifesto does, however, devote a substantial amount of space to the issue of “health tourism”, whereby foreign nationals come to the UK to obtain free health care. As set out later in the article, this kind of “health tourism” actually costs less than one fifth of 1% of the NHS budget. The space devoted to this issue by UKIP is therefore wholly disproportionate to its economic importance.
The UKIP diagnosis
According to UKIP, the NHS is in crisis due to “our ageing population”, “the dramatic increase in the numbers of people suffering chronic, long-term conditions”, “uncontrolled immigration”, “EU directives”, and “endless political interference.“ The party claims that “David Cameron’s government wasted billions on a top-down reorganisation he promised would not happen.”
UKIP is right about the first two claims. As people live longer due to improved socioeconomic conditions and medical technology, they acquire multiple different chronic long-term conditions – known in the trade as “multi-morbidity”. This is putting a strain on health care resources across the globe. It also poses a challenge for clinicians who typically specialise in one type of disease, and find it hard to treat multiple different diseases at the same time.
UKIP also has a point about top-down reorganisation. Successive governments over the past 60 years – this one included – have indeed spent a fortune in administrative costs, on what Professor Alan Maynard calls the perpetual “re-disorganisation” of the NHS.
But the party’s points about immigration and EU directives are red herrings. Arguably, immigration actually provides a net benefit to the NHS, with an influx of foreign born workers and the migration of mostly young and healthy workers, who rarely use the NHS, yet contribute their share in taxation. It is is true that the EU working time directive has slightly increased NHS costs, by reducing the long working hours of trainee doctors and hence reducing a source of “free” labour to the NHS.
But this issue is trivial in comparison with the other main economic drivers of increased health care expenditure that are not mentioned by UKIP, which include cost-increasing medical technology, rising expectations of health care in the consumer age, and the “cost-disease” of rising costs and stalling productivity in all labour-intensive industries.
UKIP fails to diagnose these problems, or to offer solutions for how they will arrange for the introduction of new technologies, manage people’s expectations of health care, or improve the productivity of the workforce.
The UKIP cure
UKIP proposes a number of remedies for the NHS, the first of which is extra spending. The party pledges to spend £12 billion over five years, which includes £300 million a year of additional funding for mental health services, £130 million of which is earmarked specifically for dementia. The party also promises to expand the medical workforce by adding 8,000 more GPs, 20,000 more nurses, and 3,000 more midwives.
UKIP also plans to shift the medical workforce towards A&E, by improving working conditions for emergency medicine consultants and piloting the use of GPs in A&E. Experimentation such as this should be welcomed; policies like this could work, but there is currently not enough evidence either way.
The party wants to regulate NHS managers through a “license to manage”, and by transferring regulatory functions from Monitor and the Care Quality Commission to local authorities. UKIP describe these measures as “effective and powerful health care monitoring”. Yet these are peculiar proposals – successful private sector managers need no “license to manage”, and it seems odd to hand over a national regulatory function to local authorities. And UKIP provides no evidence that either of them will deliver benefits. All we can be sure of is that they would both impose administrative costs as NHS officials shuffle from one organisation to another, yet again.
The UKIP manifesto also pledges to end PFI contracts, and negotiate op-outs from the EU Clinical Trial Directive, the EU Working Time Directive, and the Transatlantic Trade and Investment Partnership (TTIP).
The UKIP manifesto claims:
Every year the NHS spends up to £2 billion of UK taxpayers’ money treating those ineligible for free care. This bill includes foreign nationals who come to Britain to deliberately seek NHS services at no cost to themselves; those who live here but who do not qualify for free care; treatment for illegal immigrants and those who overstay their visas.
This is misleading. The £2 billion figure comes from a European Commission report on migrant EU citizens who have residency, but do not work in the country they have moved to. But most such EU citizens are eligible for free NHS care under EU rules –- the same reciprocal rules that allow UK citizens to access free health care in other EU states.
Although accurate data do not exist, the best available estimate of the cost of treating people who deliberately travel to the UK for free NHS treatment is between £70 million and £300 million, from a report produced for the Department of Health by a research consultancy firm and cited in the British Medical Journal. The approximate mid-point of this estimate – £200 million – represents less than one fifth of one percent of the £112 billion spent on the NHS in 2013/14.
UKIP have form in making exaggerated claims about health tourism. During a TV election debate, Nigel Farage claimed that people “can come into Britain from anywhere in the world and get diagnosed with retroviral drugs that cost up to £25,000 per year per patient”, and that 60% of people diagnosed with HIV are “not British nationals”. But figures from Public Health England actually show that 44.8% of new HIV diagnoses in 2013 were in people recorded as foreign born, who may be British nationals, and most of whom probably acquired HIV while living in the UK.
Hospital car parking
UKIP estimate that offering free parking would cost NHS hospitals about £200 million a year – about the same as the annual cost of health tourism. They fail to mention that travel costs more than parking, that financial support for travel and parking is already available for people on low incomes, or that free parking could increase congestion and stress for those unable to find a space – see this report by the University of York Centre for Health Economics.