Health check – healthmedicinet

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When Theresa May faced the BBC Question Time audience on Friday, one of the trickiest questions came from a nurse.

The prime minister was asked how she could expect their support given the 1% cap on pay rises, leaving Theresa May battling to explain why such restraint was necessary.

After all, in its manifesto, the Conservatives said that NHS spending was to increase.

By the end of the Parliament, the Tories have promised that funding in England will be £8bn higher a year once inflation is taken into account.

It does not set out how this will be paid for, although the party insists economic growth is key to spending more.

What’s in the manifesto?

However, as with all manifestos, you need to look at what is not being said as well as what is.

The £8bn refers to only one part of the overall budget – the money allocated to front-line services. This accounts for just over three-quarters of the entire health budget.

There was a lack of detail about much of the rest of the pot, which goes on things like staff training and public health programmes such as stopping smoking, apart from the promise of extra investment in buildings.

During the last Parliament these pots were cut to help pump more money into the front-line services. The same could happen again – albeit with some protection this time for the buildings budget.

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What is also not obvious is that the £8bn is much less than the health service has been used to. Before 2010, the NHS had been getting an extra 4% a year over its history.

This reflects the fact that the health service faces rising costs from factors such as the ageing population, the cost of new drugs and lifestyle issues like obesity.

But those rises dried up between 2010 and 2017. Since then the NHS has been getting about 1% a year.

What difference will the £8bn for the next Parliament make to that trend? Very little.

Forecasts suggest the spending plans amount to just over 1%.

But the Tories are not alone on this. The Nuffield Trust think tank has been looking at the spending plans set out by all three main parties – and concluded there is very little between them. And all three fall well short of the 4% average.

It explains why, despite the promises of extra money, the Tories have felt it necessary to continue with the pay cap.

It’s not in the manifesto – instead that talks about “benefits” such as flexible working and new support for staff with mental health problems – but it remains very much a part of their wider NHS policy.

Following the last election, the then chancellor George Osborne announced public sector pay was to be capped at 1% until 2019.

That, as the nurse pointed out on live television, continues to remain in place.