Ahead of every General Election, manifestos provide an insight into how each party wants to be seen by the electorate and shed (some) light onto the areas they might focus on, should they be elected.
To get a sense of how this year’s manifestos measure up against those of the past, we’ve waded through years of political slogans, photos of smiling supporters and an impossible number of Union Jacks to spot trends in health in the Labour, Conservative and Lib Dem manifestos from 1997 to today.
The most frequently mentioned health issues in the 2024 manifestos were mental health, followed (not closely) by cancer, public health/prevention, and waiting lists. As the graph below illustrates, focus on these issues has waxed and waned over the years. While some of the variance can be attributed to wider political circumstances – the 2017 election was arguably so Brexit-dominated it left less room for other issues – it is possible to draw lessons from how the political salience of health issues has changed, including what today’s debates could mean for the manifestos at the next election.
Unsurprisingly, waiting lists have been one of the biggest health talking points of this election. The television debates have seen fiery exchanges around the issue, and the public’s patience is running thin – with Rishi Sunak laughed at by the audience during the first ITV leaders debate when he claimed that waiting lists were coming down.
We see this reflected in the manifestos. Labour have made waiting times one of their key priorities, with Sir Keir Starmer listing “cut NHS waiting times” as one of his six pledges for change, while the Conservatives and Liberal Democrats have also made commitments to meet targets in the next Parliament.
The pattern of mentions for waiting lists over time is particularly interesting. Despite NHS waiting lists being high in 1997, and Labour making improvements in access one of its key pledges, the volume of references in manifestos was perhaps lower than might have been expected. However, the issue gained salience in 2001 when other parties flocked to highlight the lack of progress and the mathematical gymnastics deployed by the Government to claim they were keeping the pledge to cut waits (sound familiar?).
Following their win, Labour renewed its focus on NHS performance, and it is a mark of the efficacy of this approach (in secondary care at least) that the issue lost its salience from 2001-10. We can see that the upwards trajectory begins again when waiting lists creep back up from 2015 onwards and has now returned to 1997 levels. If the next government is not able to address the waiting lists and get voters on side, then other parties can be expected to take advantage as they did in 2001 – and given the increased volatility of politics today, this might not be a mistake they can afford to make.
We also see a continued upward trend in a focus on mental health over the years – an issue championed chiefly this year by the Liberal Democrats, which alone have 16 mental health policies.
Prior to 2010, manifesto references to mental health could be counted on one hand. Since then, references have steadily increased, reaching a peak in 2017 where mental health was referenced 87 times – likely due to continued strain on provision of mental health support and major commitments on mental health from NHS England in the lead up to the 2017 elections. It is notable that all three of the main parties are actively speaking about mental health on this year’s campaign trail; likely a reflection of the increased awareness of mental health in the years since the COVID-19 pandemic, and long waiting times for mental health treatment which has been called a “national emergency” by NHS bosses.
As we’ve seen from 2010 to now, the inability to translate commitments on mental health into tangible improvements has meant sustained scrutiny on the government, reflected in the manifesto mentions. If the incoming government can’t make big changes on mental health in their first term, then we can expect mental health to stay on the political agenda for the next election.
Cancer is mentioned the most out of all individual conditions in the 2024 manifestos – although this is mainly in relation to wider issues within the NHS, such as early diagnosis and waiting times. Looking back across the years, cancer received the most attention in the manifestos in 2010 when the Conservatives pledged to create a Cancer Drugs Fund to help patients access cancer drugs – this was in response to rising challenges in access to medicines that had taken up significant media attention in the preceding years.
The Cancer Drugs Fund still exists today (albeit in different form) and continues to shape access policy, demonstrating the potential long legacy of manifesto commitments.
References to cancer then dwindled in 2015 and 2017, before they began to climb again in 2019 – perhaps a reflection of the growing waiting lists for cancer treatment. With all parties making ambitious commitments on cancer care in 2024, the direction of the graph in five years' time will give a clear indication of the wisdom of this approach.
A relative rise in mentions of public health and related policies over the past two elections – perhaps sparked in 2019 by the NHS Long Term Plan’s focus on prevention or the Department for Health and Social Care’s vision document “Prevention is better than a cure” – coupled with the decrease in disease specific references signals a growing consensus on the need for a more preventative and holistic approach to health going forward. This is echoed by mentions of pharmacy throughout the manifestos, which is positioned within the context of moving healthcare into the community.
While the volume of rhetoric on prevention and public health may have increased, this has yet to translate into significant change in policy making, with public health budgets falling in real terms and secondary care continuing to dominate NHS spending.
The key question for the next five years is whether the next government will be able to change the picture, or if coalface commitments on the waiting list, GP access and urgent care will once again take priority.
NHS waiting lists
Mental health
Cancer
Public health