General Election 2024: What are England’s major political parties saying about race and health?

Conservatives

On health, the Conservative manifesto contains many familiar promises, focusing primarily on prevention and efficiency. The party have recommitted to their plan to ban smoking for future generations and have re-stated their promise to reduce NHS waiting lists, despite numbers not having come down since the pledge was first made by the Prime Minster at the start of his premiership. Similarly, the manifesto contains a repeat of the 2019 promise to deliver 40 new hospitals and, if reelected, the Conservatives will continue to develop their Major Conditions Strategy, about which the Observatory has written before, expressing concerns that the strategy shifts focus away from race and racism, and towards more simplistic measures of inequity.

On equity more generally, the Conservative party have focused their pledges on ‘equality of opportunity’. They describe the country as ‘a multiethnic, multi-racial, multi-faith success story’ and commit to ‘tackling unfair ethnic disparities across education, employment, health and the justice system’, in a continuation of their Inclusive Britain Action Plan. The manifesto makes no explicit reference to race or racism but does make a pledge to ‘support continued research into disparities in maternity care’ and commits to introducing controls on all ‘Equality, Diversity and Inclusion’ initiatives and spending as part of its overall mission to cut government bureaucracy.

Labour

Labour’s health pledges also focus on waiting lists, increased access to appointments, and better integration. They have heavily promoted their commitments to increasing weekend and evening appointments, and to developing a National Care Service, which they say will help to ease pressure on the NHS.

The Labour party manifesto also recommits to its ‘landmark Race Equality Act’ and says it will ‘root out racial inequalities’. Announced earlier this year, the proposed Act includes provisions to enshrine equal pay in law and mandate the reporting of ethnicity pay gaps. On health, the Act seeks to impose on Integrated Care Boards a duty to develop a race equality action plan, and to improve ‘cross-cultural’ content in clinical training. The Act also reflects the Observatory’s own calls for Mental Health Act reform, better quality ethnicity data, and a commitment to close the gap in maternal mortality.  Elsewhere, the manifesto explicitly highlights the challenge of health inequalities, and includes a commitment to ‘tackle the social determinants of health’.

Liberal Democrats

Like the other major parties, the Liberal Democrats have focused on access to appointments, primarily in primary care. They’ve also committed to modernising the Mental Health Act, albeit without making any explicit reference to the inequities baked into the current Act. On health inequalities, they have pledged to increase the Public Health Grant – money given to local authorities by the government to aid public health initiatives –  and want to earmark part of the increase for ‘those experiencing the worst health inequalities to co-produce plans for their communities’.

They’ve also committed to establishing a ‘Health Creation Unit’ inside the Cabinet Office ‘to lead work across government to improve the nation’s health and tackle health inequalities’. Further details are not given, however, on how this unit would function, or what its priorities would be. Finally, the Liberal Democrats have committed to creating a Patients Charter, designed ‘to harness lived experience of patients and embed patient voice, partnership and safety standards across health’. No specific reference is made to race (or any other specific protected characteristics) in outlining how the might work charter.

The Liberal Democrats have also made a high-level commitment to develop and deliver a Race Equality Strategy to ‘address deep inequalities, including in education, health, criminal justice and the economy’. Although details are relatively light, plans do include a specific pledge to reduce ‘the disproportionately high maternal mortality rates for black women and eliminating racial disparities in maternal health.’

Key takeaways

There are promising signs in these manifestos that some of the major parties are taking seriously the need for race equity, but there will be work to do over the next parliament to hold any government accountable for effective and equitable delivery of their pledges.

All three parties have pledged to do something to tackle the NHS waiting list. While these pledges are welcome, there will need to be some consideration of race equity when it comes to implementation. The Observatory’s work has shown that the elective backlog has not historically impacted all ethnic groups equally, with Asian groups experiencing a greater deficit of care than their White counterparts. For all major parties, efforts to reduce the waiting lists must therefore include consideration of the unequal way in which these vast backlogs are impacting marginalised communities. There must also be special consideration about how any new appointments are accessed or allocated, ensuring that additional capacity benefits underserved communities, and doesn’t simply provide easier access to those already highly engaged.

Similarly, all three parties have made pledges in their manifestos to either boost appointment numbers or boost “choice” within the system, with each alluding to the need for more hours to be worked by already overstretched NHS staff. While these ambitions may be laudable in themselves, there are already warnings from professional bodies about the lack of workforce capacity available to deliver such expansions. With workforce shortages, industrial action ongoing among doctors, and a large number of staff still impacted by long-COVID, any expansion of service will need to be supported through the effective delivery of the NHS’ Long Term Workforce Plan.

It is positive to see that parties have pledged to take strategic action on race equity but, as ever, the road to implementation is long, and the nuances of enactment will be hugely consequential. This election could prove to be a crucial turning point in this field but, with discourse around race equality having proved fractious over the past few years, any incoming government will need to be willing to cut through divisive rhetoric and focus on robust, evidence-based solutions to tackle this problem for the good of patients and the public.

You can read the Observatory’s own Manifesto for Race and Health here, where we set out seven priorities for any incoming government.