Far from the "Brexit election" we were told to expect, it would seem we're now heading to the polls amid "a fight for the survival of the NHS". At least, that's what Jeremy Corbyn claimed when he shared leaked papers documenting US-UK post-Brexit trade talks that, he says, prove the Tories want to sell off the health service.
Boris Johnson has repeatedly denied the NHS is up for sale, but the 451-page dossier shows the US wants "total market access" to be the baseline assumption of negotiations. Discussions on drug pricing and the pharmaceutical industry were also included.
Aside from all that, the health service is ailing after nine years of austerity: there's been only a marginal increase in funding, despite a surge in patient demand and healthcare costs. Performance has deteriorated to its worst level on record, and the key targets for cancer treatment, routine hospital care and A&E are consistently being missed. The staffing crisis – there are some 100,000 vacant roles in England, including a shortage of 44,000 nurses – is making hospital bosses fearful for patient safety, while mental health provision has suffered year-on-year cuts of at least 8 percent in real terms.
One thing is for sure: whichever party is elected to govern the country on the 12th of December, it will have a considerable job on its hands to restore the NHS. Let's see what the main parties are promising for the health service in their manifestos. Bear in mind that these only apply to England – tuition fees and education are devolved matters in Wales, Northern Ireland and Scotland.
While getting Brexit done is very much central to the Tory campaign, the manifesto does include some health sector promises that appear appealing – although a little underwhelming and not all new. The manifesto reiterates that "the NHS will not be on the table" in trade talks, but the Scottish National Party still wants this claim enshrined in a new law.
There are pledges for the "biggest ever cash boost", of £34 billion a year, and 50,000 more nurses (although that figure includes 18,500 retained staff, and is being received with some scepticism by nurses themselves). The party also promises 6,000 extra GPs (but remember how the Tories failed in their plans to recruit an additional 5,000 by 2020?) and says it will build 40 new hospitals over the next decade. This is misleading, because it probably won't.
How will this be paid for? Partly, by upping the charge people from overseas pay to access the NHS and extending the practice to include EU nationals. If that concept is not already jarring enough for you, consider this: the Tories claim the increase of the international health surcharge from £400 to to £625 will raise more than £500 million a year – but it's unclear how they came to this figure. On top of this, the move entirely disregards the fact that people from overseas often already contribute to the NHS indirectly through payments such as VAT and taxes. The party also aims to raise funds by not going ahead with its planned corporation tax cuts.
Repairing the NHS – whose formation is one of Labour's "proudest achievements" – is an immediate task, the party says. It wants to reverse privatisation, urgently, although how it would legally cut short contracts with firms is unclear.
There is a commitment to increase spending by an average of 4.3 percent a year, compared with the 3.2 percent rise under current government plans over the next four years. The promised boost is higher than that being offered by the Tories and Lib Dems, but is still below the 5 percent annual average increases needed, according to the Institute for Fiscal Studies and the Health Foundation.
Free prescriptions and dental check-ups for all are on the table, as are 27 million additional GP appointments a year. As our population continues to get older and sicker, the latter could only be achieved by growing the workforce substantially, but Labour says it would make it a reality with more doctor training places.
The party also pledges an additional £1.6 billion a year for mental health, says it will more than double annual spending on child and adolescent mental health services and put psychological conditions on a par with physical illnesses. Obesity in young people is another target, and the sugar tax would be extended to include milk drinks. Fast-food shops near schools would also be banned.
All this, Labour says, will be delivered by a net-zero carbon NHS. The promises being made in the manifesto are extensive if nothing else, but where is all this cash – and a lot of it would be needed – coming from?
The party plans to introduce a higher income tax rate for the country's top 5 percent of earners (45p for people on £80,000-plus, 50p for those on more than £125,000). This is estimated to raise only £5.4 billion – less than 7 percent of the £83 billion Labour plans to create by taxing higher earners.
Most of the money, though (£30 billion), will come from reversing corporation tax cuts and taxing multinationals. The IFS warns, however, that the party is unlikely to be able to deliver the spending hikes it promises.
Among the Lib Dems' priorities is introducing a penny income tax rise to create an additional £7 billion a year, which would be ring-fenced for health and social care, and a £10 billion capital fund. In the longer term, they want to develop a dedicated "Health and Care Tax" so a Lib Dem government can be explicit about what it is spending on the health service.
Another top priority is reforming – although not repealing – the Health and Social Care Act, which was introduced in 2012 during the coalition government and intensified privatisation. The party is also pledging to end the GP shortfall by 2025.
Like Labour, the Tories and the Green Party, the Lib Dems promise to treat mental health with the same urgency as physical health, and will boost funding by £11 billion, introduce 24-hour services and offer free prescriptions to people with chronic mental health conditions.
The Lib Dems say they will fund the spending with the "£50 billion Remain Bonus", which it expects will come from staying in the European Union. While the figure is a reasonable assessment of forecasts, there is still a great deal of uncertainty, according to independent fact-checking charity Full Fact.
Essentially, if you are among the voters who view the NHS as the defining issue of this election, the Labour and Lib Dems' ambitions will appeal. If getting Brexit done at whatever cost is for you, vote Tory.
Confused about which party to vote for in the upcoming general election? Check out VICE's handy primer to all the manifesto policies here.