The health service is a big issue in any UK election. There are two main reasons why, this time round, the arguments are particularly fraught. One is the sense of crisis engulfing the system after a decade of cuts, with A&E waiting times in England the worst on record, and a shortage of 100,000 staff (in a workforce of 1.3 million) predicted by experts to grow to 350,000 by 2030. Allied to this is a consensus that many of the long-term challenges faced by the system are simply not being addressed. These include the overhaul of social care, which is universally acknowledged to be necessary but apparently no closer to happening than it was in 2010, and huge rises in the number of people who are obese, and children being referred to mental health services.

The second theme is the prospect of US demands for market access and higher drug prices as part of any post-Brexit trade deal. There were typically mixed and confused signals on this issue during the summer from President Trump, and strong denials from Conservative leadership contenders that the NHS would feature in bilateral talks. But set against such assurances are the US administration’s stated goal of raising prices for US medicines abroad, in order to lower them at home, and expert opinion. Andrew Hill, an adviser to the World Health Organization, predicts that the NHS drugs bill could rise from £18bn to £45bn a year.

With 59% of voters naming the NHS as the biggest issue facing the country (though only 18% say that policies on health will determine how they vote), and a chance that the increased demands of winter could see the situation in some hospitals spiral out of control, Conservative campaigners recognise the danger. The health secretary, Matt Hancock, has been meeting the NHS England boss, Simon Stevens, weekly, and No 10 is also closely involved.

But the question is what, if anything, the Conservatives have to offer the health service, beyond the 3.4% annual increase to which they are already committed, taking the total budget from £115bn to £135bn over the course of the next parliament. Regular hospital visits by Boris Johnson indicate that his party believes it has a positive story to tell, and is prepared to brazen it out when confronted by angry staff or patients, as he has been more than once. But the fact is that the settlement agreed by Theresa May’s government was known at the time not to be enough, with a 4% increase recommended by thinktanks as the minimum required to reverse years of decline caused by cuts (and the additional burden imposed by council cuts to public health and addiction services to be taken into account).

Determined not to be outdone, Labour has offered a “rescue package” that it says will be worth £5.5bn more a year by 2023-24, funded by higher taxes. The policy has the merit of giving voters a clear choice: to spend a lot more money, or not? But while it is right that health spending should be among key election issues, the public should not be given the false impression that it is all about the money. A swift resolution of the doctors’ pensions dispute and the return of nurses’ training bursaries (as promised by Labour) would ease staffing pressures, for example. So would doubling the number of medical school places. But staff shortages are a global issue. So is the role of prevention and public health, particularly in countries where lifestyle-linked illnesses have risen sharply. Rather than a bidding war, politicians should engage in a debate about their plans to make the UK a healthier country.

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