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    In the two decades since the publication of the Sutherland Royal Commission report on long-term care the issues around the cost of caring for an ageing population remains one of the major issues in public policy. And we remain no nearer to its resolution.

    While varying elements of catering for long-term care remain the responsibility of the UK Government, devolution has allowed a fair level innovation and diversity in approach including the introduction of free personal care in Scotland which was one of the main recommendations of the Sutherland Commission.

    In Wales the National Assembly’s Finance Committee has recently published a useful report on the matter from a Welsh perspective.

    In very broad terms the report looked at two inter-related issues i) delivering quality care and ii) how that care will be accessed and paid for.

    The report highlighted that while social care in under considerable financial pressure in Wales the level of spend has remained broadly flat in real terms between 2009-10 and 2015-16 compared to a 6.4% decline in England. None the less with an increasingly older population the per capita spending has reduced by 12%.

    In responding to this pressure, and despite the increase in numbers, there was evidence that fewer older adults were receiving care. It was suggested that this was in part a reflection of the Welsh Government’s policy to promote more self-reliance and a better matching of service to need but concerns was also expressed that eligibility criteria were being tightened which means that it is more difficult to access care.

    There is a greater proportion of unpaid carers in Wales compared to other parts of the UK and Europe representing 12% of the population. They are responsible for 96% of the care that is given in the community even though 65% of older carers have health problems of their own. The Social Services and Well-being Act (2014) in Wales was intended to increase support for carers but of the 370,000 carers only about 6,200 / year had an assessment with less than 20% receiving an offer of care. In response the Welsh Government has said that it is preparing a major publicity drive to make the carers more aware of their rights and to better equip social workers in their assessment of carers’ needs.

    In Wales the means testing for care services is more generous that in England with the Welsh Government committed to increasing the capital eligibility thresholds for residential care to £50,000 by the end of it present term. In addition there is a cap on the level of payments for domiciliary packages. There were concerns that these thresholds could deprive social services departments of vital resources but the Welsh Government grant support has prevented that from happening.

    The social care sector remains in a fragile state.. There are many instances in which private domiciliary care companies have handed back contracts to local authorities who have, in some instances, been obliged to in-source the service. The residential care sector is also under pressure particularly smaller more community based care homes. In part this is down to the fees that it is able to agree with social services departments. The rates vary across Wales, often inexplicably, and the Welsh Government has committed itself to introducing a new assessment methodology to bring greater transparency and consistency in the fee structure. In addition it is hoped that this new process will address the concerns where self-funding care home residents are paying fee levels which are, in effect, cross subsidising the public sector.

    These problems are compounded by the difficulties in the recruitment and retention of staff with some providers reporting turnover levels of 25-33% every year. There are real issues of pay, status and training that need to be addressed. The Welsh Government has been promoting the voluntary registration of domiciliary care workers from 2018 with the target of compulsory registration by 2020. As well it is committed to reducing the use of zero hours contracts and to requiring a delineation between travel and work time in the working day. However it is still difficult to keep care staff when faced with better pay and conditions in other parts of the public and private sector. And all of this is likely to be exacerbated by the UK’s departure from the EU.

    The report also looked at future funding models. The Welsh Government believes that a UK wide solution would be preferable but the continuing postponement of the UK Government’s green paper on social care means that other options will have to be looked at including the use of Welsh income tax powers which will be available from April 2019.

    In addition a lot of consideration was given to the social care levy which has been advanced by Prof Gerry Holtham and Tegid Roberts.. Their proposal involves the HMRC to collect a levy between 1-3% depending on a person’s age. This sum would be lodged in an investment fund and used to pay for an enhanced social care package. However the report strongly believed that there needed to be a wider public debate on what the public could expect to receive in return for their contributions. The Welsh Government has established an Inter-Ministerial Group on Paying for Social Care with five separate work streams to consider the the full range of the implications of such a social care levy.

    The Welsh Government’s policy statement A Healthier Wales (2018) confirmed its intent to support closer collaboration between health and social care in Wales using regional partnership boards as their main instrument to achieve this. Concerns were expressed that Wales lacked a sufficiently robust evidence base to inform social care planning thought the Welsh Government was not convinced about this. There was also a recognition of the very useful role that the Intermediate Care Fund has played in facilitating joint working between health and local government bodies.

    Overall this is a useful report which highlights many of the key challenges facing social care in Wales. However there is little evidence that the Welsh Government is in a position to move toward an fully integrated “health and care service” free at the point of use or that it is likely to seek the devolution of the administration welfare benefits service which could allow for a more innovative proposals for the paying for the care of older people in Wales.



    Reclaim Social Care Conference 17.11.18 final flier

    Full details also on the Events page. Please circulate as widely as possible.

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    There is a silent and largely-ignored army of 1.2 million people over 65 in the UK providing unpaid care to another person. The size of the army is growing, the pressures are increasing while support from the state is being withdrawn. Our society cannot function without the support of older unpaid carers and yet they are increasingly being asked to function without the support of society. A crisis is waiting to happen.

    Carers provide unpaid care by looking after an ill, older or disabled family member, friend or partner. Some people find caring a rewarding experience because they are helping someone they love who has perhaps looked after them in the past. But when carers are themselves growing older and more infirm, when there is no other option, when care has to be given 24/7 without respite, when it cuts people off from their friends, the things they like doing and the wider society, and when it comes with financial pressures and debts, it can have a hugely negative impact.

    Life expectancy is increasing. The conditions for which older people have traditionally provided  care are changing as people with stroke and Down’s Syndrome, for example, live longer. More older people are looking after even older relatives and many are co-caring; it is not unusual to find a mother of 95 looking after her daughter of 70 who has Alzheimer’s Disease.

    Cuts in public spending are having a significant impact on carers in general and on older carers in particular, both as direct users of services and in relations to support for them as carers. Services in the community for older adults have seen the biggest reductions, with £539 million taken out of home and day care alone between 2009/10 and 2012/13. The number of older people receiving publicly funded services fell by 26 per cent (245,855 older adults) over this period.

    In addition, there is a crisis among professional carers who are working for low wages in difficult conditions (eg zero hours contracts) and are being stretched to cover the amount of care needed by the growing number of older people, disabled people and severely disabled children and those who are in the workforce have very low wages and poor terms and conditions of service (eg zero hours contracts). Restrictions on immigration will worsen labour supply. Funding cuts have also affected voluntary sector organisations, making them, in turn, less able to offer support to carers.

    All of this means that the burden of care is increasingly falling on older carers who are increasingly part of the human infrastructure that keeps our society, including our NHS, functioning while being under severe emotional, physical and financial pressure themselves.

    Older carers: the facts

    Poor co-ordination of data makes the impact of these factors difficult to quantify. But here are some of the facts that we do know.

    • There are 1.2 million carers aged 65 and over in England. Whilst the number of carers has risen by 11% since 2001, the number of those over 65 rose by 35%.
    • The number of carers aged 85 and over grew by 128% in just ten years. A larger proportion of those aged 85 and over in England and Wales were providing unpaid care in 2011 than in 2001; 8.8% in 2011 compared to 5.0% in 2001. Over half of those aged 85 and over who provided care in 2011 were providing 50 or more hours of care in an average week.
    • Nearly half (45%) of arers aged 75 and over are looking after someone who has dementia.
    • The most recent estimates show that the average saving to the state made by each unpaid carer is £18,471 each year. This would mean that the contribution of older carers is over £23.6 billion a year.
    • Two thirds of older carers have long-term health problems or a disability themselves. In the most recent survey of carers by Carers UK, 92% said that caring has had a negative impact on their mental health, including stress and depression. Carers providing round the clock are more than twice as likely to be in bad health than non-carers and this is likely to increase as carers get older.

    The loss of earning, savings and pension contributions can mean carers face long-term financial hardship into retirement.

    In 2014, half of carers (49%) said they feel society does not think about them at all.

    This is a health issue

    Nobody could deny that dementia and many other conditions that mean people need care are health issue or that carers are saving the NHS billions. Carers themselves experience physical and mental illness as a result of their care role. Yet much of the dwindling support for carers comes from outside the health system.

    The devastating situation for carers is directly related to the current crisis in health and social care. Aside from any considerations of humanity, morality and the duty of the state to look after the most vulnerable people, it is incredibly short-sighted not to provide proper support for the hundreds of  thousands of older people who are providing unpaid care. This is a priceless resource for society which, if it collapses, will bring unimaginable human and economic costs to the NHS as well as the wider society. Conversely, proper investment in support for older carers would bring great rewards. Providing a mandatory assessment which simply quantifies carers’ needs and then telling them that there is no money to meet those needs (the current position for many) is almost worse than no assessment.

    The above are some of the reasons why social care should be as much as an issue for SHA as health care and why we need to develop a vision of care that encompasses both. There will always be informal care by people for those they love, but there are some obvious steps that the next Government could take in the health and care arena to improve the situation for carers and for those they care for:

    • immediately reverse the cuts in social care
    • introduce a system of free social care based on agreed definitions of need
    • do away with the artificial distinction between health and social care
    • ensure that information is systematically collected on carers and, separately, older carers, their experiences of caring and its impact on them
    • ensure there is a statutory right to support for carers identified in needs assessments
    • give carers a statutory right to respite from their caring roles
    • provide funding to combat loneliness and isolation among older carers, support for older carers on the death of the person they care for and new opportunities for community involvement following bereavement
    • value professional care workers, who provide support for unpaid carers, and improve their wages and working conditions.
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    I am honoured to have been invited to write a response to Andy Burham’s recent speech on his vision for an integrated health service, in relation to how it affects disabled people. Before I begin I think I should assist in avoiding any confusion by explaining I am not that Simon Stevens, the one in control of health services in England. Instead, I am an independent disability consultant with 20 years experience of social care as a service user and someone working in the field in many ways.

    Labour is promising a fully integrated health and social care system hailed as one service that meets everybody’s needs. It should be firstly noted this is very different to the parallel ‘National Care Service’ they were proposing just before the last election. While the integration of health and social care looks logical and promising, for disabled people of working age particularly, this concept could be quite damaging.

    To understand this, it is important to explain some context. Labour left Government in 2010 when personalisation was the key theme of social care policy. It must be understood that personalisation was a professionals friendly step-down to full independent living as defined by the old disability movement. At this time, personalisation was already a disappointment to most as professionals have watered it down to meaningless words, but it was better than nothing.

    The last 5 years has seen Winterbourne and the rise of the carers movement as the right of carers appears to have been given priority over service users by this Coalition government. At the same time, a new and vocal ‘sick and disabled’ movement has grown out of the opposition to the welfare reforms, demanding welfare over inclusion and independent living, leaving many disabled people, particularly those with high support needs, out of the political agenda. This means Labour has lost its historical links with the independent living agenda as it now simply sees disability as a welfare issue as it promises to deliver Iain Duncan Smith’s reforms better than he could.

    This means the integration agenda could be a convenient opportunity to retire personalisation as the priority appears now to be reducing hospital admissions and bed blocking, rather than a quality of life as social beings which people require to be included and active citizens. The priorities scare me because it has the potential to undo social care and under the control of health, potentially revive long-stay hospitals as a convenient way to cheaply manage people.

    Social care is not just about preventing falls or allowing quicker hospital discharges. If we add the ever growing power of the carers movement, which has mostly squashed independent living out of the agenda, I predict things can only get worse for disabled people unless there is a major shift in the culture of health and social care towards independent living and including social based outcomes. It is highlighted by Andy Burham’s remark that ‘severely’ disabled children now live longer and may even need adult services. This is a very odd thing to say as it is firstly totally out of date as there is not a sudden crisis in the transition between child and adult services, a problem that has always existed. But more worrying is that it shows some welfarist prejudice, as he suggests children with high support needs just need warehousing, under the direction of their carers (as no one has parents anymore), to continue into adulthood as the need for a decent education and employment opportunities appears to be irrelevant.

    Labour’s policy is confirming the general welfarist thinking on disabled people in terms of those fit for society and employment opportunities, and those who are unfit for society. When Labour still wants to ‘look after’ old people like they are all war heroes without a mind of their own, it is clear disabled people who require social care are automatically deemed unfit for society, mindless objects of pity who will be controlled by this integrated system.

    I want Labour to be fully committed to independent living and inclusion for all regardless of age, but I fear they will simply set up a new and improved Independent Living Fund, reinforcing the two tier system we have now where only those who demand independent living gets it, where people like myself remain ‘lucky’, while the rest are warehoused or left as the property of their families.

    Enablement and Empowerment are cornerstones of an effective and cost efficient health and social care system, but when professionals fight to keep their jobs and control of their piece of the cake, costly disempowerment will continue to be the order of the day and so any new money will simply be swallowed up by empire building. This means that unless Labour is willing to replace the engine of the new “NH&SCS”, as opposed to simply giving it a new spray job, it will be business as usual in this new game of musical chairs.

    I fear Labour’s plans are going to potentially destroy social care in terms of personalisation and independent living, as its bigger brother, Health, takes centre stage making all the demands. Unfortunately, it is a bit late for this election to go back to the drawing board to design a better policy!

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    Proposals Labour should consider:

    • Introduce a mandatory minimum level of training on high-incidence special educational needs, developmental issues and behaviour management as part of initial teacher training, as well as training for Early Years Professionals. Additionally, at least one In Service Training day per academic year should be given over to upskilling teachers and support staff on issues relating to Special Educational Needs – as every educator is an educator of children with additional learning needs, every educator should be given the skills to be able to do so effectively. This would serve the dual benefit of both improving identification (particularly early intervention, but also at all stages of school), as well as reducing the need for specialist support for those with needs which can be met in an inclusive classroom environment, leading to better outcomes for young people and less stress for teachers. Resources for training should be co-produced and sourced from experts in the sector, and be checked and distributed by the Office for Educational Improvement.

    • Special Educational Needs Co-ordinators (SENCOs) to be a member of Senior Management Team – we want the best teachers to take the lead on improving provision for Children and Young People with SEN within their schools, but anecdotal evidence suggests that this responsibility is often given to junior teachers, those whom the school leadership deems to be undeserving of more senior roles, or sometimes taken by the Head as an indistinct role. By requiring SENCOs to be part of the Senior Management Team within a school, this will positively influence the choice of individual to perform the role, incentivise good teachers to work towards becoming a SENCO, and increase the ‘clout’ that they have within schools to drive improvement amongst their colleagues.

    • SENCOs already in post should be required to undertake the National Award within an agreed timeline – the National Award has been ensuring that new SENCOs have the specialist knowledge required to influence change in their schools; we believe that all SENCOs should have this qualification.

    • Teaching schools should be ‘good at SEN’ – to ensure that what training teachers learn at university is reinforce by practice, part of the criteria for designating teaching schools should be that they are recognised by OFSTED as being good or excellent at providing for children with SENs, and that the leadership are committed to inclusive education, including working in partnership with local special schools to support specific needs and upskill teaching staff..

    • Boost the importance of Early Years Area SENCOs – identifying SENs early is crucial, yet the early years workforce is the least qualified in the education sector. With the expansion of free nursery education for disadvantaged two year olds over the next few years, demands on EYASENCOs will increase dramatically, yet due to cuts to Local Authority budgets anecdotal evidence suggests that these posts are being deleted. If we are to use the opportunity that the 2 Year Old Offer will present, we need networks of specialists on hand to help train Early Years workers on identification and provision, so need to ensure that there are sufficient EYASENCOs employed in localities to meet need.

    • Take steps to encourage and support people with SENs to pursue a career in teaching – anecdotes from the evidence sessions raised concerns that aspiring teachers with certain SENDs (including dyslexia or deafness) are being put off or excluded from pursuing teaching qualifications due to the entry requirements and the Medical Fitness to Teach regulations. Labour in government should review these regulations and the application process to ensure that potentially competent teachers are not being excluded from training.

    • Labour should support personal budgets and direct payments, where they are shown to improve provision for all children, and offer value for money – we will also seek the following assurances on the face of the Children and Families Bill:

    • Parents who choose to take up personal budgets should be provided with expert advice on commissioning services.
    • Parents who do not wish to take up personal budgets will not be adversely affected.
    • Local authorities should have a commissioning and ongoing scrutiny role in ensuring that the quality of services (including independent advice services) in their area is high, and that they provide value for money.
    • Providers should be licensed, and therapies and other services they provide should be evidence-based and approved by an independent body.
    • The Department for Education should collect and annually publish information on Local Authorities, including the number of tribunal cases, nature and cost of cases – by increasing transparency, this measure will provide a powerful disincentive for the LAs whose corporate culture is to refuse statutory assessments or obfuscate on statemented obligations to reduce costs, provide an incentive for them to participate constructively and resolve problems in mediation, and give parents a measure by which they can hold their LA and its elected members to account. Other information which could be published includes number of statements completed on time, number of pupils sent to out-of-authority provision (and cost), attainment and destinations. If this does not improve performance, we will explore the possibility of greater powers for tribunals to impose effective sanctions.

    • The needs and competencies of the wider family should be central to drawing up the  Education, Health and Care Plan – having a child with an SEN or disability can be an extremely stressful for parents, and for other siblings or family members, and while the professionals are coming together to draw up the EHCP, it would be an effective use of their time to consider the needs of the whole family, rather than just the child as an individual. Supporting a child’s family to understand how to cope with and cater for a child’s SEN or disability is often the most cost-effective kind of intervention, and should be encouraged. However, over-estimating the ability of a family to support a child with certain conditions can also be detrimental to all concerned, affecting the mental health of family (including other siblings) and child, aggravating certain conditions, negating efforts and resources spent elsewhere, and increasing the likelihood of the need for more expensive residential care later on. Professionals therefore need to pay due regard to the ability of the family to cope, providing or recommending support where appropriate.

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    Selected health amendments endorsed at Labour’s National Policy Forum in Milton Keynes 18-20 July 2014. This report is not comprehensive. A set of fully amended documents will be available on the Labour Party’s Your Britain website.  Each paragraph is a separate amendment. Only the most significant are included. They will be cobbled together into a coherent narrative, but that is not what we have at the moment.

    Labour’s commitment to equality

    Labour is the Party of equality. We believe that no person should suffer discrimination or a lack of opportunity because of their gender, gender identity, age, disability, race, religion, socio-economic status or sexual orientation. In government, every decision we take will be taken with that in mind. We will ensure the policies across these eight documents and in our manifesto will be implemented ensuring that they further rather than hinder this cause.

    Labour has always led the fight for equality, but our fight is not yet won. We will not rest until everyone can live their lives free from hatred, fear and oppression. In government we will work to remove the structural and social barriers that stand in our way.

    Car Parking

    We also recognise that car parking charges have an impact on people’s ability to access and work in our health service, excessive charges clash with the founding values of the NHS, that the service should be free at the point of need. A survey by Macmillan Cancer Trust showed that the families of cancer victims could face parking charges of more than £400 per year that places real strain on families. Labour notes recent hikes in hospital car parking charges, which have added to the cost of living crisis facing families. Labour will undertake a review with a view to ensure a fair system of charging.


    Across the UK there are 6.5 million unpaid carers of which many receive no financial support of any kind, and this number is expected to rise to 9 million over the next 25 years.

    Labour believes that local authorities must be provided with the support required to ensure that carer’s needs are identified and assessed with appropriate assistance provided. In doing so this will help unpaid carers across the country, providing them with support that will in turn increase their quality of life and that of those they care for.


    Health and Wellbeing Boards will have a central role in the commissioning process for people with long-term conditions, disability and frailty – people whose care is often most fragmented and who are heavy users of health and care services. The Health and Wellbeing Board would be responsible for creating a local collective commissioning plan for this group of people – within a nationally defined outcome framework for the development of whole-person care – with a duty of CCGs and Local Authorities to enact the collective commissioning plan.

    In caring for those with complex needs, where local partners in communities want to move to a single budget for health and social care, or Joint Ventures, and have the capability to do so, the legislative framework should allow this to happen.

    Competition and Markets

    The NHS is the most important creation of the Labour movement – free at the point of need to embody our collective identity and the duties we owe to one another. We will ensure it remains rooted in the values that underpinned its creation – cooperation not privatisation and fragmentation. In a planned and collaborative system, Labour will reintroduce the NHS as the preferred provider so that NHS services do not needlessly face the threat of competition and destabilisation.

    Repealing the Act will ensure that the Secretary of State has a duty to provide a comprehensive national service which is free at the point of need, that private patients are not put before NHS patients, and that the conflicts of interest the Act created are tackled. We will also ensure that the Secretary of State is able to give directions to the NHS. Labour will break down barriers that prevent or deter co-operation. Labour will take competition law out of the NHS by ending Monitor’s role as an economic competition regulator and by scrapping the Section 75 regulations that force services to be put out to tender.

    By contrast, the Government’s free market approach has seen competition used to break up successful NHS services. Some studies have shown that marketised healthcare systems have worse health inequalities and higher costs, and in some situations marketization can lead to poorer quality care, for example higher hospitalisation rates. In a planned and collaborative system Labour will reintroduce the NHS as the preferred provider so that NHS services do not needlessly face the threat of competition and destabilisation. Labour’s commitment to the whole person care agenda will progressively reduce the purchaser provider split across the NHS, enabling local providers to determine how quality services should be delivered within the scope of a national framework. All Trusts – Foundation, NHS and Community Trusts – will need to be accountable to the public and operate within a collaborative and integrated system not a free market free for all. To support this, the mixed economy of Trusts and Foundation Trusts will need to be reviewed so that all service providers are fully integrated to deliver the whole-person care agenda in a collaborative, not competitive, way, and fully accountable to the public. Where additional services funded by the NHS (e.g. from the not for profit sector) they must work in close partnership with the NHS and terms and conditions of staff and public accountability must be prioritised to ensure we achieve high standards in care and terms and conditions. As part of this process we will review the effectiveness of the current TUPE legislation and make improvements where necessary. Labour recognises there is a role for the third sector and a limited role for independent sector organisations in providing health and care services where there are gaps in delivery, or where the NHS is unable to provide a high quality service.

    Meaningful choice is about the type of service that is provided and the way that service is delivered not which organisation is delivering it. As a result a Labour Government will abolish the damaging and overwhelming market system of “any qualified providers” that does nothing to provide real choice to patients. Instead of relying on a narrow form of choice, Labour will create a national entitlement, written into the NHS Constitution, to ensure that patients get legal rights to access to the services they need.

    In 2003 the previous Labour government established Foundation Trust Hospitals in England with the aim of making hospital services more accountable to local communities by giving Trust members a real say over their running. Ten years on the consensus is that, whilst more than 2 million people are members of Foundation Trusts, the model has not achieved its full potential and there is a need to re-awaken the original ambition behind it. One Nation Labour believes in more ‘people-powered’ public services and so a future Labour Government will consider ways of strengthening the role of members within Foundation Trusts and work to better engage and involve NHS staff in Trust membership.

    Health and Care Workforce Conditions

    Labour will restore the collection of Race Equality and ethnicity data as part of the specific duty on employment for public authorities bound by the general Public Sector Equality Duty. |Labour will develop a framework of action to tackle discrimination in the workforce of the NHS; measures to eradicate institutional racism in the workforce and to remove the ‘glass ceiling’ for workers from BAME communities.

    Labour will continue to support the excellent work carried out by health unions and strengthen and support the collective bargaining structures in the NHS. As part of this Labour will work towards a fairer system of pay setting that allows all parties a fair and informed process on pay determination. Labour would also commit to better supporting the social care workforce and ensuring that the integration of health and social care services never sees terms and conditions being levelled down, instead spreading the good practice in the NHS to social care; and we will investigate and consider the longer term goal of being able to bring care workers within Agenda for Change in line with the Kingsmill Report

    Social care workers carry out some of the most important work in society, caring for the sick, elderly and the disabled. Yet the current care crisis is seeing the work they do being increasingly undervalued. As well as the work being physically and emotionally demanding and often undertaken in social hours, there is strong evidence of exploitation in the care sector. This is something which Labour will strive to put right, including by tackling the abuse of zero hours contracts. Labour is committed to strengthening the enforcement of the National Minimum Wage and incentivising employers to pay the Living Wage, because we recognise that care workers are playing an invaluable role in meeting one of the greatest challenges we face as a society, and deserve to earn a decent living and be recognised for their work in caring for our most vulnerable loved ones some councils are already commissioning care providers to pay the living wage and this is a model that should be explored more widely. This is why Baroness Kingsmill has carried out a review of how to better understand and tackle exploitation in the care sector.


    Our vision of whole-person care recognises that the integration of services will deepen over time and that through both the restoration of a truly national health service through repealing the Health and Social Care Act and a strengthened national entitlement of services to be provided and patient rights, written into the NHS constitution, the postcode lottery will be minimised. Models of delivery should be developed from a strong evidence base of clinical and social effectiveness. This is about re-shaping the way care is delivered within communities and reducing health inequalities, and not another top-down structural reorganisation.

    Local Authority Responsibilities

    Greater localism of services should be a priority for future developments of the NHS. The transfer of Public Health responsibilities to Local Authorities has shown that this can have a beneficial impact, helping to deal with local priorities and local problems. There should however be an overarching framework to ensure that issues of post code lotteries do not dominate.

    Mental Health and Equalities

    Taking part in community activity is a vital way of protecting and improving mental health. The NHS support the growth of local voluntary and community groups as a whole, cooperating with the other services which have a mutual interest in this. We will ensure that health agencies play an active part in community development, with the clear objective of strengthening the role of the community and voluntary sector in relation to health. Labour will ensure all health and social care providers are compliant with the equalities act. It is also important that mental health providers are compliant with the Equalities Act.

    NHS agencies and providers will therefore be expected to play their part in ensuring that every locality has a thriving third sector. NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so. We will encourage firms to involve employees in businesses so that job control is increased. In other countries, such as Germany, workers councils are commons place in businesses.

    Labour recognises the link between unemployment and mental illnesses especially depression. Labour will ensure that mental health patients have equal treatment and resources as patients with physical illnesses. To ensure that mental health patient waiting times are reduced and that the distances travelled to access those services should not be excessive, Labour should take steps to introduce waiting time and access standards for mental health services.

    Local Authority Health and Wellbeing Boards should be informed by Mental Health and Wellbeing Strategies ensuring preventative as well as curative services and interventions.

    The needs of children with mental ill health are currently poorly addressed, with limited services provided. A future Labour Government will ensure that o this area of child health care will be properly resourced and that children needing mental health care will have their needs prioritised at the same level as those suffering from physical conditions.

    Labour recognise that failings in the provision of mental health care for BAME communities remain inadequate. Labour will put in place measures to improve the delivery of mental health care for BAME communities and in particular treatment, care and services for patients on psychiatric wards and services for young Black males

    NHS Funding

    We want to see a community in which power, wealth and opportunity are in the hands of the many not the few and where the rights we enjoy reflect the duties we owe. This will not happen in an unhealthy society where wealth is primarily inherited and the benefits of economic growth go to those who are already rich. Labour’s long-term goal is to break the link between a person’s social class and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this.

    Labour will develop new funding mechanisms for health and social care providers based on delivering quality, equitable and integrated services and incentivising health promotion and preventative care, rather than simply on volumes of episodic treatment. The Government has taken NHS funding away from deprived areas, hitting communities and risking an increase in health inequalities. Labour is committed to investing to improve primary care access, with a particular focus on tackling the health challenges of need and deprivation.

    The last Labour Government successfully brought UK health spending in line to that of other comparator economies after nearly two decades of Tory neglect. The Coalition’s ideological cuts agenda is now reversing that trend. This is not acceptable. The next Labour government will guarantee that health care is publicly funded through progressive means at levels that sustain it as a world leading public service. Funding will be redirected into service provision and will build on the last Labour Government’s levels of funding. On social care the starting point is that the status quo, including the government’s version of the Dilnot reforms, is no longer an option. Social care has never benefitted from a universal contributory system of funding and yet is intrinsically linked to health care. Funding within health will be redirected into service provision to ensure that it is spent to maximum effect.


    Alongside changes to protect the NHS from future privatisation, we will ensure all outsourced contracts for services, including under the Health and Social Care Act 2012, are properly managed to ensure they are meeting clinical and financial standards. Where contracted services are failing, we will consider all the options, including bringing them back into the public sector. Future contracting decisions will be based on what contributes to integration through the whole person care agenda.

    Labour will also insure that existing and future procurement projects for public infrastructure and services are scrutinised and action taken to ensure they deliver best value for money for the taxpayer and the NHS, learning from past experience, using contractural flexibility to the full and making sure that charges are not at the expense of patient care or appropriate terms and conditions for staff.


    Labour will also ensure that procurement models for public infrastructure and services deliver value for money for the tax payer and the NHS, learning from past experience, using contractual flexibility to the full, and making sure that they are not at the expense of appropriate terms and conditions for staff.

    Primary Care

    As part of the next Labour Government’s plan to improve services for patients and ease the pressure on hospitals, the next Labour Government will give all NHS patients the right to a same-day consultation with their local GP surgery, the right a GP appointment at their surgery within 48 hours or the right to book an appointment more than 48 hours ahead with the GP of their choice. To help ease pressures and support the delivery of these new standards, we will invest an extra £100 million a year in general practice, funded by savings made from scrapping the Government’s new competition rules which have led to increased costs in the NHS, and from cutting back on the new bureaucracy created in the Government’s NHS reorganisation. The last Labour Government increased GP numbers to record levels, but numbers have fallen since 2009/10 and the Government is far off meeting its stated goal of 3,250 training places a year. So GP recruitment will be a priority for Labour, including through promoting general practice as a career choice, supporting GP returners back to work and encouraging recruitment in under-doctored areas.

    General Practice is under pressure through squeezed budgets, falling recruitment and new commitments from greater involvement in commissioning. It is important that General Practice is able to serve patients, improve access and outcomes. Labour will work with GPs to improve GP registration, including in hard to reach groups. NHS Walk-in Centres have played a vital and successful role in enabling people to access care and reliving pressure on A&E. We have been clear that it is short-sighted to close walk in centres. So it is a huge concern that a quarter of walk-in centres have been closed since 2010. Labour continues to support Walk-in centres. Where they are well used and valued, they should be retained. Labour will review the impact that closures of walk-in centres have had on people’s ability to access primary care services.

    Public Health

    Given that there is public demand for both high standards of health and social care, and for low taxes, governments should take a strong approach in promoting healthy living to reduce NHS expenditure and increase quality of life and healthy life expectancy. To that end, Labour will introduce initiatives and measures to reduce; smoking and excessive alcohol consumption; excessive sugar, salt and fat in food; food fraud, and air pollution.

    The Government’s ‘Responsibility Deal’ has lost credibility as professional bodies have withdrawn from it due to the domination of the agenda by commercial interests. Commercial interests are not necessarily aligned with the aim of improving population health, and excessive consumption of foods high in sugar, salt and fat can have a significant negative impact on the health of citizens and consequently create demands on the Health Service. The growth of chronic illness such as Type 2 Diabetes serves to illustrate this point.

    We will make healthy choices easier by encouraging affordable healthy products such as fresh fruit and vegetables while taking action to help people avoid the excessive consumption of unhealthy products high in fat (including trans fats), salt and sugar, including through regulation where appropriate. We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers wherever it is sold.

    We will also take action to tackle supermarkets selling dangerous quantities of low-cost alcohol that fuel binge drinking and harm health, and further action to help young people not take up smoking.

    Labour will work to eliminate inequalities in providing public health information to ensure improvements in service delivery benefit BAME communities.


    We will reverse the introduction in the care Bill of sweeping powers to force changes to services across an entire region without proper public consultation. We will also extend freedom of information legislation to cover all organisations delivering public service contracts, including the private sector. On coming into office, we will be clear that service changes and reconfigurations should be clinically driven, not financially driven.

    Regulation of private care agencies

    Labour will ensure more effective regulation of public and private health care providers. We will review progress on the ‘certificate of fundamental care’, recommended by the “Review of healthcare assistants and support workers in NHS and Social Care” to see if further steps should be taken.

    Regulation of therapists

    Labour strongly believe that being LGBT is not an illness and it should never be treated as something which is curable, which is why we believe public money should never be spent on ‘conversion or cure’ therapies. Labour will ensure that existing safeguards are strengthened to prevent this from happening and will examine the effectiveness of the current system of regulation. Labour will work with the professional bodies to ensure that publically funded services enforce the Equalities Act 2010.

    Social Care

    The current eligibility criteria for social care are often interpreted according to available resources locally, often rendering them meaningless. National minimum eligibility criteria must be used to set a baseline giving everyone the right to be kept safe and well. Beyond this, Labour will work with key interests to agree the standard of wellbeing and independent living for older and disabled people, in line with the UN convention (on the rights of persons with disabilities) that our society should aspire to, and to help inform future spending priorities.

    A One Nation Labour government will seek to ensure that no on fears their old age or struggles to cope with the care of a loved orv&.21st century care service that is integrated with the NHS and focused on the person being cared for must be underpinned by professional standards, regulation enshrined in law and a trained and valued workforce on fair pay, terms and conditions, and represented through a sectoral body. We cannott ask our system and workforce to do more for less as our elderly population increases and demand for care rises. Such a system would be as transformative as the introduction if the NHS for those who need care, their families and care workers across the country – that majority of whom are women.

    …operating from the starting point that the status quo, including the government’s version of the Dilnot reforms, is no longer an option. Various ways of supporting and funding improved care must be considered. Bureaucratic and misleading Resource Allocation Systems used by councils should be reformed, with personal budgets becoming optional as part of a new focus on making personalisation meaningful

    Transatlantic Trade and Investment Partners

    Labour share the concerns that have been raised about the impact that TTIP could have on public services. Labour believes that the NHS and all public services need to be more, not less, integrated and we are concerned that including public services in the final TTIP could increase the fragmentation of health services that is already taking place under this Government, That is why we believe that the NHS and public services should not be included in any TTIP agreement.

    Labour believes that key to an EU US trade deal that we would encourage the rest of Europe to support, which avoids a race to the bottom and promotes decent jobs and growth would be safeguards and progress on labour, environmental and health and safety standards.

    Labour has raised concerns over the inclusion of an ISDS mechanism in TTIP. Labour believes that the right of governments to legislate for legitimate public policy objectives should be protected effectively in any dispute resolution mechanisms.

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    Part of our response to the Labour Party Policy consultation June 2012

    What aspects of your local NHS could be improved upon?

    1. The local NHS is expected to tackle problems associated with the consumption of alcohol, tobacco and other addictive drugs, too much fat sugar and salt and a sedentary lifestyle with little support from central or local government.
    2. GP services that provide proactive and responsive primary care – they seem to provide ever less.
    3. Mental health services that are effective, have a social model of mental distress (while treating biological problems) and are integrated into he wider social and health support systems.
    4. Proper public dentistry system rather than the anarchic patchwork of profit seeking private contractors.

    Are there positive examples in your local NHS that others could learn from?

    1)     Cooperative Commissioning: Lewisham have agreed to implement this new approach to collaborative work.

    2)     LINk database: Lewisham LINk has designed and used a database into which all patient experience is placed. We now have 1000s of comments which can be used to guide commissioning decisions in the patients’ interests.

    3)     A Patient and Public Involvement Strategy that is simple, cheap and effective in Lewisham – and very collaborative, bringing together all the key players.

    4)     Community Development that works with local people and local organisations to improve health and behaviour change.

    5)     Collaborative partnerships in Oxfordshire between health and social care in the areas of learning disability (intellectual disability), rehabilitation of older people; community (salaried) dental service. Walk in clinics before the PCT axed them!

    6)      North Lancashire CCG is pioneering a self care project to try and change Health Professionals and patients attitudes to this. It is a supertanker to turn round but can be done. If Labour grasp this one they could be streets ahead on this issue.

     What kind of service do we want to see for carers and families are there any examples of local services that are working well?

    1. We don’t think there is perfection anywhere. The key principle is to create channels of communication and the opportunity to challenge what the services do – the major improvements in our experience have all come about as a result of this. Some of this can be mandated via policy but a lot comes from local commitment and hard work – easier if there is an enabling policy context.
    2. There are far too many stories of carers of people with learning difficulties or dementia being completely ignored by hospital services


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