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    Only 4 candidates sent personal statements for the SHA.

    Angela Rayner Statement

    Keir Starmer Statement

    Richard Burgon’s Short statement for the Socialist Health Association

    Rosena Allin-Khan Statement

    Here are the links to the candidates profiles on the Labour Party website.

    Rebecca Long-Bailey( personal leadership weblink)

    Rebecca Long-Baily ( Labour Party website profile)

    Lisa Nandy ( personal leadership weblink)

    Lisa Nandy ( Labour Party website profile )

    Keir Starmer

    Rosena Allin-Khan

    Richard Burgon

    Dawn Butler

    Ian Murray

    Response to an SHA representative’s question at a Husting’s

    At a packed meeting last night in Oxford Rebecca Long-Baily


    Ballot executed via Election Buddy and postal voting papers running from 24/01/2020 to 30/01/2020 for the Election Buddy ballot and 22/01/2020 to 04/02/2020 for the postal ballot papers ( to allow time for the papers to be delivered and returned. Postal ballots were sent 2nd class and included a SAE ( 2nd class ).

    955 Online voters emails and membership number were entered into the EB ballot.

    63 postal papers ( plus another 9 for hard bounced email addresses ) were sent out.

    325 votes submitted, 1 spoilt and 28 paper votes returned. ( not all paper ballot returned contain a vote for both the Leader and Deputy Leader. )

    The results are as follows.

    Ballot for the SHA nomination for the future Leader of The Labour Party.

    Name of CandidateEB BallotPaper BallotTotal votes
    Keir Starmer149 (45.8%)14163
    Rebecca Long-Bailey120 (36.9%)8128
    Lisa Nandy45 (13.8%)348
    Emily Thornberry11 (3.4% ) 112
    Jess Phillips11

    Total number of votes tallied      325 

    Jess withdrew her candidature after postal ballot papers were sent out.

    Ballot for the SHA nomination for the future Deputy Leader of The Labour Party.

    Name of CandidateEB ballotPaper ballotTotal votes
    Angela Rayner118 (36.3% )10128
    Richard Burgon88 (27.1% )795
    Rosena Allin-Khan54 (16.6% )155
    Ian Murray36 (11.1% )339
    Dawn Butler29 (8.9% ) 332


    Keir Starmer wins and is the SHA nomination for Leader of the Labour Party.

    Angela Rayner wins and is the SHA nomination for the Deputy Leader of the Labour Party.

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    SHA Scotland Meeting

    Further to the notice of the AGM to be held on 23 January, I am writing to notify members of an additional agenda item.

    ·         Scottish Labour Deputy Leader nomination – There are two validly nominated candidates after the first stage – Jackie Baillie and Matt Kerr. The next stage is CLP/Affiliate nominations and SHA Scotland is entitled to make one nomination.

    The UK Party Leader and Deputy Leader nominations are the responsibility of UK SHA and all paid up members should have received a communication from them on this issue.

    I look forward to seeing you on Thursday.

    Yours fraternally

    Dave Watson

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    I have been requested to post the Scottish Labour Party Manifesto 2019.


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    David Taylor-Gooby, Secretary of the North East Branch, has asked us to put this information on the website.

    Dr Williams is a respected as a hard working MP, with a reputation for honesty and integrity.  He is an SHA member, in fact the only NE MP in the SHA.  He still practices as a GP.  He is a formidable SHA campaigner, but only has a majority of 888.  David would like to enlist our support for Dr Williams where we can.



    1 Comment

    The introduction of Accountable Care Organisations – or whatever they are called this week – brings a lot of talk not only about integrating health and social care, but also about local accountability.  The accountability seems to be more about accountants than about democracy, but in principle local elected councillors could have a voice in the working of health services  which they haven’t had for many years.  We asked our members how health had featured in their local election campaiogns.

    Of course we were looking mostly at how local Labour parties dealt with health – but some of our members reported that the Green Party had more to say about the NHS than Labour.

    Enfield Labour Party

    Their manifesto said they had  IMPROVED HEALTH:

    • Increased fitness with 12 outdoor gyms and outdoor playing spaces
    • Opened a world class sexual health clinic
    • Cut smoking prevalence by 6% since 2012
    • Helped cut the life expectancy gap between the rich and poor and cut teenage pregnancy rate in the borough

    and pledged that they would:

    • launch a Borough Poverty and Community Fairness Commission
    •  tackle discrimination based on sex, race, disability, age, sexual orientation, gender reassignment, religion or belief, marital status, or pregnancy and maternity
    • oppose Tory policies that drive division and disadvantage in our community and tackle the causes of childhood poverty giving every child a good start in life
    • develop our holistic approach to adult social care meeting needs in housing, advocacy and support
    • continue to oppose the privatisation of our NHS
    • campaign for more GPs and better surgeries
    • put public health at the heart of policies for improving the quality of life of residents by promot-ing healthy lifestyles and physical activities
    • continue to subsidise leisure facilities and services for older people
    • give mental health the same priority as physical health
    • support increased integration between the NHS and Adult Social Care to meet residents’ needs and cut bureaucracy
    • reduce air pollution through clever design and screening of roads
    • crackdown on illegal tobacco and cigarette selling
    • ensure food safety standards and hygiene in business premises

    Hertfordshire Labour Party

    Hertfordshire leaflet

    Colchester Borough Labour Party

    reported they had redesigned two outdated sheltered housing schemes to provide fully accessible 21st Century older persons’ apartments.

    Manifesto commitments:  A Labour-led council would improve the health and wellbeing of the Borough and its residents by:

    • Continuing to question whether the merger of Colchester and Ipswich Hospital Trusts is in the best interests of our residents and communities;
    • Demanding a greater say in the NHS Sustainability and Transformation plans and programmes for our area, which means objecting to one Clinical Commissioning Group run from Suffolk;
    • Involving the Borough Council in the integration of health and social care provision;
    • Lobbying the government to significantly increase spending on the NHS;
    • Providing more sheltered, supported and extra care accommodation by working with a range of partners across all sectors;
    • Campaign on easy accessibility for all public buildings – especially the Work Capability Assessment centre;
    • Instigating more Changing Places toilets.

    Manchester Labour Party

    Put Health and Social Care at the front of their campaign – as perhaps is appropriate when Manchester is said to be leading the way.

    Manchester people made caring for those most in need in the City their number one priority so it is the number one priority for Manchester Labour. By taking control of our health and care services we will protect our NHS and help Manchester people live longer, healthier, happier lives.

    We will:
    ● Increase pay for homecare workers to at least the Manchester Living Wage
    ● Employ more people to support vulnerable residents to stay in their own homes using the 1.5% Council Tax increase raised for adult
    ● Begin construction of at least 200 homes for older people at social rents as part of our extra-care schemes
    ● Invest to improve local access to community mental health services

    1 Comment

    The election showed that people across the country welcomed a left-leaning set of policies.

    The financial crisis and the right-wing’s austerity response to it has left the country poorer and more unequal both financially and socially. By offering a comprehensive manifesto that showed a practical route towards more investment in the country, its institutions and its people, Corbyn and McDonnell have broken the assumptions of Labour Party policy-making since 1997.

    Political conversation in the UK has moved so far to the right in the last 20 years that social democratic polices commonplace across Europe are seen by the media as radical and left-wing here. And Keynesian economic policy was seen as dangerously radical.

    So, at least we can feel on more popular ground demanding an end to privatisation and more investment into the NHS.

    The NHS should not even be seen as a cost to the state and to all of us. It is an investment with at least a 4:1 return.

    As the economist Ha-Joon Chang says 

    Both Labour and the Tories see tax as a burden that needs to be minimised. But would you call the money that you pay for your takeaway curry or Netflix subscription a burden? You wouldn’t, because you recognise that you are getting your curry and TV shows in return. Likewise, you shouldn’t call your taxes a burden because in return you get an array of public services, from education, health and old-age care, through to flood defence and roads to the police and military.

    If tax really were a pure burden, all rich individuals and companies would move to Paraguay or Bulgaria, where the top rate of income tax is 10%. Of course, this does not happen because, in those countries, in return for low tax you get poor public services. Conversely, most rich Swedes don’t go into tax exile because of their 60% top income tax rate, because they get a good welfare state and excellent education in return. Japanese and German companies don’t move out of their countries in droves despite some of the highest corporate income tax rates in the world (31% and 30% respectively) because they get good infrastructure, well-educated workers, strong public support for research and development, and so on.

    So, we should be demanding right now an end to this unstable DUP/Tory connection – even if the DUP interest in more state investment in public services comes into play. We want a comprehensive set of policies that tackle not only the immediate requirements to prevent a Greek-style collapse of the health service, but an approach that begins to tackle the causes of the causes of ill-health: health inequalities, child poverty, poor housing, degradation of the educational system, isolation, communities under pressure with reducing support and civic life.

    While we wait for this unstable arrangement to collapse, we need to keep making clear demands for the NHS and the wider system. If necessary, GPs and nurses must go further than at present towards industrial action. We cannot wait for the NHS to unravel.

    We now have a far clearer mandate – we can take forward a left-leaning set of policies and feel that we are not alone.

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    Cheered up by last week? The last few weeks have given us a respite from a seemingly endless wave of victories by populists and the right: after a miserable 2016, we have seen the radical right narrowly defeated in the Austrian presidential election, heavily defeated in the second round of the French presidential election and in the legislative vote, in decline in Germany and locked out of government in the Netherlands. And did I mention a hung parliament in the UK?

    Brexit bus

    It might be nice to relax and go back to critiquing neoliberalism, but we should not. The populist radical right is still a force to worry about for four reasons.

    First, these electoral victories are not so impressive as they might look. In electoral terms, these votes are still scary. Only in the context of 2016 should we be glad that over forty percent of the French and Austrian electorates have voted for candidates from the darkest areas of the right.

    Second, the right is directly wielding a lot of power. The radical right is in government or close to it in a number of smaller European countries. Trump is president. Despite much wishful thinking, he is likely to be president until January 2021. The UK is still likely to be governed by the Conservatives… partnering with the Democratic Unionists, a party of the radical right that has benefited until now from the refusal of the UK media to pay attention to Northern Ireland.

    Third, the right shapes agendas. There is an alarming coincidence between the manifestos of UKIP and the manifesto that gave the Tories one of their highest-ever vote shares in the last election. The French even have a word for it: Droitisation, or the way the far right pulls the moderate right and even the center-left towards it, aping its arguments in an effort to get its voters. Theresa May’s whole campaign is a nice example of that. But Jeremy Corbyn, who broke with convention on so much, didn’t break with the increasingly nativist tone of politics on Brexit or immigration control.

    Fourth, as the last two years have shown, politics after a decade of financial crisis isn’t easy to predict. Parties and party systems across the West have been losing stability for decades, social democratic parties have been eroding and the center-right becoming less centrist while the populist radical right parties grow.

    Political scientists have written much about the populist radical right, which I review in a new article (free). The populist radical right has three characteristics. It is populist, siding with the people’s common sense over elite knowledge. It is nativist, believing there is a nation that needs defending. And it is authoritarian, expressing love and respect for authority. In the UK, that means UKIP and the DUP as well as some solid fraction of the Conservative party.

    This is basically a toxic brew from the perspective of any likely reader of this blog. Populism is affirming since it relies on arguments anybody can understand. Authoritarianism is both popular in its own right and easy to trigger with, for example, scare stories about migrants.

    Nativism, finally, can lead to “welfare chauvinism”, or what Alexandre Afonso calls “fake socialism”: not a neoliberal platform of cutbacks, but rather a generous and very exclusive, nativist welfare state. Think a well funded NHS that you can only use if you provide two forms of ID proving you legally reside in the UK. Trump, Le Pen, and May all campaigned on platforms with a strong element of welfare chauvninism.

    Fortunately, there is not a lot of research showing that the populist radical right in office actually pursues welfare chauvinist policies. For a long time, the research found that they ran on welfare chauvinist themes and then enacted classic right-wing cutbacks (which is what you would expect of parties with a strong base in small business people who are notoriously hostile to regulation and welfare states). More recent research has found that in systems where they enter government in coalition, such as Austria or Belgium, they achieve little and what they achieve is in restricting access to benefits- more chauvinism, but not more welfare. The main reason or that is coalition government, which tempers the policy effect of any given party. The newest research seems to show that they also cut back less on welfare budgets relative to more conventional right parties. So: lots of chauvinism, not so much welfare.

    In other words, the potential of welfare chauvinism is not being exploited, or at least consistently translated into policy. Trump is a particularly extreme example. After running as a welfare chauvinist candidate (whose logic pointed to a fully funded NHS for white people), he is promoting a Tea Party agenda that will be devastating to, in particular, working class rural whites above fifty who are a key part of his support. May talked a good welfare chauvinist game until people saw the Conservative manifesto, which was chauvinist without the welfare.

    As the Canadian writer Jeet Heer noted of the unexpectedly good Labour result, it “looks like you can get young people, minorities, and white working class in a coalition if you offer them something.” That is a niche worth filling. Social Democratic parties exist to fill it, and collapsed after instead becoming unconvincing catch all parties. The populist radical right remains a threat, but if it empowers social democrats to actually pursue social democracy, then the long run outcome might be positive.

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    In order to achieve health for everyone we need

    Safety, peace and security

    This means peace of mind, which includes freedom from fear and violence in the home, community, nationally and internationally

    Equitable social, economic and environmental conditions for health

    This means fair wages, decent income, safe working conditions, clean and safe environments, decent affordable housing, affordable, safe and clean transport

    Food and water security and sustainability

    This means a safe and stable supply of nutritious food and clean water, and food production that does not waste resources and can be maintained indefinitely

    Universally available and holistic health and social care

    This means high quality health and social care throughout life, that takes account of the whole person, and which is free at the point of use and publicly provided

    A fair, more equitable economic and social system that recognises the strength of social diversity and solidarity

    This means a fair and equitable economic and social system that is in everybody’s interests and a recognition that different groups of people have more in common with each other than differences

    Engaged, informed and politically active population

    This means that people are fully involved in the democratic process and have access to unbiased information to enable them to make political judgements

    Loving, supportive and respectful relationships

    This means people can feel secure in their family and personal relationships without fear of violence, prejudice or interference from others.

    Meaningful, accessible education for all

    This means a fair and equitable education system that is tax-funded and available to all, from primary schools to higher education.

    Background to the UK Charter for Health

    Thirty years ago, the Ottawa Charter for Health Promotion generated worldwide interest in a new public health, based on the promotion of healthy public policies, environments conducive to health, inclusive public services and community and individual action. Forty countries, including the UK, signed up to the charter. Thirty years later we have a clearer understanding of the relationships between politics, public policy and health but are still battling against the odds to realise the aims of the charter. Over the summer of 2016 the Politics of Health Group working with The Equality Trust and Birmingham City University, held a number of events around the country, where people and organisations from across the social spectrum gathered to discuss how we can achieve health justice in the UK.

    The findings from these meetings fed into a national event on 23rd November 2016 when over 100 people came together at Birmingham City University to work on a new charter for health for the UK – specifically, a charter that challenges health inequalities head on. Kate Pickett (co-author, with Richard Wilkinson, of The Spirit Level) made a powerful case for change, demonstrating how the economic model that has held sway for over 30 years has not only failed to shift the gross inequalities in health that are a stain on British society, but has exacerbated them. The day resulted in ideas aplenty for policy and action.

    The UK Charter for Health is drawn from the ideas and feedback from the meetings held in 2016 (for details see here), and from other similar work such as the Politics of Health Group Charter for Health, The Scottish People’s Health Manifesto and student work at the university. Over the coming period we hope that concerned communities, organisations, professionals, politicians, activists and campaigners will use the charter to promote discussion and develop ideas for action to reduce inequalities in health. We want the charter to become a catalyst for a new strategic direction – one that recognises the social and economic determinants of poor health – and by putting the charter into practice make it a powerful tool for change.

    The Politics of Health Group


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    A manifesto with and for disabled people

    Over the last seven years disabled people have borne the brunt of the cuts inflicted on them by the Conservative Government and the Coalition before them. The cuts have had a detrimental effect on the lives of disabled people, cutting living standards and undermining their access to education, social care and to justice.

    Two years ago the United Nations  convened a committee to investigate state violations of the UN Convention of the Rights of Persons with Disabilities (UN CRPD). Last year the UN published their report and concluded that the Conservative Government had committed ‘grave, systematic violations of the rights of persons with disabilities.’ This is a damning indictment of the treatment of disabled people by the Conservatives, one which shames us as a country.

    We believe in a social model of disability, a society which removes the barriers restricting opportunities and choices for disabled people. As such we will build on the previous Labour government’s commitment to disabled people in 2009 as signatories to the UN CRPD. A Labour government will incorporate the UN CRPD into UK law.

    We are proud of the manifesto we have developed with, and for, disabled people, and would like to take the opportunity of thanking everyone who has taken part in Labour’s Disability Equality Roadshow over the last year. We have crossed the length and breadth of the country to engage with disabled people and their carers, capturing their views on what needs to change for disabled people to live full and independent lives. We will continue to work with disabled people in government, fulfilling our promise of ‘nothing about you, without you’.

    Disability Equality


    Labour is the party of equality and diversity. The next Labour government will ensure that no-one in our society is held back. We know that fairer societies are better for all of us. To truly achieve this, the next Labour government  will build a Britain for the many: a fairer, more equal and diverse society that treats people of all backgrounds and abilities with dignity and respect.

    Over the last seven years, disabled people, including people with physical or mental impairments and long-term health conditions, have been scapegoated by the Conservative Government and the Coalition. A 2016 UN inquiry found that since 2010 the UK Government has been responsible for ‘grave, systematic violations’ of the UN Convention of the Rights of Persons with Disabilities. The Conservatives have stonewalled this unprecedented inquiry and refused to enact its recommendations.

    Disabled people are twice as likely to live in poverty compared with non-disabled people in part due to the extra costs associated with their disability. This has not stopped the Conservatives from disproportionately targeting disabled people with their destructive cuts. Currently 4.2 million disabled people live in poverty and new evidence indicates that this number is increasing as a result of cuts in support. According to Scope, the 2012 Welfare Reform Act has cut nearly £28 billion in social security support from 3.7 million disabled people. The 2016 Welfare Act cuts are adding to the real suffering many disabled people are experiencing. And of course this doesn’t include the cuts in social care, or the NHS, or education or transport, all of which have directly affected disabled people.

    In 2016, the Labour Party launched the Disability Equality Roadshow, to ensure as we developed new policies for government, we fully engaged with disabled people and their carers, committing to the principle ‘nothing about me, without me’. As part of the Disability Equality Roadshow, we travelled the length and breadth of the country, meeting with thousands of disabled people, carers and stakeholders. We discussed the issues they face and their priorities for the future, focusing on the articles of the UN CRPD. Disabled people who were unable to attend the events were able to submit their views to us online. We have collated and consolidated all of this information in the pledges that we set out here in this manifesto ‘With and for Disabled People’.

    Only Labour will champion the rights of disabled people and build a country where disabled people are supported to lead fulfilling and independent lives. We are committed to a social model of disability and will enshrine the UN Convention on the Rights of Disabled People fully into UK law. Labour will do away with the Work Capability and Personal Independence Payment assessments and replace them with a personalised, holistic process which provides each individual with a tailored plan, building on their strengths and addressing barriers, whether finance, skills, health, care, transport, or housing related. We will reverse cruel Conservative changes to Personal Independence Payments, which are denying 160,000 disabled people the support they need and we will scrap the Conservatives’ punitive sanctions regime. Under a Labour government, disability issues will be incorporated into every single government department. Labour will support disabled people into work, halving the disability employment gap. And we will reverse cuts to the Work-Related Activity Component of Employment Support Allowance, affecting half a million sick and disabled people.


    • Labour supports a social model of disability. People may have a condition or an impairment but are disabled by society. We need to remove the barriers in society that restrict opportunities and choices for disabled people.
    • Labour will build on the previous Labour Government’s commitment to disabled people in 2009 as signatories to the United Nations Convention of the Rights of Persons with Disabilities . A new Labour Government will incorporate the UN CRPD into UK law.
    • Labour will transform our social security system. Like the NHS, our social security system should be there for all of us in our time of need, providing security and dignity in retirement and the basics in life should we become sick or disabled, or fall on hard times.
    • We will repeal cuts in social security support to disabled people through a new Social Security Bill published in our first year of office.
    • Labour will scrap the Work Capability and Personal Independence Payment assessments and replace them with a personalised, holistic assessment process which provides each individual with a tailored plan, building on their strengths and addressing barriers, whether finance, skills, health, care, transport, or housing related.
    • Labour will change the culture of the social security system, from one that demonises sick and disabled people to one that is supportive and enabling. As a starting point we will scrap the Conservatives’ punitive sanctions regime and change how Job Centre Plus staff are performance managed.


    “ We [disabled people] are treated as being guilty by the DWP until we prove that we are innocent.”
    “The current social security system is taking away peoples’ choices over their lives and taking away their fundamental rights.”

    Disability Equality Roadshow participants


    • Labour will transform our social security system. Like the NHS, our social security system should be there for all of us in our time of need, providing security and dignity in retirement and the basics in life should we become sick or disabled, or fall on hard times. We will repeal cuts in social security support to disabled people through a new Social Security Bill published in our first year of office.
    • Labour will reverse the cruel cuts to Personal Independence Payments, Employment Support Allowance Work-Related Activity Group and Universal Credit Limited Capability to Work and we will repeal the hideous Bedroom Tax which has punished so many disabled and non-disabled people. The Conservatives’ punitive sanctions will go too.
    • Labour will scrap the discredited Work Capability and Personal Independence Payment assessments and replace them with a personalised, holistic assessment process which provides each individual with a tailored plan, building on their strengths and addressing barriers, whether financial, skills, health, care, transport, or housing related.

    Over the last seven years, disabled people have borne the brunt of the social security cuts from the Conservatives and the Conservative-Lib Dem Coalition before them.

    The 2012 Welfare Reform Act has been estimated by Scope to have cut approximately £28 billion in social security support from 3.7 million disabled people in spite of it being well recognised that disabled people are twice as likely to live in poverty as non-disabled people in part by virtue of the extra costs associated with their disability.

    The 2012 Act included the introduction of Personal Independence Payment (PIP) to replace Disability Living Allowance (DLA), a new sanctions regime, and new assessment processes for Employment and Support Allowance (ESA) and PIP. All of these have had serious concerns raised about them, including from the UN inquiry who said there were ‘grave, systematic violations’ on the rights of disabled people, the Information Commissioner concerning the deaths of claimants following their Work Capability Assessment finding them fit for work, and indeed the most recent reviewer of PIP who raised concerns yet again about the quality and reliability of the PIP assessment process where two thirds of decisions are overturned on appeal.

    According to the Coalition Government’s estimates, by 2018, 600,000 fewer people will be getting PIP than received DLA. The mental health charity MIND has revealed that 55% of people with mental health conditions transferring from DLA to PIP are being assessed as ineligible for PIP or having their support reduced. These figures are before the disgraceful introduction of new PIP regulations without any debate in Parliament, which overturned two tribunal rulings that people with mental health conditions should receive the higher rate of PIP support. So much for parity of esteem for people with mental health conditions: another broken promise from the Conservatives.

    The Conservative Government’s own figures show that since 2010, we are spending less and less in supporting disabled people as a percentage of our country’s wealth (Gross Domestic Product, GDP). Eurostat data from 2012 shows that we ranked 17th out of 32 EU countries in spending on disability support as a percentage of GDP.

    In spite of the Conservatives pledging not to cut support to disabled people in their 2015 manifesto, the 2016 Welfare Reform and Work Act did exactly that. In addition to the four-year freeze in social security support affecting disabled people, the 2016 Act cut financial support by £1500 a year to half a million disabled people who had been found not fit-for-work but who may be in the future on the ESA Work-Related Activity Group.

    In Scotland, in spite of talking the talk, the Scottish National Party (SNP) has failed to tackle the difficulties disabled people face with the devolved powers at their disposal. The SNP Government had the opportunity to protect disabled people from the full impact of the Conservatives’ punitive social security cuts as the social security budget was due to be devolved to the Scottish Parliament under the Scotland Act this year. Although they now have control over 11 types of social security support, they have failed to make any discernible difference to the lives of disabled people.

    The Conservatives have fostered an insidious culture of fear and blame to justify their programme of cuts, deliberately attempting to vilify social security claimants as the new undeserving poor. Labour will transform our social security system to one that is efficient, responsive, and provides basic support. Time and time again, we have heard how worthless the system makes people feel. For the vast majority of people who have paid into it all their working lives, this is insulting.

    Work should always pay more than being on social security; but relying on social security should not leave people feeling worthless and abandoned as it does now.

    Labour has already pledged to get rid of the discriminatory and unfair Bedroom Tax, but we will also scrap the discredited Work Capability and Personal Independence Payment assessments and replace them with a system based on personalised, holistic support, one that provides each individual with a tailored plan, building on their strengths and addressing barriers, whether finance, skills, health, care, transport, or housing related. We want to stop the profiteering from these assessments, so we will use public or voluntary sector organisations which are local and accessible to claimants, not those private companies that have manipulated the system for maximum profits.

    The Conservatives’ punitive sanctions system must go too, so Job Centre Plus will be reformed and not just assessed on how many people they get off their books. Labour will change the culture of our social security system and how the public see it. Like the NHS, it is based on principles of inclusion, support and security for all, assuring our dignity and the basics of life were we to fall on hard times or become incapacitated. It is there for all of us should any one of us become sick or disabled.


    “ I declared my mental health condition [when I applied for a job] and even though my experiences and qualifications made me suitable for the position, I didn’t even get an interview. Even though I am similarly or better qualified than others going for the same job.”
    Disability Equality Roadshow participant


    • Labour will halve the disability employment gap by supporting employers retain employees who may have developed a long-term health condition or an impairment. Job Centre Plus will have a new duty to work with local authorities and local employers on recruitment needs and practices. Employees with an impairment or chronic condition will have a new right to flexible working.
    • We will require organisations with over 250 employees to report annually on the number and proportion of disabled people they employ.
    • We will commission a review to explore how we can expand Access to Work support, including for self-employed disabled people.
    • Labour will review specialist employment services and will work with local authorities, unions and the voluntary sector to develop local, alternative employment opportunities for disabled people transitioning into employment or who may need more supportive work environments, such as the social enterprise ‘Enabled Works’ in Morley, Leeds.

    The disability employment gap – the gap in employment between non-disabled and disabled people – is currently 31%. In 2015, it was 32%. The Conservatives pledged to halve the disability employment gap in their 2015 General Election manifesto. At the current rate it will take 50 years for this to be achieved. Although four million people with disabilities are working already, there are another three million who are available to and want to work, but are currently unemployed. As the vast majority (90%) of disabled people have worked previously this is a waste of their skills, experience and talent.

    There are implications for the economy and society as a whole. Research from the Social Market Foundation has estimated that halving the disability employment gap and supporting one million more disabled people into work would boost the economy by £13 billion a year.

    There are many reasons for the disability employment gap including a lack of information and advice for employers. A recent survey showed 15% of disabled people felt they had been discriminated against when applying for a job, and one in five while they were in work. That’s why the next Labour government will work with employers to overcome these issues through stronger laws and proper enforcement of the Equality Act.

    The Conservatives’ warm words have not been followed up with any meaningful action. After closing 48 Remploy factories for disabled people in 2013, making 2,000 people redundant in the process, they failed to transfer the money that they had saved from these closures to support disabled people into work. The chaos and inadequacy of the specialist employment support programme, Access to Work, which last year supported just over 37,000 disabled people into and at work, and Job Centre Plus’ Disability Employment service show the Conservatives are not serious about tackling the disability employment gap.

    The SNP government in Scotland also promised to reduce the disability employment gap by at least half. However, since they took office they have failed to propose any policies that would help disabled people find meaningful employment and to tackle the disability employment gap.

    Labour has already pledged to halve the disability employment gap. Over the next ten years we want to see a cultural shift in attitudes to people with chronic and fluctuating health conditions and disabilities in work and across society as a whole. To raise awareness of disability and work issues, every year we will require organisations with over 250 people to publish the number of disabled people that they employ.

    We will support disabled people to stay in work or get back into work by increasing the numbers of disabled people who will be able to receive Access to Work support. We also want to expand Access to Work support to self-employed disabled people. We will ensure specialist disability employment advisers are there to support disabled people as part of our reform of Job Centre Plus.

    Labour recognises that for some disabled people it may not be possible to participate in mainstream work; as such more supportive work arrangements need to be developed. We will provide ‘seed corn’ funding for the development of local enterprises such as the co-operative ‘Enabled Works’ in Morley, Leeds. It is over 70 years since legislation was first introduced to prohibit employment related discrimination against disabled people. Labour will lead the charge for a fair deal for disabled people in work and beyond.


    “ Disabled people must be properly supported to access all available education and training opportunities.”
    Disability Equality Roadshow participant


    • Labour will tackle the discrimination against disabled children in accessing education, including in Free Schools and Academies.
    • We will address the disability education gap, which stops disabled children fulfilling their potential, replacing the flawed Education, Health and Care Plan assessment, which has been used to restrict access to support. We will also address issues with skilled support and resourcing, and ensure effective transitioning to adult services.
    • Labour will deliver a strategy for children with special educational needs and disabilities (SEND) based on inclusivity, and embed SEND more substantially into training for teachers and non-teaching staff, so that staff, children and their parents are properly supported.
    • Labour will make sure that the Modern Apprenticeship programme is open to all, and increase the numbers of disabled trainees included in the programme.
    • • Labour will place a duty on all higher education institutions to ensure that their courses are accessible to disabled students, including through scrapping tuition fees, course support and support for living costs.

    The school funding crisis means that disabled pupils with Special Education Needs (SEN) are not only inadequately supported in mainstream schools, but are being excluded from these schools seven times more than non-disabled peers. Often they and their family’s only choice is special residential schools. Labour believes disabled children and their families should be able to attend a mainstream school when they want to.

    The Conservative Government has failed to tackle the disability employment gap and has failed to deliver an education policy that enables children with special education needs, physical or learning disabilities (SEND) to reach their potential which would enable them to participate fully in society.

    SEND young people are more likely to not be in education, employment or training at 19 years of age. The Conservatives have failed to engage with children and young people and enable them to have more autonomy over their lives and empower them through education and employment. Labour will deliver a strategy for children with special educational needs and disabilities (SEND) based on inclusivity, and embed SEND more substantially into training for teachers and non-teaching staff, so that staff, children and their parents are properly supported.

    Although the 2014 Children and Families Act introduced Education Health and Care Plans (ECHPs) from birth to 25 years providing the potential for a more joined-up needs assessment and care plan, it is clear that the ECHPs are in effect restricting access to support for all but those with the most severe needs. Getting an assessment in the first place requires monumental efforts from parents and teachers alike, and on top of that there are issues with the quality of these assessments.

    But help in caring for disabled children has also been hit by the Conservatives. On average, it costs three times as much to raise a disabled child. Families with disabled children face considerable additional expenditure on heating, housing, clothing, equipment and other items compared with other families. And yet the Conservatives’ programme of social security and social care cuts are making it harder for families to cope, let alone thrive so that their children can develop to be the best that they can be. Transitioning to adult services is also still a huge issue, with severe financial pressures facing social care adding to the difficulties of moving from children’s services.

    Similarly, young disabled people have found it really hard to get on apprenticeship schemes and with Conservative cuts to disabled students’ allowances (DSA) the onus has been placed on universities or disabled students themselves to ensure that their access needs are supported.

    Labour has pledged to tackle the disability education gap and to reform the ECHP process, including improving access to and reliability of assessments, and adequate support to implement the ECHP.

    We will make sure that Modern Apprenticeships are open to disabled people, increasing the numbers of disabled apprentices year on year. And we will increase accessibility of higher education to disabled students by placing a duty on all universities and higher education institutions to define in their access scheme how disabled students will be supported, including through tuition fee structures and bursaries for living costs.


    “ Lack of safe and secure affordable housing is a barrier to disabled people living independently.”
    Disability Equality Roadshow participant


    • Labour will develop environments that enable disabled people to live independently, and not in isolation, reflecting our commitment to Article 19 in the UN CRPD.
    • We will build more accessible and disabled-friendly new homes as part of our affordable housing programme.
    • Labour will stop the expansion of driver-only operation on board trains. Guards are essential for allowing disabled passengers access to trains.
    • Labour will reverse the cut to the funding to the Access to All programme, which was set up to improve accessibility to all of Britain’s railway stations.

    Conservative cuts to public transport have disproportionally impacted on disabled people who rely more heavily on it to get around. In particular, cuts to local bus services, especially in rural areas have had a profound impact on disabled bus users, as many disabled people live in a household with no car, and disabled people use buses more frequently than non-disabled people. Fewer than one in five railway stations is fully accessible and train providers have been criticised for the decline in the quality of the services they provide for disabled passengers, including something as basic as toilet facilities.

    The Conservatives’ cuts are also impacting on where disabled people are able to live, affecting their ability to live independently. The Bedroom Tax, cuts threatening the viability of supported housing projects for disabled and older people, and the freeze in Local Housing Allowance are all having a big impact on disabled people being able to afford to continue to live in their homes. This is on top of a national housing crisis with the lowest level of house building in peacetime since the 1920s, and a ballooning of insecure and poor quality private rental housing.

    Labour has promised to ensure that we will build more accessible and disabled friendly new homes as part of our commitment to build 100,000 new affordable homes a year.

    We will also stop the expansion of driver-only operated trains, which has a direct impact on disabled people’s ability to travel. By removing guards, disabled passengers lose the guarantee that they can turn up and travel when they want; instead disabled people will be forced to give 24 hours’ notice that they wish to travel.


    “Cuts to the NHS are falling hardest onto disabled people.”
    Disability Equality Roadshow participant


    • Labour, in partnership with disabled people, will seek to develop a network of local, ‘one-stop-shop’ independent living hubs to be led by disabled people, reflecting our commitment to Article 19 in the UN CRPD.
    • Labour will give the NHS the resources it needs by investing an additional £37 billion over the next parliament.
    • Labour will ensure the social care system is fully funded by investing £8 billion in the next parliament, and laying the foundations for a National Care Service.
    • Labour will increase the status of domiciliary care workers by introducing training and career pathways for carers to progress. And we will exclude people’s homes from the means-test for domiciliary care.
    • Labour will increase Carer’s Allowance to £73 a week, an increase of 16%, in recognition of Britain’s dedicated, unpaid carers.

    There is strong evidence that the Conservatives’ austerity measures have had detrimental effects on the health and care of disabled people, as well as their ability to live independently. In addition to failing to deliver ‘parity of esteem’ for people with mental health conditions, the number of specialist learning disability nurses has discernibly decreased. Under the Conservatives there has also been a reduction in training commissions for learning disability nurses.

    Since 2010, the Conservatives have cut £4.6 billion from social care which means that across the country, people with chronic health conditions, disabled and older people who go into crisis or have an accident are being admitted into hospital when this could have been avoided had they been better cared for in the community. And the lack of social care in the community means that many people end up staying much longer in hospital than they need because they can’t be safely discharged.

    In 2015 the SNP government proposed ‘a real alternative to austerity’ in Scotland. Instead, they have slashed more than £1.5 billion from local services like social care. The SNP has had the powers to top-up Carer’s Allowance since September 2016, but they are yet to use it. Carers are still waiting for the promised increase in the allowance. After two manifesto pledges in 2015 and 2016, a six month feasibility study and endless questions, carers in Scotland are no better off.

    Labour is committed to the equal right of all disabled people to live in the community, with choices equal to others as expressed in Article 19 of the UN CRPD. We will work with disabled people and local agencies seeking to develop a network of local, independent living hubs – a ‘one-stop-shop’ for all a disabled person’s needs – to enable this. These would be run by disabled people, foster independence, facilitate peer or advocacy support, as well as providing practical support for disabled people. Several examples of good practice were visited or mentioned at different Disability Equality Roadshow events, including Sheffield’s Centre for Independent Living and Equal Lives in Norwich.

    Labour wants to improve the status of domiciliary care work, which we believe for far too long has been seen as low-skilled, low-paid work. We will develop training with career pathways and progression for paid carers.

    And we will also support Britain’s unsung heroes; our unpaid carers, who provide millions of hours of unpaid support to loved ones, friends or neighbours every week, and are estimated to save the country over £132 billion a year. A Labour government will increase Carer’s Allowance from £62 a week to £73 a week in recognition of the contribution carers make.


    “ The justice system can leave disabled people feeling scared and alone. Some cases of hate crime have been so bad that disabled people have had to move homes in order for the abuse to stop.”
    Disability Equality Roadshow participant


    • Labour will ensure disabled people have the same access to justice as nondisabled people. We will strengthen the Equality Act in order to empower disabled people to confidently challenge all forms of discrimination and prejudice, wherever it occurs.
    • Labour will ensure annual reporting of the levels of disability hate crime and violence against disabled women, putting into place comprehensive national action plans to stop these crimes.

    Disabled people’s ability to access justice has been hit by the Conservatives’ cuts to legal aid support, to local government and to local law centres that provide free legal advice to communities.

    Cuts to legal aid mean less support to challenge social security decisions, affecting up to 80,000 disabled people. Although welfare rights agencies have tried to fill the void, the Conservatives have plans in the pipeline to abolish face to face tribunal hearings on social security matters.

    In addition to the Conservatives’ legal aid cuts, tribunal fees of up to £1200 introduced in 2013 have made it harder for disabled people to challenge discrimination. As a result, disabled people find it very difficult to challenge employers’ potentially discriminatory behaviour.

    The Conservatives have also failed to expand the scope of the law to cover crimes committed against people on the basis of disability, even though these hate crimes are now on the rise.

    Given the Conservatives’ continued threats to abolish the Human Rights Act, there are concerns that equal recognition under the law for disabled people may be at risk. Similarly, the Conservatives’ proposed Great Repeal Bill has yet to define what EU legislation will be transposed into UK law, including that which promotes and protects the rights of disabled people.

    Labour will ensure that disabled people have equal access to justice as nondisabled people. We will strengthen the Equality Act so that it works better for disabled people. A Labour government will reinstate the public sector equality duties and seek to extend them to the private sector, ensuring all citizens benefit from this Labour legislation. A Labour government will enhance the powers and functions of the Equality and Human Rights Commission, making it truly independent, to ensure it can support people to effectively challenge any discrimination they may face.

    We will ensure that under the Istanbul Convention, there is annual reporting of the levels of disability hate crimes and violence against disabled women, and comprehensive national action plans to stop these crimes are put in place, including training for the police.


    “Disabled candidates are deterred from standing as candidates; they receive very little support or guidance. There’s a complete lack of information on how to participate and stand in local, regional and national elections”.
    Disability Equality Roadshow participant

    Disabled access


    • As a political party, Labour will adopt accessible selection processes at local, regional and national levels of political office, and ensure reasonable adjustments for disabled candidates in recognition of the additional costs that they face.
    • Labour will undertake a review of sports, arts and leisure venues to determine how access to people with different conditions and impairments can best be improved.

    The Conservatives have failed to build on the work Labour undertook in government enabling disabled people to participate in cultural life.

    Disabled people are still under-represented in many walks of life, from drama to sport to politics. Similarly the opportunity for disabled people to participate as spectators and enjoy a football match or concert is too often still denied to them.

    Despite the commercial success of the Premier League, a recent study by the Equality and Human Rights Commission showed that just seven out of 20 Premier League teams are providing the minimum recommended space for wheelchair users, and just seven of 20 have adequate ‘changing place’ toilet facilities for disabled people.

    Labour will address these issues by undertaking a review of access and inclusiveness in sports, arts and leisure venues, considering the needs of people with different disabilities.

    We will also promote the use of British Sign Language (BSL) by developing a BSL National Plan for England, reflecting a similar scheme developed in Scotland by Scottish Labour. The next Labour government will also introduce legislation to give legal status to BSL through an Act of Parliament.

    Labour will open up democracy to disabled people, many of whom have felt disenfranchised for too long. We will develop an inclusion and access strategy that ensures disabled members are able to participate fully in all local party activities, and that there is a fair and accessible selection process for all candidates for local, regional and national levels of political office.

    As a political party Labour will provide training and ensure reasonable adjustments for disabled candidates in recognition of the additional costs that they will face.


    Tagged | Comments Off on Nothing About You Without You

    The NHS is facing persistent rising costs and funding pressures. Health care needs continue to rise as a result both of an ageing population and of a changing profile of morbidity, with increasing numbers of people suffering multiple long-term conditions. Even more cost pressures arise from technology and medical advances, and the labour intensive nature of much health care means that the NHS rate of inflation is significantly higher than the general rate of inflation.

    Funding pledges

    Yet neither the Labour nor the Conservative manifestos promise adequate funding. While the Conservatives are promising an extra £8bn a year by 2022, and Labour an extra £12bn in comparison with current funding, this represents in both cases a further decline in the proportion of the GDP being allocated to health care (from 7.3% in 2017/18 to 7.0% and 7.2% respectively, according to the Nuffield Trust). This is likely to reflect a commitment by Conservative-led administrations to reduce the share of the national income accruing to the NHS and, perhaps, a view in Labour circles that the NHS has so far got off lightly under austerity, compared to other departments’ cuts.

    While the obduracy of the government and its ideological ambivalence concerning the NHS make the Conservative proposal unsurprising, Labour’s stance must be seen as a disappointment. The impact of the financial stress endured by those working in the service, and the mounting scale of cuts and closures to services consequent upon inadequate resourcing are effectively being disregarded.

    Labour promises extra capital funding but does not say by how much; the Conservatives promise £10bn of capital expenditure but do not say where the funds will come from. There is of course an irony in borrowing more expensively from the private sector when public borrowing is so cheap.

    Mental health services

    Commitments to funding are not a minor detail since they point to doubts as to whether the parties’ other health proposals can be achieved – and this is not just the re-pledged commitment by the Conservatives to a ‘truly seven-day NHS’. Labour promises ‘well-resourced services’, ‘safe staffing levels’ and ‘world-class quality of care’ despite the fact that inadequate funding may make these impossible to achieve. Labour will also attempt to ‘tackle’ the rationing of services and will end the ‘routine breach’ of safe bed occupancy levels but as each is likely to entail an expansion in capacity, the party’s stance on funding may impede their achievement.

    This will be a source of particular anxiety to those keen to see improved mental health services. Here, Labour promise parity of esteem; ring-fence budgets; increase the proportion of the mental health budget spent on children; and end out-of-area placements. Oblivious to the consequences of their stance on funding, the Conservatives promise that those with mental health problems will get the ‘care and support they deserve’ and that medical training will ensure a deeper understanding of mental health.

    Health care reorganisation

    The Conservatives remain committed to the contentious Sustainability and Transformation Plans (STPs), drawn up in secret at a local level to reorganise services and simultaneously cut their costs. The privileging of financial sustainability has rather overtaken the promised transformation. But, contrary to government and NHS England assumptions, transferring services out of acute hospitals and into community settings is unlikely to achieve cheaper health care if they are to remain high quality services. Moreover, the transitional period itself requires additional funding. ‘Vanguard projects’ are currently piloting new ways of providing services and local NHS leaders are being expected to implement changes while an evidence base is still to be produced.

    Labour does not promise a roll-back of STPs but instead a ‘halt and review’, with local people invited to participate in redrawing them. This feels an ambiguous passage in the manifesto which might reflect the competing pressures of cautious endorsement of STPs from some think-tanks, given the funding constraints and the perceived desirability of making more services available in community settings, on the one hand, and the fierce opposition, on the other, from local people who experience their STP as the vehicle by which large-scale cuts and closures are being implemented.

    Staffing levels

    Quality services also require adequate staffing levels. Labour has costed its plans to reinstate bursaries for nurses and to lift the pay cap for NHS staff – some of whom have suffered more than a 10% reduction in the real terms value of their pay since the financial crash. Its commitments on NHS staffing – recruitment and retention – differ somewhat from those in the Conservative manifesto. Labour promises an immediate guarantee of the rights of EU staff, lifelong education and development for doctors, and reinstating the role of the independent pay review body. The Conservative Party promises 10,000 extra staff in mental health service, an extra 1500 doctors a year in training, stronger staff entitlement to work flexibly, and the development of new roles in health care. This is perhaps to facilitate the shift to more generic roles heralded in some STPs, and the greater use of unregistered nurse associates and physician associates to supplement (or supplant) the registered professionals. Where all these staff will come from remains unclear. The Conservatives offer EU nationals working in the NHS only the promise that they will do their best for them in the Brexit negotiations.


    Those who have been campaigning against privatisation and the use of market forces in the NHS will welcome Labour’s commitment to reversing the privatisation of the NHS. They will also hope that this is compatible with Labour’s promise to introduce a new legal duty on the Secretary of State to ensure ‘excess private profits are not made out of the NHS at the expense of patient care’. They will certainly welcome the repeal of the infamous 2012 Health and Social Care Act.

    The Conservative manifesto also points to the prospect of legislative change and indicates that the provisions of the Health and Social Care Act – a highly unpopular piece of legislation among both campaigners and professional associations – may not be sacrosanct where they interfere with the implementation of STPs. This hints at the fact that much STP activity has occurred outside statutory provision and is an implicit acknowledgment by the Conservatives that Accountable Care Organisations (ACOs) offer a better route to commercialisation than a model based on a competitive provider market in a time of financial constraint. Anti-privatisation campaigners, aware that ACOs can be contracted out to non-public organisations and always suspicious of Conservative intentions, will take little comfort from this.

    This was first published on the British Politics and Policy blog.

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    Election Briefing Note May 2017


    • The current amount of public expenditure on social care for older people in England each year is less than 0.5% of GDP. To put this in context, the UK currently spends around 2% of GDP on armaments and defence and 0.7% of GDP on foreign aid.
    • The manifesto commitments of all the 3 major parties on social care mean that publicly-funded social care will remain highly rationed over the next 5 years and will only be available to those older people with the most substantial care needs.
    • It is unclear whether the spending commitments made by any of the major parties will even sustain this already very low level of service coverage. As things stand local authorities will need around an extra £2.5bn year by 2020 to continue to provide a highly rationed service. The number of people receiving publicly funded social care has fallen despite the fact that the population is growing older and living longer.
    • All 3 major parties are now committed to introducing a “cap” on how much an individual should pay towards their own social care costs (hitherto known as the Dilnot cap).
    • In 2013 the Department of Health estimated that the Dilnot cap (if set at £72K) would cost the tax payer £2bn a year, that it would cost around £200m a year to administer (involving the additional assessment of 500,000 people) and that it would only benefit 100,000 people with significant assets.
    • Most importantly, the implementation of the cap would not lead to the expansion of publicly social care to cover those with moderate care needs and so would do little to reduce the burden on the NHS or on informal carers or improve the lives of many older people.
    • This briefing note shows that only by injecting a substantial amount of public funds into the care system will social care become a service which enhances the lives and independence of our older people. Capping care costs would benefit a relatively small number of people and would have little impact on either the quality or the availability of care.


    The Conservative Party’s manifesto proposals have put the funding of social care at the heart of the election debate. However, the narrow – and sometimes ill informed – commentary by the media has allowed politicians from all the major parties to avoid answering serious questions about how they will tackle the real crisis in social care and has allowed them to sidestep awkward questions about how much their proposed solutions will cost the taxpayer and who they will benefit. This briefing note sets out:

    • The nature of the social care funding crisis
    • The causes of the crisis
    • An assessment of the solutions proposed by the 3 major parties, what they are likely to cost and who they will benefit.

    This briefing note focuses on the issues relating to social care for older people, however, it should be noted that people under 65 also receive a significant amount of social care; 18 – 64 year olds receive around £6.5 billion a year. The social care funding gap set out here includes the gap between what local authorities need to provide all the social care for their local populations and not just for older people.

    The social care crisis

    The crisis in social care which the manifesto commitments seek to tackle is not something which will hit in 10 years time, it is happening right now.

    It is a crisis where local authorities are estimating that they will need an extra £2.5bn a year in 3 years time just to continue providing the existing highly restrictive level of care to people; where gaining access to local authority funded care is impossible for all but the most dependent older people, and where both care homes and home care providers regularly go bust. The extent of the exact gap in social care funding is the subject of some debate. The Association of Directors of Social Services estimate that by 2019/2020 that around £2.6bn will need to be funded whilst the Health Foundation, Kings Fund and the Nuffield Trust estimate that the total funding needed will be £2.4bn to £2.8bn. These estimates assume that care will be restricted to only those in need of substantial care and attention and that they will fund the cost of the new national living wage. They also refer to the entire costs of adult social care and not just for those over 65. See this excellent summary here from Adam Roberts Public Finance March 2017:

    It is a crisis where the workforce which provides highly intimate care services to mainly older people often receives little or no formal training and often earns less than the minimum wage. For those older people who are able to access local authority funded care at home, their time with a care worker is often rationed to just 15 minutes, whilst for those who receive care in a residential care home around 25% of the care homes in England are rated inadequate by the care home regulator. The Leonard Cheshire Disability found in 2013 that 6 out of 10 local authorities were commissioning home care in 15 minute slots.

    For those whose needs are not met by the local authority and who fund their care themselves out of their own income, they too experience the same problems with poor quality of care. However, because many care homes would not survive if they relied only on the poor levels of funding from local authorities, these self-funders are often charged almost 50% a week more than local authority residents and so in effect subsidise the cost of their care.(Laing Buisson (2015), Care of Older People: UK Market Report 27th Edition.) The restrictions on the availability of state-funded care for older people places a significant burden on the so-called informal workforce, mainly female family members who have to take time out of work to care for their relatives.

    In and of itself this is a crisis which affects hundreds of thousands of people and their families each day, but it also has significant consequences for the NHS. A major reason why hospital A&E departments are regularly overwhelmed and why hospital beds cannot be freed up is that local authorities do not have enough money to provide care to large numbers of older people, even those that they deem to meet their highly restrictive criteria. Thus as the social care crisis deepens so too does the crisis in the NHS.

    The making of the social care crisis

    The source of this crisis lies in three facts about social care provision which appear to be poorly understood by the media.

    “Publicly funded social care has been rationed due to budget cuts and so is now limited to those who are most in need”

    The first is that social care which is provided to older people has always been a responsibility of local authorities, not the NHS, and since the 1960s has been increasingly restricted only to those who have very significant care needs. (See Allyson Pollock, Colin Leys, David Price, David Rowland and Shamini Gnani Chapter 7 Long Term Care for Older People NHS PLC Verso 2004)  This means that in order to get local authority-funded social care an individual now needs to be highly dependent, with very high care needs. In an under-reported move in 2015 the Coalition government introduced national minimum eligibility criteria to ration social care only to the most in need – in order to qualify an individual needs to have ‘substantial’ care needs – anyone deemed less needy than this must fund their own care.  (The Care and Support (Eligibility Criteria) Regulations 2015)

    Although the demand and the costs to local authorities in providing social care have increased – due to an aging population – central government payments to local authorities have actually reduced by 9% in real terms between 2009/10 and 2014/15. (National Statistics and NHS Digital Personal Social Services: Expenditure and Unit Costs England 2015-16 October 2016)  This means that rather than being a service to assist older people to stay well and active and out of hospital, social care is a service now focused on those who have experienced a major crisis in their lives for example, following a stroke or a fall or due to the worst aspects of dementia.

    And because of the funding cuts from central government, local authorities are struggling to pay for even this highly rationed form of care. The Nuffield Trust, the Kings Fund and the Health Foundation estimate that the number of older people receiving care has shrunk by 400,000 in 5 years. ( The Kings Fund, the Nuffield Trust and the Health Foundation ‘The Autumn Statement Joint statement on health and social care’ ) This has particularly affected those types of community care such as meals on wheels or home care which can have the most impact on the independence and well being of older people (see figure below)

    social care users

    (Source: Health Foundation ‘Focus on: Social Care for older people’ Ismail, Thorlby, Holder 2014)

    Finally, the share of GDP which goes into public funding of social care for older people each year in England is less than 0.5% (9 Raphael Wittenberg and Bo Hu ‘Projections of Demand for and Costs of Social Care for Older People and Younger Adults in England, 2015’ Personal Social Services Research Unit PSSRU Discussion Paper 2900 September 2015 ) . To put this in some context, the UK currently spends around 2% of GDP on defence and armaments and 0.7% on international aid. “Social care funding – unlike the NHS – has always relied on a form of “death taxes”. Because property values have increased and government has cut funding, the amount paid by older people towards their care has gone up.”

    The second key fact about the social care crisis which has often been overlooked by the media is that large numbers of highly dependent older people have been denied access to state funded care because of their existing assets (usually their home) and their income (usually their pension) for many years.

    Charging individuals for their care, is not a new phenomenon, nor is taking their house from them after their death to fund residential care, as this has been part of the way social care has been funded going back to the National Assistance Act 1948. Whilst charging has become more common in recent decades – again due to local authority budget cuts – it is not new. For example, a survey in 2001 found that around 70,000 older people had sold their homes in order to fund their care.(A survey of the number of people forced to sell their homes to pay for nursing or residential care, Liberal Democrats 2001)

    So “death taxes” of the type being referred to in the media to pay for care are not a new phenomenon. In fact the latest survey of local authorities shows that councils have a claim against the homes of older people to pay for their care worth around £72m. ( National Statistics and NHS Digital Personal Social Services: ‘Expenditure and Unit Costs England 2015-16’ October 2016 See Appendix A )

    However, charging older people for social care has become increasingly more common as more people have been assessed as having too much money or their houses have increased in prices sufficiently for them to be deemed ineligible to receive state funded care.

    “Privatisation and the market in social care have been used to keep costs down to the bare minimum.”

    The third fact about social care which is seemingly little understood is that in order to provide it as cheaply as possible local authorities have been under significant pressure from government to contract out the provision of care services to the private sector. As a result, over 90% of both home care (domiciliary care) and residential care (care homes) is now provided by the private sector. Through using private providers, who generally tend to pay workers less, and through getting private providers to compete with other on the basis of price, cash-strapped local authorities have sought to keep the rising costs of providing social care down to the bare minimum. (Centre for Health and the Public Interest “The future of the NHS – lessons from the market in social care in England” October 2013 )

    Such an approach has driven down the quality of care (and resulted in the notorious 15-minute time slots), but it has also brought many care homes and domiciliary care companies to the point of bankruptcy. The response of the 3 main parties to the crisis – who benefits and how much is it likely to cost?

    The response of the 3 main parties to the social care crisis can be broken down into two parts: providing some additional funds to just about maintain a highly restrictive service, and protecting the assets and wealth of a small number of richer older people.

    “The 3 main parties are committed to keeping social care as a residual service for only those with substantial needs.”

    In order to address the crisis in social care and the impact that this is having on the NHS and informal carers, a significant injection of funds is needed: to improve the quality of care available, to pay the workforce properly, but also to expand the number of people who receive state-funded care so that social care moves beyond being a service reserved for those with significant care needs to one which genuinely enhances the lives of older people and prevents them from entering into ill health and hospital prematurely. A well funded service could prevent another large-scale collapse of a care home chain, which the government predicts is highly likely to happen in the next 5 years, and prevent home care operators from cancelling their contracts with local authorities.(The Guardian ‘Care contracts cancelled at 95 UK councils in funding squeeze’ 20th March 2017 )

    However, none of the 3 main party manifestos gets close to addressing (or even recognising) this need. The Labour Party does pledge to increase the amount of funding going into social care – by £8 billion over the course of the Parliament – with the aim that this will fund the increase in wages for the sector and end 15-minute care slots for those receiving home care. However, this is just about the amount necessary to fill the shortfall of £2.5bn which has arisen due to the funding cuts made under the previous two governments. As a result, Labour’s funding commitment would still only be sufficient to fund public care to older people with high care needs. Whilst it promises to do away with the 15-minute care slots and fund the national living wage for care workers, it is unclear how it could achieve this with such a small increase in funding.

    The Liberal Democrats promise to spend an additional £6bn over the course of the Parliament, but this is to go on both the NHS and on social care so it is not clear whether its funding proposals would meet the existing social care shortfall. The Conservative manifesto makes no statement about additional resources to fund social care other than the additional £2bn over 3 years which has already been committed in the last budget before the election.

    As a result all 3 major parties fall short in promising to fund anything above the current bare minimum of social care provision.

    “The 3 main parties are all committed in some way to protecting the assets and wealth of mainly richer older people”

    However, what the 3 major parties are now all committed to is insulating older people and their families from the worry of having to pay for social care. All 3 major parties are now committed to introducing the social care funding approach similar to that recommended by Andrew Dilnot in 2011. This approach is to cap an individual’s liability to pay for social care at a certain level – after which point the state will pick up the bill – as well as to increase the amount that an individual can keep before having to contribute to the cost of their care.

    Whilst none of the major parties has said what level the cap should be set at there is an existing analysis undertaken by the Department of Health which explains how the scheme works, how much it will cost and who will benefit.

    In 2013, when the Coalition government legislated to introduce the “Dilnot cap”, the Department of Health published an impact assessment which looked at the scheme and assumed that the cap on the total amount an individual would have to pay for their care would be around £72k. (Norman Lamb MP ‘Social Care Funding Impact Assessment’ Department of Health 08 April 2013 )

    Interestingly, this impact assessment sets out that the overriding benefit of the policy is to create “peace of mind” amongst people as they entered old age as they would know that if they were to fall ill and need social care they would not be faced with “catastrophic” care costs as these would be capped at £72k level. It would also allow them to pass on £100k of their assets to their children. It does not aim to move publicly-funded social care from being a residual service to being something more comprehensive.

    The cost of providing this “peace of mind” to people entering retirement was estimated in 2013 to be just under £10bn at 2011 prices over a 10-year period, plus an additional £2bn over the same period to administer the scheme. This works out at around £2bn a year at 2011 prices once the scheme is fully up and running. (see figure 8 taken from the DH impact assessment)

    social care costs

    The Labour Party manifesto is the only manifesto which acknowledges that this policy will cost the taxpayer a significant amount. In fact, Labour’s national care scheme – which appears to be mainly focused on introducing the proposals similar to those recommended by Dilnot – is said to cost around £3 billion a year.(The Labour Manifesto states –“In its first years, our service will require an additional £3 billion of public funds every year, enough to place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.” )  Neither the Lib Dems nor the Conservatives set out what the financial impact of this approach will be.

    The 2013 Department of Health impact assessment estimates that 10 years after the scheme is introduced this scheme will benefit an additional 100,000 people who would receive care which they would otherwise have had to pay for (see figure 7 below from the DH impact assessment).

    Figure 7

    What is not mentioned by any of the major parties in their manifestos is that a significant amount of money each year – around £200m, according to the impact assessment – would need to be spent just to assess the estimated 500,000 people who would come forward seeking to access care.(This figure comes from the Department of Health consultation on the subject in 2013 ) This assessment would involve calculating their wealth and the value of their housing assets – that is £200m which would not be spent on providing care but on local authority administrators.

    Because the purpose of the Dilnot proposals is to expand state-funded social care to those deemed too wealthy to currently access it, the 2013 impact assessment shows that the scheme would disproportionately benefit those with higher incomes and assets (the rich) compared to those with fewer assets (the poor) (see figure 11 from the DH impact assessment below) Or, as a further analysis found, by 2030 this would mean that the Dilnot Cap would be worth £52 per week (2010 prices) on average to care recipients aged 85+ in the highest quintile ( the richest group), compared with £20 per week for those in the lowest quintile (the poorest group). ( Ruth Hancock, Raphael Wittenberg, Bo Hu, Marcello Morciano and Adelina Comas-Herrera ‘Long-term care funding in England: an analysis of the costs and distributional effects of potential reforms’ Unit PSSRU Discussion Paper 2857 April 2013)

    Again, there is no assumption within this approach that the changes in funding arrangements would bring in any additional resources from charges on property or income. Instead the scheme assumes that the taxpayer will fund this additional £2bn a year. So the taxpayers’ money which goes to protecting the assets of these 100k or so richer people will be money which is not available to fund or public services such as the NHS or schools.

    So what would the taxpayer get for this £2bn a year? An increase in the number of people receiving social care who have lower care needs, so that the burden on the NHS can be reduced? An increase in the payment to care homes and home care operators, so that they can avoid bankruptcy and pay their staff the national living wage or invest in their training?

    Unfortunately not. The costing done by the Department of Health assumes that state-funded care will still be restricted to those with very high care needs and that the current costs of providing social care – such as how much care staff are paid and how much care homes receive – will in effect remain the same for the foreseeable future. Any plans to increase payments to care providers or to expand the coverage of social care to those with lower care needs would not only send the bill for this policy soaring but would require a much more substantial increase in the overall social care budget, neither of which is contemplated within this proposal.


    Based on the Department of Health’s analysis of the Dilnot Cap and the funding commitments set out in the manifestos, it looks as though all 3 major parties are proposing a policy which does little to address the fundamentals of the current social care crisis but which could potentially benefit around 100,000 or so people, all with significant assets depending on where the social care cap is eventually set. It is a policy which, irrespective of where the cap is set, will cost around £200m a year to run and which will do nothing to alleviate the pressures on the NHS. Whether this is worth the taxpayer paying in the region of an additional £2bn a year at a time when all major parties are proposing small increases in funding for the health service is the real question which the media should be asking.



    First published by the Centre for Health and the Public Interest

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