Category Archives: Election

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reported they had redesigned two outdated sheltered housing schemes to provide fully accessible 21st Century older persons’ apartments.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

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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

INTRODUCTION

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.

KEY PLEDGES

  • 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.

ENSURING AN ADEQUATE STANDARD OF LIVING AND SOCIAL PROTECTION

“ 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

PLEDGES

  • 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.

WORK AND EMPLOYMENT

“ 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

PLEDGES

  • 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.

EDUCATION AND TRAINING

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

PLEDGES

  • 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.

ACCESSIBLE ENVIRONMENTS

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

PLEDGES

  • 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.

HEALTH AND SOCIAL CARE

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

PLEDGES

• 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.

ACCESS TO JUSTICE

“ 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

PLEDGES

  • 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.

PARTICIPATING FULLY IN POLITICAL, PUBLIC AND CULTURAL LIFE

“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

PLEDGES

  • 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.

 

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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.

Privatisation

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

Summary

  • 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.

Introduction

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.

Conclusion

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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Extracted from the Liberal Democrat manifesto.

The NHS and social care services are in a state of crisis. The Conservatives have left them chronically under-funded, while need continues to grow and patient care suffers. Social care is facing a funding blackhole of £2 billion this year alone and more than a million older people are missing out on the care that they need.

People are routinely left stranded in hospital after they finish their treatment because the follow up care and support they need is not available. Nearly two-thirds of NHS Trusts ended the last financial year in deficit.

Yet Labour and Conservative politicians refuse to be honest with the public about the scale of the crisis or the tough decisions which are needed to protect these vital services.

Liberal Democrats recognise that Britain’s health and social care services are our most treasured national institutions. Any party seeking to lead the country after this election should be prepared to take bold action to safeguard them. This isn’t about doing the easiest thing, it is about doing what is right and what is essential.

Liberal Democrats will take five key steps in order to put our health and social care system back on a sustainable financial footing:

  1. An immediate 1p rise on the basic, higher and additional rates of Income Tax to raise £6 billion additional revenue which would be ringfenced to be spent only on NHS and social care services.
  2. Direct this additional investment to the following priority areas in the health and care system: social care, primary care (and other out-of-hospital care), mental health and public health. This represents the most efficient and effective way of spending these extra resources – ensuring they will have the greatest impact on the quality of care patients receive.
  3. In the longer term and as a replacement for the 1p Income Tax rise, commission the development of a dedicated Health and Care Tax on the basis of wide consultation, possibly based on a reform of National Insurance contributions, which will bring together spending on both services into a collective budget and sets out transparently, on people’s payslips, what we spend on them.
  4. Establish a cross-party health and social care convention, bringing together stakeholders from all political parties, patients groups, the public, and professionals from within the health and social care system to carry out a comprehensive review of the longer-term sustainability of the health and social care finances and workforce, and the practicalities of greater integration. We would invite the devolved administrations to be a part of this work.
  5. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility. This would report every three years on how much money the system needs to deliver safe and sustainable treatment and care, and how much is needed to meet the costs of projected increases in demand and any new initiatives – to ensure any changes in services are properly costed and affordable.

Our longer-term objective will be to bring together NHS and social care into one seamless service – pooling budgets in every area by 2020 and developing integrated care organisations.

Valuing the NHS and Social Care Workforce

Our health and social care services’ greatest resource is their staff, working tirelessly under immense pressure. This Government has left them feeling embattled and undervalued.

To support the NHS and social care workforce we will:

  • Guarantee the rights of all NHS and social care service staff who are EU nationals, the right to stay in the UK.
  • End the public sector pay freeze for NHS workers.
  • Reinstate student nurse bursaries.
  • Support innovation in how organisations can empower staff and patients, including learning from innovative social enterprises delivering community and mental health services.
  • Protect NHS whistle-blowers.

GPs in particular have been put under considerable strain due to severe under-funding and neglect from the Conservatives, leaving many people waiting weeks to get appointments. GPs are the core of what the NHS is and they need support to ensure that the NHS is able to survive and thrive. We will:

  • Produce a national workforce strategy, ensuring that we never again experience a shortage in the numbers of GPs, hospital doctors, nurses and other professionals that the NHS needs.

Equal Care for Mental Health

In government, we fought tirelessly to reduce the historic inequality between the way physical and mental health are treated in the NHS and are proud of the strides forward we made. We legislated to give mental and physical health equality under the law. We introduced the first waiting time standards for access to treatment for mental health. We introduced the crisis care concordat which dramatically reduced the number of people who end up in police cells when they experience a mental health crisis; and we secured more money for children and young people’s mental health service. But we know that not enough resources reach front line services and that in the fight for parity of esteem, there is still a very long way to go. We will:

  • Ringfence funding from within the one penny Income Tax rise, to provide additional investment in mental health
  • Continue to roll out access and waiting time standards for children, young people and adults. This will include a guarantee that people will not wait more than six weeks for therapy for depression or anxiety, and no young person will wait more than two weeks for treatment when they experience a first episode of psychosis.
  • Increase access to clinically- and cost-effective talking therapies so that hundreds of thousands more people can receive this support.
  • Examine the case for introducing a dedicated service for children and young people based on the Australian ‘headspace’ model and building on many excellent Youth Information, Advice and Counselling Services.
  • Transform mental health support for pregnant women, new mothers and those who have experienced miscarriage or stillbirth, and help them get early care when needed.
  • Continue to promote and invest in the Frontline programme to fast-track exceptional graduates into children’s social work, as well as the Think Ahead scheme aimed at encouraging high-achieving graduates to pursue a career in mental health social work.
  • Ensure that no one in crisis is turned away, with new waiting time standards and better crisis care in Accident and Emergency, in the community and via phone lines. This will enable us to end the use of police cells for people facing a mental health crisis.
  • End out of area placements, ensuring those admitted to hospital for mental ill-health are able to be treated close to home.
  • Ensure that all frontline public service professionals, including in schools and universities, receive better training in mental health.
  • Roll out the Liaison and Diversion programme nationally, helping to identify people who have mental health problems, learning disabilities, substance misuse or other vulnerabilities when they first come into contact with the criminal justice system
  • Tackle stigma against mental ill-health, including by building on the good work done by organisations like Heads Together and changing the standard of proof in suicide conclusions in the Coroner’s Court.
  • Ensure that LGBT+ inclusive mental health services receive funding and support.

Medical research is vital for developing new and better treatments. We will fight the threat Brexit poses to medical research funding. We support the principle that all medical trials using public facilities or resources should comply with the Open Trials standards, and that a fair proportion of all public funding for medical research should be focused on research into mental ill-health. We also favour the further development of open access academic journals.

Home not Hospital: Joining up health and social care

We need services that fit around people’s lives, not ones that force them to fit their lives around the care they need. This will become increasingly important as our population ages and the number of people living with long-term conditions continues to grow. It is also more cost-effective to support people to be able to live at home rather than endure lengthy stays in hospital. We must move away from a fragmented system to an integrated service with more joined-up care, and more personal budgets so that people can design services for their own individual needs. We believe this should happen from the bottom up, suiting the needs of local communities.

The number of family carers is rising, including in the ‘sandwich generation’ who find themselves trying to care for their children and their parents at the same time. Carers are unsung heroes; we need to do more to help them. We will:

  • Finish the job of implementing a cap on the cost of social care, which the Conservatives have effectively abandoned.
  • Move towards single place-based budgets for health and social care by 2020, allowing local areas to decide how best to provide the full spectrum of care for their community.
  • Remodel the healthcare funding system to eliminate perverse incentives, by moving away from payments for activity and introducing tariffs that encourage joined-up services and promote improved outcomes for patients and better preventive care.
  • Ensure those who work in the social care sector are properly trained, with accessible career pathways, and are suitable to practice by introducing a statutory code of conduct backed up by a care workers’ suitability register.
  • Raise the amount people can earn before losing Carer’s Allowance from £110 to £150 a week, and reduce the number of hours’ care per week required to qualify.
  • Give the NHS a legal duty to identify carers and develop a Carer’s Passport scheme to inform carers of their NHS rights, such as flexible visiting hours and access to support.
  • Provide more choice at the end of life, and move towards free end-of-life social care, whether people spend their last days at home or in a hospice.
  • Evaluate the valuable work of hospices with a view to putting them on a more sustainable financial footing and allowing them to expand their services.

Better access to community services

Most people’s experience of the NHS is their local GP, or the nurses and support staff who visit them at home or work in community clinics. Access to care in GP surgeries and closer to home is better for patients and will also help reduce pressure on hospitals, Accident and Emergency departments and ambulances. We will:

  • Promote easier access to GPs, expanding evening and weekend opening to meet the needs of local patients, encouraging online, phone and Skype appointments, encouraging GPs to work together in federations, and allowing people more choice.
  • Provide national support to struggling GP practices, preventing mass practice closures
  • Support GPs to come together to collectively provide services such as out-of-normal-opening-hours appointments
  • Use innovation funding to promote GP-led multi-disciplinary health and care hubs, including mobile services to keep people out of hospital.
  • Encourage GPs and other community clinicians to work in disadvantaged areas through our Patient Premium – which would give incentive payments to clinicians.
  • Ensure that any changes to the way pharmacies are funded do not leave local areas without reasonable access to a community pharmacist.
  • Review the rules for exemption from prescription charges to ensure they are fair to those with long-term conditions and disabilities.

Helping people stay healthy

It is better for patients and for the NHS if we keep people healthy in the first place, rather than just waiting until people develop illnesses and come for treatment, but 40% of NHS spending is on diseases that are preventable. We need to do more to promote healthy eating and exercise, making people aware of the dangers of smoking and excessive consumption of alcohol and other drugs, and helping to improve mental health and wellbeing. We will:

  • Move towards a health and social care system that empowers and encourages people to better manage their own health and conditions and to live healthier lives.
  • Publish a National Wellbeing Strategy, which puts better health and wellbeing for all at the heart of government policy.
  • Implement the recommendations of the O’Neill report on antimicrobial resistance to ensure responsible prescribing and investment in diagnostics and innovation.
  • Make Pre-Exposure Prophylaxis (PrEP) for HIV prevention available on the NHS.
  • Support effective public awareness campaigns like Be Clear on Cancer and learn from what works when designing new health promotion campaigns to change behaviour.
  • Keep public health within local government, where it is effectively joined-up with preventive community services, and re-instate the funding cut from public health budgets by the Conservatives.
  • Develop a strategy to tackle childhood obesity including restricting the marketing of junk food to children, restricting TV advertising before the 9pm watershed, and closing loopholes in the sugary drinks tax.
  • Encourage the traffic light labelling system for food products and publication of information on calorie, fat, sugar and salt content in restaurants and takeaways.
  • Introduce mandatory targets on sugar reduction for food and drink producers.
  • Reduce smoking rates, introducing a levy on tobacco companies so they fairly contribute to the costs of health care and smoking cessation services.
  • Implement the recommendations of the Keogh review to regulate cosmetic surgery and ensure that the NHS is not picking up the tab for private malpractice.
  • Introduce minimum unit pricing for alcohol, subject to the final outcome of the legal challenge in Scotland.
  • Develop a public health campaign promoting the steps people can take to improve their own mental resilience – the wellbeing equivalent of the ‘Five a Day’ campaign.
  • Support good practice among employers in promoting wellbeing and ensure people with mental health problems get the help they need to stay in or find work, with a ‘Wellbeing Premium’ to reward employers who take clear action to measurably improve the health of their employees.

We will develop a just settlement for haemophiliacs who were given contaminated blood, and for their families.

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Extracted from the Conservative Manifesto

The mental health gap

It was Conservatives in government that gave parity of esteem to the treatment of mental health in the National Health Service. We have backed this with a significant increase in 57 funding: since 2010 we have increased spending on mental health each year to a record £11.4 billion in 2016/17, with a further investment of £1 billion by 20/21, so that we can deliver the mental health services people deserve. We will now build on this commitment.

First, we will address the need for better treatments across the whole spectrum of mental health conditions. We will make the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment.

Improving treatment services will not be sufficient, however. We will also reform outdated laws to ensure that those with mental illness are treated fairly and employers fulfil their responsibilities effectively.

The current Mental Health Act does not operate as it should: if you are put on a community treatment order it is very difficult to be discharged; sectioning is too often used to detain rather than treat; families’ information about their loved ones is severely curtailed – parents can be the last to learn that their son or daughter has been sectioned. So we will introduce the first new Mental Health Bill for thirty-five years, putting parity of esteem at the heart of treatment.

We will transform how mental health is regarded in the workplace. We will amend health and safety regulations so that employers provide appropriate first aid training and needsassessment for mental health, as they currently do for risks to physical health, and extend Equalities Act protections against discrimination to mental health conditions that are episodic and fluctuating. We will consider the findings of the Stevenson-Farmer Review into workplace mental health support, working with employers to encourage new products and incentives to improve the mental health and wellbeing support available to their employees. And, as we did with Dementia Friends, we will train one million members of the public in basic mental health awareness and first aid to break the stigma of mental illness.

The disability gap

We will build on the proud Conservative record in supporting those with disabilities, including the landmark Disability Discrimination Act of 1995. We want to see attitudes to disability shift as they have for race, gender and sexuality in recent years: it should be completely unacceptable for people with disabilities to be treated negatively.

We will get 1 million more people with disabilities into employment over the next ten years. We will harness the opportunities of flexible working and the digital economy to generate jobs for those whose disabilities make traditional work difficult. We will give employers the advice and support they need to hire and retain disabled people and those with health conditions. We will continue to ensure a sustainable welfare system, with help targeted at those who need it most. We will legislate to give unemployed disabled claimants or those with a health condition personalised and tailored employment support.

We believe that where you live, shop, go out, travel or park your car should not be determined by your disability. So we will review disabled people’s access and amend regulations if necessary to improve disabled access to licensed premises, parking and housing. We will work with providers of everyday essential services, like energy and telecoms, to reduce the extra costs that disability can incur.

A long-term plan for elderly care

Our system of care for the elderly is not working for the hundreds of thousands currently not getting the dignified and careful attention they deserve, nor for the people and organisations providing that care, nor is it sustainable for today’s younger people who will potentially one day face care costs themselves. It is not fair that the quality of care you receive and how much you pay for it depends in large part on where you live and whether you own your own home.  Where others have failed to lead, we will act. We have already taken immediate action, putting £2 billion into the social care system and allowing councils to raise more money for care themselves from Council Tax. We are now proposing medium and long-term solutions to put elderly care in our country on a strong and stable footing.

Under the current system, care costs deplete an individual’s assets, including in some cases the family home, down to £23,250 or even less. These costs can be catastrophic for those with modest or medium wealth. One purpose of long-term saving is to cover needs in old age; those who can should rightly contribute to their care from savings and accumulated wealth, rather than expecting current and future taxpayers to carry the cost on their behalf. Moreover, many older people have built considerable property assets due to rising property prices. Reconciling these competing pressures fairly and in a sustainable way has challenged many governments of the past. We intend to tackle this with three connected measures.

First, we will align the future basis for means-testing for domiciliary care with that for residential care, so that people are looked after in the place that is best for them. This will mean that the value of the family home will be taken into account along with other assets and income, whether care is provided at home, or in a residential or nursing care home.

Second, to ensure this is fair, we will introduce a single capital floor, set at £100,000, more than four times the current means test threshold. This will ensure that, no matter how large the cost of care turns out to be, people will always retain at least £100,000 of their savings and assets, including value in the family home.

Third, we will extend the current freedom to defer payments for residential care to those receiving care at home, so no-one will have to sell their home in their lifetime to pay for care.

We believe this powerful combination maximises protection for pensioner households with modest assets, often invested in the family home, while remaining affordable for taxpayers. We consider it more equitable, within and across the generations, than the proposals following the Dilnot Report, which mostly benefited a small number of wealthier people.

An efficient elderly care system which provides dignity is not merely a function of money. So our forthcoming green paper will also address system-wide issues to improve the quality of care and reduce variation in practice. This will ensure the care system works better with the NHS to reduce unnecessary and unhealthy hospital stays and delayed transfers of care, and provide better quality assurance within the care sector. We will reduce loneliness and promote technological solutions to prolong independent living, and invest in dementia research. As the majority of care is informally provided, mainly by families, we will give workers a new statutory entitlement to carer’s leave, as enjoyed in other countries.

Creating a sustainable elderly care system means making decisions about how the rising budget devoted to pensioners is spent, so we will target help where it is needed most. So we will look at Winter Fuel Payments, the largest benefit paid to pensioners, in this context. The benefit is paid regardless of need, giving money to wealthier pensioners when working people on lower incomes do not get similar support. So we will meanstest Winter Fuel Payments, focusing assistance on the least well-off pensioners, who are most at risk of fuel poverty. The money released will be transferred directly to health and social care, helping to provide dignity and care to the most vulnerable pensioners and reassurance to their families. We will maintain all other pensioner benefits, including free bus passes, eye tests, prescriptions and TV licences, for the duration of this parliament.

OUR NATIONAL HEALTH SERVICE

Our National Health Service is the essence of solidarity in our United Kingdom – our commitment to each other, between young and old, those who have and those who do not, and the healthy and the sick. The Conservative Party believes in the founding principles of the NHS. First, that the service should meet the needs of everyone, no matter who they are or where they live. Second, that care should be based on clinical need, not the ability to pay. Third, that care should be free at the point of use. As the NHS enters its eighth decade, the next Conservative government will hold fast to these principles by providing the NHS with the resources it needs and holding it accountable for delivering exceptional care to patients wherever and whenever they need it.

The money and people the NHS needs

In five ways, the next Conservative government will give the NHS the resources it needs.

First, we will increase NHS spending by a minimum of £8 billion in real terms over the next five years, delivering an increase in real funding per head of the population for every year of the parliament.

Second, we will ensure that the NHS and social care system have the nurses, midwives, doctors, carers and other health professionals that it needs. We will make it a priority in our negotiations with the European Union that the 140,000 staff from EU countries can carry on making their vital contribution to our health and care system. However, we cannot continue to rely on bringing in clinical staff instead of training sufficient numbers ourselves. Last year we announced an increase in the number of students in medical training of 1,500 a year; we will continue this investment, doing something the NHS has never done before, and train the doctors our hospitals and surgeries need.

Third, we will ensure that the NHS has the buildings and technology it needs to deliver care properly and efficiently. Since its inception, the NHS has been forced to use too many inadequate and antiquated facilities, which are even more unsuitable today. We will put this right and enable more care to be delivered closer to home, by building and upgrading primary care facilities, mental health clinics and hospitals in every part of England. Over the course of the next parliament, this will amount to the most ambitious programme of investment in buildings and technology the NHS has ever seen.

Fourth, whilst the NHS will always treat people in an emergency, no matter where they are from, we will recover the cost of medical treatment from people not resident in the UK. We will ensure that new NHS numbers are not issued to patients until their eligibility has been verified. And we will increase the Immigration Health Surcharge, to £600 for migrant workers and £450 for international students, to cover their use of the NHS. This remains competitive compared to the costs of health insurance paid by UK nationals working or studying overseas.

Fifth, we will implement the recommendations of the Accelerated Access Review to make sure that patients get new drugs and treatments faster while the NHS gets best value for money and remains at the forefront of innovation.

Holding NHS leaders to account

It is NHS England that determines how best to organise and deliver care in England, set out in its own plan to create a modern NHS – the Five Year Forward View. We support it. We will also back the implementation of the plan at a local level, through the Sustainability and Transformation Plans, providing they are clinically led and locally supported.

We will hold NHS England’s leaders to account for delivering their plan to improve patient care. If the current legislative landscape is either slowing implementation or preventing clear national or local accountability, we will consult and make the necessary legislative changes. This includes the NHS’s own internal market, which can fail to act in the interests of patients and creates costly bureaucracy. So we will review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care.

We expect GPs to come together to provide greater access, more innovative services, share data and offer better facilities, while ensuring care remains personal – particularly for older and more vulnerable people – with named GPs accountable for individual patients. We will support GPs to deliver innovative services that better meet patients’ needs, including phone and on-line consultations and the use of technology to triage people better so they see the right clinician more quickly. We will ensure appropriate funding for GPs to meet rising costs of indemnity in the short term while working with the profession to introduce a sustainable long-term solution.

We will introduce a new GP contract to help develop wider primary care services. We will reform the contract for hospital consultants to reflect the changed nature of hospital care over the past twenty years. We shall support more integrated working, including ensuring community pharmacies can play a stronger role to keep people healthy outside hospital within the wider health system. We will support NHS dentistry to improve coverage and reform contracts so that we pay for better outcomes, particularly for deprived children. And we will legislate to reform and rationalise the current outdated system of professional regulation of healthcare professions, based on the advice of professional regulators, and ensure there is effective registration and regulation of those performing cosmetic interventions.

We will also help the million and more NHS clinicians and support staff develop the skills they need and the NHS requires in the decades ahead. We will encourage the development of new roles and create a diverse set of potential career paths for the NHS workforce. And we will reform medical education, including helping universities and local health systems work closer together to develop the roles and skills needed to serve patients.

We want the NHS to become a better employer. We will strengthen the entitlement to flexible working to help those with caring responsibilities for young children or older relatives. We will introduce new services for employees to give them the support they need, including quicker access to mental health and musculoskeletal services. We will act to reduce bullying rates in the NHS, which are far too high. We will take vigorous and immediate action against those who abuse or attack the people who work for and make our NHS.

Exceptional standards of care, wherever, whenever

Outcomes in the NHS for most major conditions are considerably better than three, five or ten years ago. However, the founding intention for the NHS was to provide good levels of care to everyone, wherever they live. This has not yet been achieved: there remain significant variations in outcomes and quality across services and across the country. We will act to put this right.

To help the NHS provide exceptional care in all parts of England, we will make clinical outcomes more transparent so that clinicians and frontline staff can learn more easily from the best units and practices, and where there is clear evidence of poor patient outcomes, we will take rapid corrective action. We will ensure patients have the information they need to understand local services and hold them to account.

We will empower patients, giving them a greater role in their own treatment and use technology to put care at their convenience. In addition to the digital tools patients already have, we will give patients, via digital means or over the phone, the ability to book appointments, contact the 111 service, order repeat prescriptions, and access and update aspects of their care records, as well as control how their personal data is used. We will continue to expand the number of NHS approved apps that can help monitor care and provide support for physical and mental health conditions. We will pilot the live publication of waiting times data for A&Es and other urgent care services. We will further expand the use of personal budgets. We will also continue to take action to reduce obesity and support our National Diabetes Prevention Programme.

Our ambition is also to provide exceptional care to patients whenever they need it. That is why we want England to be the first nation in the world to provide a truly seven-day healthcare service. That ambition starts with primary care. Already 17 million people can get routine weekend or evening appointments at either their own GP surgery or one nearby, and this will expand to the whole population by 2019.

In hospitals, we will make sure patients receive proper consultant supervision every day of the week with weekend access to the key diagnostic tests needed to support urgent care. We will also ensure hospitals can discharge emergency admissions at a similar rate at weekends as on weekdays, so that when someone is medically fit to leave hospital they can, whichever day of the week it is.

We will retain the 95 per cent A&E target and the 18-week elective care standard so that those needing care receive it in a timely fashion. We will continue to help the NHS on its journey to being the safest healthcare system in the world. We will extend the scope of the CQC to cover the health-related services commissioned by local authorities. We will legislate for an independent healthcare safety investigations body in the NHS. We will require the NHS to continue to reduce infant and maternal deaths, which remain too high.

Our commitment to consistent high quality care for everyone applies to all conditions. We will set new standards in some priority areas and also improve our response to historically underfunded and poorly understood disease groups.

In cancer services, we will deliver the new promise to give patients a definitive diagnosis within 28 days by 2020, while expanded screening and a major radiotherapy equipment upgrade will help ensure many more people survive cancer.

We will continue to rectify the injustice suffered by those with mental health problems, by ensuring that they get the care and support they deserve. So we will make sure there is more support in every part of the country by recruiting up to 10,000 more mental health professionals. We shall require all our medical staff to have a deeper understanding of mental health and all trainees will get a chance to experience working in mental health disciplines; we shall ensure medical exams better reflect the importance of this area. And we will improve the co-ordination of mental health services with other local services, including police forces and drug and alcohol rehabilitation services.

We have a specific task to improve standards of care for those with learning disabilities and autism. We will work to reduce stigma and discrimination and implement in full the Transforming Care Programme.

We will improve the care we give people at the end of life. We will fulfil the commitment we made that every person should receive attentive, high quality, compassionate care, so that their pain is eased, their spiritual needs met and their wishes for their closing weeks, days and hours respected. We will ensure all families who lose a baby are given the bereavement support they need, including a new entitlement to child bereavement leave.

Children’s and young people’s health

We believe government has a role to play in helping young people get the best possible start in life. We are seeing progress: smoking rates are now lower than France or Germany, drinking rates have fallen below the European average and teenage pregnancies are at record lows. We will continue to take action to reduce childhood obesity. We will promote efforts to reduce unhealthy ingredients and provide clearer food information for consumers, as our decision to leave the European Union will give us greater flexibility over the presentation of information on packaged food. We shall continue to support school sport, delivering on our commitment to double support for sports in primary schools.

We understand the massively increased pressures on young people’s mental health. We will take focused action to provide the support needed by children and young people. Half of all mental health conditions become established in people before the age of fourteen. So we will ensure better access to care for children and young people. A Conservative government will publish a green paper on young people’s mental health before the end of this year. We will introduce mental health first aid training for teachers in every primary and secondary school by the end of the parliament and ensure that every school has a 73 single point of contact with mental health services. Every child will learn about mental wellbeing and the mental health risks of internet harms in the curriculum. And we will reform Child and Adolescent Mental Health Services so that children with serious conditions are seen within an appropriate timeframe and no child has to leave their local area and their family to receive normal treatment.

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Social care policy has been subject to much muddle, tinkering and the perpetual promise of a fairer funding system – a promise which is never fulfilled. Now is the time to end the confusion and create a social care system that is fit for the 21st century and which is in harmony with the socialist principles which underpin the NHS.

This policy proposal offers a solution which is fair, sustainable and which would be hugely beneficial to all citizens and families across the country.

The three key elements of the proposal are:

  1. Fund a universal system and end means-testing – Social care must be put on the same footing as healthcare, funded from general taxation, with resources distributed fairly, only on the basis of need.
  2. Invest in citizenship and community – Social care must offer support that people and families can shape to their circumstances, and that helps people contribute as citizens and strengthens family and community life.
  3. End privatisation and the complexity of the current system – Social care must be integrated into one national system that invests resources locally and ends the wasteful procurement systems that currently undermine human rights.

The problems in social care grow ever deeper the case for reform grows stronger:

  • Deep cuts in funding mean that 40% fewer adults are supported than in 2009.
  • Cuts to children’s social care are combined with growing numbers going into ‘care’.
  • Vicious means-testing systems push people into poverty in order to get care.
  • Funding for local government (council tax and business rates) is not a sustainable base for social care.
  • Individualised funding has become a confused mess of competing schemes, like personal health budgets.
  • People are not offered flexible support, instead they are encouraged to take their budgets as cash and employ your own staff, even when this is burdensome.
  • The regulatory system doesn’t work, rarely spotting abuse and undermining good practice.
  • Procurement rules push privatisation and discourage local community investment.
  • The system treats people as consumers, not citizens, undermining solidarity.
  • The system fails to respect the demands of the UN Convention on the Rights of Persons with Disabilities.

Background

The distinction between health and social care was created by the Thatcher reforms of the early 1990s and the term ‘social care’ is now commonplace, however it is rarely found in other countries and it can be more confusing. It may be more useful to think instead about the overall system to support disabled and older people who need on-going support and assistance and to call this Long Term Care (LTC).

Confused leadership

If we examine the organisation of LTC in the UK we find it is confused, weak and fragmented. Not every country in the UK is exactly the same, but in England responsibility is divided between 5 different government departments:

  • Department for Communities and Local GovernmentDCLG – local government and housing related support
  • Department of Health – DH – adult social care
  • Department for Education – DfE – children’s social care
  • Department for Work & Pensions – DWP – disability benefits
  • Office for Disability Issues – cross department leadership (in practice junior to DWP)

Since the introduction of austerity leadership has deteriorated further as responsibility for policy problems has been pushed onto local authorities or NHS organisations.

Fragmented funding

Furthermore these departments oversee a variety of funding streams for LTC, managed in a number of different ways:

  • Children’s social carestatutory responsibility, managed by local government
  • Adult social care for working age disabled peoplealso a statutory responsibility, managed by local government, but subject to different legislation
  • Adult social care for older peoplealso managed by local government
  • Continuing Health Care for people with chronic health conditions – managed by the NHS
  • Mental health services – managed by mixture of NHS and local government
  • Palliative and other long-term care and nursing services – managed by the NHS
  • Supporting People funding – managed by DCLG via local government
  • Independent Living Fund – The coalition Government closed down this national scheme that allowed some disabled people to get a budget for personal assistance but the scheme has been maintained in Scotland and Northern Ireland.

The overall level of public funding available for Long Term Care is certainly much higher than the £19 billion currently spent via local government. However the precise level will depend on which NHS or other services are treated as part of the LTC.

Ongoing crisis

Local government, particularly in England, has had its funding savagely cut since 2010. This has led to deep cuts to adult social care, with about 40% fewer people receiving social care now than in 2009.) There have also been severe cuts in other local support services.

The severe cuts in social care have not gained the attention of the media nor the general public. Although the 2017 budget saw talk of additional funding for social care for the first time since 2010. Instead of genuine funding reform there has been much talk of theintegrationof health and social care for over 30 years. However much of this appears to be a policy smokescreen. These Better Care Fund arrangements seem to be an inadequate cross-subsidy from the NHS to social care (robbing Peter to pay Paul) and there is no evidence that they have led to any significant innovations or meaningful reform.

The human rights of disabled and older people have been persistently ignored and the system has been treated as of marginal relevance to mainstream political debate. In fact the current system is also out-of-date in its assumptions about what people want and need and it tends to reinforce negative images and assumptions about disabled and older people:

  • On-going heavy investment in private and charitable residential care, despite the fact that this is not the support most people want.
  • The problems in social care are seen as causing problems for the NHS rather than being treated as problems in their own right.
  • While there is much talk of ‘personalisation’ mostly people are forced either to accept inflexible services ‘commissioned’ by statutory bodies or to take on the often onerous responsibilities of managing a ‘direct payment’ (receiving their budget as a cash payment and often employing their own support staff).
  • There is minimal innovation, inclusion or accessibility for disabled and older people in our local communities.
  • Confusion in central government is mirrored by confusion at the local level with responsibilities unclear and fragmented.
  • Instead of respecting people as citizens and family members, with something to contribute, the system has adopted a consumerist ideology which is misplaced and wasteful.

The following proposals provide a framework for leaving behind this ineffective, and often toxic, legacy, and redesigning the welfare system so that it properly respects our human rights and the unique value of all human beings, no matter their age or impairment.

Key principles

In the future policy must reflects the need for the UK to create a system which is consistent with its responsibilities as a signatory to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) which includes a universal right to the support necessary to enable independent living (Article 19).

If the UK Government took seriously its human rights responsibilities this would revolutionise our approach to long term care.

The five key principles for any future system of long term care must include:

  1. Universal coverage – The need for LTC is part of the normal risk of life and should be treated just as health and education.
  1. Maximum risk-pooling – The most efficient way of insuring ourselves against the costs of impairment or frailty is to all pool resources in order to cover that risk, as with the NHS.
  2. Equity – The system should be equitable and should not discriminate against people because of condition, age or geography.
  3. Entitlement – All citizens should benefit from the system and should not be disadvantaged by income or ability to pay. The system should be funded from general taxation and be free at the point of use, as with the NHS.
  4. Control – All citizens should be able to get the right flexible support to meet their needs, to be able take the level of control that is right for them and their families.

In addition, If the UK were to apply these principles then it would be more in line with current developments across OECD countries:

On equity and efficiency grounds, a majority of OECD governments have set up collectively financed schemes for personal and nursing care costs. Many are also moving towards universal entitlements to coverage of LTC costs.” [OECD (2011) Help Wanted?: Providing and Paying for Long-Term Care. OECD.]

Similarly the UK would also be in line with an international trend from Canada, the USA, Australia, Scandinavia and Eastern Europe to shift more power and control to citizens themselves, rather than to merely place people within services, minimising control and the opportunity to exercise citizenship.

Proposals in more detail

1. Partnership

Any future policy should be developed in partnership with and with support of disabled and older people themselves. In particular the National Pensioners Convention (NPC) and other groups led by disabled people must be central to the definition of any detailed proposal.

2. Human rights

Future policy must be based on human rights and the UN Convention on Rights of Persons with Disabilities (UNCRPD). The Convention confirms that all disabled and older people, no matter their age, condition or impairment, have full human rights and must be supported to be independent and contributing members of society – equal citizens.

Currently the UK is a signatory to the Convention but since 2010 it has been extremely negligent in meeting its international human rights responsibilities. For instance, in 2016, the UN Committee on the Rights of Persons with Disabilities reviewed the UK Government’s policies and stated:

“…there is reliable evidence that the threshold of grave or systematic violations of the rights of persons with disabilities has been met in the State partyThe core elements of the rights to independent living and being included in the community, an adequate standard of living and social protection and their right to employment have been affectedfreedom of choice and control over their daily activities restricted, the extra cost of disability has been set aside and income protection has been curtailed as a result of benefit cuts, while the expected policy goal of achieving decent and stable employment is far from being attained.

Any future policy for LTC must make commitment to clear and enforceable human rights central to its strategy.

The foundation stone for this policy must be full social commitment to the creation of a robust, enforceable, universal entitlement to the support necessary for independent living. This right would exist for people of all ages. In effective the whole of society would guarantee to set aside the resources necessary to make sure that any of its members who needed extra support to participate as an equal would receive that support.

3. Universal scope

This right would extend to all people needing on-going support. It would include support for disabled people regardless of age or impairment (people with physical, sensory or cognitive impairments). It would include all people needing on-going support because of their mental health or chronic health conditions. It would include childrens social care and support for people who are at the end of life.

The purpose would be to create one single, universal and flexible system to replace much of current social care provision, and also to include only those elements of NHS funded services that would genuinely benefit from being converted into flexible entitlements (e.g. Continuing Healthcare, and some mental health provision). This system would end the system of Personal Health Budgets and make clear that means-testing, charging and private insurance has no place in the modern welfare state.

There would also need to be in place an infrastructure of services to support people with information, advocacy, social work and nursing expertise and support to manage their entitlements. Local community support would need to be established to ensure that any individual entitlements were convertible into effective support.

4. Means-testing

There is no moral case for applying means-testing to social care and the impact of the vicious levels of means-testing in the current system are highly toxic:

  • People with higher incomes or assets get no benefit from social care and have no interest in supporting it through the ballot box or by taxation.
  • People on modest incomes or with assets are tempted to give away what they have to family or to spend their resources in order to become eligible for social care.
  • People who are eligible for support are discouraged from earning additional income if they can, as this means they will lose their social care support.
  • Means-testing is carried out using an expensive and cumbersome ‘charging system’ often raising no more money that the system costs to implement.

Already the system is confused. Children and families are not means-tested, but adults are means-tested. People needing adult social care are means-tested, but if their needs are re-assessed as ‘health’ needs then they stop being means-tested. None of this makes any sense and it often undermines the possibility of effective joint-working or integration between health and social care.

Self-funders currently spend about £10 billion on care, which is 0.5% of GDP. In essence this policy can be funded by asking people to pay a very small tax increase in order to cover themselves against the risk of having to pay for their care privately and potentially losing all their assets. A similar policy change in Australia involved the introduction of a hypothecated tax in order to pay for all fully funded universal system for working age adults. It was introduced by the recent Australian Labour government and was so popular that the incoming Liberal government was not able to touch it.

5. Delivery

The right to personalised support to achieve independent living would be delivered through a balance of individual entitlements and community-based support, made up of the following elements:

  • Flexible and individualised services, provided by statutory and local community organisations
  • People being able to manage their own budget or choose their own support if they want
  • Peer support and community-led systems of support
  • Independent advocacy and information services
  • Social work and professional advice

Support arrangements, in a healthy system, will not be static. They will change over time as citizens, communities and local leaders innovate, identify and share best practice.

This system would also end the use of procurement and tendering systems, which have had a very damaging impact on local statutory and community services. Currently services for disabled people are put out to tender and people are sold offto the lowest possible bidder.

The only way to avoid being part of this inflexible system is take your budget as a direct payment and about 25% of adult social care is organised in this way. But this is often neither feasible nor advisable, and it can bring many additional burdens. In practice there are IT systems available which could replace the current mess of contracting, invoicing and payment systems and which could make flexible services possible for everyone. In fact the NHS currently owns 50% of PHB Choices, and it (or some similar system) could easily be developed to provide a coherent solution for the whole system – giving people choice and control but not forcing people to use direct payments.

6. Organisation

A renewed system for LTC needs to have clear and coordinated leadership at a national level, combined with the right kinds of being decisions being made at an individual, practitioner or local level. There are a number of ways this could be achieved and much would depend on the details of how any further devolution of powers in the UK might work, however an outline proposal is as follows:

  • Overall national leadership for LTC could move to DCLG
  • Local communities would receive a ring-fenced LTC budget calculated on the basis of need
  • Local community support systems would be organised through local government, in partnership with NHS agencies
  • Assessment of entitlement and setting of budgets would be organised locally
  • Individual budgets for people would be portable, flexible and clear

This system would combine fairness with good governance and positive incentives.

7. Advocacy

One of the major failings of the current system is the fragility of individual and collective rights. Within local communities people have only the weakest notion of their entitlements and as the cuts programme began most charities, now highly dependent on central or local government funding, failed to mount any defence of peoples human or legal rights. Any new system must be underpinned by legal and advocacy systems that protect people form this kind of systemic abuse.

8. Economics

There have been a wave of failed initiatives to calculate the cost of ‘social care’ and to determine suitable systems of funding. It is vital to create a sustainable system of funding to underpin rights created by the new system. Instead of building on a failed system and the assumption that residential or nursing care is the default model for support we need a fundamentally different approach to the economics of independent living:

  • Focus on the costs of exclusion versus the benefits of inclusion and contribution
  • Avoid the crisis and cost inflation caused by high eligibility thresholds
  • Support families, who already provide over 80% of care in practice
  • Minimise the bureaucracy and regulation built into the current system
  • Avoid the direct and indirect costs of means-testing
  • Build on current investments within the NHS and local government

This issue is also important to the definition of eligibility. Currently the system has made it very easy for people to be deemed ineligible for support, however significant their needs. A new system will seek to enhance contribution and connection by all citizens. Systems like local area coordination, or a renewed focus on community social work, would provide a better basis for building a sustainable system than the current care management system, that was imposed on local government by Mrs Thatcher.

9. Wider policy change

These changes need to be considered in the context of wider changes in policy. In particular it is clear that if communities become more welcoming places and if all citizens benefit from the right balance of rights and responsibilities then the whole system becomes stronger and more sustainable. Here are some examples of beneficial changes that would make independent living a reality:

  • Housing policy – more accessible properties and robust and flexible housing entitlements
  • Social security policy – more income equality, lower benefit reduction (marginal tax) rates (or even better, a basic income) and greater acknowledgement of the increased living costs for disabled people and families
  • Education policy – more inclusion innovation at every level of education
  • Health policy – protection from eugenic or prejudicial end of lifepolicies and a commitment to the equality of all
  • Employment policy – greater protections and support for disabled employees to achieve and maintain jobs, greater support for families who take on caring responsibilities

Conclusion

What is outlined above is a reasonable policy for a wealthy society in the early years of the 21st Century. The fact that it may seem ambitiousis that we have not yet created the necessary conditions to make it seem reasonable. To do this we will need to see:

  • More opportunities for disabled and older people to lead the way in making the case for change
  • An effective alliance, led by disabled and older people, but embracing families and professionals
  • Clear communication of the key messages and universal benefits of this new approach
  • Support from and for politicians with the vision to back these changes

None of this is impossible. These kinds of changes were achieved by the Every Australian Counts campaign and are leading to the most substantial international effort to support the human rights of disabled people. There is no reason why the UK could not do something similar.

This paper was produced by Dr Simon Duffy on behalf of the Socialist Health Association on 21st April 2017

This document is one of a series developed by the SHA that underpin our recommendations for the Labour Party Manifesto (weblinks). Each has been developed with contributions from many experts and curated by Brian Fisher through an SHA Policy Commission. They remain in draft and have not been approved by SHA Central Council. They offer an opportunity to explore policy in more detail through debate. They are timely as the NHS is such a key part of the election.

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Addressing the social determinants of health is an important foundation for the health and wellbeing of our citizens. The fundamentals of life such as access to clean water and safe waste disposal; housing which provides enough space, clean air and efficient heating; education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all be assessed and developed as a holistic approach to public health.

Local and national democratically accountable governments need to hold these strategic responsibilities and be supported by public health officers at Chief Medical Officer level in national governments and District Directors of Public Health at local government level. These officials need to be professionally independent chief officers and be required to report annually on the health of their populations with reference to other populations and assessing health inequalities and their recommendations on priorities.

Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.

  • The nation’s Chief Medical Officers (CMOs) will be required to report annually on the health of their populations to their governments. The UK CMOs will be required to submit an annual report directly to Parliament charting progress in UK comparative performance in terms of population health, health inputs, care processes and patient outcomes (both patient and clinician reported). Such a report will need to consider the UK health outcomes in an international context.
  • Directors of Public Health within local authorities should be adequately resourced executive directors able to make recommendations which must be integral to decision-making by the council’s chief officers.
  • Social care and other local authority provision and relevant services and proposed developments should be included in public health plans.
  • All local authority policies and plans should be subject to an environmental and health impact assessment.
  • All policies in government will be subject to an assessment of their impact on the public’s health.
  • Strategies and plans for wellbeing should be agreed at local, sub-regional and regional level and should be used to guide decisions about service provision, major investments and reconfigurations.
  • Infectious diseases require attention to high uptakes of vaccination and immunisation and the promotion of hand hygiene and the reduction in the use of antibiotics to help prevent the growth in antimicrobial resistance.
  • The public health remit must include promoting health, protecting health as well as effective (evidence based) health and social care. All these three domains of practice require robust systems of appraisal of evidence, systematically collated knowledge and information.

ENVIRONMENT/CLIMATE CHANGE

  • The NHS must maximise environmental sustainability and engage with the strategy that protects and improves health within environmental and social resources now and for future generations.
  • Such sustainability strategies mean reducing carbon emissions, minimizing waste and pollution, building resilience to climate change and nurturing community strengths. See separate section on sustainability and planetary public health (in preparation with David Pencheon of the NHS Sustainability Unit).

AIR QUALITY

  • We will take urgent steps to reduce the air pollution caused by road traffic, particularly by diesel engines.
  • We will reconsider strengthening the regulation of vehicles, taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
  • All this in the context of decreasing coal fired electricity generation and proportionately increasing the use of renewables.

FOOD AND DRINK

  • We will remove the VAT exemption from sugar and raise tax on the simple sugar content of drinks and foods such as breakfast cereals. 
  • We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers by standardised information in the form of WHO recommended traffic lights and standard information wherever it is sold.
  • We will ban the use of trans fats in food products and push for the ban to be extended internationally.
  • We will introduce minimum unit pricing for alcohol and encourage lower alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol.
  • The sale of tobacco and alcohol in supermarkets should be regulated so separate areas are identified to display and pay ensuring better supervision and differentiating alcohol and tobacco from a normal family shopping basket.
  • Tax should be proportionate to alcohol strength

HOUSING

  • We will introduce minimum standards for healthy housing construction to ensure sustainable housing quality and reduce the risk of adverse impacts such as fuel poverty through inefficient heating/insulation.
  • Internal ventilation is also required to reduce the risk of house dust, fumes to ensure clean air.
  • Housing should be located near green spaces and close to play ground amenities for children.

WORKFORCE

  • In conjunction with a strengthened Health and Safety Commission, we will introduce measures to ensure that workers feel more in control of their own work. Workers and their trade unions should be represented on company boards?
  • Occupational health will become a responsibility of the NHS to provide a national service with local generalist and more specialist regional resources.
  • A healthy workplace must be the expectation and employers be held to account on best practice and minimum standards in line with health (both physical and mental) and safety legislation.

DRUGS AND TOBACCO

  • The taxation system will make healthier products like fresh fruit and vegetables more affordable while making less healthy processed food products better regulated and relatively more expensive.
  • We will progressively raise tobacco tax and the age below which it is unlawful to supply tobacco to young people.
  • Personal, social and health education (PSHE) will be compulsory in schools appropriate to the age of the child and directed to inform and empower children to look after themselves. 
  • We will bring forward proposals to reform the law on misuse of drugs to minimise risk which will include alcohol, tobacco and other drugs.

TRANSPORT/ SPORT.

  • The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.  
  • We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists
  • We will remove VAT from bicycles and encourage cycle to work and other workplace incentives.
  • We will progressively ensure access for all to affordable public transport
  • Physical activity should be encouraged in schools with whole school activities, travel to school schemes as well as specialist sports teaching.
  • All local authorities must introduce 20mph speed limits on all residential roads so this speed becomes the urban road norm.
  • Transport policies need to be strengthened so that city centres are largely free of private cars with access ensured by efficient public transport, cycle and pedestrian access.
  • Overall transport policies should be biased towards walking and cycling, bus and trains and vehicles that are increasingly electric or other low carbon fuels.
  • We recommend that transport policy should accept a hierarchy of walking >cycling >public transport, to include good provisions for disabled people
  • Air transport needs to be increasingly regulated and air fuel tax applied. We must actively encourage more use of continental trains as an alternative to short haul flights.

CHILDREN

  • We will ensure children have received high quality PSHE through their school years so they are aware of gender and sexual and interpersonal relationships, understand the distortions of on line pornography and be empowered to say no.
  • We will ensure contraception and sexual health clinics are easily accessible to reduce the risk of sexually transmitted diseases and unwanted pregnancy
  • More investment in the training and employment of midwives and Health Visitorss to ensure that sufficient support from midwives and health visitors is available for women and babies, especially solo parents and young mothers,
  • We will increase benefit rates for pregnant women so that they can afford a healthy diet and suitable accommodation.
  • Every school must have a named school nurse and a school counsellor, for which more funding will be required
  • Children’s mental health services need to be improved and made adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.
  • We will ensure that there is parity of treatment in health and social care services in respect of both youth and age. 
  • Services must be improved in transition from child to teenager and teenager to adult

HEALTH INEQUALITIES

  • Improving health requires addressing the social determinants of poor health based on the principle that there is a role for an interventionist state, for redistribution of wealth and power, and a role not just in planning and commissioning but in delivery. 
  • Labour’s long-term goal is to break the link between a person’s social class, their social situation and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this.
  • We recognize the importance of the early years (pregnancy and first 5 years of life) and there should be workplace benefits to enable generous maternity and paternity leave, state nursery provision and safeguarding along the lines of Scandinavian countries.
  • The establishment of an Office of Health Equity to promote and monitor the application of the Fair Society, Healthy Lives policies of giving every child the best start in life; enable all children, young people and adults to maximize their capabilities and have control over their lives; create fair employment and good work for all; ensure a healthy standard of living for all; create and develop healthy and sustainable places and communities and strengthen the role and impact of ill health prevention.
  • Health impact assessment of all government policy will be used to reduce inequalities in income and wealth and those caused by trade, foreign and defense policy

THE IMPORTANCE OF COMMUNITIES

  • NHS agencies and providers will ensure that every locality has a thriving third sector largely funded by grants rather than contracts.
  • NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so.
  • Health agencies will play an active part in deploying community development to improve health protection through community empowerment, help tackle health inequalities and encourage responsive statutory agencies.

This document is one of a series developed by the SHA that underpin our recommendations for the Labour Party Manifesto. Each has been developed with contributions from many experts and curated by Brian Fisher through an SHA Policy Commission. They remain in draft and have not been approved by SHA Central Council. They offer an opportunity to explore policy in more detail through debate. They are timely as the NHS is such a key part of the election.

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