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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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    The UK has one of the highest levels of income inequality in the developed world, and evidence shows that this harms our physical and mental health, hinders our education, damages our economy, restricts social mobility, reduces levels of trust and civic participation, and weakens the social ties that bind us.

    We have astronomical pay inequality, with workers trapped on poverty wages while chief executives take home jackpot-like pay packets. Britain’s top bosses are paid on average 165 times more than a nurse; 140 times more than a teacher; 132 times more than a police officer, and 312 times more than a care worker. We have staggering wealth inequality, with the richest 1,000 people in Britain owning more wealth than the poorest 40% of the population put together.

    We have a housing crisis which locks the vast majority of renters out of home ownership, with too many trapped in substandard housing, and an outdated council tax system that hits the poorest hardest.

    We have a shocking gap in healthy life expectancy which condemns the poorest to 20 fewer years of healthy life than the richest.

    We have unacceptable attainment gaps between equally bright children from richer and poorer backgrounds. We have people falling through gaping holes in our safety net, a record high for food bank usage, rising death rates for babies and the frail elderly, and rising child poverty.

     

    Equality Trust

    But it doesn’t have to be this way. Inequality is not inevitable. Here, The Equality Trust sets out its policy priorities for all political parties.

    To effectively tackle the social and economic inequality blighting our society and to achieve a fair Brexit, we need fair work, fair tax, fair chances and a fair deal.

    Fair Work

    • Protect and progress workers’ rights: strengthen trade union rights, introduce employment rights from day one, and ban forced zero-hours contracts.
    • Recognise the contribution of every worker: require large and mediumsized companies to publish the ratio of remuneration between the highest paid and the median employee, along with a justification of the ratio, annual changes to it, and a plan for its reduction.
    • Give workers a voice: require one third of the members of companies’ executive boards to be comprised of employees, and require elected employee representatives on remuneration committees.
    • Give workers a genuine stake in their workplaces: promote industrial democracy in our economy by encouraging the growth of the cooperative and mutuals sector.

    Fair Tax

    • Ensure the broadest shoulders bear the greatest burden: reinstate the 50p top rate of income tax, which affects approximately the top 1% of earners.
    • Transform council tax into a progressive property tax: re-evaluate properties and create new bands with higher rates for high value properties.
    • Explore the most effective ways of distributing wealth fairly and efficiently: establish an independent Commission on Wealth.
    • Ensure business benefits our society: strengthen measures to tackle tax avoidance, reverse the race to the bottom on corporation tax and prevent the UK from becoming a tax haven.

    Fair Chances

    • Help level the playing field and ensure pupils’ diverse needs are met: end selective education, properly fund a comprehensive education system for all, and introduce universal free school meals.
    • End child poverty: reinstate child poverty targets and commit to eliminating child poverty.
    • Reduce health inequalities and improve health for all: properly fund the NHS and social care, and address the root causes of poor health and the health gap.
    • End the two-tier justice system: abolish employment tribunal fees and restore legal aid.

    Fair Deal

    • Tackle our housing crisis: establish a large scale house building programme, prioritising social housing and truly affordable housing, built to high quality and environmentally friendly standards.
    • Ensure Local Housing Allowance rates rise in line with increases in local private rents.
    • Let low-income families keep more of the money they earn: restore Universal Credit work allowances and reduce the taper rate to 55%.
    • Ensure everyone can keep up with rising living costs: restore the link between annual increases in social security levels and inflation.
    • Ensure public bodies consider how their decisions affect inequality: commence the socio-economic duty in Section 1 of the Equality Act 2010.

    Will your local candidates tackle inequality?

    Here are some suggested questions that we could all raise at hustings and other local and national events in the run up to the General Election to determine candidates’ commitment to a fairer society:

    • Would you support further tax cuts for billionaires over properly funding the NHS?
    • What would you do about the fact that nurses who care for our loved ones are paid hundreds of times less than bosses at some of our country’s biggest companies?
    • Do you believe children should be segregated at age 11 by a grammar school system that benefits the rich and hurts the poor?

    Will you support us? The Equality Trust is working to reduce social and economic inequality in order to build a better society. But to do so we need your help. Our work depends on generous donations from individuals who share our vision. Please help support active campaigning for a fairer society by becoming a supporter of The Equality Trust.

    • Please visit www.equalitytrust.org.uk/support-us to set up a Direct Debit; or
    • Please send a cheque payable to The Equality Trust to: Freepost EQUALITY TRUST; or
    • Please text EQUA16 £10 to 70070 to donate £10 (the JustGiving service accepts text donations of £1, £2, £3, £4, £5 and £10). We also welcome applications to affiliate to The Equality Trust from business, trade unions and the public sector, as well as from co-ops, charities, social enterprises and campaign groups.  And if you want to get involved in tackling inequality where you live, you can join or start a local equality group.

    The manifesto was collective endeavor by the  Equality Trust, as everyone chipped in.   Lucy wrote it up and designed it.

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    The Socialist Health Association has been developing health policy for some months under the dedicated leadership of Dr Brian Fisher, building on our wide and deep experience of the health system, going well beyond the NHS. We suggest 4 key recommendations for England, recognising that the devolved nations make their own policies. We have also suggested 3 more secondary recommendations which could also be considered.

    Four Key Recommendations:

    1. A NATIONAL HEALTH AND CARE SERVICE (NHCS)

    Bringing together our separate health and social care systems to become one unified care system driven by the political values and professional / organisational principles that underpin the NHS. This can be achieved by a gradual, non-disruptive process.

    The political values are:

    • a system with national standards;
    • funded from progressive taxation;
    • delivered by locally accountable bodies that rely on committed staff many of whom have professional training and professionally established responsibilities;
    • evidence based; relies on the notion of “co-production” between service users and professional staff – people playing an active role in their care and professionals welcoming, respecting and responding to that role.

    Funding; At least 10% of GDP should be for health and care funding, and all parts of the system should be appropriately funded.

    Mental Health; We support parity of esteem and funding for mental health and the continued development of integrated services which jointly address mental, physical and social needs.

    This offers other significant opportunities for improving health and care:

    • Social Care free at point of use, beginning with conditions such as end of life care and extending as the situation permits and in as short a timescale as practicable.
    • There must be a full commitment to the universal right to the support necessary to enable independent living, consistent with the United Nations Convention on the Rights of Persons with Disabilities.
    • Boosting community care and community services for the frail elderly
    • Hospitals should be funded to deliver best care, using the best equipment, medications and methodologies according to the evidence base.
    • Hospitals should be funded to provide sufficient beds and services where the community option is not in the patients’ best interests.
    • New drugs, treatments and methodologies should be appropriately funded for patients according to the evidence base.
    • Research in publicly owned hospitals, universities and laboratories should be appropriately supported and funded.
    • The importance of informal carers to be recognised. They should be fully supported and their sacrifices recognised. We support the recent proposal to increase carers benefits and we support extending them to all carers.
    1. AN END TO PRIVATISATION

    Care, free at the point of need and funded out of general taxation, provided by public bodies. Labour will restore the duty of the Secretary of State to deliver a comprehensive, universal NHS publicly provided and managed service, meeting clinical need. This needs to be achieved with as little disruption as possible. The NHS Bill 2016-17 provides a model for legislation in the first weeks of a Labour Government. Legislation should include the relief of NHS bodies from PFI debt.

    This has implications for what is currently called commissioning. Commissioning outside the market is called planning which still must be done somewhere based on needs and assets assessment. Wales and Scotland offer excellent examples.

    • Commissioning/planning must be separate from provision and free of any form of conflict of interest or undue influence.
    • Planning functions must be democratically accountable and cannot be given to the private sector under any circumstances.

    It also has implications for Trust status:

    • The NHS will no longer regard Foundation Trusts as free-standing competitive corporations. Foundation Trusts will be reintegrated into the NHS family.
    1. A FULLY FUNDED NHS AND CARE SERVICE

    Labour will fund the NHCS to enable a comprehensive service which will either mean reaching the EU average, or at least 10% of GDP.

    1. ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH

    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; social and affordable housing which provides enough space, good oral health delivered via the NHCS with active interventions, 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. We support the child poverty abolition target for 2020.

    This has implications for the service:

    • Chief Medical Officers and District Directors of Public Health need to be professionally independent.
    • They would be required to report annually on the health and health inequalities of their populations 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.

    Three  Secondary Recommendations: 

    1. EXPLORE A MIXED ECONOMY IN PRIMARY CARE

    There are advantages and disadvantages to the independent contractor status. The SHA would recommend a trial of a mixed economy, where in some areas, primary care is salaried and in others as it is now, the benefits and risks to be evaluated.

    1. COMMIT TO DEMOCRATIC, ACCOUNTABLE AND TRANSPARENT HEALTHCARE

    Co-production is the process of working with NHS users. This applies at a macro level, planning local and national NHS services in collaboration with citizens and users; it also applies at an individual level in the consultation between patient and clinician where shared decision-making takes place.

    • A commitment to responding not only to needs as defined by clinicians, but needs as defined by users, carers and citizens. We see the process as a meeting of experts – the NHS offers its clinical expertise. The patient is an expert on their own strengths – and the impact of ill-health on them.
    • The community can, with help, identify key issues that matter to them and work with the statutory sector to address those issues – evidence shows that this process protects health. Community development is one key mechanism.
    1. BREXIT AND THE NHS AND CARE SERVICE

    The NHS and social care are utterly dependent on labour from overseas. Without them the NHS will struggle. We would like to see recruitment and employment of staff from the EU and other countries allowed. We want Labour’s policy on Brexit to focus on the economy and free movement.

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    Sion Simon

    We’ll defend our NHS, prioritising mental health and championing a healthy region
    I want to see an outstanding NHS in the West Midlands – with parity of esteem between mental and physical health,  supported by a physical activity strategy for everyone in the region. Yet the Tories are doing their best to destroy it.

    This is how we will take control of our NHS in the West Midlands:

    • Defend the NHS against Tory cuts – demanding our fair share so that frontline services in the West Midlands are of the highest standard. Seek powers to devolve more NHS strategic planning and commissioning to the regional level.
    • On taking office I will immediately convene a task and finish group, using the outstanding professional expertise we have in the region – to radically redesign our approach to both the health care and social care of our older people. We will seek extra powers from government if needed.
    •  The Tories have shortchanged the care of our older people. We will have to use our skills strategy to create a bigger care workforce, encourage new entrants to the market through social enterprises and push for universal recognition of the Ethical Care Campaign, which champions our region’s caring home-workers.
    • Back the NHS by working with local universities to train more nurses and doctors in the West Midlands – and keep them in the region. We’ll work with our hospitals to grow the number of local people we train to deliver the NHS of the future.
    •  Mental health to have parity of esteem with physical health – working with partners to achieve early diagnosis and treatment, more and better support for carers, and steps to tackle stigma. Fully implement the WMCA Mental Health Action Plan, while extending a pro-active approach towards mental health to childhood.
    •  Work with local authorities to produce a West Midlands strategy for physical activity, giving everyone in the region the confidence, opportunity and motivation to participate in sport and recreation.
    •  Maintain and grow the world class research base in life sciences of the West Midlands – strengthening partnerships between universities and local business.
    •  Give people more control over their own health – by supporting the development of apps that provide health information, supporting the development of personalised care budgets, and crucially improving prevention of health
      problems. We’ll bring public services together to promote health initiatives, promoting healthy food availability and tackling bad practices in advertising and promotion of unhealthy food.
    • Make the public realm as supportive and inclusive as possible for those with dementia, autism, and all those with conditions that need particular forms of support – and encourage a wider understanding of the care required for these people to live with appropriate dignity and vitality.
    • We will raise awareness of the importance of children’s oral health, promote new schemes in nurseries and schools and aim to reduce the number of child tooth extractions – which cost our NHS millions every year.
    • In line with our ethos of early intervention, we will introduce a new general principle in the West Midlands that no child here who needs mental health support will be turned away or forced to wait long periods to access the support they need.
    •  We will encourage innovative approaches to GP prescribing across the West Midlands, where GPs are able to offer patients a range of non-traditional support, working with voluntary organisations to deliver more counselling and
      help to get active.
    •  Monitor the impact of health and social care  devolution in Greater Manchester and move to replicate successes, providing sufficient funding is secured from central government.
      • Working with the NHS to tackle health inequalities and improve awareness of LGBT issues and tackling domestic abuse in the LGBT community and the barriers that exist around reporting.

    More about Sion’s manifesto

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    Statement by Labour candidates for election as governors of Greater Manchester Mental Health NHS Foundation Trust.

    This is a challenging time for the NHS, particularly for mental health services. We are a group of Labour Party members campaigning for genuine parity of esteem for mental health, in order to ensure that patients get the full range of services and quality care that they deserve.

    We believe that:

    • Prevention is always better than cure, where possible, through the promotion of wellbeing within the community and ensuring that support is available to people who need it sooner rather than later.
    • A variety of mental health training within schools, workplaces and communities is essential to reduce the number of admissions, combat stigma and promote mental wellbeing.
    • A&E and community services for people experiencing a mental health crisis are currently inadequate and must improve. No patient should have to stay in police custody due to a lack of beds.
    • Patients must be treated with the utmost respect and compassion, and their feedback valued along with the opinions of friends and family as well as the wider community.
    • Mental health services must be properly funded by the government, including funding aimed at tackling the social factors contributing to mental illness.

    As Governors we will ensure that feedback from service users and their friends and families is kept at the forefront of care provision by Greater Manchester Mental Health NHS Foundation Trust. We will make certain that the Trust is properly represented in the “Devo Manc” environment so that services are adequately funded and supported across all of Greater Manchester.

    Bryan Blears – Salford

    Michael Crouch – Service User and Carer

    Peter Dodd – City of Manchester

    Thomas McAlpine OBE – City of Manchester

    Simon Morton – Staff – Non-Clinical

    Voting will open on 14th February 2017. Electors will receive an e mail containing unique voting details

    This is the first time we have had an SHA slate in an election.  In England you can be a member of your local Foundation Trusts, and there are also many which have a category of membership for the whole of England. 

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    Our Manifesto: Health & Wellbeing

    Before drafting my manifesto for Mayor I want to do things differently. I want to involve as many people as possible in developing policy ideas that will make a real and meaningful difference to people’s lives.

    At the Health and Wellbeing Manifesto conference, we heard from users, carers, experts and interested parties alike about the things that really matter and could improve the lives and the quality of healthcare for residents across Greater Manchester.

    The ideas suggested:

    1: Care workforce needs to be further valued and recognised

    2: Integrated health and social care pathway

    3: Prioritise investment in community care

    4: Upskilling, training and valuing of current staff and to help aid recruitment.

    5: Introduce a Greater Manchester Ethical charter

    6: Argue for an increase in the budget for health and social care from Government

    7: Make Greater Manchester Autism friendly

    8: Make the internet safer and promote a campaign on children’s mental health

    9: Prioritise investment in preventative mental health services

    10: Focus on public health education in schools

    11: Integrated approach to mental health in the workplace

    12: Make the case for an increase the number of health visitors

    The ideas highlighted received the most votes at the conference and will be explored further as the next step in this process.

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    It’s clear that this poll has been overwhelmed by bogus votes, so we will rerun it in a more secure fashion.

    Who should we support as Leader of the Labour Party?

    • Owen Smith (68%, 541 Votes)
    • Jeremy Corbyn (30%, 238 Votes)
    • Neither (2%, 17 Votes)

    Total Voters: 796

    Loading ... Loading ...

    This poll closed at midnight on Sunday 24th July.

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    An election for the Leadership of the Labour Party has been formally triggered. The National Executive Committee has met and agreed the procedures and timetable for the selection and these are set out below.

    Procedural Guidelines

    1. The election of the Leader will be held under the constitutional rules as detailed in Chapter 4 of the Labour Party Rule Book, ‘Election of a leader and deputy leader’.

    2. The National Executive Committee (NEC) has constitutional responsibility to ensure that procedures, including the length of any contest, are laid down in advance of any such contest and that these procedures are adhered to throughout the campaign. These general procedures are set out below. In addition, there shall be a Code of Conduct, including any spending cap, for Candidates. The General Secretary will issue a Code of Conduct, or ‘Purdah rules’, for all Labour Party Staff.

    PROCEDURE COMMITTEE

    3. There shall be a Procedures Committee to oversee the election process. The Procedures Committee will comprise of:

    General Secretary (Returning Officer)

    NEC Officers (Ann Black, Keith Birch, Diana Holland, Jim Kennedy, Paddy Lillis, Ellie Reeves, Mary Turner, Tom Watson)

    Margaret Beckett MP

    Glenis Willmott MEP

    4. The election will commence the day that the National Executive Committee agrees with the publication of notice of election.

    5. The Labour Party will supply to all eligible electors a candidates’ statement booklet along with a postal ballot paper at no additional cost to candidates. Candidates will need to provide a photo and a statement up to the 

    maximum of 250 words. The distribution of the booklet and postal vote packs may be by electronic or print versions.

    6. The national party will arrange a series of hustings which all candidates are expected to attend.

    NOMINATIONS

    7. Nomination papers will be provided for all Members of Parliament (Westminster and European). The closing date of PLP and EPLP nominations is set out in the timetable. Nomination papers may be received by hand or signed and scanned back to the Returning Officer before the deadline. In exceptional circumstances, and at the discretion of and with verification by the General Secretary, nominations from members of the Commons PLP and the EPLP will be accepted in a format other than the official nomination paper.

    8. Individual members of the Commons PLP may nominate themselves or one other member of the Commons PLP for the position of Leader.

    9. Nominees who achieve 20 per cent (51 nominations) support of the combined Commons members (currently 231) of the PLP and members of the EPLP (currently 20) will be declared validly nominated and go through to the One Person One Vote (OPOV) ballot of the contested position.

    10. All nominations must be received by the General Secretary of the Labour Party by the time and date detailed in the timetable.

    11. Valid nominees must formally accept their nominations, once declared by the Procedures Committee, in writing to the General Secretary by noon on the day following the close of the nomination process.

    12. All aspiring candidates or their agents must attend the compulsory PPERA briefing organised by the Labour Party. The General Secretary will invalidate any candidate(s) who fails to attend the PPERA briefing.

    13. All nominations will remain valid once submitted unless the nominated candidate fails to meet their obligations set out above or has withdrawn in writing to the General Secretary. MPs and MEPs who nominated a candidate who withdraws or is disqualified will be entitled to submit a further nomination prior to the deadline. Nomination forms will be re-issued to affected MPs and MEPs. If at the close of nominations there is only one validly nominated candidate s/he will be declared elected.

    14. Nominations (including the names of individual MPs and MEPs) will be recorded and published daily on the Labour Party website.

    SUPPORTING NOMINATIONS

    15. Supporting nomination papers will be sent out to all eligible stakeholders. Only supporting nominations received on the official form, signed by the appropriate authority (CLP Secretary/TU General Secretary/Responsible Officer in Socialist Societies) will be accepted.

    16. Each fully paid up affiliate (trade union, socialist society, etc.) may submit one supporting nomination for the position of Leader.

    17. Each CLP may submit one supporting nomination for the position of Leader. CLP Supporting Nomination meetings shall be open only to those eligible members who are entitled to vote in the leadership election. All members shall face a membership verification check at the door. No registered or affiliated supporters may attend CLP nomination meetings unless they are also an eligible member.

    18. All supporting nominations must be received by the General Secretary of the Labour Party by the time and date detailed in the timetable.

    19. Supporting nominations will be recorded and published on the Labour Party website daily.

    ELECTOR ELIGIBILITY CHECK

    20. Labour Party members on the national membership system and not lapsed from membership at the date set on the timetable will be eligible to vote. Affiliated supporters and Registered Supporters, as defined by the NEC, who have been registered with the Labour Party at the date set on the timetable will be eligible to vote.

    21. CLPs have the opportunity to check on-line through Members Centre the membership in their constituency for those that are in arrears.

    22. No abuse of any kind by members or supporters shall be tolerated. All eligible members and supporters must conduct themselves in a calm and polite manner and be respectful to each other at all times. Behaviour including, but not limited to, racist, abusive or foul language, abuse against women, homophobia or anti-Semitism at meetings, on social media or in any other context will be dealt with according to the rules and procedures of the Labour Party.

    23. Any disputes as to the eligibility of individual members must be raised by the date set on the timetable. The NEC have designated the Executive Director of Governance to rule on eligibility of individual members and his/her decision will be final.

    BALLOT

    24. The National Executive Committee has appointed an independent organisation, ERS, to conduct the One Person One Vote (OPOV) ballot.

    25. The party will conduct a ballot of all eligible electors for the contested position using the OPOV process, single round preferential voting system. This ballot will take place by post and secure electronic voting. Details will be contained in the voting package or voting email. Details will be sent to the address or electronic address registered on the National Membership System. During the actual ballot ERS will provide a helpline should an individual member have a problem.

    26. Ballot papers for Members of Parliament and Members of the European Parliament will be sent to the address registered on the National Membership System unless otherwise indicated to the General Secretary.

    The voting package sent to all members will consist of (or the electronic equivalent):

    Covering letter

    Ballot paper

    Return envelope

    Candidates’ statements and lists of nominations and supporting nominations

    27. The procedure for preference voting in the ballot is shown below.

    28. All validly nominated candidates must supply a photo and a statement of a maximum of 250 words to the party. This will be included in the booklet of candidates’ statements and details of nominations received which will be sent out to members. The statement must not exceed the stated word allowance.

    29. Contact details for up to five channels may be supplied in addition to the 250 words.

    30. The last date for reissuing ballots that have been lost or not received will be set out in the timetable.

    THE COUNT

    31. Will be by counting of preferential votes.

    32. If no candidate receives more than 50 per cent of the vote in the first round, the result will be recalculated eliminating the candidate with the lowest number of votes and redistributing those votes according to expressed preferences until one candidate exceeds the 50 per cent threshold.

    33. The result will not be published prior to its formal declaration.

    CLP MEETINGS

    34. All normal party meetings at CLP and branch level shall be suspended until the completion of the leadership election. The only meetings which shall be organised while this timetable is in place are:

    • Meetings solely for the purpose of making a supporting nomination
    • Campaign planning meetings for by-elections or devolved mayors
    • Any meeting agreed with the explicit permission of the Regional Director (General Secretary)

    REGISTERED SUPPORTERS

    35. Qualifications

    • Must be over 18
    • Must be on the Electoral Register with a valid polling number
    • Must supply a valid email address, home address and date of birth, and able to pay fee online.
    • In all other respects must meet the qualification criteria of membership of the Labour Party.
    • Pay a fee of £25.
    • Must be validly registered by the date shown on the timetable.
    • Must agree the following Data Protection Statement.
      1. By supplying personal data to register as a supporter you agree that the Labour Party, elected representatives of the Labour Party, and any candidates in internal Labour Party elections in which you are entitled to participate may contact you using any of the data supplied.
      2. By entering your email address and/or phone number you agree to receive communications from us, from which you can opt-out using the unsubscribe link in each email we send. Text messages can be opted out at any time using the appropriate stop message.
      3. We will not share your details with anyone outside the Party.

    AFFILIATED SUPPORTERS

    36. Affiliated supporters already on the party’s membership system will be eligible to vote, subject to affiliates reconfirming their eligibility and that:

    • They remain a member of the trade union or socialist society (and pay the political levy where appropriate).
    • They remain on the electoral register at the address provided.
    • In all other respects must meet the qualification criteria of membership of the Labour Party.

    37. Affiliates will have until the date on the timetable to reconfirm these details for existing affiliate supporters.

    38. New affiliate supporters may be recruited within the deadline set out in the timetable.

    Timetable and Freeze Date

    The Special Conference at end of the Collins Review concluded that all selection timetables should be, once started, as short as possible. The Collins Report also states: “The NEC should agree the detailed procedures for leadership elections including issues regarding registration, fees and freeze dates.” The Party requires members to hold six months’ continuous party membership on the freeze date to be eligible to take part in a selection.

    DATE

    EVENT

    Tues 12 Jan

    Join the Labour Party on or before this date to vote in the leadership election.

    Tues 12 July

    Timetable agreed. Freeze date for membership eligibility

    Thurs 14 July

    Timetable published

    Mon 18 July

    EPLP and PLP briefing, followed by EPLP and PLP hustings

    Mon 18 July

    Registered supporters applications open

    Mon 18 July: 7pm

    EPLP and PLP nominations open

    Wed 20 July: 5pm

    EPLP and PLP Nominations close and supporting nominations open

    Wed 20 July: 5pm

    Last date to join as registered supporter

    Thurs 21 July: Noon

    Deadline for validly nominated candidates to consent to nomination

    Fri 22 July

    Hustings period opens

    Mon 8 Aug: Noon

    Final date for membership arrears to be paid in full.

    Mon 8 Aug: Noon

    Final date for new and updated affiliated supporter lists to be received

    Mon 15 Aug: Noon

    Supporting nominations close

    w/c Mon 22 Aug

    Ballot mailing despatched

    Wed 14 Sept: Noon

    Last date for electronic ballot reissues

    Fri 16 Sept

    Hustings period closes

    Wed 21 Sept: Noon

    Ballot closes

    Sat 24 Sept

    Special conference to announce result

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