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Labour: A shot in the arm for the NHS?
Although Labour leader Ed Miliband said little or nothing around tackling the UK budget deficit he stuck to safe Labour territory at the Party Conference. The highlight of his seventy minute speech was the announcement that an incoming Labour government will create a £2.5 billion a year NHS “Time to Care Fund” as part of his plan to save and transform the NHS. This pledge, one of six in a ten year plan, gained the longest round of applause of the day. He said that the first priority for the fund will be to support 20,000 more nurses, 8,000 more GPs, 5,000 more careworkers and 3,000 more midwives. It is claimed that his will help address a growing problem which has meant one in four people not getting a GP appointment within a week, more than half of nurses saying their wards are dangerously understaffed, and community care services which can often prevent people from needing expensive hospital treatment in crisis.
The aim of the fund is to give doctors and nurses the time to care properly for patients, as well as beginning to transform services in communities and at home so the NHS can meet the challenges of the 21st Century at a time of financial pressures. A key element will be the impact on community services which should keep us healthy and ease the pressure on NHS frontline services.
It is planned to raise the £2.5 billion for the Fund by asking those living in houses worth over £2m to pay more tax, a co-ordinated crackdown against tax avoidance, and asking the tobacco companies to contribute towards the costs they impose on the NHS through a windfall levy. This means that new charges or general increases in taxation are not planned to fund increased resources for the NHS. The principle of a mansion tax already has the support of the Liberal Democrats, but much more detail needs to be worked though to tackle, for example, potential new avoidance loop holes or taxing asset rich cash poor residents with little ability to pay. Watch this space.
This morning shadow health secretary, Andy Burnham, provided more detail on Milband’s earlier announcement. He spoke of bringing social care in to the NHS so that it is built around an individual’s and family needs, dealing with a single service and a single team. He said that bringing the services together was the key to unlocking wasted expenditure. He called for hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care - physical, mental and social. New teams would be recruited that could go out into the community to ensure that people are able to stay independent in their own homes. Providing social care would no longer be regarded a second class profession but given the respect that it is long overdue.
In addition as the party had previously announced, both Miliband and Burnham re-enforced Labour’s intention to repeal the Health and Social Care Act and Section 75 in particular.
Labour’s plans for a joined up, fully integrated health and social care system was disclosed at the Party Conference in Brighton last year. Much more detail on how this will all play out will be revealed in the coming months as we draw closer to the May election.
The future of the NHS and social care, including its funding in the wake of increased demand and an ageing population, is likely to be a crucial battleground for next May’s General Election. Next up, the Conservative Conference in Birmingham next week.
A need to accept that health and social care will cost more?
This week saw the publication of a report from The Commission on Residential Care which is chaired by former Care Minister Paul Burstow MP and has over the past year explored the future of residential care– from care homes to extra care villages and supported living, for older and disabled people. You can read a copy of the report by following this link to demos.co.uk
The Commission had two main objectives. First, to create a vision of ‘housing with care’, not bound by existing definitions, but based on the outcomes that people want and value. And second, to set out how the existing offer could change to deliver this vision, across financial, operational, governance and cultural aspects of care.
The Commission found that despite there being many examples of good care, it is surrounded by negative perceptions fuelled by the headline cases that make the headlines.
The Commission made a number of recommendations to embed good practice and challenge public perceptions. These included enshrining a broader, more accurate definition of ‘housing with care’ throughout government policy; greater co-location of care settings with other community services; expanding CQC’s role in inspecting commissioning practices; and promoting excellence in the profession through the introduction of a license to practice and a living wage. The Commission concluded that these measures, among others, could help build a housing with care sector fit for the twenty-first century.
September 4 saw the long anticipated final report of the independent Commission on the Future of Health and Social Care in England (Barker Commission) by the Kings Fund. You can read a copy of the report by following this link to kingsfund.org.uk
This report examines the current health and social care system and proposes a new approach that redesigns care around individual needs. The Commission concludes that this vision for a health and care system fit for the 21st century is affordable and sustainable if a phased approach is taken and hard choices are made about taxation. We still under spend a number of other European nations when it comes to healthcare and the Commission believes it is feasible to be able to spend between 11-12% of GDP by 2025 to meet the inevitable rising demands on an ageing population.
It has recommended that health and social care should have a single ring fenced budget with central commissioning. Not many will argue with ring fenced budgets for social care and bringing both together might speed up efforts towards integrated care. But this does require yet another reorganisation which won’t be welcome. Clinical Commissioning Groups have not been in existence for long and some will say that they have not had the opportunity to develop and deliver well coordinated care.
The Commission wants those with critical needs to receive free care at the point of use and believes this should also be extended to substantial need when then economic situation allows. By 2025 those whose needs are moderate should also receive free care. Pathways should be simplified to respond to changes in need. It wants to see a new “care and support allowance” and personal budgets to give individuals more control over the support they receive.
The Commission has made some radical and controversial proposals on how to raise £5 billion to pay for this expansion. Proposals include removing exemptions on free prescriptions and means testing TV licences and the winter fuel allowance. Also suggested is requiring those over 40, in retirement and high earners to pay more in national insurance. These proposals may prove unpopular especially those which involve means testing of the vulnerable.
But firstly, politicians of all parties need to agree that more money needs to be spent. Whether it is paying decent wages and providing better training for care staff or to providing free care for those with most critical needs more funding is essential. It is not possible to meet rising demands purely by efficiencies. More funding needs to come from somewhere and this primarily equates to increased charges or taxes. It could of course come from making other choices around scaling down other big ticket projects. But with elections just 9 months away and older voters more likely to take part in a general election than other age groups, are any parties brave enough to bite the bullet?
Our response to the Kings Fund report 'A new settlement for health and social care'
In response to the release of the Kings Fund report A new settlement for health and Social Care, published today 4 September 2014. The report recommends that some benefits should only be given to those older people most in need, and that those savings and increased taxation should be used to fund the inevitable increased cost in social care. Follow this link to read the full report A new settlement for health and Social Care
Britain is facing an ageing population, which along with many positives, also brings challenges. To allow a truly preventative and personalised approach to care for older people, which should be our focus when looking to reduce costs, it is essential that health and social care budgets are unified and integrated. The voluntary sector has an important role to play in bringing down the costs of care and ensuring the individual needs of older people are met.
David McCullough, Chief Executive