In its Five Year Forward View published last week, NHS England has set out it how it wants to change the health service in the coming years.
The challenges are vast but not insurmountable. In particular the report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered.
One of these new models of care includes engagement with communities and citizens in new ways to build on the energy and compassion that exists across England. NHS England estimates that three million volunteers already make a critical contribution to the provision of health and social care in England. We have services in more than 300 hospitals across the country, with 14,000 volunteers working in shops, cafes, on trolley services, offering befriending services on wards, and support on a return home through our Home from Hospital service. Royal Voluntary Service knows from the variety of support it offers to patients and their families while they’re in hospital, and to older people on their return home the real positive difference this can make to lives. Indeed, an analysis of the Hospital 2 Home service we run in Leicestershire identified that readmissions of older people supported by the scheme are half the national rates.
Our own survey carried out earlier this year indicated the support offered by volunteers is worth £487million to Britain’s healthcare service. Our survey also showed that nearly two thirds of Britons believe that volunteers play a vital role in the NHS, and 63 per cent agree that they provide essential emotional support to patients when doctors and nurses are stretched for time. Furthermore, 54 per cent said they feel the work of volunteers should be better utilised to help relieve the pressure on the health service.
The help provided by volunteers to the health service mustn’t be underestimated and volunteers need to be taken seriously. A report by the Kings Fund last year suggests that for the average trust, every pound invested in volunteering could yield around £11 in added value. It recognised that trusts need a more sophisticated approach for measuring the value of volunteering, to include patient experience and quality of care.
The report also identified that just over 50 per cent of acute trusts have a formal strategy for the future of volunteering which indicates that much more could be done to better match volunteers to the roles where they can add most value. Although their work may be simple, it is a source of vital support and we know that the emotional benefits volunteers offer to patients can make a real difference to wellbeing. However, to continue to help more people during a hospital stay or on a return home, we require a radical shift in culture. Volunteers can work side by side with professionals to support older people have an impact well beyond what statutory services alone can achieve.
Funding in both NHS and social care is tight and will continue to be so for the foreseeable future. A NHS funding gap of £30billion by 2020/21 is often quoted as a worst case scenario by sector experts. NHS England says that action will be needed on three fronts – demand, efficiency and funding - to bring this figure down. The role of the voluntary sector is crucial in meeting this aim and we are ready to play our part.
On the day of a historic first parliamentary seat for UKIP in Clacton, I look back at this week’s health and social care announcements from the Liberal Democrats and compare them to the messages from Labour and Conservative over the past few weeks.
There were some big announcements from Norman Lamb on mental health aimed at narrowing the gap in how physical and mental health is treated. There were also new pledges that will benefit carers by offering a £250 ‘Carers Bonus’ paid annually by 2020 and increasing the carers allowance earnings disregard from £100-£150, allowing carers to keep more of what they earn.
Lamb also made commitments to shift the system from repair towards prevention, further integration and more personalisation and control to individuals, continuing the emphasis that the Lib Dems have placed on these themes in the coalition. Lamb also made special reference to the important role that volunteers in the community can play in reducing loneliness and hospital admissions.
On funding the Lib Dems committed to put an additional £1billion into the NHS above the ring fenced amount in 16/17 and 17/18 and free social care for people at the end of life. In addition the Lib Dems pledged to reform pensions so that the current ‘triple lock’ indexation is made permanent through law.
During the conference a motion on Age Ready Britain was debated. The motion highlighted that there is no single action or policy that will prepare the UK for an ageing society - it requires a co-ordinated approach across many areas of public policy to create an age-friendly nation. In particular the conference called for a Cabinet Committee on wellbeing and ageing to be established, the appointment of a Minister for Ageing and a statutory independent Older People's Commissioner. It was also recommended that Health and Wellbeing Boards should be strengthened and other important recommendations were made around housing and the planning system.
The dust has now settled and it’s clear that health and social care will be a key battleground in next May’s general election.
All the main parties made new pledges to increase NHS funding to some extent, from ring fencing by the Conservatives to Labour’s new £2.5 billion “Time to Care Fund”. However, it seems that the Lib Dems have made the clearest commitment on funding and have accepted the immediate urgency by pledging to re-open next year’s funding settlement. There is a good deal of agreement on the need for more integration but a lot more is hidden behind party politics on competition and other structural issues.
But will a billion here and there make the difference? Experts indicate that by 2020 the NHS funding gap will be in the region of £30 billion. Therefore, the sums being pledged significantly underplay the massive scale of the challenges that the health and social care services face in the next few years, especially with an increasing demand from an ageing population with a growing number of complex conditions.
The Lord Filkin led House of Lords Committee on Public Service and Demographic Change in 2013 said that Governments had been woefully underprepared for ageing and that there had been a collective failure to address the implications. Without urgent action ageing could turn into a series of miserable crises. He called for all political parties to consider the ageing society in their manifestos for the 2015 election. It appears from the events of the past 3 weeks that the main parties are still not prepared to tackle this head on.
We call on all parties, whoever comes to power next May, to engage with the voluntary sector to help them get their policies right and to build a stronger agreement about the changes needed to create better health and care.
Posted by Steve Smith at 15:17
Friday, 10 October 2014.
On Older People’s Day when there are a record level of more than 1 million people aged 65 or over in work, the Prime Minister announced that a future Conservative Government will raise the tax-free personal allowance from £10,500 to £12,500. Furthermore the threshold at which people pay the 40p rate, currently £41,900 will rise to £50,000.
In yesterday’s closing speech the Prime Minister announced his commitment to balance the books by 2018. To achieve this the Conservatives will need to find £25 billion worth of savings in the first two years of the next Parliament. £25 billion is actually just three per cent of what government spends each year.
On Tuesday Health Secretary Jeremy Hunt announced that the NHS budget would not be cut like those health services in Greece, Portugal or Italy but would continue to be protected and rise in real terms in the coming years.
Political commentators have yet to analyse the content of the speech in detail. However ,it’s become clear that a commitment to £25 billion more in Government savings, whilst maintaining NHS expenditure and giving billions of pounds back in tax cuts is not going to be easy. It will mean some savage cuts to other Government budgets. Local authority budgets have come under a lot of pressure in recent years and this looks set to continue for some time. Many council based services that frail and older people rely on could be put at risk. This will make the work of the voluntary sector all the more important.
The Government argues that the only way to continue to increase spending in the NHS was to have a strong economy. Hunt was keen to stress that the two building blocks to improving the NHS were personal care and personal choice.
The first step towards this is integration of the health and social care system. Hunt pointed to the 150 local authorities working with local NHS partners on Better Care Fund to pool commissioning to reduce emergency admissions.
He added that personal care means more than integration, it needs a response from GPs too and he announced the training and retaining of an extra 5,000 GPs. Key to this personal care was providing better access to GPs. Improved out of ours access to GPs is to be rolled out to 25% of the population and then to all by the end of the next parliament. In time the whole population would have access to GPs between 8am and 8pm and during weekends.
Last year the Government announced that over 75s should have a GP named on their medical record responsible for their care. In the new GP contract for 2015 this is to be expanded so that every single person in England will have a family doctor named on their record and responsible for their care. In addition everyone will have access to their own medical records by April 2015.
There was some good news for older people with pension pots. On Monday Chancellor George Osborne unveiled a new tax cut for pensioners. In a bid for the grey vote, he announced that the Government would abolish the "punitive" 55% tax that is levied when people pass on a pension pot. The change will apply to all payments made from April 2015, and means that people will be able to pass on their pension pot effectively tax-free.
Next up the Liberal Democrats.