Party conference season: the key announcements on health and social care

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This year’s party conference season has been unusual for many reasons. The obvious focus on Brexit is one of these. But given that pretty much everyone thinks we are close to a general election, they were also a chance for the parties to trail some of the non-Brexit commitments with which they hope to entice the electorate. What stood out for health and social care?

The Conservatives are the current party of government. This means that a lot of their intentions are already in the public domain – whether the £20.5 billion real-terms spending commitment, the NHS long-term plan or the prevention green paper. They added to this a commitment to provide £2.7 billion for six hospital rebuilds (with a further 34 schemes to be worked up) and a Health Infrastructure Plan that commits to a five-year rolling programme for investment. This is clearly good news for the hospitals concerned and their patients – but this plan did not include a commitment to overall NHS infrastructure spending. Until we have that, we cannot tell if the new schemes are the first down payment to overcome the severe NHS maintenance backlog and invest in, for example, better premises for general practice and mental health – or if they in fact come at the expense of these other priority areas.

'The Prime Minister has again said the Conservative Party would solve the problem of social care but again has not said how, a silence that will not be credible for much longer.'

The Prime Minister has again said the Conservative Party would solve the problem of social care but again has not said how, a silence that will not be credible for much longer. Instead it is the Labour Party that has set the pace on fundamental reform of social care for older people. First, their policy document commits to (and costs) introducing free personal care (as in Scotland) and adds in a cap on lifetime spending but does not immediately cover working age adults. Even so, this is the kind of fundamental reform many have been waiting and arguing for. Second, Labour promises to improve the working lives of social care staff, with measures ranging from ending zero hours contracts to supporting professional development. This may sound intuitively like the right thing to do but will be expensive given the current low pay in the sector. Finally, they intend to encourage greater public sector provision of social care, where the devil will lie in how this is done and how quickly.

The Labour Party also set out two other eye-catching commitments. The first means England will follow other countries of the United Kingdom in abolishing prescription charges (the Liberal Democrats propose abolishing them for people with mental health conditions). The second was an explosive mix of compulsory licensing for some new medicines alongside establishing a public sector medicines company to manufacture drugs (among other changes). England is struggling both with the prices of some new medicines and repeated rounds of shortages in many older medicines, shortages that have just led the current government to ban the export of some products. So while it’s hard to know if Labour’s radical prescription is right, it’s not hard to diagnose that there is something wrong with the current medicines market.

Summarising the Liberal Democrats health and care policy is more challenging as it runs to 49 pages of detail. As we might expect there are new commitments to improve mental health services (including more waiting times targets); action on public health including on air pollution and fast food; support for carers; same-day phone or video appointments at your own GP practice; one pence on the income tax to provide an additional £6 billion for health and social care; and a cross-party commission to set a funding settlement for the long term.

Both the Liberal Democrats and Labour make proposals to confront the deep workforce crisis in health and care (remembering the new NHS People Plan is currently under development). Both look to bring back bursaries for nurses (with the Liberal Democrats starting with mental health nurses), and Labour commits to training more GPs too. The wider package of measures from the Liberal Democrats also includes a new EU recruitment campaign, support for social care staff and, in a clear nod to the disappointingly repetitive pattern of workforce crises in the NHS, they would add a new duty on the Secretary of State to produce an annual workforce report and plan. Labour also look to the law by legislating on safe staffing.

'Both main opposition parties proposing major structural re-organisations despite the painful experience of the 2012 Act and its many predecessors.'

The temptation to turn to the law crops up in other places. While we expect the Conservatives to back the targeted package of legislative change proposed by NHS England (supported by a range of bodies, including The King’s Fund), the other parties are more radical. Labour intend to repeal the 2012 Health and Social Act. As it is not possible to turn back the clock in any simple or straightforward manner, it’s difficult to see how this would not represent a wholesale re-organisation of NHS structures. The Liberal Democrats are scarcely less radical, proposing to pass the commissioning carried out by clinical commissioning groups over to local authorities and generally strengthen the hand of local democracy. This leaves both main opposition parties proposing major structural re-organisations despite the painful experience of the 2012 Act and its many predecessors.

The manifestos and ensuing campaigns will of course see the parties fill out their commitments. To allow the electorate to make informed choices, we think this should include a transparent statement on future funding. But beyond that, if the parties want to meet the health and care challenges facing this country, they need to deliver on the fundamental reform of social care so long overdue; confront the workforce crisis; set out a range of measures to improve public health; and support – or at least not distract from – the current efforts of the NHS and its partners to better integrate care. The signs from the conferences are that the parties do intend to make health and social care a key feature of their campaigns. The risk, of course, is that none of this will be heard over the shouting about Brexit.

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Comments

Maggie Gilbert

Position
Coordinator,
Organisation
Better Living - CIO reg no 1181947
Comment date
04 October 2019

Our new CIO has been registered to demonstrate a new way of providing Care for our most vulnerable people - adults with learning disabilities and the elderly
It will bring the community at large to THEM - reducing health issues relating to isolation, loneliness and depression (saving the NHS money!), and through its community and voluntary involvement plus numerous ways of income generation - reduce the cost of Care!
It will be a new example of bringing together statutory and voluntary sectors
........and all you seem to want to do is TALK about the problem and do constant research which keeps throwing up the need to enable us to execute our plans and demonstrate their feasibility and scalability

Please talk to us!!!!
We can help find solutions!!!!!

Hubert Banks

Position
Retired,
Comment date
04 October 2019

As a 92 year old facing care costs how can I continue to support Tories when Corbyn is promising relief???

Anthony Blackburn

Position
Social entrepreneur,
Organisation
Golf In Society
Comment date
06 October 2019

Interesting rhetoric from the politicians & major parties. However, none of them understand that the only way to keep people healthy and happy is to put their CUSTOMERS at the heart of everything they do. With over four years expertise at the coal face of dementia support, it's made me more passionate than ever to continue to design ALL our services around the families we support.
The sooner the health & social care policy makers wake up to the reality of life at the coal face and LISTEN to their customers as well as the innovative providers of support, the sooner we'll be seeing older adults and their families enjoy the life they deserve.
My gut instinct is that the new social care bill will not be fit for purpose from the start as it will not be designed around person-centred support and won't face up to the fact that support workers need to be paid a rewarding wage that values their amazing talent.
In the meantime we will continue to be a shining example of how you can transform lives by putting our customers and our team at the heart of everything we do.
And finally, we at the coal face understand the challenges better than most. If we're listened to and invoved in designing future-proofed social support then the outcomes for millions of people and society will be transformational.

Pearl Baker

Position
Carer Independent Mental Health Advocate & Adviser,
Organisation
Independent Mental Health Advocate and Adviser
Comment date
06 October 2019

In my opinion not one of the Parties will or able to deliver on their 'rhetoric', firstly the four day week proposed by Labour and increase in the minimum wage will not generate enough TAXES to bring about their new idea. The idea that you should have the right to purchase the Private rented accommodation is 'off' the scale', buy to let buyers will just not buy Properties to let anymore, then we have insufficient Council Houses for those who will never earn enough to own their homes.

Homelessness already on the increase will be set to increase further if they don't tackle the Council House shortage. 'Affordable Homes' are not affordable.

GP Appointments are hard to come by, making life difficult for those caring for others, this is getting worse.

Health & Social Care 'integration' is just a word, it has made life more difficult because we are not 'included' into the Conversation.

Mental Health has not improved for those in the Community, no Support, no Activities, in fact 'nothing of anything'. The only way to improve those you care for is to organise and pay for the Health & Social Care they need including Housing, and the expertise to challenge a system of Welfare Benefits that have left many in debt, and without 'food' and much more.

ICS 'Integrated Care System' is an absolute waste of time, no co-ordination across the country, not even access to notes for someone who has become ill in Scotland, but previously treated down South.

Customers, Patients, Carers are NOT put at the Heart of the Conversation because nobody speaks to us.

I paid £500 for Private assessment, including scans, and proposed therapy, i could walk without pain four days later, this would not happen via an NHS GP. Population Health is about those who can pay to alleviate pain, and those who have to endure it for months, sometimes years. It is about the 'have's and the have nots'.

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