Key questions on health and social care for parliamentary candidates
Funding crisis in health and social care
As the debate about the NHS heats up in the final weeks before the General Election on 7 May, the issue of future funding has risen to the top of the agenda. The debate is focusing on both NHS and social care funding and the relationship between the two. Many commentators argue that “unless social care is fixed, the NHS will not cope and cannot improve”. While NHS funding has been spared from ‘real-term cuts’ since 2010, local government funding has not been ring-fenced and one of the consequences has been a 17 per cent fall in spending on social care for older people. Age UK has stated that there are currently 900,000 older people aged between 65 and 89 who have unmet needs for social care. Looking to the future, The Five Year Forward View, which provides a blueprint for the development of the NHS calls for an additional £8 billion funding per annum by 2020. The funding gap in social care is estimated to reach £4.3 billion by 2020.
At the time of writing, we clearly need to hear much more detail from the political parties on how, if elected to Government, they would tackle the funding crisis in health and social care.
BGS and the General Election
This is the backdrop against which the BGS secretariat and officers have been engaging with the UK political parties since the new year. The focus has been on the Six Decisions we are asking the next Westminster Government to take to promote excellent healthcare and support for older people. The six decisions include calls for an end to the divide between health and social care and adequate investment in both: http://www.bgs.org.uk/ pdfs/2015ne/2015manifesto_summary.pdf. In many respects our involvement with politicians in several of the main parties has been heartening. We have met politicians who are alert to the care needs of older people, well briefed on health and social care issues and who support the need for reform within the system.
Key questions for parliamentary candidates
Nonetheless, the reality is that parties’ plans for the future funding of the NHS and social care remain incomplete. An election campaign offers professionals who know the health and care systems intimately, a chance to make their concerns known to decision-makers. That is why I am prefacing feedback from our political meetings with a call to BGS members to take every opportunity to question parliamentary candidates in your constituencies about their parties’ future funding plans for the NHS and social care.
Now is the time to press, with utmost courtesy, for detail on how parties would close an £8 billion annual gap in NHS funding and a £4.3 billion gap in social care funding by 2020.
That said, what have we found in our interactions with politicians? We met Natalie Bennett, Leader of the Greens, in the wake of her party’s annual conference. She had just announced a commitment to free social care for the over 65s and was keenly interested in the training and working conditions of social care staff; the relationship between staff morale and quality of care in the health and social care system; and the maintenance of the NHS as a public health service.
The Greens would earmark an NHS tax to maintain funding at European average levels.
Andy Burnham MP, Shadow Secretary of State for Health told us that the Labour Party is committed to giving people new rights to care at home, with free social care for those who are at end of life; to the development of a year-of-care tariff for those with complex needs, such as older people with frailty, which would cover all of a person’s care costs over a year; and to personalisation of care which would benefit older people living with frailty, dementia, complex care needs and multiple long-term conditions.
Labour would introduce an annual £2.5 billion Time to Care Fund to pay for additional GPs, nurses and midwives.
Norman Lamb MP, Minister for Care and Support (who we met at a panel discussion convened by National Voices) has called for a single government Department for Health and Social Care; for the set-up following the election of a non-partisan commission to examine all issues related to future of the NHS and to engage the public in this discussion; and that, by 2018, every locality would have a single pooled budget and single commissioning for health and social care.
Asked by BGS about the divide between NHS care free at point of access and social care means-tested at point of access as an impediment to delivery of integrated care, the Minister said that, if we were starting now, we would not design the system in the same way. However, there is also a need to be pragmatic and, uncomfortable though it sometimes is, the current arrangement is not ultimately an impediment to provision of good quality care.
The Liberal Democrats have pledged £8 billion a year to the NHS by 2020/21 and an extra £5 million a year to mental health services.
In the absence of a face-to-face meeting, the BGS wrote to the Conservative Party requesting comment on their future plans for older people’s health and social care. The Prime Minister and Leader of the Conservative Party, David Cameron MP responded. He thanked our membership, saying “Their work is invaluable and I am immensely grateful for all they do”. He stated that there had been a real terms increase of £6.5 billion in funding allocated to NHS between 2010/11 and 2015/16. The Prime Minister highlighted their investment in the Better Care Fund to promote integrated care; the restoration of named GPs for patients; and the Challenge on Dementia 2020 which he launched earlier this year, embodying their commitment to make England the best country in the world for dementia care and support with an increased emphasis on post diagnosis support, and on dementia-specific training for NHS staff.
The Conservatives have promised to continue to ring-fence the NHS budget and to provide real terms increases from 2015 to 2020. An allocation of £5.3 billion from current NHS funding has been promised to the Better Care Fund.
National Health Action Party
The National Health Action Party responded spontaneously to the BGS Call to the Incoming Government. Dr Clive Peddell, on behalf of the Party, fully endorsed the six decisions set out in the Society’s position paper.
Make your voice heard between now and the General Election
This feedback provides a flavour of how each of the political parties is thinking on healthcare and social support of older people. In an election campaign, issues become fluid and positions can shift dramatically and quickly. A good way to keep abreast of party political developments on health and social care is to follow The King’s Fund General Election tracker which is updated regularly: http://election.kingsfund.org.uk/.
Finally, I would ask that between now and May 7th, please do take every opportunity to explore with parliamentary candidates in your constituency what their party’s thinking is on the funding gap in the NHS and in social care.
If you have any comments or questions, I would be happy to hear from you.