Health and Social Care

Labour’s Vision

Labour believes in a strong and secure NHS, where healthcare is based on need, not the ability to pay. We need to make sure we have a health and social care service that is fit for purpose and that can meet the challenges of today. The Labour Party believes in a fully integrated health and social care system which looks after the needs of our ageing population, treats people with dignity and ensures that mental and physical health are treated equally.

The scale of the challenge currently facing our NHS and social care system is huge. Our NHS is going through its biggest financial squeeze in history and the system is struggling to cope. Chronic underfunding of health and social care services, coupled with workforce shortages, is causing increasing stress and anxiety for both staff and the patients that they work so hard to care for.

The Conservative Government has failed to give our health and social care services the resources they need to ensure that patients receive the care they deserve. An increasing number of people are waiting too long for operations, key performance targets, such as the four-hour A&E waiting time target and the 62-day cancer treatment target, are being missed month after month. Older and vulnerable people are being left stranded on hospital wards because there is nowhere safe for them to go. Our social care system is under severe pressure, with increasing numbers of people getting little or no assistance to help them deal with basic daily tasks such as washing and dressing.

Underfunding is also having a negative impact on the ability of local authorities to support preventative public health initiatives such as sexual health programmes, smoking cessation services and measures to reduce obesity. There are real concerns that reductions to funding for prevention are short-sighted and will likely contribute to an increased burden on the health system in the future.

The NHS is Labour’s proudest achievement. We have a duty to protect both patients and staff, and ensure that people can access the care they need, when they need it, through a publicly provided service.

The issues

Last year the Health and Care Policy Commission looked specifically at the issue of mental health and explored issues surrounding early intervention and prevention in mental health, as well as what steps need to be taken to achieve true equality between physical and mental health.

This year the National Policy Forum (NPF) identified further work on funding, social care and public health.

Funding

As a result of Conservative policies on health and social care, our system is underfunded and overstretched. The Conservative Party has failed to grasp the size of the challenge facing health and social care, and patients are being let down as a result. NHS spending per person will be cut next year and experts have suggested that by 2020 there will be a gap in social care funding of at least £2.6 billion. In addition to this, it is expected that funding for public health will fall by at least £600 million in real terms by 2020/21 and figures also show that mental health funding fell by £600 million over the course of the last Parliament. NHS trusts finished 2015/16 £2.45 billion in deficit, the highest on record.

The period between 2009/10 and 2014/15 saw the lowest five year growth in public spending on health in the UK since the 1950s. Under the last Labour Government, the average annual growth rate was 5.9 per cent, compared to 1.1 per cent under the Coalition Government (2010-2015).

In addition to existing funding pressures across the board, local health communities are being asked to find savings totalling £22 billion, as set out in NHS England’s Five Year Forward View. Finding savings of this level, while at the same time developing and implementing Sustainability and Transformation Plans (STPs), is expected to put huge pressure on local hospital services, and is likely to have a knock-on effect on community and primary care. There are real fears that STPs will lead to the downgrading or closure of some local services (e.g. A&E departments and maternity units).

The demographic of our country is changing. Our population is ageing rapidly, and the number of people living with multiple complex and long term conditions has increased. As a consequence, health and social care services are under immense pressure, sometimes struggling to meet the needs of patients. There has been a 56 per cent increase in the number of days lost to delayed transfers of care since 2011; 1.8 million people waited longer than four hours in A&E departments last year; GPs are struggling to cope with an increasing workload and the 62 day cancer target has not been hit for three years.

Health needs are constantly evolving and demand on the NHS is growing as a result. Patient demand for access to new drugs and treatments is increasing and Clinical Commissioning Groups in England are being forced to make difficult decisions about what treatments and drugs they can offer with reduced budgets.

The health and care system is under enormous financial pressure. There are calls from across the political spectrum, and from health and care experts, to boost funding for services in the immediate term by providing an urgent injection of funding to shore up services under significant strain. However, a more long-term, sustainable solution must be considered if we are to secure the future of our health and social care services.

Questions
  • What steps need to be taken to ensure that a universal health care system, free at the point of need, is maintained?
  • What steps should be taken to ensure long-term, sustainable funding for health and social care?
  • What can be done to ensure that the NHS and social care receives adequate funding in order to meet rising demand?
  • Is there scope for further savings in the NHS, without compromising the quality of patient care?
  • What can be done to mitigate the potential impact of Brexit on our health and social care workforce?

Social care

As a result of choices the Conservative Government has made, social care is facing a funding shortfall of £1.9 billion next year, and by 2020 the gap could be as much as £2.6 billion. UK public spending on social care is set to fall to less than one per cent of GDP by 2020, and it has been estimated that as many as 1.2 million people are now living with unmet care needs – this means that they are receiving no help to perform daily tasks such as washing and dressing.

The number of people aged 65 and over is increasing. According to the National Audit Office, the number of older people in England (aged 65 and older) rose by 20 per cent between 2004 and 2014 and this upward trend is set to continue. The impact of a rapidly ageing population will have a significant impact on the health and social care system. Both delayed discharges and emergency admissions to hospital have increased in recent years – between 2010/11 and 2014/15 there has been an 18 per cent increase in emergency admissions of older people to hospital.

The Government has failed to provide the social care system with sufficient funding. The social care precept, which allows local councils to raise council tax to pay for social care, is not a sustainable, long term solution to the financial challenges facing the system. Despite the fact that around 95 per cent of councils decided to use the precept in 2016/17, the amount raised will not even cover costs related to an increase in the National Living Wage.

The Government has neglected to address serious funding issues in health and social care. In last year’s Autumn Statement, the Government failed to provide a single extra penny for social care and this year’s Spring Budget was a missed opportunity to give social care an immediate cash injection to help cope with increasing pressures. The Government’s announcement to provide £2 billion over three years is woefully inadequate, when we take into account that the social care funding gap for next year alone is this amount.

Action needs to be taken to protect older and vulnerable people, who are increasingly being left to fend for themselves. Many are living with unmet care needs, or are being left trapped on hospital wards with nowhere to go. Carers are under increasing pressure to provide care to a growing number of older people, and unpaid carers, for example family members, are being left to cope with little or no extra help.

Questions
  • What steps need to be taken in order to improve our social care system for older people and those with disabilities?
  • What steps need to be taken to join up health and social care?
  • How can care workers and those who care for family members and relatives best be supported?
  • Recognising that a large part of the social care market is currently run by private sector providers, what should the government’s approach be to this part of the sector?

Public health

NHS England spent over £5 billion on ill health linked to being overweight or obese in 2014/15, and it is estimated that £14 billion a year is spent on treating diabetes. According to a recent report from the Health Foundation, the Department of Health estimates that 70 per cent of the total health and social care spend in England is for the treatment and care of people with long-term conditions, such as diabetes and heart disease.

Cuts to the public health budget in England are putting prevention of ill health at risk – we have already seen in-year cuts to public health budgets of £200 million, and by the end of this Parliament it is expected that funding for public health will fall by around £600 million. Cuts of this scale could put at risk sexual health services, cancer screening, smoking cessation and measures to reduce obesity. Furthermore, there are concerns that cuts in the number of Sure Start centres will negatively impact people who benefit from the use of these services.

Our public health workforce is also under pressure, faced with cutbacks from local authority budgets. Shortages of both health visitors and school nurses are putting the existing public health workforce under unsustainable pressure. There are concerns that staff are finding it increasingly difficult to provide much needed advice to children and young people, at a crucial point in their lives, because they are so overstretched. Preventing ill health at an early age is vital for the future health and wellbeing of children and young people. A third of children aged between two and 15 are either overweight or obese, and without firm action to combat childhood obesity, there are real fears that its prevalence will continue to increase. The Government’s much delayed and watered down Childhood Obesity Plan published last summer was a missed opportunity to deal with this issue head on.

We need to be aware of the impact issues such as housing, employment and education can have on people’s health and wellbeing. As a society it is crucial that we identify ways in which to promote preventative measures, in order to improve the quality of people’s lives and to reduce the burden of ill health on our health and social care services. Developing a range of policies to address health inequalities in our society is vital if we are to improve the health of people of all ages, from all parts of the country.

Questions
  • What policies should be put in place to tackle health inequalities in our society?
  • What can be done to support parents in helping to improve their children’s health?
  • What action should be taken to deal with the obesity crisis facing our country?
  • How can people be encouraged to take a greater interest in their own health?
  • Are there particular public health issues that affect specific groups in our society (e.g. LGBT, BAME) and if so, what strategies should be adopted to address these?
  • When looking at public health in devolved countries of the UK, what can we learn from different approaches and policies?