A Better Plan for the NHS Health and Care

The NHS is our country’s most precious institution and Labour’s proudest achievement – the embodiment of how by the strength of our common endeavour we achieve more than we achieve alone.

Its founding values – compassion; cooperation; healthcare based on need, not ability to pay – are as important today as they were in 1948, but the health challenges we face today are very different. An ageing population, the increasing prominence of mental health problems and particularly the growing numbers of people with multiple conditions – all of these pose challenges for our health and care services.

Our services haven’t yet changed to reflect this new reality. They look at each of our needs separately, rather than the whole person behind them. The result is that care is fragmented, problems get missed and patients and families can feel passed around from one organisation to another.

Far from reshaping services so they can rise to these challenges, the Conservative led Government has taken things in the wrong direction. The Health and Social Care Act distracted the NHS from the vital task of service reform and imposed a market framework on the NHS that is fragmenting services and making integration harder. Social care is close to collapse after billions have been removed from council budgets. Primary care and community services that help people stay healthy outside hospital have been stripped back, leading to A&Es and hospital wards becoming overwhelmed. And short-sighted cuts to training and recruitment have led to staffing shortages and huge pressures on the frontline.

That’s why the general election cannot come soon enough. The answer to the challenges we face is not to set hospital against hospital, but to ensure the NHS has enough doctors and nurses with the time to care and to join up services from home to hospital. We are committed to raising £2.5 billion extra over and above the Conservatives’ plans – through a mansion tax on properties over £2 million, tackling tax avoidance and a levy on tobacco firms – to invest in new staff and support service transformation. And to get more from the money we currently spend, we will focus on prevention and early intervention, rewriting the rules so that health providers are paid for helping people stay healthy outside hospital rather than simply waiting for them to fall ill.

Underpinning our vision will be powerful new rights in the NHS Constitution, such as a single point of contact for those with complex needs and increasing choice over where you receive treatment – with the home increasingly becoming the normal setting for care. Mental health will finally be given the same priority as physical health.

Achieving a world-class health and care service will also require tackling the very real problems that we have seen develop in recent years, such as the culture of care visits limited to just 15 minutes and the crisis in general practice.

And we will repeal the Government’s terrible Health and Social Care Act, not to reorganise structures, but to put the right values – those founding values – back at the heart of the health service.

Introduction

In 2015, the NHS finds itself under threat and its future uncertain. Dragged down by an unwanted reorganisation, services are going backwards and patients are finding it harder to get the care they need. A&E is in crisis, waiting lists are at their highest for six years and one in four people wait a week or more to see a GP.

Cuts to social care have put even greater pressure on the NHS. Some 300,000 fewer older people are receiving social care compared to five years ago. As a result more older people are struggling and ending up in A&E, while bed days lost to delayed discharges are now at record levels.

Five more years of decline would make the NHS unrecognisable from the service people cherish and rely on today. Worse still, Conservative plans for extreme spending cuts in the next Parliament mean they simply will not be able to protect the NHS.

Labour, the party that created the NHS, is determined to rescue and rebuild it as a national health and care service, and this manifesto sets out the steps we will take to get there.

First, we will restore the right values – co-operation and collaboration, not privatisation and fragmentation. This will enable us to join up care from home to hospital, bringing together three fragmented services into a single service coordinating all of a person’s needs – physical, mental and social. Powerful new rights over how and where your care is delivered will make care truly personal, and help drive the integration of services.

Central to rescuing the NHS and transforming services will be investing in more doctors and nurses so the NHS has time to care. Our plans include 20,000 more nurses and 8,000 more GPs, helping to ease the pressure in hospitals and provide better care outside hospital. This is essential if we are to tackle the spiralling agency bill that is contributing to the financial crisis so many hospital trusts are currently facing.

Investment in new staff will help us improve access to care, guaranteeing GP appointments within 48 hours and cancer tests within one week. It will also allow a renewed focus on prevention, early diagnosis and early intervention, which are critical not only to improving health and wellbeing but to ensuring the NHS can remain financially sustainable for the long term. We will pursue a far more ambitious approach to public health than we have seen under the current government. And we will make parity of esteem between mental and physical health a reality on the ground, in particular working to end the neglect of child mental health.

It won’t be possible to rescue and strengthen the NHS without tackling the crisis in social care. We are determined to drive up the quality of social care services, with new year-of-care budgets to incentivise better care in the home and action to tackle the exploitation of the social care workforce. And it is precisely because we recognise the value of social care that we reject the Conservatives’ plans for extreme spending cuts in the next Parliament, which would see hundreds of thousands fewer older people getting the care they need.

Labour’s plan is a better plan for the NHS, one that will lift the service out of its current downward spiral and help put it on a sustainable footing so it can meet the challenges of this century as well as it did the last.

Labour’s better plan for health and care

• Recruit 20,000 more nurses and 8,000 more GPs, paid for through a £2.5 billion Time to Care Fund, funded by a mansion tax on properties worth over £2 million, tackling tax avoidance and a levy on tobacco firms
• Guarantee a GP appointment within 48 hours and on the same day for those who need it
• Guarantee a maximum one-week wait for cancer tests and create a new Cancer Treatments Fund to improve access to drugs, radiotherapy and surgery
• Join up services from home to hospital with a single point of contact for those who need it – bringing together physical health, mental health and social care
• Improve access to mental health support, with a new right to talking therapies enshrined in the NHS Constitution – just as people currently have a right to drugs and medical treatments
• Tackle the scandal of 15 minute care slots, recruit 5,000 new care workers to help provide care for those with the greatest needs at home, and introduce a new system of safety checks for vulnerable older people
• Ensure that when changes are proposed to local hospital services, patients and the public have a seat around the table from the very start, helping design and decide on plans for change
• Repeal the Health and Social Care Act to scrap David Cameron’s privatisation plans and put the right values back at the heart of the NHS

Restoring the right values

Labour will ensure that the NHS remains rooted in the values that underpinned its creation.

Care, compassion and co-operation are as important now as they were when the NHS was founded in 1948. But in recent years we have seen those values slowly eroded by the Health and Social Care Act which has placed the values of the market and competition at the heart of the health service. The Act also removed the Secretary of State’s historic duty to provide a comprehensive health service and allowed hospitals to raise up to half of their income by treating private patients.

The effects of the Health and Social Care Act have been all too apparent. Service standards are declining. Accountability for problems in the NHS is ducked by ministers. Service improvements and collaboration have been hindered by competition law, and millions have been wasted on competition lawyers.

To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides and will need to be freed from running wasteful tenders that make integration harder to achieve. Labour’s first Queen’s Speech will bring forward a bill to repeal the Health and Social Care Act. This will not be another top-down reorganisation – we will work through the structures we inherit – but it will put the right values back at the heart of the health service.

Our bill will restore proper democratic accountability for the health service, and will introduce tougher safeguards on hospitals’ ability to raise Private Patient Income – in order to ensure that NHS patients are always put first. It will repeal the market framework, removing the role of Monitor and the Competition and Markets Authority as economic regulators enforcing competition, and scrapping the ‘Section 75’ regulations that have effectively made tendering statutory. This will be replaced with an ‘NHS Preferred Provider’ framework, to ensure that the NHS is not destabilised by market competition, and we will draw a clear distinction between not-for-profit and for-profit providers by giving voluntary sector organisations the benefit of longer and more stable arrangements. Labour’s repeal Bill will legislate to ensure NHS services are fully protected from EU procurement and competition law, and we will ensure the NHS is protected from the TTIP treaty.

There is a limited role for independent sector organisations in providing services where there are gaps in delivery or where the NHS cannot provide a particular service. But that must be in a role supporting the public NHS – not to replace it and break it up. On those occasions where private companies are involved in providing clinical services, Labour will impose a cap on the profits they can make from the NHS to ensure resources are spent on patient care.

Labour will:

• Restore the Secretary of State’s historic duty to provide a comprehensive health service and ensure proper democratic accountability
• Repeal the market, scrapping the ‘Section 75’ regulations that have effectively made tendering statutory
• Put in place an ‘NHS Preferred Provider’ framework, to ensure that the NHS is not destabilised by market competition
• Where private companies are involved in providing NHS-funded clinical services, impose a cap on any profits they can make from the NHS
• Ensure the NHS is protected from the TTIP Treaty
• Place tougher controls on hospitals’ ability to raise Private Patient Income, in order to ensure NHS patients always get put first

Joining up care from home to hospital

Today, long-term conditions like cancer, heart disease and dementia account for 70 per cent of all NHS spending, and increasing numbers of people are living with more than one condition.

As the Independent Commission on Whole-Person Care, chaired by Sir John Oldham, set out, this poses challenges for the health and care system and requires services that are joined up around the individual.

But the current Government’s reforms are holding the NHS back from meeting these challenges. The Health and Social Care Act 2012 distracted the NHS from the vital task of reshaping services and imposed a market framework on the NHS that is making service integration harder. Services that support people to stay healthy outside hospital – such as GP services, mental health services and social care – have been stripped back, in turn pushing up demand on hospitals.

The next Labour Government will integrate health and care services into a seamless system of ‘whole-person care’. This approach will bring together three fragmented services into a single service coordinating all of a person’s needs – physical, mental and social – with integrated, multi-disciplinary care teams working around the individual. This will enable better coordination of care. It will allow a greater focus on prevention and early intervention. And it will enable more care to be offered in the home rather than the hospital.

As part of this, we will also ensure better integration between the ambulance service, NHS 111 and GP out-of-hours services.

To help drive this transformation, Labour will introduce powerful new rights in the NHS Constitution.

All people with complex needs will be entitled to a personalised care plan, developed with the individual and their family, and tailored to personal circumstances – not restricted by service boundaries. We will give people with complex conditions a single point of contact for all of their care needs, to act as their advocate in the system, and the option of a personal budget where appropriate. We will introduce new rights on care in the home, including giving all women a clear expectation that they can exercise real choice over where to give birth, where clinically appropriate, and giving those who are terminally ill with the greatest care needs the right to be in their own home at the end of their life, with all care provided on the NHS.

Access to new technology, alongside the provision of information, is a key part of empowering people needing care. It is also key to helping families and friends support each other in their care. We will allow patients and carers to access their records and communicate with services online, making it easier for people to manage their own conditions and stay at home for longer.

For too long, care for women who have miscarried has not been good enough. Compassionate care and clear information make an important contribution towards minimising the trauma of miscarriage. Labour will commit to improving the quality of miscarriage care, and joining-up the different services responsible for women who experience miscarriage.

To support integration of services, we will bring budgets, commissioners and providers together at a local level. Health and Wellbeing Boards will be supported to become a vehicle for system leadership. Local areas will be supported to develop NHS integrated care organisations and networks. Providers will be incentivised to focus on prevention through year-of-care budgets, which will cover all of a person’s care costs over a year. Measures in the outcomes frameworks will be integrated to better coordinate performance monitoring across health and care.

There also needs to be a change of role for Monitor, driving integration by focussing on the viability of whole health economies, rather than just the individual organisations within them.

Integration cannot be imposed by top-down edict. It must be driven at a local level and designed around local needs. The journey to the end point will be determined locally – what makes sense in inner city Birmingham might not make sense in Cornwall. We will encourage communities to consider the appropriate model for their local health and care service and to move there at the appropriate pace.

Labour will:

• Give all people with complex needs a personalised care plan covering all of their care needs, developed with the individual and their family and tailored to personal circumstances
• Give all people with complex needs a single point of contact for their care
• Support those who are terminally ill with the greatest care needs to remain at home at the end of their life if they wish, with homecare provided on the NHS
• Give patients the right to access their records and communicate with services online
• Ensure anyone diagnosed with a long-term condition is linked up with peer support, so that no-one has to deal with a long-term condition by themselves

Better access to primary care and diagnostic tests

Under the Conservative-led Government patients are finding it harder see a GP. One in four people now wait a week or more, or can’t get an appointment at all, and the number of people saying they can regularly see their preferred GP has also declined. This is bad for families, who depend on their local GP service, and is putting huge strain on A&E. Studies have estimated that 5.8 million A&E attendances a year occur because people cannot get a GP appointment.

The next Labour Government will guarantee the right to a same-day consultation with a doctor or a nurse at your GP surgery, and the right to a GP appointment within 48 hours. We will also ensure patients have the right to book more than 48 hours ahead with the GP of their choice.

Helping people get quicker access to the help they need will improve health outcomes; for example, one recent study has found that patients able to see their GP within 48 hours are less likely to have their initial cancer diagnosis as an emergency hospital admission. Ensuring the ability to book ahead with the GP of your choice is important for those patients whose priority is not speed but the ability to plan ahead and to see the same doctor; for example, another recent study found that a five per cent increase in patients seeing their preferred GP was associated with a three per cent decrease in emergency admissions. In monitoring performance against these new access standards, we will give equal priority to continuity and the ability to book ahead.

Labour is committed to recruiting 8,000 more GPs by 2020. This expansion of capacity will play a key part in helping the NHS deliver this access guarantee, and in ensuring more people can see their GP at a time convenient to them, such as evenings and weekends. But we also know that general practice is under enormous pressure, so we will also invest an extra £100 million in GP surgeries to support the delivery of these new access standards, paid for through savings from removing competition bureaucracy from the NHS. We will also work to reduce the paperwork burden on GPs, giving them more time to care for patients.

Early diagnosis is another major priority for improving health and ensuring the NHS remains sustainable for the future. For example, earlier diagnosis is critical to improving cancer survival, because treatment is more likely to be successful at an earlier stage.

By 2020, the next Labour Government will guarantee a maximum one-week wait for cancer tests and results, on route to a goal of a one-week maximum wait for all urgent diagnostic tests by 2025. This guarantee will be funded by investing £150 million extra a year in diagnostic capacity, matched by revenue raised through a new levy on tobacco firms. We will start with a focus on those tests for which experts say there could be particularly important benefits, such as abdominal ultrasound for ovarian cancer and endoscopy for bowel cancer, before broadening the guarantee out to a wider set of tests. We will ask clinicians and experts to advise on the specific set of tests and the priorities for implementation.

Speeding up tests will have several benefits, including helping people get treatment quicker and reducing the anxiety around waiting for a cancer test result. And this extra investment in diagnostic capacity will be part of a broader drive to improve access to testing in primary care and to remove barriers to GPs requesting tests.

Labour will:

• Improve access to a GP by guaranteeing appointments within 48 hours, or on the same day for those who need it
• Help patients plan ahead by giving people the right to book further ahead with the GP of their choice
• Save £100m from competition red tape to invest in better GP access
• Ensure that by 2020 no-one waits longer than one week for vital cancer tests
• Introduce a levy on tobacco companies, to support extra investment of £150m a year in the NHS
• Create a new Cancer Treatments Fund to improve access not just to the latest drugs but also to the latest forms of radiotherapy and surgery

Improving Cancer Survival

Labour’s goal is to match the best in Europe for cancer survival, which would save 10,000 lives a year.

Our cancer test guarantee is part of a wider plan to improve early cancer diagnosis. Our plans include more public awareness campaigns – including making the Teenage Cancer Trust’s programme of awareness sessions on cancer available to every school in England – and ensuring GPs have access to the training and support they need to diagnose cancer. On cancer screening, we will roll out the Bowel Scope Screening programme to the whole country and we will ask the National Screening Committee to make recommendations within a year on whether we should introduce new lung and ovarian cancer screening programmes.

Labour will also create a new Cancer Treatments Fund to improve access not just to the latest drugs but also to the latest forms of radiotherapy and surgery. The Tory-led Government’s decision to restrict a fund for extra investment to drugs has led to thousands of patients missing out on cutting-edge radiotherapy and surgery – the two forms of treatment that are responsible for nine in ten cases where cancer is cured. As part of this, Labour will guarantee that any patient in receipt of a drug from the Cancer Drugs Fund, when it comes to an end in March 2016, would continue to be offered that drug in the Cancer Treatments Fund.

Labour will publish a new cancer strategy within six months of entering government, including a plan to tackle ageism in cancer treatment.

Investing in staff so the NHS has time to care

Over the last five years, staff numbers have not kept pace with demand. More than half of nurses say their ward is dangerously understaffed, there are fewer GPs per head compared to 2010 and the Government’s own GP taskforce has concluded that “there is a GP workforce crisis”. Cuts to nurse training – with 8,000 fewer nurse training places during this Parliament than if numbers had been retained at 2010 levels – have added to the shortage of nurses, forcing the NHS to recruit one in four nurses from abroad in the last year and creating a spiralling bill for agency staff too.

The shortage of staff, and the failure to value the staff we have, is holding the NHS back.

Labour will raise £2.5 billion a year for a Time to Care Fund, funded through a mansion tax on properties worth over £2 million, cracking down on tax avoidance and a new levy on tobacco firms. This will enable us to deliver, by 2020:

• 20,000 more nurses, helping ensure safe staffing in hospitals, and providing personalised care outside hospital to families with the greatest needs.
• 8,000 more GPs, to help people stay healthy outside hospital and to tackle the GP access problems faced by hundreds of thousands of families every week.
• 3,000 more midwives, to provide safe, one-to-one care to women during labour.
• 5,000 new care workers to work in integrated care teams – the beginning of a shift towards an NHS focussed on providing joined-up support to help people to stay in their home, particularly at the end of life.

These new staff will enable us to drive service transformation, supporting new models of care and new ways of working.

They will also help ensure the NHS has enough staff with the time to care. For example, these extra nurses will help ensure safe staffing in hospitals. The extra GPs will not only help improve access but help address the squeeze on consultation times. And the 3,000 more midwives will, for the first time, allow us to guarantee all women one-to-one care from a midwife during labour. This will mean the midwife is able to give her full commitment to being with the woman whilst she is in labour, and is widely accepted to improve the quality and safety of care for women and their babies.

Delivering these extra staff numbers will require action on a range of fronts, including increasing the number of training places, developing new targeted apprenticeship routes into training, improving retention of existing staff and encouraging more staff to return to practice.

Labour will reverse recent cuts to nurse training to reduce the reliance on overseas recruitment and to ensure young people in Britain have better opportunities to enter the nursing profession. As part of our Time to Care Fund, Labour will train 10,000 more British nurses above current training levels so that we achieve an average 21,000 training places a year in the next Parliament.

On public sector pay, Labour believes in national pay frameworks and the stability and recognition they give to the health and care workforce. Labour will respect the views of independent Pay Review Bodies – rather than irresponsibly brushing them aside or reneging on the agreed processes as the current Government has recently done.

Staff morale and wellbeing are also essential. Labour will work to foster a more positive culture and a better dialogue with the health and care workforce. And we will create a new NHS staff champion to help improve workplace culture and cut the high rates of work-related stress, bullying and abuse that too many staff face.

We will work with staff to build a consensus around the expectation on the health and care workforce in providing seven-day services.

Labour will:

• Raise £2.5bn a year for a Time to Care Fund, funded by a mansion tax on properties over £2m, tackling tax avoidance and a levy on tobacco firms
• Recruit 20,000 more nurses, 8,000 more GPs, 3,000 more midwives and 5,000 new care workers by 2020
• Increase training places to reduce reliance on overseas recruitment and agency staff, including training 10,000 more nurses in the next Parliament above current training levels
• Recommit to the Pay Review Body process, and respect the views of the independent Pay Review Bodies
• Create an NHS staff champion to improve staff health and well-being, and help tackle bullying and abuse

Giving mental health the priority it deserves

Mental health is the biggest unaddressed health challenge of our age. One in six people across Britain are affected by a mental health problem at any one time and the World Health Organisation estimates that by 2030 depression will overtake heart disease and cancer as the leading global burden of disease.

The Tory-led Government’s record on mental health has been one of failure and false economies, leading to greater costs and pressure on the NHS. Spending on mental health has fallen for the first time in a decade. We have seen key prevention and early intervention services stripped back, such as Child and Adolescent Mental Health Services (CAMHS) and Early Intervention in Psychosis services.

It is essential that we give mental health the priority it deserves if we are to thrive as a nation and ensure the NHS remains sustainable for the future. In this Parliament, Labour peers forced the Government to write parity of esteem between physical and mental health into law and our approach starts with a commitment to make this a reality on the ground.

Our plans to bring together physical health, mental health and social care into a single system of whole-person care will place mental health at the heart of the future system. Central to this will be the key principles of prevention, early intervention and better support set out in the recent report of Sir Stephen O’Brien’s independent Taskforce on Mental Health in Society.

We will create a new right to talking therapies in the NHS constitution – just as people currently have to drugs and medical treatments. We will also set out a strategy and timetable to deliver a waiting time standard of 28 days for access to talking therapies, for both adults and children, and to ensure that all children have access to school-based counselling or therapy if they need it. To continue the expansion of talking therapies, we will set a specific new ambition for both adult services and CAMHS to extend access to more of those who could benefit from them.

We will put in place a national programme of ‘social prescribing’ in GP surgeries and primary care, including with a focus on tackling isolation and loneliness to improve mental health. This will empower GPs to support people differently.

We will ensure that the training of all NHS staff includes mental health, so mental health problems get spotted and addressed. In particular, we want to see a core module focussing on perinatal mental health in the training of all midwives.

Labour is determined to end the scandal of the neglect of child mental health. It is simply not right that when three quarters of adult mental illness begins in childhood, children’s mental health services get just six per cent of the mental health budget. Despite the Government saying they would protect frontline services, the budget for child and adolescent mental health has been reduced year on year. This decision has led to more young people being placed on adult wards, and many sent hundreds of miles as a result of bed shortages.

So we will work to reverse the damage suffered by child mental health services in  recent years. We have set an ambition that, over time, the proportion of the mental health budget spent on children will rise as we make smart investments to improve mental health in childhood, in turn, lessening the demand on services when young people become adults. We will also ensure that all teachers have training on child mental health so they are equipped to identify, support and refer children who might need help and support.

All of these changes must be underpinned by a wider generational shift in attitudes and behaviour towards mental health. Recent years have shown some encouraging signs of improvement, but there is still much further to go. So we will continue to support efforts to fight the stigma and discrimination that too many people living with mental health problems still face.

The Department of Health’s recent consultation paper found that, although much has been done in recent years to try to improve the lives of people with mental health needs, learning disabilities and autism, we must do more to ensure they enjoy the same rights as anyone else. Labour will prioritise making meaningful progress for these groups.The first autism strategy, introduced by Labour, marked a fundamental change in public services helping adults with autism to live independent lives and find work. Labour will work with local authorities and NHS bodies to ensure that the guidance to support the updated strategy is properly implemented and understood at a local level.

Labour will:

• Ensure that the training of all NHS staff includes mental health
• Create a new right to talking therapies in the NHS Constitution, just as people currently have a right to drugs and medical treatments
• Introduce a national programme of ‘social prescribing’ in GP surgeries and primary care, including with a focus on tackling isolation and loneliness to improve mental health
• Set an ambition that, over time, the proportion of the mental health budget spent on children will rise
• Ensure that teacher training includes child mental health so that all teachers are equipped to identify, support and refer children with mental health problems
• Set out a strategy and timetable to deliver a waiting-time standard of 28 days for access to talking therapies, for both adults and children, and to ensure that all children have access to school-based counselling or therapy if they need it

Valuing social care

Recent years have seen deep cuts to local authority budgets that pay for adult social care, and the system is close to collapse. Tighter eligibility criteria mean that 300,000 fewer older people are getting care compared to 2010. Many more face inadequate, 15-minute visits: a recent survey found that 74 per cent of councils now commission 15-minute visits, up from 69 per cent last year, with one in seven home-care visits in these areas now being just 15 minutes long. And the rising burden of care charges is adding to the cost-of-living crisis.

Social care workers carry out some of the most important work in society. Yet the current crisis is seeing the work they do being increasingly undervalued. Many are on zero-hours contracts and many are paid less than the National Minimum Wage, often due to the failure to pay workers for time travelled between home-care visits. There are also low levels of training and a lack of high-quality apprenticeships in the care sector.

The growth in 15-minute visits means care workers are increasingly forced to choose between helping prepare a meal for a frail, older or vulnerable person or taking them to the toilet.

This doesn’t just make for a worse service for the people who depend on social care; in the long term it makes for a more expensive system too. It means we have more and more people not getting the support they need at home, struggling, falling ill and having to come into hospital, or lying trapped in hospital beds because of the lack of support to help them return home.

Since 2010, there has been a 49 per cent increase in the number of people aged over 90 being taken to A&E by ambulance. The Care Quality Commission also recently found that one-in-ten over-75s and one-in-five over-90s experienced an avoidable admission that could have been prevented if they had received better support outside hospital.

We want to ensure that no-one fears their old age or struggles to cope with the care of a loved one. Labour supports measures to cap the costs of care. People need a fairer deal and protection against catastrophic costs of care at the end of their lives.

We also need to improve the quality of social care. At the moment, the way we pay for care does not incentivise highquality care at home.

Labour’s plan to integrate services from home to hospital will drive out the culture of 15-minute care slots by introducing new year-of-care budgets, which will mean providers will have a much stronger incentive to invest in preventing problems and improving care outside hospital.

We will introduce a system of safety checks for vulnerable older people, to identify risks to their health and prevent problems before they occur – for example, cold homes, loneliness and depression, or risks of falling in the home.

We will work towards making all health and care settings dementia friendly, and we will work with charities, businesses and others to realise the ambition of a dementia-friendly society. To demonstrate leadership we will champion the Alzheimer’s Society Dementia Friends programme across government.

We will bring in 5,000 new care workers to help support those with the greatest needs at home, including to help those who are terminally ill with the greatest care needs to remain at home at the end of their life if they wish.

To tackle workforce exploitation in the care sector, we will ban zero-hours contracts that exploit workers, strengthen the enforcement of the National Minimum Wage and incentivise employers to pay the living wage.

We will also improve training opportunities in social care, by creating new apprenticeships and providing more opportunities for career progression for care workers. This will include our commitment to build a new generation of 5,000 care workers in the NHS, which will provide new opportunities for training and career development.

Labour will:

• Support measures to cap the costs of care and reject Tory plans for extreme spending cuts in the next Parliament that could see hundreds of thousands fewer people get social care
• Introduce new year-of-care budgets to help drive out the culture of care visits limited to just 15 minutes
• Introduce safety checks for vulnerable older people to identify risks to their health and help prevent problems before they occur
• Bring in 5,000 new care workers to help support those with the greatest needs at home, particularly at the end of life
• Tackle workforce exploitation in the care sector to improve care standards and conditions for care workers

Better Support for Carers

The next Labour Government will improve support for England’s 5.4 million carers.

As we live for longer, more and more of us are caring for elderly or disabled relatives. And carers do one of the most important jobs in society. But caring can also be a real struggle and many families feel pushed to breaking point. Too often carers have to battle against the system to try and get the support they need. A recent survey found one in three family carers who are in paid work have had to give up their job or reduce their hours because they can’t get the right support or flexible working hours.

Many carers don’t have enough time to look after their own health, and many don’t come forward for help or get any breaks. Often people don’t even see themselves as being a carer – they’re just a son, daughter, husband, wife or friend trying to look after the person they love.

Labour is determined to improve support for carers. Our approach will make sure people get the help and support they need early on, to prevent problems from developing and costs escalating – for carers, their families and the taxpayer.

Labour will:

• Ensure carers get the right help and support by placing a new duty on the NHS to identify carers
• Help carers get health problems identified earlier by giving them a new right to ask their GP practice for an annual health check
• Give families caring for people with the greatest needs a single point of contact with care services, so they don’t have to battle different parts of the system
• Ensure funding currently identified for carers’ breaks goes to carers by making sure it is properly ring-fenced
• Consult with employers, trade unions and carers organisations on how to improve flexible working for carers, which could include measures such as a new period of ‘adjustment leave’ to help families cope with a short-term crisis
• Recognise the transport costs facing carers by including carers in the groups who can be eligible for hospital car parking concessions
• Work with hospitals to ensure the valuable role carers play in supporting loved ones with dementia becomes a key part of hospital care, in line with the call of ‘John’s Campaign’
• Abolish the bedroom tax – which hits 60,000 carers and penalises them for the extra facilities they need

Better public health

Better public health policies are needed if we are to live longer, healthier lives. And left unchecked, poor public health will impose substantial costs on the health service and the wider economy. To take one example, unless firm action is taken to halt the rise in diabetes, the proportion of the NHS budget spent on treating the condition and its complications is likely to rise from approximately 10 per cent now to 17 per cent by 2035/36.

Labour’s approach to public health is borne out the desire to avoid a ‘nannystate’ approach, whilst recognising the failure of the Tory-led Government to show the strong leadership and ambition needed to match the scale of the public health challenge we are facing. This Government has failed to stand up to vested interests and their decision to rely solely on industry self-regulation and voluntary initiatives (the ‘Responsibility Deal’) is widely seen to have been ineffective.

Labour will take tough action to support parents in protecting their children from commercial pressures and the harm caused by alcohol, sugar and tobacco. To help adults take greater responsibility for their health, we will empower them with better information, and support to get physically active. We will also make use of new technology to help people make healthier decisions and enable individuals to manage conditions, such as diabetes, more effectively.

Labour will tackle the marketing of unhealthy food to children, including setting limits on the amount of sugar, fat and salt in food marketed substantially to children in major product groups – for example cereals, crisps and soft drinks.

To better protect children from TV advertising of products high in sugar, fat and salt, we will ask the Committee on Advertising Practice and the Advertising Standards Agency to report on how this can be more effectively done, including the option of lowering the required proportion of children in the audience for a programme to be considered ‘of particular appeal to children’.

We will crack down on those highstrength, low-cost alcohol products that fuel binge drinking and underage drinking. And we will give local authorities new powers so that local communities can shape their high streets and manage the future number of fast food outlets locally.

On tobacco, it has been left to Labour to lead the debates and win the fight for a ban on smoking in cars with children and the introduction of standardised tobacco packaging. Labour will set a goal that children born in 2015 will become the first ‘smoke-free generation’.

Labour will place the promotion of physical activity at the centre of public health policy with new, easily understandable recommended levels of physical activity and a new national ambition to help people get more physically active. We will reinstate the goal of all children doing a minimum of two hours PE a week. We will also look at how we can better support local communities so that they have the opportunity to use sporting facilities in schools outside school hours, including outside term time.

We will propose a new plan to locate Automated External Defibrillators (AEDs) in major public places – such as shopping centres, airports, rail stations and sports stadia. And by the time they leave school, all young people will have had access to emergency first aid training including Cardiopulmonary Resuscitation (CPR).

Our historic mission remains the same: to break the link between health and wealth and tackle health inequalities, so that no-one’s health is disadvantaged by where they live or what they earn.

Labour will:

• Set limits on the amount of sugar, fat and salt in food marketed substantially to children
• Crack down on those high-strength, low-cost alcohol products that fuel binge drinking and underage drinking
• Give local authorities new powers so that local communities can shape their high streets and manage the future number of fast food outlets locally
• Ensure public health is embedded throughout the licensing system so that measures promoting public health can be included in the licensing statement
• Ensure that, by the time they leave school, all young people will have had access to emergency first aid training including cardiopulmonary resuscitation
• Create a new national open register of AEDs (available via digital apps) to give people instant information on where to find the nearest AED in an emergency situation.
• Reinstate the goal of all children doing a minimum two hours of PE a week
• Make sex and relationships education compulsory in all English schools and set out a robust, new sexual health strategy
• Prioritise reducing infant mortality as a key area of improvement for the NHS

Improving patient safety and care quality

Labour is proud of our record on the NHS. By the time we left office, waiting lists were at a record low and public satisfaction was at a record high. To improve patient safety, Labour introduced independent regulation and inspection of hospitals and statutory protection for whistleblowers.

In the last five years, however, care problems have become more likely, not less. A recent survey of NHS staff found that the overwhelming majority think the NHS reorganisation has harmed patient care. Clinical negligence claims are up 80 per cent since 2010, requiring an extra £7 billion to be set aside for potential pay-outs. And twenty hospital trusts have deteriorated to the point where they have had to be put into ‘special measures’.

When things go wrong everyone must learn the lessons, such as with the terrible failings at Mid-Staffordshire and Morecambe Bay. In recent years, there have also been a number of examples of appallingly poor care being provided in social care settings, and also instances of abuse and neglect, such as at Winterbourne View.

Labour has ambitious plans for improving patient safety. We want to see a mandatory review of case notes for every death in hospital so that concerns can be identified and acted upon, and lessons learned. We are also committed to implementing a system of independent medical examination to identify patterns of poor care in the community as well as in hospitals.

Alongside better regulation we also need to prevent problems from happening in the first place.

The next Labour Government will recruit 20,000 more nurses and 3,000 more midwives to help ensure safe staffing on our wards. We will use service user feedback to improve the quality of care and make services more responsive. We will also make sure NHS staff are supported to deliver the ambition that all patients are treated with the highest levels of dignity and respect.

Safety and quality will be prioritised in social care services, as well as in the NHS. All NHS and care staff will be expected to receive training in whistleblowing and in listening to and acting on concerns.

Too often in recent years it has proven impossible to prosecute individuals involved in the running of care homes, whose management was responsible for creating a culture of abuse. To tackle abuse, prevent families being let down by the system and bring those responsible for allowing abuse to justice, Labour will consult on how a new offence of corporate neglect for directors of care homes could be created. This could mean offenders would be liable to a prison sentence or statutory fine if they neglect or are involved in the abuse of people in their care.

We will also take action to modernise the regulation of healthcare professionals, as recommended by the Law Commission, to ensure regulators can focus on promoting safe, compassionate care.

Labour will:

• Recruit 20,000 more nurses and 3,000 more midwives to help ensure safe staffing in hospitals
• Ensure concerns can be identified and lessons learned, by introducing a system of mandatory case-note reviews for every hospital death
• Help staff raise concerns and feel confident acting upon them with a clear expectation that all NHS and care staff receive training in whistleblowing
• Tackle abuse in the care system by consulting on a new offence of corporate neglect for directors of care homes
• Modernise the regulation of healthcare professionals, as recommended by the Law Commission

Medical Research and Innovation

Labour will make sure the importance of research and innovation is understood across the NHS. The next Labour Government will support the work of the Health Research Authority to streamline the process for setting up clinical trials. We will also ensure that the improvements set out in the European Clinical Trials Regulations are realised.

Labour will commit to maintaining the Pharmaceutical Price Regulation Scheme as it provides certainty on drug prices and enables the NHS to budget effectively for the medicines that it uses.

The current Government promised to reform how drugs are made available on the NHS but has failed to deliver this. The previous Labour government set up the National Institute of Clinical Excellence to provide high-quality, independent, clinical guidance on what treatments should be available in the NHS. A future Labour government will make sure it is fit for the future, including looking at setting tougher rules on implementing NICE guidance and ensuring there is a clear route into routine commissioning for innovative treatments.