Saving the NHS and Social Care

Extracted from the Liberal Democrat manifesto.

The NHS and social care services are in a state of crisis. The Conservatives have left them chronically under-funded, while need continues to grow and patient care suffers. Social care is facing a funding blackhole of £2 billion this year alone and more than a million older people are missing out on the care that they need.

People are routinely left stranded in hospital after they finish their treatment because the follow up care and support they need is not available. Nearly two-thirds of NHS Trusts ended the last financial year in deficit.

Yet Labour and Conservative politicians refuse to be honest with the public about the scale of the crisis or the tough decisions which are needed to protect these vital services.

Liberal Democrats recognise that Britain’s health and social care services are our most treasured national institutions. Any party seeking to lead the country after this election should be prepared to take bold action to safeguard them. This isn’t about doing the easiest thing, it is about doing what is right and what is essential.

Liberal Democrats will take five key steps in order to put our health and social care system back on a sustainable financial footing:

1. An immediate 1p rise on the basic, higher and additional rates of Income Tax to raise £6 billion additional revenue which would be ringfenced to be spent only on NHS and social care services.
2. Direct this additional investment to the following priority areas in the health and care system: social care, primary care (and other out-of-hospital care), mental health and public health. This represents the most efficient and effective way of spending these extra resources – ensuring they will have the greatest impact on the quality of care patients receive.
3. In the longer term and as a replacement for the 1p Income Tax rise, commission the development of a dedicated Health and Care Tax on the basis of wide consultation, possibly based on a reform of National Insurance contributions, which will bring together spending on both services into a collective budget and sets out transparently, on people’s payslips, what we spend on them.
4. Establish a cross-party health and social care convention, bringing together stakeholders from all political parties, patients groups, the public, and professionals from within the health and social care system to carry out a comprehensive review of the longer-term sustainability of the health and social care finances and workforce, and the practicalities of greater integration. We would invite the devolved administrations to be a part of this work.
5. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility. This would report every three years on how much money the system needs to deliver safe and sustainable treatment and care, and how much is needed to meet the costs of projected increases in demand and any new initiatives – to ensure any changes in services are properly costed and affordable.

Our longer-term objective will be to bring together NHS and social care into one seamless service – pooling budgets in every area by 2020 and developing integrated care organisations.

Valuing the NHS and Social Care Workforce

Our health and social care services’ greatest resource is their staff, working tirelessly under immense pressure. This Government has left them feeling embattled and undervalued.

To support the NHS and social care workforce we will:

• Guarantee the rights of all NHS and social care service staff who are EU nationals, the right to stay in the UK.
• End the public sector pay freeze for NHS workers.
• Reinstate student nurse bursaries.
• Support innovation in how organisations can empower staff and patients, including learning from innovative social enterprises delivering community and mental health services.
• Protect NHS whistle-blowers.

GPs in particular have been put under considerable strain due to severe under-funding and neglect from the Conservatives, leaving many people waiting weeks to get appointments. GPs are the core of what the NHS is and they need support to ensure that the NHS is able to survive and thrive. We will:

• Produce a national workforce strategy, ensuring that we never again experience a shortage in the numbers of GPs, hospital doctors, nurses and other professionals that the NHS needs.

Equal Care for Mental Health

In government, we fought tirelessly to reduce the historic inequality between the way physical and mental health are treated in the NHS and are proud of the strides forward we made. We legislated to give mental and physical health equality under the law. We introduced the first waiting time standards for access to treatment for mental health. We introduced the crisis care concordat which dramatically reduced the number of people who end up in police cells when they experience a mental health crisis; and we secured more money for children and young people’s mental health service. But we know that not enough resources reach front line services and that in the fight for parity of esteem, there is still a very long way to go. We will:

• Ringfence funding from within the one penny Income Tax rise, to provide additional investment in mental health
• Continue to roll out access and waiting time standards for children, young people and adults. This will include a guarantee that people will not wait more than six weeks for therapy for depression or anxiety, and no young person will wait more than two weeks for treatment when they experience a first episode of psychosis.
• Increase access to clinically- and cost-effective talking therapies so that hundreds of thousands more people can receive this support.
• Examine the case for introducing a dedicated service for children and young people based on the Australian ‘headspace’ model and building on many excellent Youth Information, Advice and Counselling Services.
• Transform mental health support for pregnant women, new mothers and those who have experienced miscarriage or stillbirth, and help them get early care when needed.
• Continue to promote and invest in the Frontline programme to fast-track exceptional graduates into children’s social work, as well as the Think Ahead scheme aimed at encouraging high-achieving graduates to pursue a career in mental health social work.
• Ensure that no one in crisis is turned away, with new waiting time standards and better crisis care in Accident and Emergency, in the community and via phone lines. This will enable us to end the use of police cells for people facing a mental health crisis.
• End out of area placements, ensuring those admitted to hospital for mental ill-health are able to be treated close to home.
• Ensure that all frontline public service professionals, including in schools and universities, receive better training in mental health.
• Roll out the Liaison and Diversion programme nationally, helping to identify people who have mental health problems, learning disabilities, substance misuse or other vulnerabilities when they first come into contact with the criminal justice system
• Tackle stigma against mental ill-health, including by building on the good work done by organisations like Heads Together and changing the standard of proof in suicide conclusions in the Coroner’s Court.
• Ensure that LGBT+ inclusive mental health services receive funding and support.

Medical research is vital for developing new and better treatments. We will fight the threat Brexit poses to medical research funding. We support the principle that all medical trials using public facilities or resources should comply with the Open Trials standards, and that a fair proportion of all public funding for medical research should be focused on research into mental ill-health. We also favour the further development of open access academic journals.

Home not Hospital: Joining up health and social care

We need services that fit around people’s lives, not ones that force them to fit their lives around the care they need. This will become increasingly important as our population ages and the number of people living with long-term conditions continues to grow. It is also more cost-effective to support people to be able to live at home rather than endure lengthy stays in hospital. We must move away from a fragmented system to an integrated service with more joined-up care, and more personal budgets so that people can design services for their own individual needs. We believe this should happen from the bottom up, suiting the needs of local communities.

The number of family carers is rising, including in the ‘sandwich generation’ who find themselves trying to care for their children and their parents at the same time. Carers are unsung heroes; we need to do more to help them. We will:

• Finish the job of implementing a cap on the cost of social care, which the Conservatives have effectively abandoned.
• Move towards single place-based budgets for health and social care by 2020, allowing local areas to decide how best to provide the full spectrum of care for their community.
• Remodel the healthcare funding system to eliminate perverse incentives, by moving away from payments for activity and introducing tariffs that encourage joined-up services and promote improved outcomes for patients and better preventive care.
• Ensure those who work in the social care sector are properly trained, with accessible career pathways, and are suitable to practice by introducing a statutory code of conduct backed up by a care workers’ suitability register.
• Raise the amount people can earn before losing Carer’s Allowance from £110 to £150 a week, and reduce the number of hours’ care per week required to qualify.
• Give the NHS a legal duty to identify carers and develop a Carer’s Passport scheme to inform carers of their NHS rights, such as flexible visiting hours and access to support.
• Provide more choice at the end of life, and move towards free end-of-life social care, whether people spend their last days at home or in a hospice.
• Evaluate the valuable work of hospices with a view to putting them on a more sustainable financial footing and allowing them to expand their services.

Better access to community services

Most people’s experience of the NHS is their local GP, or the nurses and support staff who visit them at home or work in community clinics. Access to care in GP surgeries and closer to home is better for patients and will also help reduce pressure on hospitals, Accident and Emergency departments and ambulances. We will:

• Promote easier access to GPs, expanding evening and weekend opening to meet the needs of local patients, encouraging online, phone and Skype appointments, encouraging GPs to work together in federations, and allowing people more choice.
• Provide national support to struggling GP practices, preventing mass practice closures
• Support GPs to come together to collectively provide services such as out-of-normal-opening-hours appointments
• Use innovation funding to promote GP-led multi-disciplinary health and care hubs, including mobile services to keep people out of hospital.
• Encourage GPs and other community clinicians to work in disadvantaged areas through our Patient Premium – which would give incentive payments to clinicians.
• Ensure that any changes to the way pharmacies are funded do not leave local areas without reasonable access to a community pharmacist.
• Review the rules for exemption from prescription charges to ensure they are fair to those with long-term conditions and disabilities.

Helping people stay healthy

It is better for patients and for the NHS if we keep people healthy in the first place, rather than just waiting until people develop illnesses and come for treatment, but 40% of NHS spending is on diseases that are preventable. We need to do more to promote healthy eating and exercise, making people aware of the dangers of smoking and excessive consumption of alcohol and other drugs, and helping to improve mental health and wellbeing. We will:

• Move towards a health and social care system that empowers and encourages people to better manage their own health and conditions and to live healthier lives.
• Publish a National Wellbeing Strategy, which puts better health and wellbeing for all at the heart of government policy.
• Implement the recommendations of the O’Neill report on antimicrobial resistance to ensure responsible prescribing and investment in diagnostics and innovation.
• Make Pre-Exposure Prophylaxis (PrEP) for HIV prevention available on the NHS.
• Support effective public awareness campaigns like Be Clear on Cancer and learn from what works when designing new health promotion campaigns to change behaviour.
• Keep public health within local government, where it is effectively joined-up with preventive community services, and re-instate the funding cut from public health budgets by the Conservatives.
• Develop a strategy to tackle childhood obesity including restricting the marketing of junk food to children, restricting TV advertising before the 9pm watershed, and closing loopholes in the sugary drinks tax.
• Encourage the traffic light labelling system for food products and publication of information on calorie, fat, sugar and salt content in restaurants and takeaways.
• Introduce mandatory targets on sugar reduction for food and drink producers.
• Reduce smoking rates, introducing a levy on tobacco companies so they fairly contribute to the costs of health care and smoking cessation services.
• Implement the recommendations of the Keogh review to regulate cosmetic surgery and ensure that the NHS is not picking up the tab for private malpractice.
• Introduce minimum unit pricing for alcohol, subject to the final outcome of the legal challenge in Scotland.
• Develop a public health campaign promoting the steps people can take to improve their own mental resilience – the wellbeing equivalent of the ‘Five a Day’ campaign.
• Support good practice among employers in promoting wellbeing and ensure people with mental health problems get the help they need to stay in or find work, with a ‘Wellbeing Premium’ to reward employers who take clear action to measurably improve the health of their employees.

We will develop a just settlement for haemophiliacs who were given contaminated blood, and for their families.