Ed Gillett is Communications & PR Manager at the BGS. Following the publication of each major political party’s election manifestos, Ed assesses how they compare to the BGS’ own pre-election call on health and social care for older people.
Last week saw the publication of the Labour and Liberal Democrat election manifestos, following hard on the heels of those from the Conservatives, Greens and Ukip. We now have a clearer picture of each party’s vision for health and social care.
But how seriously is each party taking the issue of excellent care for older people, and how do they measure up to the Society’s own pre-election policy work, in which we highlight the six key decisions facing an incoming government?
In the first of those six decisions, the BGS has called for implementation of the Barker Commission’s recommendations, including integrated health and social care budgets and free social care for those in greatest need.
The Greens have committed to both of these, the Conservatives to integration (via the Better Care Fund) but not free social care. The Lib Dems have said that they would “provide more choice at end of life, and free end-of-life care for those placed on their local end-of-life register”, while Labour have committed to integration their manifesto identifies “[the right] to receive care at home” without specifically stating whether or not care for those with the highest levels of need would be free.
Next up, building capacity in intermediate care: will the incoming Government heed the advice of the National Audit of Intermediate Care, and increase spending on rehabilitation, re-ablement and support services to £4m per 100,000 people?
None of the manifestos explicitly mention intermediate care, but all have their own visions of better care outside hospital: Labour would guarantee a GP appointment within 48 hours, recruit 5,000 new homecare workers, and introduce ‘year of care’ budgets. The Conservatives promise 7-day GP services, while Ukip want to abolish zero-hours contracts for home care workers. The Liberal Democrats have said that they’ll spend half of their allocated £1bn NHS funding on providing care in people’s homes and communities.
Another key point in the BGS policy paper is the creation of national strategic direction on older people living with frailty, dementia and long-term conditions. On this, the parties each have subtly different takes on similar ideas: Labour point to personal budgets, the Liberal Democrats to equality between physical and mental health, and the Conservatives to dementia-friendly care planning.
After a while, something of a theme emerges: for all their supposed ideological differences, the party lines on healthcare do start sounding remarkably similar. Each major party promises to improve funding and care standards, claiming that they will save the system from collapse, whilst warning that their opponents would destroy it completely. Each is similarly cagey on exactly how their plans will be achieved.
Of course, manifestos are designed for broad assertions rather than forensic detail: the “what” of the question rather than the “how”. Perhaps it’s inevitable, at this crucial stage of the election, that parties will be driven more by what they think voters want to hear than by the realities on the ground.
Take funding, for example: the NHS England Five Year Forward View spells out the need for an extra £8bn each year simply to maintain current standards of care. Neither Labour nor Ukip have committed to spending at this level; the Conservatives, Greens and Liberal Democrats have done so, but have been coy on exactly where this money would come from. And all this before we even think about paying for the improved services each party has promised; it feels a little bit like the real issue has been collectively dodged.
The issue of workforce produces similarly foggy answers: in our pre-election call, the BGS makes the crucial point that staff must be appropriately trained for the work they’ll be doing, i.e. caring for increasing numbers of older people with complex conditions and multi-morbidities. And yet, while most manifestos discuss increasing the raw numbers of healthcare workers (more GPs and nurses in particular), none of them make any mention of training, or how they’ll ensure that these new colleagues have the right mix of skills to meet patient need.
It’s important not to read too much into the simplified content of a manifesto, which by definition can’t cover everything. It’s clear that whoever’s in Downing Street after May 7 will have a far more complex and challenging task ahead of them : squaring the financial questions, enabling the design of truly integrated, patient-centred services, and responding to shifting demographics and demand.
However, the Society’s role as an advocate for our members, and our members’ roles as advocates for their patients, demands that we keep our political friends on the right track. It’s incumbent on all of us to ensure that older people remain at the heart of this debate, both in the run-up to the election and beyond.
Photo credit: John Keane via flickr.