Archive for the 'NHS' Category

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Take Care. The implications of the Conservative policy on social care

Saturday, May 20th, 2017

General elections aren’t usually about big ideas. They’re usually occasions for the parties to try to come up with visual representations of their opponents that sting, for frenetic arguments about trivial events and for their leaders to pose in unlikely photo-opportunities. Voters are expected to react, not to think.

So Conservative supporters have reacted with trepidation to the focus on their plans for long term care. This was not an afterthought but a flagship policy, mentioned in Theresa May’s foreword. This is terrain the Conservatives have consciously chosen to fight on. The manifesto proposes that:

“First, we will align the future basis for means-testing for domiciliary care with that for residential care, so that people are looked after in the place that is best for them. This will mean that the value of the family home will be taken into account along with other assets and income, whether care is provided at home, or in a residential or nursing care home.

Second, to ensure this is fair, we will introduce a single capital floor, set at £100,000, more than four times the current means test threshold. This will ensure that, no matter how large the cost of care turns out to be, people will always retain at least £100,000 of their savings and assets, including value in the family home.

Third, we will extend the current freedom to defer payments for residential care to those receiving care at home, so no-one will have to sell their home in their lifetime to pay for care.”

Cue much sound and fury about the possibility of an elderly person’s inheritance being eaten into. The opposition have been quick to label this a Dementia Tax. But what are the options?

Not everyone will need long term care. In fact, only something like one in six of us will. For those who need it, however, it can be very expensive indeed. The options are therefore: to offer long term care through the state (either with or without a contribution from the individual); to subsidise the cost of care; to set up an insurance market; or to get family members to undertake the care themselves. All these options have been tried and all have their drawbacks.

Whenever you hear about a risk that some but not all will trigger, you think of insurance as a possible model. Insurance companies have been looking at this area for years. But so far the public have not been interested in paying premiums well in advance, preferring to take their chances. This may be in part through a mistaken belief that the state would come to the rescue, but at least part of the problem is that none of us like the idea of thinking of ourselves as geriatric at any point in the future. It’s hard enough to get people to save for pensions, with the image they conjure up of being old and grey and creaky. Getting people voluntarily to provide for the possibility that they might be senile or incontinent is several steps harder.

In 2010 Labour proposed compulsory after-the-event insurance, levying £20,000 from every estate to pay for long term care. The Conservatives instantly labelled it a death tax (unfair but snappy monickers are not the sole preserve of the left). Whatever the benefits of compulsory insurance, levying money from people who demonstrably didn’t need it was always going to be a tough sell. After Labour’s defeat in 2010, the idea languished.

Labour’s proposal this time – also a flagship policy mentioned in Jeremy Corbyn’s foreword – is for a National Care Service, committing as follows:

“In its first years, our service will require an additional £3 billion of public funds every year, enough to place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care. There are different ways the necessary monies can be raised. We will seek consensus on a cross-party basis about how it should be funded, with options including wealth taxes, an employer care contribution or a new social care levy.”

So Labour is proposing to build a state system, funded initially at least in part by capped individual payments. Risks would be pooled not through insurance but through the state. Means testing is not mentioned, meaning that the rich who need care would have the bulk of their assets left untouched (though note that wealth taxes are a possible source of funds for this service).

The Conservatives’ proposal leaves care costs as primarily the individual’s responsibility, with a safety net that no one should be reduced below their last £100,000 of assets.

So who should bear the risk that you might need long term care in the future? It is undoubtedly bad luck to become so infirm. It is not immediately apparent why others should pay for that bad luck if you have the assets to do so yourself, at least at the level that the Conservatives are seeking to set as an asset floor. Paradoxically, Labour’s approach is on the face of it more sympathetic to the asset rich than the Conservatives’.

The IFS has criticised Conservative policy because it makes no attempt to deal with the fundamental challenge of social care funding, advocating an insurance model or a social insurance model. The IFS is wrong about this. It presupposes that the question is an insurance problem. But there is no evidence that the public wants the level of insurance that the IFS deems appropriate: as I’ve noted above, insurers haven’t found enough interest in this as an idea. We don’t make drivers buy comprehensive car insurance. Should we make people buy comprehensive care insurance?

What of the politics of all this? The following groups will be concerned about the Conservatives’ policy: the elderly with assets of considerably more than £100,000 who wish to leave their property to their children; the expectant children of the elderly with assets of considerably more than £100,000; and those who think that in due course they might be in one or other of the first two groups.

These are not small groups. Many in their 50s or above will fall into them, especially in southern England. Those with elderly relatives who live in and around London will be especially interested in this. It has to be noted that this is a group who carry particular clout in the media.

Meanwhile, however, what Leona Helmsley would have called the little people will be baffled at the fuss. Many of these are considering voting Conservative for the first time and may well regard this as a cue that Theresa May is drawing up policy for them rather than for the affluent. This group is more likely to be worried about the government messing around with winter fuel allowance.

It’s also worth noting that with its headline “At last, a PM not afraid to be honest with you” the Daily Mail has captured the mood of many in relation to this policy, including quite a few non-Conservatives. Those non-Conservatives probably won’t change their votes over this but not everyone is as mercenary about this as might be thought.

It is likely that as a result of this policy the Conservatives will see an appreciable drop in support among the wealthier, particularly in southern England. If, however, the grafters north of the Severn-Wash line are given a further tug in the direction of a Conservative vote, Theresa May will probably regard that as a reasonable trade-off. Some votes are worth more than others. Right now, working class votes in northern constituencies are gold dust.

Alastair Meeks




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In “normal times” concern about the NHS reaching a 15 year high would point to a big problem for ministers

Friday, March 3rd, 2017

But LAB played the NHS card in Copeland and still lost

For the third Friday in a row I’m off to hospital this morning after being one of those who’ve added to this winter’s unprecedented demand on the NHS.

At the start of February after a heavy cold I woke one morning to discover both my ears had been bleeding and I’d lost 80-90% of my hearing. This was profoundly shocking, isolating and very worrying. I realised I needed the NHS at a time when the pressure on it was absolutely enormous.

I haven’t been disappointed. My GP got me an appointment within 24 hours to see an ENT specialist and I only had to wait four days for the first hospital visit. The treatment seems to be working.

I share this because those of us without health insurance totally rely on the NHS for situations like this which is why it is so politically important.

The chart above from the latest Ipsos-MORI Issues Index has the NHS as the main concern with the level at a 15 year high. You’d have thought that this would have helped LAB but it hasn’t and playing the NHS card in Copeland didn’t prevent its humiliating loss of last week’s by-election.

Maybe the concern level is so high because voters are not convinced that LAB is the answer to anything and there is still a question mark about the Tory commitment in this area.

Mike Smithson




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Betting on whether or not Jeremy Hunt will be Health Secretary on the 1st of January 2018

Sunday, February 26th, 2017

But is there another Jeremy Hunt bet you should be making?

William Hill have a market up whether Jeremy Hunt will be Health Secretary on the 1st of January 2018. I think taking the 2/5 on him being Health Secretary on the 1st of January 2018 is the best option. Here’s why you’ll be getting a 40% return in less than ten months.

One of the things to take from the Copeland by-election is that Labour’s attempts to use the NHS to win votes isn’t effective as these tweets below confirm.

So that should help Jeremy Hunt going forward, politically speaking a Jeremy Corbyn led Labour party is as impotent as a battalion of eunuchs, any problems with the NHS won’t be effectively exploited.

Given the way Jeremy Corbyn goes through shadow cabinet members*, it is entirely possible that constant reshuffles might not allow any shadow Health Secretary to be in the role long enough to become effective at holding the government to account.

Additionally I think Mrs May has learned from David Cameron’s example and will not make annual reshuffles, so I’d expect scandals notwithstanding, Mrs May won’t be holding a major reshuffle this year, so again that should make Jeremy Hunt secure.

Since VE Day, only Nye Bevan and Norman Fowler have served as Health Secretary longer than Jeremy Hunt has today, such endurance in looking after the NHS, which has been described as the national religion, points to an adroit politician.

Were Theresa May to fall under a bus, or were she to last as Prime Minister for a decade, Hunt would be young enough to be a plausible to be her sucessor. Coral are offering 80/1 on Jeremy Hunt as next PM, it might be worth a flutter.

TSE

*My favourite statistic of the week



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The Leader of Surrey County Council – The Unlikeliest Revolutionary

Monday, January 23rd, 2017

At a time when the Daily Mail and others are eulogising over Donald Trump and extolling him as a revolutionary (though his “America First” slogan belonged to Charles Lindbergh over 70 years ago), I would argue the week’s true revolutionary is a contemporary of President Trump.

Step forward David Hodge CBE, leader of Surrey County Council.

This week Hodge announced a referendum for Surrey voters on a proposal to raise Council Tax 15% to fund additional adult social care.

It’s a bold and radical move – referenda have been held in other authorities – one example in Bedfordshire on General Election day in May 2015 saw a proposal for a Council Tax to fund extra Police soundly defeated.

It might be reasonable to argue that if people won’t vote for extra money for the Police they almost certainly won’t support a tax rise to fund extra care for the elderly and vulnerable adults.

According to the 2011 Census, the proportion of those aged over 65 in Surrey is 17.2% so that’s more than one sixth of the population.

The County Council has argued, not without some justification, that it has been badly treated in terms of central Government funding but will the residents voluntarily agree to plug the gap?

The referendum isn’t about funding – it goes much deeper and cuts to one of the central questions. How do we want to treat the elderly in society and how do they want to be treated? Many families have a strong sense of caring within the family for an elderly relative and that is laudable but caring for a relative with dementia or someone with extreme physical problems requires a level of care and dedication beyond most individuals and families.

With families having become smaller and more geographically disconnected, there are a growing number of elderly who have no one and for whom State care is the last resort. Ironically, the news this week that the Alzheimer’s Society in Surrey is closing all its centres is part of the problem. Without the funding to provide specialist transport, those in need can’t reach the centres and as they fall into disuse, they close.

A growing ageing population puts pressure on carers, care facilities and other medical facilities such as hospitals with beds “blocked” for long periods by geriatric cases.  It is a huge problem which goes unreported and in my view challenges some basic assumptions about the kind of people we are, the kind of people we think we are and the notion of respecting for all.

A Government preoccupied with free trade deals and attracting foreign investors may not want to think too much about its own elderly but the problem isn’t going to go away.

Will Surrey’s electors support the County Council and what impact will the referendum have on the forthcoming County Council elections? Surrey is a Conservative stronghold with the Party winning 58 out of the 81 Council seats in 2013.

On a wider level, IF Surrey residents back the County Council; will it encourage other authorities to seek similar mandates? If the proposal falls, the crisis in Adult Social Care won’t go away and the County Council may have to make cuts in other areas.

Could the Opposition (led by a pensioner) make headway with A New Deal for Pensioners whereby some of the current “trinkets” such as winter fuel allowance and free TV licences are sacrificed for a more comprehensive and better funded Adult Social Care system?

As for the Referendum, no one yet knows when it will be held and there have been no polls. Early Twitter reaction was hostile but that can hardly be viewed as reliable.

Stodge

Stodge is a long standing contributor to PB



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The LEAVE campaign’s message on the NHS is still resonating strongly with those who voted for BREXIT

Friday, January 6th, 2017

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The majority of leavers think BREXIT will be good for the NHS

The latest YouGov out today, asks a question that has nor been put for some time – whether people think that leaving the EU will be good for the NHS.

This was, of course, the biggest message from the officially designated LEAVE campaign and was the main theme of its referendum broadcasts. There was dispute over the £350m figure but the campaign held firm and continued using it right to election day.

What’s interesting about the latest poll is how many LEAVE voters still believe that BREXIT is going to achieve what was promised – maybe setting up a level of expectation that it might be difficult to fulfil.

REMAIN voters, as can be seen, responded to the question in a totally different way.

For the moment, of course, nobody knows whether this promise can be achieved but, no doubt, it will figure heavily in the political debate once extraction has been achieved.

Mike Smithson




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NEW PETITION calling for everyone to be able to see a GP within 48 hours needs your support

Friday, December 30th, 2016

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2017 will be dominated by Brexit but we shouldn’t lose sight of the real pressures facing our NHS, whatever your politics, writes Keiran Pedley

Until 2016, I was typical of many thirty-somethings in that I had little need to see my local GP too often. This year that changed. Due to a recurring issue I found myself having to see the GP more regularly. Nothing critical, I’m fine, but this experience opened my eyes to a real problem and prompted me to want to find out more. In this post, I want to share my experience, start a debate and hopefully win some support for a petition I have started.

The issue I want to talk about is the availability of GP appointments in the UK.

In my experience this year I have found making an appointment a struggle. It can take two weeks or more to get an appointment and not just in isolated circumstances. On the first couple of occasions I put it down to hard luck and thought little of it. However as the year progressed I continued to have the same experience. On speaking to friends and family, I have found that others have had the same experience (or worse) yet some experience no issue at all – a real ‘postcode lottery’. I decided to dig deeper.

A real problem that is getting worse

Recent headlines, buried between celebrity deaths and Trump’s latest tweets, have convinced me that something is happening that requires more attention. The incoming head of the Royal College of GPs, Dr Helen Stokes-Lampard, has warned that patients run the risk of having to wait up to a month to see a GP in crunch periods. Her warning comes after a survey of GPs in 2016 estimated that the average waiting time for a GP appointment was approximately 13 days and getting longer. Another survey published in 2016, the respected GP-Patient survey conducted by Ipsos Mori, estimated that one in five wait a week or longer for an appointment with the trend moving in the wrong direction (sample size n=124,235 patients).

Table 1: Time taken to see a GP (one week or more)

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Source: Ipsos Mori GP-Patient Survey.

It is clear from these findings that many patients are waiting more than a week to get a GP appointment and the problem is getting worse. These figures and Dr Stokes-Lampard’s warning should concern us all. The longer it takes to see a GP, the more patients are put at risk (with non-urgent problems potentially becoming urgent), the greater the pressure placed on A&E departments and the harder it is to genuinely create a health service based on preventative care. Both the scale of the problem and the direction of travel are worrying and there is a very real risk that this issue gets buried in 2017, whilst the government understandably is preoccupied by Brexit.

Take action – support our petition

So what can we do about it? As a start, I have created a petition calling on the government to set a target that everyone should be able to see a GP within 48 hours of making an appointment and I am asking for your support. The purpose of this petition is not to apportion blame or to start a party political row. Nor is it to pretend that there is an easy solution. In starting this petition, I want to raise awareness of the problem and try to place it further up the political agenda. But I can’t do that without help.

I urge everyone to support this petition – even if your personal situation locally is fine. Perhaps you weren’t aware of this problem before today because you were unaffected. However, it is clear that there is a problem and it will get worse unless political leaders are put under pressure to address it. One petition won’t solve the problem alone but with enough backing it can at least get MPs talking about it and that is step in the right direction. The 48 hour target may be ambitious but right now the most important thing is to change the direction of travel and for that reason I ask you to support this petition.

How you can help.

To support this campaign click here to sign our petition or paste this URL into your browser https://petition.parliament.uk/petitions/176412.

We would also encourage you to share this petition with your friends and family on Facebook or by email so that we can try and get as many signatures as possible.

For further info contact Keiran on twitter at @keiranpedley

Thanks for your support.

Keiran Pedley




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Situation critical. How the NHS could affect the path of Brexit

Wednesday, October 26th, 2016

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That £350m “commitment” could be damaging

The debate in Britain about health spending is fundamentally dishonest.  The left constantly press for large increases in spending.  The government constantly boasts about ever-increasing spending at or above inflation levels.  Voices on the right frequently argue for scaling back the health services that the public sector provides.  None of them address what Britain needs.

Britain’s health needs are growing at a rate far faster than inflation, even if one uses measures of healthcare inflation.  Those needs are not growing in line with prices but demography.  40% of NHS spending is devoted to those aged 65 and over, though that group comprises only 18% of the population, with this spending concentrated in the older age bands.  70% of NHS spending in England is directed towards just 25% of the population – those with incurable long term conditions.  As the nation’s population inexorably gets older and as those with incurable long term conditions can be supported more effectively, costs will inevitably rise.

Make no mistake, it is good news that we are living longer and that those with health needs can be supported more effectively.  But that good news comes with a cost and one that rises as we age.  By 2039 the Office for National Statistics estimates that those aged 75 or over will increase from 8% of the population to over 13% of the population.  (Besides being the most needy of resources, the over-75s are also the most violent.)    Healthcare costs, if no changes are made to NHS coverage, will rise far in excess of inflation for the next generation.  Increasing funds for the NHS is like throwing cakes at a bear.

There is no easy solution.  To make the books balance, either taxes will need to rise steeply, other government spending will need to be reduced significantly or NHS services will need to be cut sharply.  Probably we will need to see a combination of all three.  There is a crunch coming and it cannot be deferred indefinitely.

That crunch may be coming very soon indeed.  75% of acute hospitals are in deficit – only 8% of NHS providers were in deficit in 2009/10.  The NHS has managed to keep the show on the road in the last few years by spending more than it receives.  That is not a sustainable model in the long term and may not be sustainable in the short term.  Ambulance response rates are worsening, waiting times after referral are deteriorating (cancer treatment waiting time targets have not been met since 2014) and A&E waiting time targets are now routinely being missed, with the latest quarter showing the most patients delayed in a decade.  Pressures are building up in the system.  The sense of crisis building is palpable.

The government will be hoping for another quiet winter in the health service, as are we all.  Given the state of hospital finances and current performance, there is no particular reason to expect that hope to be met.  The media reporting on a crisis in the NHS this winter looks considerably more likely than not.

The public aren’t expecting this at all.  They’ve just voted in a referendum where they were told that £350 million a week could be saved for the NHS.  Reasonably enough they are going to ask why this has not happened.  They are unlikely to be impressed to be told that the money is not going to be available, that actually the £350 million was earmarked for other things as well, that Brexit has yet to happen, that the Leave camp are not the government and that it wouldn’t make all that much difference anyway.  Pointing at the small print will just leave the public feeling duped and angry.

If the public think that they have been had, this is probably going to do nothing to assuage concerns about how Brexit is developing.  Theresa May has pencilled in March for triggering Article 50 (subject to whatever the courts might rule about this).  Nothing much looks likely to happen before then and the vacuum about what Brexit means seems likely to continue till then, with increasing alarm among the public about the absence of a disclosed plan.  If Leave’s flagship policy comes to be seen as a con in the public’s eyes, public confidence in the whole idea is likely to dissipate at high speed. 

So Leavers should be thinking right now what they’re going to be telling the public if the NHS does go through a rough patch this winter.  The NHS’s problems could rapidly become their own.

Alastair Meeks

 



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As doctors stage their 3rd strike Ipsos-MORI finds that they are still getting strong public support

Wednesday, March 9th, 2016

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57% blame the Government 11% the doctors

With thousands of operations being cancelled because of the latest doctors strike public support for them is as high as it was for the first two strikes in January and February, according to new polling from Ipsos MORI.

The survey of adults in England finds the same proportion (65%) supporting junior doctors strikes as for the previous round of action in February (66%) – as long as emergency care is provided. Opposition to junior doctors striking has decreased by 5% to 17% compared to last month.

The new figures are published as doctors go on strike for a third time, and show that the government continues to bear much of the blame for the ongoing dispute. 57% say that the government is more at fault for the dispute continuing this long, down from 64% in February, and the number saying the junior doctors are more at fault is still low at 11% (13% in February).

However there has been a 10 point increase since last month in the number saying that the doctors and the government are both equally at fault (28%).

If it wasn’t for referendum this would be getting more attention than it is and create more problems for the Tories.

Mike Smithson