The Crisis in Health and Social Care

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2018 National Delegate Conference
20 February 2018
Carried as Amended

Conference is alarmed that our health and social care system faces an unparalleled crisis of under-funding, staff shortages, organisational upheaval and privatisation.

With the country set to celebrate 70 years of the NHS on 5 July 2018, Conference is appalled that our health service is currently embroiled in a crisis made in Westminster.

Conference notes that since 2010 successive UK governments have failed miserably to produce an adequate funding settlement for the NHS – either directly in England or via the Barnett formula in the devolved nations.

Conference is deeply concerned about the impact this is having on patients and services, with the situation coming to a head in the final week of 2017 when a record 16,900 patients were kept in ambulances waiting for hospital care in England. This led to NHS England taking the unprecedented decision to postpone operations until the end of January to relieve pressure in the system, accompanied by a series of non-apologies from the Prime Minister and Health Secretary. Some hospitals in Scotland were also forced to postpone operations over the Christmas period.

Conference notes that there have been increasing reports of widespread rationing of services as the local NHS struggles to make ends meet, and that waiting times have been rising steadily for the past year in most parts of the UK for planned surgery, Accident and Emergency attendance and cancer referrals. The average number of health beds in the EU is 5.2 per 1000 of population, but in the UK is only 2.3. The problem in wealthy country like the UK is not too many patients but too few beds.

Mental health is supposed to be an area that the government is prioritising, yet Conference notes the recent UNISON report, “Struggling to Cope”, which showed the huge pressure on our members working in mental health and the services they provide.

Conference notes government frequently attempts to divert blame for the crisis away from their own cuts – instead blaming patients, staff, managers, the elderly and migrants – all of whom have built our health and social care services since 1948.

Conference asserts that we now have a vicious circle of crisis in social care exacerbating problems for the NHS and vice versa. And Conference is dismayed that the situation is, if anything, even worse in social care. The current government has done nothing to reverse years of chronic underfunding, with the 2017 autumn budget and local government financial settlement offering far too little to close the gap between what the sector needs and what it is getting, further deepening the local authority funding crisis. Recent research published by the British Medical Journal has estimated that there have been 130,000 unnecessary deaths due to service cuts.

As a result, Conference notes that we now have a system where the care needs of large numbers of society’s most vulnerable people are not being met and where far too many care workers are left open to exploitation.

As an example of this, Conference condemns the government’s shameful decision in July 2017 to suspend enforcement action against providers who fail to pay the minimum wage to workers who sleep-in at care homes or their clients’ homes.

Conference notes that the care market remains highly dysfunctional, and continues to be based on a failed commissioning model with inadequate regulation and monitoring. Conference remains deeply concerned by the damaging effects of privatisation and by the government’s repeated failure to tackle non-compliance with the minimum wage in the sector.

Conference notes the alarmingly high levels of staff turnover and vacancy rates in social care and is extremely concerned about the impact on workforce supply (for both health and social care) of the UK’s impending exit from the EU.

Conference is therefore shocked by the government’s lack of urgency in tackling the many problems facing social care, as demonstrated by the ongoing delay in publishing a social care Green Paper, with the Conservatives apparently still reeling from the fall-out of the “dementia tax” debacle at the 2017 general election. And Conference is particularly concerned that the panel of “experts” announced by the government to begin discussions ahead of the Green Paper contains no care worker representatives.

Conference notes that, particularly in England, the health and social care system seems to exist in a state of near-permanent reorganisation. In Scotland, Wales and Northern Ireland in spite of the funding difficulties there are serious attempts towards involving staff, unions and patients in a more integrated and planned service.

Conference welcomes attempts to reinstate the importance of strategic planning in the health service and for more of the NHS to be organised on the basis of regional or sub-regional health economies – rather than focusing on individual local providers competing against one another in the open market.

However, Conference is also deeply sceptical about the ability of the NHS to achieve the level of change sought at a time when NHS funding is painfully inadequate, when there is an unseemly rush to move to new structures, and when staff engagement and patient involvement has been patchy at best.

The establishment of Sustainability and Transformation Partnerships (STPs) and the potential use of Accountable Care Systems or Accountable Care Organisations remain highly controversial in England, and Conference believes that a flawed implementation of such reforms runs the very real risk that any of the potential benefits will be lost.

Conference continues to support the principles behind health and social care integration, but this should never be used as a means of pushing through cuts, and proper safeguards must be provided for staff on job security, pay, terms and conditions.

Conference further notes that lack of funding increases the likelihood of NHS providers looking for short-term solutions to their financial woes, such as outsourcing and privatisation. This is particularly the case in England, where initiatives such as the Carter review and the Naylor report have encouraged trusts to look increasingly to the private sector.

And Conference is particularly concerned about the growing practice of NHS trusts establishing wholly owned subsidiary companies to provide support services. Under this approach members who are directly employed by the NHS are seeing their jobs and services outsourced to limited companies that are owned by the trusts but no longer part of the NHS.

Contrary to trusts’ claims, Conference does not believe that the use of wholly owned subsidiaries does anything to improve efficiency or productivity; instead it exploits a tax loophole, seeks to undermine pay and pensions, and represents further fragmentation of the NHS.

The collapse of Carillion in January has dramatically exposed the problems of outsourcing and private finance for new hospitals and facilities in the health sector. Conference believes all former Carillion services should be bought back in-house.

Conference therefore calls upon the National Executive Council to:

1)Continue to work with the TUC, STUC, WTUC, ICTU and other unions to demand that our health and social care system gets the level of funding needed to deliver comprehensive, safe, high quality services;

2)Campaign against any proposals made by STPs or other reorganisations that present dangers to staff, patients or service users;

3)Produce guidance and targeted resources to support branches take an organising approach to the changing health and social care landscape;

4)Continue to promote UNISON’s ethical care and residential care charters by pressing for more councils to sign up to them;

5)Campaign for the government to force social care companies to maintain clear minimum wage records and clear and understandable payslips for workers;

6)Campaign for regulatory change to oblige social care employers to provide their workers with a statement demonstrating compliance with the minimum wage;

7)Work to resist privatisation in all its forms, including by supporting regions and branches in campaigning against the establishment of wholly owned subsidiary companies in the NHS and urging the government to close the tax loophole that is driving this agenda;

8)Continue to campaign for social care to be directly delivered by the public sector, paid for by general taxation and both universal and free at the point of need;

9)Work with local and national campaign groups to ensure that UNISON remains in touch with those fighting cuts and privatisation in our communities;

10)Mark the NHS turning 70 by supporting the Health Campaigns Together demonstration and celebration events on Saturday 30th June 2018.