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A warning worth heeding: why health and care costs need to be integrated

It's not a case of either/or. Health and care both urgently need investment in the Budget.

This week, Simon Stevens, chief executive of the NHS, has called for more funding from the forthcoming Budget, warning that without it the quality of healthcare available to us all is sure to suffer. 

His is a call that Age UK supports. The numbers speak for themselves: the NHS is experiencing a degree of sustained belt-tightening that is unprecedented in modern times; this while an ageing population is inevitably increasing the demand for services. 

From an Age UK perspective, we worry a lot about the impact of this stress in the system on older people, for whom the ability to get the right treatment and support quickly is hugely important - whether it is to help them sustain good health and wellbeing or because they have health and care problems that need to be addressed. 

Some policymakers have argued that if only the NHS and social care were better joined up, or integrated, then this would mean money was better spent - that effectively the problem isn’t a shortage of funding but one of inefficiency and waste. 

No doubt there is always scope for improving the productivity and efficiency of all services, the NHS and care included. However, there comes a point when insufficient funding not only compromises the quality of services on offer - and access to them too - it also actually discourages professionals and organisations from working together across the healthcare interface.   

The conventional counter argument is that "a burning platform" such as that offered by the dire finances within both health and care at present is a wonderful incentive for everyone to come together for the greater good – with the shortage of funds forcing managers to pool risk and money in a way they may have resisted before.

However, this strikes me as hugely over-optimistic because there is a contrary tendency for organisations under pressure to retreat and protect what they have. Rather than nobly overcoming boundaries people patrol them all the more diligently.

I’ve seen this for myself while supporting my mother through the health and care maze. A trivial but striking example comes from a phone call I had with the member of her council’s Adult Social Care team a few weeks ago over whether she was entitled to have some grab rails fitted in her home. 

After a 20-minute "assessment" I was told that the decision of her local authority was that she wasn’t eligible. The reason was that the council’s role was to fit grab rails for the purpose of aiding safe transfers – e.g. between a bed and a chair, whereas if the grab rails were required to aid mobilisation then that was the job of the NHS. Since the rails were to go over two radiators, due to my mother’s propensity to hold onto them while moving around, thus risking a burn when they were switched on, her need fell into the second category and was thus the job of the NHS. 

It struck me that this was a rather absurd differentiation and that it probably cost more for the staff member to go through the process of deciding my mother was not eligible for this particular service than it would have done simply to install the rails! 

In addition, I was not told how to go about approaching the NHS to pursue them meeting my mother’s needs: it felt like the staff member thought they had done their job by simply diverting this particular request for help away - no doubt one of many that day. 

This is a trivial example of a problem that seems widespread. A survey of social workers carried out this summer by the Care and Support Alliance and Community Care magazine threw up numerous similar examples of council staff being told to direct any need for help onto the NHS - or somewhere else - if it could conceivably be argued that there was a valid reason to do so. I recall, for example, one respondent saying they had been told to inform a person with MS that they could not use their personal care budget to pay for transport to a local MS support group because that was a health rather than a care need. 

This is the sad and rather ridiculous position we seem to have reached in our health and care services; where more effort is sometimes being expended on pushing people away than on meeting their needs. It goes without saying that this is the antithesis of what the NHS and social care exist to do, and what the people who work for them want to do - another reason why we hope the government heeds  Mr Stevens’ call and invests more money in health and care in the Budget in two weeks’ time. Truly, we can’t go on as we are. 

Caroline Abrahams is charity director at Age UK and co-chair at the Care & Support Alliance.

Caroline joined Age UK in 2012. A social scientist and barrister, Caroline has spent her career in the voluntary and public sectors, mostly on children and families’ issues. She has worked in a senior capacity at the children’s charity, Action For Children and at the Local Government Association. Caroline has also been a policy adviser to Ministers and Shadow Ministers, and a senior civil servant. A former chair of the End Child Poverty campaign, Caroline’s policy interests include integrated health and care, family policy, poverty and the role of the voluntary sector.

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Can a “Momentum moment” revive the fortunes of Germany’s SPD?

Support for the centre-left Social Democratic Party (SPD) has sunk into third place, behind the far right Alternative for Germany.

Germany has crossed a line: for the first time in the history of the federal republic, the Social Democratic Party (SPD) has sunk into third place, polling just 15.5 per cent – half a point behind the far-right Alternative for Germany (AfD). The poll was published on the day the SPD membership received their postal ballots on whether to enter another grand coalition with Angela Merkel’s Christian Democrats, and inflamed debate further.

For the grassroots coalition opposed to the so-called GroKo (Große Koalition) the poll is proof that the SPD needs a fundamental change of political direction. Within the two grand coalitions of recent years, the SPD has completely lost its political profile. The beneficiary each time has been the far right. Yet another GroKo seems likely to usher in the end of the SPD as a Volkspartei (people’s party). Taking its place would be the AfD, a deeply disturbing prospect.

For the SPD leadership, the results are proof that the party must enter a grand coalition. Failure to do so would likely mean new elections (though this is disputed, as a minority government is also a possibility) and an SPD wipeout. The SPD’s biggest problem, they argue, is not a bad political programme, but a failure to sell the SPD’s achievements to the public.

But is it? The richest 45 Germans now own as much as the bottom 50 per cent. According to French economist Thomas Piketty, German income inequality has now sunk to levels last seen in 1913. Perhaps most shockingly, the nominally left-wing SPD has been in government for 16 of the last 20 years. Whatever it has been doing in office, it hasn’t been nearly enough. And there’s nothing in the present coalition agreement that will change that. Indeed, throughout Europe, mainstream left parties such as the SPD have stuck to their economically centrist programmes and are facing electoral meltdown as a result.

The growing popular anger at the status quo is being channeled almost exclusively into the AfD, which presents itself as the alternative to the political mainstream. Rather than blame the massive redistribution of wealth from the bottom to the top, however, the AfD points the finger at the weakest in society: immigrants and refugees.

So how can the SPD turn things around by the next federal election in 2021? 

The party leadership has promised a complete programme of political renewal, as it does after every disappointing result. But even if this promise were kept this time, how credible is political renewal within a government that stands for more of the same? The SPD would be given the finance ministry, but would be wedded to an austerity policy of no new public debt, and no increased tax rises on the rich. 

SPD members are repeatedly exhorted to separate questions of programmatic renewal from the debate about who leads the party. But these questions are fundamentally linked. The SPD’s problem is not its failure to make left-wing promises, but the failure of its leaders to actually keep them, once in office.

The clear counter-example for genuine political renewal and credibility is, of course, Labour under Jeremy Corbyn. In spite of all dire warnings that a left-wing programme was a sure-fire vote-loser, Labour’s massively expanded membership – and later electorate – responded with an unprecedented and unforeseen enthusiasm. 

A radical democratic change on the lines of Labour would save the SPD party from oblivion, and save Germany from an ascendent AfD. But it would come at the cost of the careers of the SPD leadership. Sadly, but perhaps inevitably, they are fighting it tooth and nail.

Having promised an “especially fair” debate, the conflict over the GroKo has suddenly surged to become Germany’s Momentum moment - and the SPD leadership is doing everything it can to quash the debate. Party communications and so-called “dialogue events” pump out a pro-GroKo line. The ballots sent out this week came accompanied by an authoritative three-page letter on why members should vote for the grand coalition.

Whether such desperate measures have worked or not will be revealed when the voting result is announced on 4 March 2018. Online, sentiment is overwhelmingly against the GroKo. But many SPD members (average age is 60) are not online, and are thought to be more conservative.

Whatever the outcome, the debate isn’t going away. If members can decide on a grand coalition, why not on the leadership itself? A direct election for the leadership would democratically reconnect the SPD with its grassroots.

Unless the growth in inequality is turned around, a fundamental reboot of the SPD is ultimately inevitable. Another grand coalition, however, will postpone this process even further. And what will be left of the SPD by then?

Steve Hudson is a Momentum activist and a member of both Labour and the SPD. He lives in Germany, where he chairs the NoGroKo eV campaign group.