General Election 2019: Where do the parties stand on health and social care?
Ever since its inception the NHS has been fought over by every political party.
Whose hands is it safest in and who can fund it best?
This election is no different and in fact who is best to transform it today has never been more important.
We are told the whole service is in crisis and indeed, it is.
This week we spent some time with Dr Martin Marshall, the new chair of the Royal College of GPs. In his first interview in the role he told ITV News that "moral is low. The demands have gone up and up but the number of GPs to compensate that has stayed the same".
He goes on to say the number of patients he sees in a day has doubled in the 30 years he’s been practising. What then would solve this problem in primary care? Investment he says, we need more GPs, nurses, pharmacists, investment in technology, computer systems, buildings etc etc.
It’s a long list which basically means more money. Only then, he says, will primary care be able to prevent patients going straight to A&E and block the system further down the line.
Each party thinks it can help solve Dr Marshall and his colleagues’ problems.
The Conservatives have promised 6,000 new doctors by 2025 - creating 50 million more appointments. Labour haven’t quite committed as much, they say they'll provide 27 million more appointment by expanding GP training places from 3500 to 5000 a year and the Lib Dems will end the shortfall of doctors by 2025 by staying in EU and training more GPs.
Unless any of this comes to pass the problems in primary care will continue, Dr Marshall says.
To see for myself the impact a lack of funding in primary care has on the rest of the system, I went to the A&E department at Southampton hospital. It was 11am and already there were patients on trolleys sitting in the corridor.
Dr Christopher Hill told me this is completely normal, not just in the winter when demands are higher, but all year round now. The staff are at breaking point, he says. Many have gone part time because they can’t cope with the pressure full time. That means they are always struggling to fill rosters and need to train more nurses and doctors willing to work full time.
He says the NHS needs to be looked at in a holistic way, you can’t fix the problems in hospitals without first fixing the problems in primary care or social care.
He wants capital funding, to expand and update his A&E, more staff and crucially a transformation in social care so that when patients are fit to leave the hospital they have somewhere to go or have care on hand at home.
Money is on offer for the day to day running of the NHS, which many experts agree will help in the short term but not long term.
Labour is promising to hand out the most - an extra £26.7 billion a year for the NHS by 2024. The Lib Dems have pledged £23 billion a year for NHS England.
And the Conservatives have committed to an extra £21 billion a year.
Social care keeps coming up. So I spent afternoon with a carer in Southampton. Vivian Chalk was on her way to see Margaret, a 92-year-old who’s pretty much housebound. Vivian had thirty minutes to spend with Margaret, she wanted more but had other customers to see.
Vivian told me the pressure she is under to get from one customer to another is enormous. If there’s traffic it eats into her time with those who rely on her and if anyone needs anything extra on a visit she simply can’t offer it.
Vivian’s boss Bernadette Mills, who has both council and private customers, explains the council pay so poorly for carers she simply can’t afford not to have private customers. Bernadette’s main concern for social care generally is lack of staff, poor working conditions and a need for joined up thinking between health and care. Without this she says, the elderly will continue to ‘bed block’ because there simply isn’t provision in the community to look after them.
Social care is the one thing successive governments have failed to get to grips with. Who will pay for care, how will it be paid for, should there be a cap on costs and does everyone agree are all questions that have never been answered.
Labour say personal care will be free - costing them £11billion a year and they want a cap on care costs. The Conservatives say they will bung social care an extra billion pounds a year and find cross party consensus on long term funding, as will the Lib Dems who are also offering £3 billion a year.
But there’s no real detail on social care reform from any of the parties which begs one simple question. How will the crisis in the NHS ever be resolved if social care isn’t also dealt with?
You must decide who best can answer this.