General Election 2017 Policy Briefing Policy@Manchester

On June 8, the country will again be heading to the polls in a general election called less than two months beforehand. This has left a relatively short time period for parties to produce and communicate their manifestos and for the media and the public to scrutinise party policies and influence the debate.

We have produced this briefing, drawing on the expertise of academics at The University of Manchester to develop some key recommendations and challenges for the Government that will be elected next month. These span across four key areas; health and social care; science, industry and skills; energy and environment; and inequalities.

Seven-Day NHS

The concept of a '7-day NHS' has been a prominent political issue since it was popularised by David Cameron in the run-up to the 2015 General Election. Sadly, the debate has often generated more heat than light, with many commentators preferring to promote sensationalist statistics - about 'weekend effects' and workforce crises - than examine the complexity of the proposal itself. There are different challenges associated with the concept of a '7-day NHS' between primary, secondary and community services. Extending primary care services will be a costly and complex endeavour, which makes it all the more important that the objectives and delivery strategy for this approach is based on genuine public understanding of the issues, as well as informed debate.

Aspects of the '7-day NHS' concept, as it applies to primary care, that have not been fully recognised include:

  • The concept of a '7-day NHS' has been shown to be diverse and complex, both at scale and over time. The new government will need to address exactly how it aims to deliver 7-day access to primary care provision and if/how the services offered will ensure quality, equity and continuity of care.
  • There is a backdrop of wider primary care and NHS reorganisation in Greater Manchester, and across England, that will affect the implementation of a 7-day access provision for primary care. With Manchester's health and social care devolution providing an early template for Sustainability and Transformation Partnerships (STPs), that are in development in other areas, the incoming government should address how it intends to navigate and negotiate the implementation of 7-day services in areas subject to devolved health agreements.
  • The provision of 7-day primary care services to date highlights the challenge of social renewal and the retention of existing staff within the NHS. In addition to current consultations on the expansion of medical education and training of new staff, the new government should urgently consider a renewed effort to identify and resolve the key issues that determine staff recruitment and retention in the NHS.

-Doctor Natalie Ross

Dr Natalie Ross

Sustainability and Transformation Partnerships

Since April 2017 all NHS organisations now form part of a local Sustainability and Transformation Partnerships (STPs) in England. These 44 Partnerships are intended to enable collaboration across geographical areas to support delivery of health and social care. STPs are to have a basic ‘governance and implementation support chassis’ (STP Board, Chair, programme management support etc.) but many of the fundamental challenges for STPs remain and the incoming Government should consider that:
  • STPs are not statutory bodies so may have limited powers to make change happen;
  • The current legislation underpinning the delivery of health and social care is not necessarily helpful for establishing and operating STPs. For example, all organisations within an STP are currently regulated separately, and collaboration may be impeded by the operation of competition law;
  • More meaningful engagement will be required with Local authorities, the third sector, the workforce (health and care), patients and the public to widen the understanding of what STPs are aiming to achieve and gain buy-in to proposals for change;
  • Squeezed budgets in social care and public health are likely to have knock-on effects for STPs and their plans;
  • Timescales are very tight, and the landscape is changing fast as accountable care systems are already being encouraged as the next step of STP evolution. Understanding what has worked in which contexts may be difficult in this rapidly changing environment.

- Doctor Anna Coleman

Dr Anna Coleman

Read Anna's blog for more information on Sustainability and Transformation Plans which have been renamed Sustainability and Transformation Partnerships following the publication of ‘Next steps on the NHS Five Year Forward View’ (2017).

Innovation in Health

Strong economic growth from a Government-led industrial strategy is arguably the most critical factor for national prosperity during the next 5 years as we exit the European Union. The health and life sciences sector has been marked as one of the best opportunities for growth and is an area where UK research is internationally competitive.
  • The incoming Government should work to identify those targeted interventions capable of unlocking the fastest and most significant economic growth in the health and life sciences sector.
  • The new Government needs to work out what is needed to maximise the free-flow of ideas and people between industry, healthcare and university settings.
  • Historically, the UK’s health and life sciences sector has tended to prioritise the quickest possible routes to profit, rather than allowing intellectual property and commercial development projects to reach their full potential. The incoming Government will need to outline an approach that encourages longer term growth of small and medium-sized enterprises, and resists the tendency towards premature exploitation of promising research and practice.
  • If there is to be a Government-led industrial strategy for health and life sciences, should this be retained at a UK level, devolved down to regional level across the whole UK or focused on existing areas of strength, such as the ‘Golden Triangle’ of the South East? Government must take a strategic lead on this question and provide clarity and consistency on how the process develops from here.
  • Adopting innovation within the NHS to improve care and reduce inefficiency has been challenging. How we identify and overcome these challenges will be a key test for the new Government’s approach.
  • Greater integration of health and social care and moves towards personalised medicine generate enormous, rapidly increasing IT and data handling needs. It is vital that Government encourages strategies for unified data platforms that can work across the NHS.
  • The OECD PISA school rankings place the UK 15th internationally for science and 27th for maths. The incoming Government will need to create and pursue a new long-term strategy to improve maths and scientific literacy as a contributor to the economic potential of the health and life sciences sector if we are to improve in this area.

-Professor Neil Hanley

Prof Neil Hanley

Workforce

The NHS faces many workforce challenges, including:

  • Rising workloads and resource pressures
  • Long term pay restraint and declining staff morale
  • Uncertainties surrounding Brexit and status of existing staff from European Union
  • Recruitment and retention of some roles, e.g. GPs, nurses etc.
  • Long term deficits in workforce planning, as highlighted by the recent House of Lords Select Committee report on NHS long term sustainability
  • A changing context with the rapid development and roll out of new models of care

Policy relating to the NHS therefore needs to take account of:

  • Short, medium and long term measures to improve the desirability of NHS careers
  • Realistic and evidence-informed understanding of what may be delivered by changes to skill mix, and what such changes cannot deliver. For example, whilst the delivery of care by a range of non-medical clinicians is well accepted by patients, there is as yet little evidence that such care models reduce costs overall.
  • The need for greater integration between all health sectors and social care requires multidisciplinary approaches to training and workforce development
  • Renewed focus upon long term workforce planning

-Professor Katherine Checkland and Professor Damian Hodgson

Prof Katherine Checkland and Prof Damian Hodgson

Emergency services

The next government should:

  • Establish an overall strategy for ambulance trusts: Ambulance crews of different clinical capacity are routinely sent to all kinds of calls, from traditional life-threatening emergencies such as trauma, cardiac and stroke, to patients requiring social and psychiatric care, and to unplanned primary care and minor illnesses. What kind of emergency response do we want and how might it be designed? This is a pressing issue given the increase in volume and increase in variety of calls that result in 999 callouts. More mundane and everyday issues are becoming emergencies because of shortages elsewhere.
  • Address retention rates and vacancy rates which remain a major concern, even after the movement of paramedics onto the Agenda for Change Band 6 pay bracket. Pay is clearly one element of low staff morale, but the problem goes deeper, relating to an unforgiving and troublesome workplace culture. Ways to improve the everyday work culture need to be given a higher profile.
  • Urgently address physical, emotional, and psychiatric health of front-line responders: for example, giving them more time to recover, to reflect, to share good practice and to develop a workplace culture of compassion and professionalism rather than a relentless drive to hit response targets.
  • Clarify how ‘blue light services’ (fire, police and ambulance) can work closer together: if the government is serious about ‘blue-light integration’ then we need to see detailed strategies that are properly informed by the wide range of stakeholders, that make up Britain’s very complex healthcare, local government, fire and rescue, and policing landscape. If no serious proposals emerge then it may be better to drop these potentially costly plans and refocus on defending and augmenting the existing provision.

-Professor Leo Mccann

The challenges of automation

Investing in automation does not always directly substitute for human workers; the pattern of automation of the most routine work, and the upskilling of the work for humans alongside the new machines, is the story of the economy for at least the past 70 years and probably the entire period since the Industrial Revolution. However, technological advances within the next 10-20 years are likely to lead to a period of change in the labour market at least as big as in past waves of automation.
This will bring significant economic challenges , and the policy responses to past automation have been worse than inadequate. The old industrial centres got ‘left behind’, with many redundant workers unable to find new jobs, unsuited to the new kinds of skills needed in expanding businesses, and trapped in a spiral of unemployment, poverty and ill health that still characterises too many people in these parts of the country.
Automation will create winners and losers. The Government should be working now to ensure there is a strategy in place to provide better for the losers next time around, before the robots arrive, not after.

- Professor Diane Coyle

Prof Diane Coyle

Education and skills

Thanks to protected funding settlements under previous governments, education is not quite in the same state of crisis as social care or perhaps the NHS. But Brexit notwithstanding, the new government should be setting out a bold new vision and policy programme for schools and lifelong learning. England’s system (education is a devolved responsibility) is neither achieving every government’s ambition of boosting our position in the global standards race nor closing the gap between richer and poor pupils and increasing social mobility. While governments have focused on increasing higher education participation, adult skill levels lag those of our major international competitors and it is increasingly hard to find funding to upskill or retrain.
After nearly 30 years of continuity in education policy, it’s time for a change. Curriculum and assessment are at the heart of the problem in schools. Narrow curriculum and a focus on rigour, standards and performance are ramping up anxiety and creating social division and alienation not increasing learning. The new government should probably avoid more immediate tinkering with curriculum and assessment and appoint a Royal Commission on Education to reconsider its purposes and how they might be achieved, drawing on a breadth of international examples and learning from all round the country. Meanwhile it should:
  • Increase funding for 16-19 and adult education, funded through general taxation and corporation taxes, and use this to extend youth apprenticeships, restore community learning opportunities and fund adult learners to reskill.
  • Stop spending on new free schools, University Technical Colleges and grammar schools and invest those funds in the state school system, increasing funding to schools in disadvantaged areas to recognise the additional challenges they face.
  • Drop school-level accountability systems at age 16 and below and instead look to all schools, colleges and training providers in an area to set and work towards improved outcomes for all learners at age 19.

- Professor Ruth Lupton

Prof Ruth Lupton

Technology

Technology now spans across all policy and service delivery areas, developing faster than the policy-making process. However, governments can respond to and use technology to make a difference on a number of key issues:
  • It is an absolute priority to speed-up the deployment of ultra-fast fibre infrastructure throughout our cities and towns; whilst also embracing the incredible potential of 5G mobile. We also have to double-down our efforts to connect rural and hard-to-reach communities to ensure they are not left behind
  • We must ensure our educational institutions are embracing digital technologies, online learning, and providing our school, university and other students with work and life ready understanding of everything from coding, to cyber security, and the tools they need to make sense of a complex and rapidly changing technological age
  • The law will never respond as quickly as technology can change but we can ensure that the foundations of our legal system are compatible with the digital age
  • Entrepreneurs are the source of the ideas that will transform our economy, society and culture. Alongside supporting tech startups, we must encourage tech scale-up entrepreneurs, This policy must extend to social entrepreneurs, for they will be the architects of the solutions to many of our most intractable problems.

- Professor Vikas Shah

Prof Vikas Shah

Low carbon energy

If the next Government wants to protect the UK from the very real dangers of climate change, it needs to think beyond electricity, to heat and transport:

  • Around a third of the UK’s energy consumption is used for heating. Enforcing energy efficient building designs should be mandated in new developments.
  • District and community heating schemes that can deliver low cost and secure heating fired from a low carbon source such as biomass.
  • Low carbon alternatives to natural gas can be introduced into the gas grid to reduce carbon emissions

These all require policy incentives and infrastructure investment, which should be top priorities for the next parliamentary term.

-Professor Patricia Thornley

Prof Patricia Thornley

Nuclear energy

The role of nuclear power in reducing carbon emissions is imperative, as a mature technology and a proven and effective low-carbon energy source. The total amount of electricity generated by nuclear power stations around the world already saves the equivalent of over two billion tonnes of carbon dioxide emissions every year. Nuclear power is essential for meeting any realistic carbon emission reduction targets, and so the next Government must commit to adopting a policy framework that allows nuclear power to play its part in averting the catastrophic change in climate that we now face.

- Professor Melissa Denecke

Prof Melissa Denecke

Racism at work

Almost 50 years since the Race Relations Act was amended to outlaw racial discrimination in employment, evidence strongly demonstrates that there remains a need for employers and the Government to take urgent action against the entrenched nature of racism and racial inequality. Recommendations for the next Government include:
  • Commissioning research that explores the ways in which, if at all, employers are fulfilling their equality duties and how employers respond to instances of racism in the workplace;
  • Institute new legislation regarding the procurement of government and public sector contracts to ensure that all tenders are subject to an Equality Impact Assessment;
  • Proposals for an annual government review into the nature and scale of racism in the workplace and racial inequality in labour market participation;
  • Eliminating the costs of employment tribunals as a means of empowering employees to challenge racism at work; and
  • Addressing the issue of ‘language proficiency’ in ways that protect the rights of ethnic minority workers.

- Dr Stephen Ashe and Professor James Nazroo

Gendered austerity

Measures to reduce spending on public services and welfare, in a bid to reduce the national deficit, have wide-ranging impacts across different social groups. The main differences that tend to be discussed are those between working class and middle class communities, but the reality is much more complex. Women bear the brunt of economic crises and gaps created by a retreating welfare state are typically attended to by women in communities and families, underpinned by care work necessary for social reproduction. This includes undertaking the majority of care for children, the elderly and disabled; volunteering in the community; and taking on extra paid work, often low paid and part time.
As we prepare to elect a new Government, we must look beyond simply representing the diverse society we live in, to ensure that such diverse groups are also equally served and considered by our elected representatives. Parties across the political spectrum should therefore commit to policies that recognise and support the essential work of care, such as reversing cuts to public services and social security, investing in social infrastructure (care, health, education and training services, social security and housing), and raising the minimum wage to a level that ensures a decent living.
Commitments should also be made to assess the cumulative effect of cuts to public services, whereby individuals, families and groups are rarely hit by one policy, but are likely to be affected on multiple fronts, by multiple policies, at the same time. Added to this, commitment is required to assess the gendered impacts of policy-making, as a step towards addressing the injustice that certain policies impact on some parts of our society - women, disabled, and vulnerable groups - more than others.

- Dr Sarah Marie Hall

Dr Sarah Marie Hall

International aid

Given the current international upheavals, it’s more important than ever for the UK to maintain its global leadership on poverty eradication, and with the debate around UK aid growing, we need to put it in perspective. An aid budget of £14.8 billion sounds like a lot, but its global impacts are comparatively small compared to what the UK could achieve with a ‘joined up’ approach to key international policies.
The next UK Government could reduce tax avoidance and evasions in low income countries by closing British linked tax havens; do more to promote a fair international trading system through the WTO; honour its Green Fund commitments to mitigate the effects of climate change; and, more effectively deal with refugees by allowing them to work and support their families. The combined impact of these policies, which don’t require additional aid spending, would turbo-charge the UK’s development influence at a stroke.

- Professor David Hulme

Prof David Hulme

The opinions expressed in this briefing belong to the respective authors and do not represent the views of The University of Manchester

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