The government’s insistence on innovation and transformation in return for funding that is below the 4 percent real terms increase estimated to meet need has resulted in some eye-catching announcements, but detached from the still missing social care green paper and lacking a robust workforce plan, it rings hollow.
With a spending review expected this year, the government has an opportunity to end the fragmentation of public health, the NHS and social care. It must do so with an understanding of the implications for women’s equality from the outset.
With further delays expected on the government’s social care green paper, the NHS has had to put together a ten year plan in isolation from services that go hand-in-hand with securing the healthiest outcomes for an aging population. Adult social care spending fell by almost 10 percent between 2009/10 and 2016/17 and the King’s Fund estimates a funding gap of £18 billion by 2030/31 based on current spending.
When care is not funded properly, it is women who are forced to do it without pay, often at the cost of their own income, health and wellbeing. Twice as many women as men care for someone outside their household, and women in their 40’s to 60’s are most likely to reduce their working hours as a result of caring responsibilities.
Brexit is likely to exacerbate workforce issues in both health and social care, with little clarity over how the new immigration rules affect recruitment of foreign nationals, and no assurances for carers and support staff. There are already 90,000 social care vacancies, with predictions of 100,000 more assuming the government goes ahead with plans to impose the same immigration restrictions to EU nationals as it currently does for non-EU nationals. The Department for Health and Social Care’s own report to the Immigration Advisory Committee warned that women would have to drop out of work to fill the gap in social care. This is not a solution.
The impact of neglecting social care on the health service is well documented. The independent Care Quality Commission warned in October last year that the additional funding boost for the NHS would be wasted without a long-term plan for social care; with A&E wards across the country straining under the pressure of being unable to discharge people into the community without care packages.
Women are the backbone of our national health service, they make up three quarters of the workforce, rising to 90 percent of nurses and midwives. It is their dedication and hard work that delivers so much of our health services, yet this overlooked when it comes to the grand plans trailed in the media. Nurses have seen an average 14 percent real terms pay cut since 2010, a recent survey found three out of four nurses said they are worse off now than five years ago.
The government’s ten year plan has also failed to address one of the biggest challenges of all: staff shortages and vacancies. An organisation that relies on a largely female workforce must not only increase wages to at least match inflation, but also allow for flexible working and caring responsibilities; address its gender and ethnicity pay gaps, and end the culture of bullying and harassment reported by too many employees. The government must also reinstate bursaries for nurses and midwives to combat rising vacancies and turnover rates.
We welcome the announcement of plans to increase mental health services, particularly support for new parents. Suicide is the biggest killer of women between six weeks and one year after giving birth, which is why the Women’s Equality Party calls for all women and their partners to have timely and comprehensive access to high quality perinatal mental health services when they need it.
We also welcome commitments to improve safety in maternity services, but again these plans fail to address workforce challenges. Childbirth is the most common reason for admission to hospital in England, yet maternity services represent only around 3 percent of health spending. Today’s plans must address shortages of midwives, one of the key causes of the closure of almost half of maternity units in 2017. Plans must also include a review the causes of higher mortality rates for black and working class women in childbirth, and urgent action to address them, as outlined in our equality in health policies.
The focus on cancer survival rates is welcome, but must not neglect gynecological cancer research, which struggles to attract the same levels of funding as other cancers yet devastates women’s lives - 58 women a day are diagnosed with a gynecological cancer, and 21 women a day die from one.
The Health and Social Care Act 2012, which moved public health services from the NHS to local authorities, combined with consistent cuts in public health funding mean that sexual and reproductive health services, which provide women with vital specialist health services, are struggling to survive. The Women’s Equality Party is calling for the reintegration of sexual health, reproductive health and HIV services, with ring-fenced funding so that these services do not continue to be lost to councils’ shrinking budgets.
We welcome NHS England’s plans to invest in prevention, but we also note the ongoing cuts to public health budgets that fund the very services aimed at early detection and prevention of ill health. These cuts have been made as part of the same austerity agenda that has stripped services and welfare from millions of people, hurting women the most. The links between poor health outcomes and poverty are well established, and the best preventative approach the government could prescribe is a genuine end to the austerity that is driving women and families into hardship.