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Our country is seeing massive changes in the make-up of the population. The number of centenarians is projected to rise eightfold from 14,500 in 2012 to 110,000 in 2035. As well as these demographic changes, we are seeing more people with complex and long-term conditions.

Integrating health and social care in local areas will mean services will be organised around the needs and abilities of individuals, helping them to remain independent in their own homes. However, this cannot be done in one year. It will need at least a five-year, fully funded transformation programme to deliver benefits to patients and taxpayers alike.

To improve the health of the nation we need to start early, prioritising children to give them the best possible start in life. Preventing problems such as obesity and diabetes from occurring in the first place by intervening in their early years will help to reduce the burden of ill health later in life.


To be able to do this, the new government must:

In the first Queen’s Speech

Announce a new Public Services Bill that will:

• Give everyone access to a seamless health and care service that better meets their needs by ensuring Health and Wellbeing Boards are the place which joins up the commissioning of primary, secondary and social care services in a coherent way.

•  Give councils the power to take public health issues into account when making licensing decisions.

Announce a new Fiscal Devolution Bill to:

•  Help the three and a half million overweight or obese children by reinvesting a fifth of the existing VAT on soft drinks, fast food and confectionery in activity programmes. The NHS currently spends £1 million an hour on diabetes, equivalent to 10 per cent of its annual budget.

•  Help people live healthier lives and tackle the harm caused by smoking and excessive drinking by reinvesting a fifth of existing tobacco and alcohol duty in preventative measures and supporting licensing and trading standards departments to better tackle the black market in alcohol and tobacco. Reducing smoking rates by just five per cent would save 4,000 of the lives lost every year to smoking. Reducing by a tenth the working days lost to alcohol misuse alone would save £770 million.

In the first Budget

The Chancellor will:

• Fully integrate the funding for the commissioning of adult social care and health as a step towards the single point of commissioning. A separate transformation fund will be needed to ease the initial impact of these changes and should contain clear incentives to deliver change. This can be funded by a review of the Barnett formula.

•  Announce a fundamental review of the tariff system of costs for NHS services to incentivise prevention, not treatment, keeping people healthier throughout their lives.

In the first 100 days

The new government will:

• Launch a national campaign to raise the profile of social workers to attract 1,000 graduates and reduce the number of experienced social workers leaving.

• Promote the ‘five tests for health and social care redesign’ as best practice to support local consultation on redesigning services to focus on prevention and early intervention, reducing pressure on hospitals and A&E services. The five tests will ask:
– Are the proposals based around people?
– Are they locally accountable?
– Are they evidence-based?
– Do they support a community budgeting,
place-based approach?
– Will they make a difference?

• Announce and fund the setting up of a new volunteering scheme to support communities, rewarding local volunteers with small discounts in council tax.


Councils are finding new ways to focus on prevention, integrate care and keep people in their own homes:

Birmingham City Council

• ‘Be Active’ is a scheme provided free of charge by Birmingham City Council to tackle health inequality and associated deprivation levels by offering access to free physical activity sessions. Residents can take part in free swimming, exercise classes or attend the gym at any council-run leisure centre. The scheme, which has now been expanded into the city’s parks, has over 400,000 members – well over a third of Birmingham’s population. For every £1 spent on ‘Be Active’ the return for the local NHS is £22.80 in terms of health care related benefits.

The Royal Borough of Greenwich

• The Royal Borough of Greenwich has joined with local NHS services and thirdsector organisations to develop an integrated health and care service. This includes teams of nurses, social workers, occupational therapists and physiotherapists who respond to emergencies at care homes, A&E and GP surgeries. They work on a coordinated basis handling those cases that can be dealt with through treatment at home or through placement in a community-based ‘Intermediate Care Bed’. Over 2,000 patient admissions were avoided through immediate intervention from the Joint Emergency Team. There were no delayed discharges for patients over 65 and almost £1 million has been saved from the social care budget.

Leeds Neighbourhood Networks

• The Leeds Neighbourhood Networks initiative uses community volunteers to support over 21,900 older people to live independently in the community. Its work has prevented 1,450 older people from going into hospital and supported 617 being discharged from hospital. Intensive support in the home is currently being provided for 540 older people and 5,540 older people are being provided with one-to-one support, including befriending or escorting on shopping trips and outings. In the last year, 26 safeguarding referrals have been made to Leeds Safeguarding Unit by the schemes, 16 of which had direct involvement by the schemes and have protected older people from abuse, thanks to the schemes’ volunteers and professionals.