Public service professionals" hopes for the next government

In the run up to the general election on June 8, we asked professionals working across public services what they think are the biggest problems in their sector at the moment, and what they want to see from the UK’s major political parties.

Here’s what those working on the frontline in housing, local and central government, healthcare, social care, and the voluntary sector had to say.

‘I want to see compassion’

There is a lack of mental health services, a lack of supported housing projects and just a lack of resources generally. Homeless people who are lucky enough to find accommodation are hit on day one with letters about council tax, water rates, bin collections … It’s too much for someone who may have been rough sleeping for months and in temporary B&Bs for years before that.

I want to see compassion. I don’t believe people should “sponge” off the government but punishing people with sanctions is not the answer. Some people need a little more support then others and I believe if they get this they will have more chance of putting back into the coffers in the future. We need to care about each other, not penalise and punish those who struggle the most.

Anonymous, homeless charity worker

‘Address the reasons why doctors are leaving in droves’

A&E departments are increasingly stretched as patient demand outstrips what the NHS provide. Doctors are leaving in droves to work abroad or change career. We desperately need more nurses – but scrapping the bursaries for nursing students, a real terms pay cut and Brexit is disastrous for recruitment. GP numbers are falling, despite the government’s promise to appoint 5,000 new GPs.

Several things could be done. Guarantee the NHS budget for the next five years as a percentage of GDP (such as 8%), increase social care budgets so hospitals don’t have to keep patients longer than is medically necessary and reinstate the bursary for nursing students.

I certainly don’t want to see the introduction of the proposed conscription of doctors to four years in the NHS after medical school. Any government coming in needs to address the reasons why doctors are leaving (low morale, long hours, poor training, feeling undervalued, increasing workloads, increasing weekend work for less pay, demonisation by the media) rather than simply forcing them to stay.

Tom Palmer, 31, A&E doctor

‘I’d like to see national insurance breaks on health and future care provision insurance’

People are not planning for their future health, financially or
physically. The cost of a care home is astronomical and while taxpayers’
money is being thrown at it now, it’s going to get a lot worse
. I’d like to see national insurance breaks on health and future care provision insurance.

Fiona, 44, finance manager for a charity that provides care homes

‘We need rent caps and more social housing urgently’

The housing crisis is all-consuming and has a dramatic impact on virtually every other area of policy. The benefit cap, for example, punishes vulnerable people for not having access to social housing which successive governments have sold off. It is because families are forced to rent at high costs from the private sector that their benefits end up so high. That is the fault of landlords, not claimants. We need radical overhaul of the benefit system – I see things worsening on a daily basis.

I’d like to see a tenants’ union given the right to collectively bargain rent levels

There has been some focus on the insecurity of tenancies in the private sector. This is an important point, but what the increasing number of evictions boil down to is that landlords evict because they want to charge higher rents or because tenants cannot afford the rents they are already charging. We need rent caps. Other western European countries do this. I’d also like to see a tenants’ union given the right to collectively bargain rent levels at national and regional levels. The bottom line is we need to build more accommodation – especially social housing – very urgently.

Greg, housing adviser

‘I want a recognition that poverty contributes to social problems’

Social work is is overstretched and increasingly technocratic. The trend towards family therapy ignores socio-economic problems and seeks to reconcile parents to their current condition. I want to see a recognition that poverty is a contributing factor to social problems.

Many of our clients experience overcrowded housing conditions. There are fewer and fewer opportunities to remain in the area they grew up in, where their children go to school and where their family and friends can offer a support network. Many are unemployed and resigned to poverty. Very few are politically engaged.

After that we need investment in community solutions to social problems, such as increased funds from local authorities to youth arts and sports projects, as well as a firm commitment to social housing projects.

Arthur, 25, child protection social worker

‘Cuts have dramatically and irreversibly damaged local government’

Significant efficiencies have been achieved in local government since 2009, and it is certainly arguable that this – rather than increasing council tax – should have been done anyway prior to the recession. But eight years later there is no fat left to trim. Cuts have dramatically and irreversibly damaged local government.

If the new government does not reinstate a fixed central government grant (as opposed to fixing spending according to the level of council tax and business rates collected, which discriminates against poorer parts of the country) then very soon the Local Government Association’s warning that councils will need to make deep cuts to essential services will come true.

Finally, wages were frozen for three years, followed by five years of 1% rises. Give staff a pay rise, even if only at the level of CPI inflation. Five more years of pay freezes will force many talented members of staff to permanently leave the sector.

Anonymous, local government lawyer

‘Most police problems can be solved with more money for NHS and social services’

The police suffer from a chronic shortage of detectives, while overworked response officers get hardly any time off, or even time to adequately investigate at a crime scene. Most police problems can be solved with more staff and more money for the NHS and social services.

We need funding to recruit more detectives, and increase salaries for those detectives as an incentive to take on more stress and responsibilities. Then we need vastly more money for the NHS and social care; there is an overwhelming dependence on the police to deal with mental health crises, having cut social care to the bone and beyond. I would support a separate NHS tax.

We should h​​elp people to change their lives rather than imprison them

Vastly improving rehab programmes would prevent re-offending. Our current system costs millions and achieves nothing. This would involve legalising drugs and treating addiction as a medical problem not a crime. We should help people to change their lives rather than imprison them and make a life of crime more likely. Legalising and taxing drugs will save us a fortune in the long run.

Anonymous, police officer

‘We may need the return of housing inspectors’

Government policy does not reflect the realities of the housing market. Firstly, we need to increase supply. Quadruple council tax for all properties left empty for more than six months, rising to ten times if left empty for three or more years. This will prevent private landlords “going on strike”. A land tax designed to make land-banking extremely unprofitable should be followed by commitment to building council-owned homes for rent that are genuinely affordable. Councils are accountable to the public and elected representatives of their communities in a way that other providers are not. Right to buy should be extended to housing association tenants, but the properties must be sold at market value, no more discounts, and all proceeds used to build new homes to rent and for low-cost home ownership.

Then we need to raise standards, by putting in place mandatory registration and licensing of all privately rented accommodation. Housing association regulations should include housing management and value for money – we may well need the return of housing inspectors! Repeal the 2016 Housing and Planning Act and regulate rents – the amount of money being sucked out of the wider economy by ever-rising rents is damaging to the overall state of our country.

Andy, 52, retired head of housing in the West Midlands

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Public service professionals" hopes for the next government

Government fails to commit to diesel scrappage scheme in UK clean air plan

The government’s new plan to tackle the UK’s toxic air crisis does not commit to a scrappage scheme for dirty diesel cars and places the largest burden for solving the problem on to local authorities.

These could impose charges on older diesel cars to keep them out of polluted areas, but the government said other measures should be considered first.

Ministers were forced to act after a series of humiliating defeats in the courts, which ruled earlier plans illegal. ClientEarth, the environmental law firm which sued the government, is now examining the new proposals and could go back to court again if it decides the measures will not reduce illegal levels of air pollution in the “shortest possible time”, as the law demands.

Levels of nitrogen dioxide, emitted mostly by diesel vehicles, have been above legal limits in almost 90% of urban areas in the UK since 2010. The fumes are estimated to cause 23,500 early deaths a year and the problem was declared a public health emergency by a cross-party committee of MPs in April 2016.

The government first lost to ClientEarth over the adequacy of its strategy in April 2015 and was ordered to come up with a new plan. The release of these proposals was buried on the September Saturday in 2015 when Jeremy Corbyn was first elected Labour leader, while the final plan was published on “take out the trash day” in December that year, along with dozens of other ministerial statements and many hundreds of government documents.

However, the plan included just six clean air zones (CAZs) – Birmingham, Leeds, Nottingham, Derby, Southampton and London – where some polluting diesel vehicles would be charged to enter city centres. ClientEarth, believing this to be inadequate, went back to court and won again in November 2016.

Court documents revealed that the Treasury, then run by George Osborne, had blocked proposals from other government departments for 16 CAZs in towns and cities blighted by air pollution, due to concern about the political impact of angering motorists. Both the environment and transport departments also recommended changes to vehicle excise duty to encourage the purchase of low-pollution vehicles. But the Treasury also rejected that idea, along with a scrappage scheme for older diesels.

The government continued to delay action, asking the court for 10 months to develop another new strategy, but lost again, with the judge ordering a new draft plan by 24 April and a final plan by 31 July.

However, ministers then argued that the tradition of “purdah” before elections, when no official announcements are made, should allow the postponement of the strategy until after the general election on 8 June. This was again rejected, with Mr Justice Garnham saying: “The continued failure of the government to comply with directives and regulations constitutes a significant threat to public health.”

Conservative ministers have sought to blame previous Labour governments for giving tax breaks for diesel cars, which produce less climate-warming carbon dioxide. But experts say all governments since the 1990s have done this.

Furthermore, government officials at the time were aware that diesel cars produce high levels of NO2 but they expected tightening EU emissions regulations to curb the problem.

However, car manufacturers found ways to circumvent the rules and across the industry produced vehicles that emit far more NO2 on the road than in the official lab-based tests. Transport campaigners argue that, as in Germany and France, car makers should be forced to pay for upgrades to their vehicles to cut pollution.

“The real villains here are the car companies who cheated tests, and lied to everyone about the pollution coming from their diesel vehicles,” said Greenpeace’s Areeba Hamid. “Drivers are right to feel conned, but what we can’t do is carry on letting these dodgy diesel cars pollute our towns and cities with toxic air.”

Government fails to commit to diesel scrappage scheme in UK clean air plan

The government must not force me and other disabled people out of our homes | Tessa Bolt

I have Down’s syndrome and I live in supported housing. Today a parliamentary select committee has put out a report on the government’s planned changes for supported housing that could force people such as me with a learning disability out of our homes.

Last year the government said it wanted to make changes to funding for supported housing that would limit payments to the local housing allowance rate and let local councils have control over the extra money needed to give people supported housing. This would mean people such as me could lose our right to have our housing paid for and that there could be a lot less supported housing available.

Both these changes would obviously be really bad. Thankfully today’s report agrees, which is good to hear as it is what me and other people in supported housing have been saying for a long time. But I’m still very scared the changes could happen.

In March I gave evidence for this report. It was a historic event as I was the first person with Down’s syndrome ever to give evidence to a select committee. I was very proud to be taking such a big step for people with a learning disability, especially as I know these changes could mean that thousands of people like me lose their homes and independence. As a society, we’d be going backwards.

Before supported housing, people with a learning disability had to live with their families or live in institutions. Most care professionals think institutions are not the best place for people with a learning disability; in some cases people end up having to live far away from everyone they know, and sometimes too, without proper support, people can even be in danger of abuse and neglect. I don’t think that’s a life anyone would choose.

I moved into supported housing when I was 30. Before then I had lived with my parents. I love them but I wanted to be independent. Nobody wants to still be living with their parents at 30! After a lot of talking, my parents agreed and I now live in a house run by Golden Lane Housing, with Elizabeth and Katie, two other ladies who have a learning disability. I love living with them – we’re like family.

I couldn’t live on my own without support, but I don’t want full-time care, because I’m not a child. Supported housing means I can be independent but have day-to-day support from Mencap. My support worker Jeanette helps me get out and do the things I love, which include volunteering at Oxfam, my local bookshop and the Cancer Trust. I make my own choices and I get to live the life I want, something everyone has the right to do.

But this will all change if the government’s planned changes happen. A cut could mean that I couldn’t afford to pay my rent any more. I wouldn’t be able to live with Katie and Elizabeth and I might lose my day-to-day support. It makes me scared for my future because I’d have to move away from my home, my friends and my voluntary jobs and go and live with family. It could change my whole life in a way that I don’t want.

But I’m lucky. A lot of people with a learning disability don’t have family who can support them, so they could be forced to live in an institution, where the support and accommodation might not be right for them. They could away from everything they know and they would lose all their independence. This would be a huge step back for everyone with a learning disability.

I make my own choices and I get to live the life I want, something everyone has the right to do

It is a scary thought and I think it’s clear the government isn’t thinking about all the people who use supported housing. So I’m glad that the select committee report has said that these changes could lead to a really bad situation. This is also what a lot of supported housing providers and Mencap have said and it’s what I think as well. But I don’t know if the government will listen to this new report.

I think things would be very different if people such as me had more of a voice, more power. I don’t think changes like this would be happening. That’s why it’s important that the government listens to us.

I would say to the government: “Stop and think about what you are doing!” It’s good to save money; I am not against changes. But things have to be fair for everyone, and until you can guarantee that changes won’t take away people’s homes, independence and happiness, then these are changes that the government can’t afford to make.

The government must not force me and other disabled people out of our homes | Tessa Bolt

High court orders UK government to explain clean air plan delay

The government has been ordered back to the high court to explain its last-minute bid to delay publication of the UK’s clean air plan.

Politicians and environmental groups had complained that ministers were “hiding behind the election” after they said they could not publish the proposals because of election purdah.

The high court said on Tuesday that there would be a new hearing on Thursday where ministers will have to defend their application.

James Thornton, CEO of the environmental lawyers ClientEarth, who brought the original case against the government, said they would present their response at the hearing on Thursday.

“This is a public health issue and not a political issue. Urgent action is required to protect people’s health from the illegal and poisonous air that we are forced to breathe in the UK.

“This is a matter for the court to decide once the government has made its arguments because it is the government which has not met, and instead seeks to extend, the court’s deadline for the clean air plan, to clean up our air.”

Ministers had been under a court direction to produce tougher draft measures to tackle illegal levels of nitrogen dioxide pollution, which is largely caused by diesel traffic, by 4pm on Monday. The original plans had been dismissed by judges as so poor as to be unlawful.

But after the announcement by Theresa May of a general election on 8 June, ministers lodged a lengthy application to the court late on Friday. It asked judges to allow them to breach the Monday deadline to “comply with pre-election propriety rules”.

Politicians and environmental groups reacted with anger, claiming ministers were “hiding behind the election” to justify delaying publication of the government’s long awaited proposals instead of tackling the UK’s air pollution crisis. Health experts warned the lack of government action had potentially put thousands of lives at risk.

The mayor of London, Sadiq Khan, said: “It is frankly outrageous that the government thinks it can continue to bury its head in the sand about the serious health impacts of air quality in London and across the country. The prime minister has once again missed this golden opportunity to show real leadership in tackling and improving the air we breathe, which should have been done well before the pre-election period.”

Andrea Leadsom, the environment secretary, was summoned to parliament on Monday to answer urgent questions. During the debate she said she was “personally deeply committed to the importance of ensuring clean air” but had been told by officials in the Cabinet Office that it would breach purdah rules to publish the plans in the run-up to the election.

The government has applied to publish draft plans on 30 June followed by the full policy in September, she said.

Leadsom, who also revealed that it was the second application to delay publication that her department had submitted to the courts, insisted the move would not postpone the rollout of the proposals.

The scale of the air pollution crisis was revealed in a joint Guardian-Greenpeace investigation this month showing hundreds of thousands of children were being educated within 150 metres of a road where levels of nitrogen dioxide from diesel traffic breached legal limits.

Last week figures obtained by Labour showed that more than 38 million people, representing 59.3% of the UK population, were living in areas where levels of nitrogen dioxide pollution were above legal limits.

Research consistently shows that exposure to traffic fumes is harmful to children and adults. Children are more vulnerable because their lungs are still developing and exposure to nitrogen dioxide reduces lung growth, causes long-term ill health and can result in premature death.

ClientEarth’s lawyers will attend the hearing, which has been listed by the court for Thursday at 10.30am. The court has set aside two and a half hours.

High court orders UK government to explain clean air plan delay

Government tries to shelve pollution action plan until after election

The government has made a last-minute application to the high court to delay the publication of its plan to tackle the air pollution crisis.

Ministers were under a court direction to produce tougher draft measures to tackle illegal levels of nitrogen dioxide pollution, which is largely caused by diesel traffic, by 4pm on Monday. The government’s original plans had been dismissed by judges as so poor as to be unlawful.

But following the announcement by Theresa May of a general election on 8 June, ministers lodged a lengthy application to the court late on Friday. It is understood they are asking judges to allow them to breach Monday’s deadline and submit a draft in June – after the general election.

It is understood that a full policy will not be produced until September this year.

The government has had months to come up with its air quality plans and Whitehall sources indicated to the Guardian this week they would be published in time.

The late application to delay publication was condemned by the environmental lawyers group ClientEarth, which successfully took the government to court over its air quality plans. MPs have said air pollution in the UK is a public health emergency that causes 40,000 premature deaths a year.

James Thornton, CEO of ClientEarth, said: “We are urgently considering the government’s application to delay the publication of the draft air quality plan which was received on Friday evening, less than one working day before the plans are due.

“It is far from acceptable that ministers have left this to the very last minute. The government proposes to delay the publication of the air quality plan despite the clear public health risk caused by illegal air quality. These plans are essential to safeguard public health and they should be put in place without delay.”

The application is likely to be considered by judges on Monday. Judges have already told ministers that their plans were taking too long and imposed the deadline to force the government to come up with new measures more quickly.

The government lodged a lengthy application shortly before 7pm on Friday to the court, which was too late for the court to accept. It will now be considered early next week.

Thornton said the general election was not an acceptable reason to delay taking action against air pollution.

“This is not a political issue but a public health issue. Whichever party is in power, the British public need to see an air quality plan which relies on good scientific evidence and which ensures that people no longer have to breathe toxic air and suffer the grave consequences to their health as a result,” he said.

Greenpeace also condemned the delaying tactics. Anna Jones, from Greenpeace UK said: “Ministers have had months to come up with a robust plan to tackle illegal air pollution. They have no excuses to delay its publication any further.

“The Cabinet Office guidance makes it clear that essential consultations can still be launched during purdah, and even mentions safeguarding public health as a ground for exceptions.

“Air pollution is a full-blown public health emergency, linked to thousands of premature deaths and a host of health problems. If the government intends to use the election as a pretext to buy more time, that would only be a sign that they just don’t get the gravity of the situation.”

A joint Guardian/Greenpeace investigation revealed this month that hundreds of thousands of children were being educated within 150 metres of a road where levels of nitrogen dioxide from diesel traffic breached legal limits.

A spokesman for the Department for Environment, Food & Rural Affairs said: “We are firmly committed to improving the UK’s air quality and cutting harmful emissions. We are seeking an extension to comply with pre-election propriety rules.”

Government tries to shelve pollution action plan until after election

On mental health, the royal family is doing more than our government | William Davies

The public profile of mental health experienced another boost this week, thanks to some moving comments made by Prince Harry and the Duke of Cambridge about the impact of their mother’s death, nearly 20 years ago. The two royals are working for the Heads Together campaign, which seeks to combat the stigma surrounding mental health issues, and to encourage people to speak more openly about their difficulties.

Harry’s admission that he had ignored his own emotional distress for several years before eventually having counselling was a valuable contribution, from a figure more commonly associated with laddish machismo. William’s focus on male suicide statistics was also a good use of his celebrity.

The royal family cannot get involved in divisive party political issues, and so we can only conclude from these interventions that mental health is something that exists beyond the fray of politics. Breaking the “stigma” surrounding mental health issues is certainly not something that one would want to identify as a leftwing or a rightwing agenda.

There is no more damning indictment on British society in 2017 than the prevalence of mental distress among children

On the other hand, political parties have been keen to make the mental health agenda their own. Theresa May has established mental health as one of the key areas where she hopes to signal her government’s concern for everyday human suffering, making a high-profile speech in January that also stressed the importance of breaking the stigma that clouds the issue.

All of this presents something of a riddle. Mental health problems have risen in profile to the point where the prime minister and the heir to the throne are personally committed to combating them. Yet there is scarcely any public discussion about where they actually stem from. Losing a parent at a vulnerable age, as Harry did, is terrible and harmful – but epidemics do not arise purely out of private tragedies.

The stigma attached to mental health is a real problem in workplaces and schools, as are the benefits of overturning it. But stigma can scarcely be viewed as the cause of what it stigmatises.

The orthodoxy that has taken root since the 1980s is that mental health problems are disorders of the brain. The success of SSRIs since the launch of Prozac in 1987 has helped to entrench this view. This doesn’t mean that mental illness can’t be treated with “talking cures”, such as cognitive behavioural therapy or by being more open about one’s emotions, as Prince Harry has argued. But the idea that mental health problems are illnesses just like any other illnesses has become one of the main ways in which the stigma is challenged. Comparisons with cancer have become common.

The idea that one is simply “unwell” no doubt provides comfort to many people wrestling with their own depression or anxiety. But it also blocks out a whole host of more fundamental cultural, political and economic questions regarding the distribution of distress in our society – the sorts of questions that the Duke of Cambridge would be less likely to grapple with.

‘There is scarcely any public discussion about where [Britain’s mental health problems] actually stem from.’ Photograph: SilverHub/Rex Features

There is no more damning indictment on British society in 2017 than the prevalence of mental distress among children. Nearly a quarter of a million are receiving mental health treatment from the NHS, and those contacting Childline complaining of anxiety and exam-related stress have been climbing year-on-year. Rates of self-harm amongst young girls have risen by 42% in a decade.

Are we to believe that it was simply “stigma” that swept all this under the carpet in the past? Or might children be telling the truth, when they say they feel overwhelmed by the requirement to perform, excel, keep up? The NSPCC reports that some children are having to sit mock exams just a few weeks after returning from the summer holidays. Think about what that means and does psychologically. What does Theresa May have to say about that? British children have become damagingly competitive, and less forgiving of failure. Which minister will have the guts to stand up and say to children that being average is OK?

Adult mental health problems may present themselves as medical and be treated as such, but they are not immune to sociological analysis. Researchers have found that adult mental health is worse among those who frequently moved house as a child. Today’s housing crisis is tomorrow’s mental health crisis.

Rising household indebtedness is another major culprit, especially the kinds of problem debts that are associated with week-by-week financial precarity. Children suffer when their parents are too stressed or depressed to listen to them or play with them. Debt problems break up families.

Austerity has been disastrous for the nation’s mental health. The British Psychological Society has called for a termination of benefit sanctions (which are effectively designed to produce anxiety); academics have shown the deep emotional harm wrought by the bedroom tax. Teachers, who live under the constant spectre of monitoring and performance assessment, are seeking medical help for stress in shocking numbers.

The seductive concept of “public sector productivity gains” conceals thousands of personal tragedies among doctors, paramedics and local government service providers, many of whom cling to a dream of exiting their profession. And these are the same people who look after the wellbeing of our children and mental health patients.

No doubt mental health will feature prominently in party manifestos, now that it’s gone mainstream. Whether any of the above gets a look-in remains to be seen. Labour should be shouting about it, and not allow the hypocritical architects of austerity an inch of this territory. Next time a Labour politician is patronised as being too leftwing by a journalist, the evidence on what inequality does to our minds should be slung back.

So, yes, we need to talk more. And, yes, stigma surrounding depression and anxiety makes things worse. But it’s not just ourselves and our medical histories we need to talk about. We also need to talk about what sort of society we’ve built, and what the alternative might look like. For all their good intentions, Harry and Wills might need to sit that one out.

On mental health, the royal family is doing more than our government | William Davies

Bereaved families bring case against government over prisoner suicides

Relatives of prisoners at HMP Woodhill who have taken their own lives are to bring a legal challenge against the institution’s governor and the justice secretary for allegedly failing to introduce basic safety measures. Eighteen prisoners have killed themselves at the jail in Milton Keynes since early 2013 despite repeated recommendations and guidance from coroners’ reports and official bodies that investigate deaths in custody.

The most recent death at Woodhill was before Christmas, shortly after the high court granted permission for the case to be heard. Deaths in custody reached a record high in England and Wales last year. In 2016, there were 119 self-inflicted deaths; the previous year there were 89.

The action has been brought by Pearl Scarfe and Julie Barber, the mother and sister of Ian Brown, who took his life in his cell in Woodhill on 19 July 2015, and Jamie Blyde, the brother of Daniel Dunkley, who died on 2 August 2016, four days after he was found hanging in his cell.

The families are seeking to persuade the court to order that the governor of Woodhill prison and the justice secretary, Liz Truss, take urgent action to reduce the risk of self-inflicted deaths in the future. Woodhill had the highest suicide rate of any prison in 2016; seven prisoners killed themselves there last year.

Barber said: “Ian was much loved. Our loss has been unimaginable. We all miss him every day. I believe if he’d had the help and support he needed he’d still be here. Every time I hear about another death in the prison, I think: ‘Why?’

“If lessons had been learned when my brother died, all those families would not have had to go through what we have had to go through. It’s hard for us to hear about more deaths. It makes me angry that suicides have happened that could have been prevented if changes had been put in place, as they should have been.”

The judicial review, to be heard at the Royal Courts of Justice in central London, is being supported by Inquest, the organisation that helps relatives at coroners’ courts. Inquest says it is concerned about the lack of a national oversight mechanism to monitor, audit and follow up actions taken in response to recommendations by the Prisons and Probation Ombudsman and coroners.

Deborah Coles, the director of Inquest, said: “The number of self-inflicted deaths occurring in prisons in England and Wales is currently at record levels. It is therefore more vital than ever that preventative actions are identified, changes implemented, and sustained improvements enforced to prevent future deaths.

“The current system for learning lessons and implementing changes arising from deaths in custody is not fit for purpose; it does not adequately prevent future deaths, meet the hopes and needs of bereaved families, or satisfy the wider public interest.

“The deplorable situation at HMP Woodhill is just one stark example of a much wider national problem. Deaths occur time and again as a result of repeated failings. Families are told that lessons will be learned, but nothing changes. The reality is that the Ministry of Justice has wholly failed to address the unacceptable rise in self-inflicted deaths.”

Jo Eggleton, a solicitor at the law firm Deighton Pierce Glynn, who represents the families of Brown and Dunkley, said: “[They] have shown great strength in bringing this claim. Despite the awful ordeal they have been through, they have put themselves on the line to try and protect others and prevent future deaths.

“They and the other families of men who have died at Woodhill that I represent share this common goal and have worked together to try and make it possible. They should be recognised and applauded for that. It’s just a shame that this claim has had to be brought at all.”

In a letter to Truss last week, the Labour MP Harriet Harman, the chair of parliament’s joint committee on human rights, called for a national oversight mechanism “with a duty to collate, analyse and monitor learning outcomes and their implementation arising out of deaths in prisons”.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.

Bereaved families bring case against government over prisoner suicides

For children’s health, the government has to treat sugar like cigarettes | Gary Taubes

Let us not get out hopes up. Public Health England is in a very difficult position. Faced with unprecedented levels of obesity and diabetes, with a nation that keeps getting fatter and sicker, the agency clearly has to act. The obesity and diabetes epidemics represent a “slow-motion disaster,” as Margaret Chan, director general of the World Health Organisation, phrased it. So inaction is unacceptable.

Yet virtually everything PHE does now is likely to be either too little – unlikely to have any meaningful effect on the prevalence of obesity and diabetes – or too much, in that the industries that may indeed be responsible for the problem are likely to fight it. While the Treasury develops a levy for sugary soft drinks, PHE hopes to induce the producers of sugary foods to reduce the sugar in their products by 20%. If they can reformulate the product, all the better. If not, they should shrink the size of the product itself.

Commendable as PHE’s initiative is, reasons to be pessimistic abound. The programme is based on the idea that sugar does its damage to the body and to children merely through the calories it contains. As such there’s nothing particularly unique – either toxic or addictive – about sugar, as I and others have been arguing. We just consume too much of it.

Guidelines say children should have a maximum of 24-30g of sugar per day – a third of what they’re actually consuming

On the one hand, it’s hard to win a legal battle with an industry when the best you can argue is that we like their products a little too much for our own good. Some rigorous research targeted at answering the question of whether sugar has toxic qualities independent of its calories would help enormously here, even if it took years to complete.

On the other hand is the simple question of how much we can expect a 20% reduction in sugar to help. Will it curb the epidemics? Avert the slow-motion disaster? PHE predicts that this voluntary sugar reduction program will result in 200,000 fewer tonnes of sugar consumed in 2020 than are consumed today, and so 20% fewer overweight children as well. As Ernest Hemingway’s Jake Barnes might have put it in The Sun Also Rises, “isn’t it pretty to think so?”

Even if a 20% reduction in sugar consumption is achieved in three years (and that alone may be unprecedented) it pales in comparison to what health officials imply is necessary to get children eating healthier. UK guidelines now suggest that children should be consuming a maximum of 24-30g of sugar per day – six to seven sugar cubes. Even less for kids under six. According to a recent PHE survey, that’s one-third of what they’re actually consuming (much of which apparently comes in the morning as part of what their parents think of as a healthy breakfast).

So now, assuming industry goes along with this voluntary programme, and assuming that kids don’t respond to smaller portions or sugar-reduced formulations by eating more, both of which are possible, what’s the chance that we’ll see a significant curbing of the epidemics, even if the 20% goal is reached?

Let’s use cigarettes and lung cancer as our pedagogical example, confident, as we are, that cigarettes cause lung cancer. Cigarette consumption in the UK peaked in the mid-1970s when half of all men smoked and over 40% of women. Together they averaged 17 cigarettes a day. Now let’s imagine that we didn’t get those smokers to quit, but we managed to cut their consumption by 20%. Instead of 17 cigarettes a day, they’re averaging 14.

Would we expect to see a decrease in lung cancer prevalence? Would we expect that the lung cancer epidemic would be curbed at all, let alone within a few years of peak consumption? I would wager that even the PHE authorities would acknowledge that such a change would have little effect. Reasons here, too, would abound. Among them that it takes lung cancer risk 20 years to return to baseline after the smoker quits. So these 14-a-day smokers would still be at high risk, albeit perhaps not quite as high.

Indeed, in the US, per capita smoking began to decline in the mid-1960s, immediately after the surgeon general’s landmark Report on Smoking and Health. Lung cancer rates stopped rising only 30 years later. By then, per capita consumption had dropped by almost 50%. More importantly, when it comes to cigarettes, public health authorities don’t target the number of cigarettes smoked, but the number of smokers. Cut that number significantly, as we did, and lung cancer rates fall.

We see an overweight child with a chocolate bar and our tendency is to think that the chocolate bar is the proximate cause. Get rid of that chocolate bar, or shrink it in size, and we have a child who never gets overweight to begin with. But these epidemics of obesity and diabetes have been in the works since the late 19th century, cooking along, quite likely passed down from sugar-eating mothers to their children even in the womb. If so, our kids are getting fatter not just because they’re eating sugar, but because they’re programmed – epigenetically, in the scientific lingo – before they’re even born.

This epidemic has deep roots and may require drastic action to curb. That PHE is acting is admirable. But maybe we should treat this like cigarettes: aim to curb the number of sugar consumers, rather than the amount of sugar they consume. It will still take time to see an effect, but the odds of success will rise.

For children’s health, the government has to treat sugar like cigarettes | Gary Taubes

New rules for Indian mothers – so long as the government accepts they exist

The Indian government’s new maternity bill, which comes into force this week, has been branded an elitist policy that will do little or nothing to help the vast majority of the country’s mothers.

According to women’s groups, the new rules – which raise maternity leave from 12 to 26 weeks, putting India ahead of France and the US – will apply only to a small fraction of the female workforce.

“It’s as if, for the government, 95% of India’s women don’t even exist,” said Juin Dutta, from Paatshala, a group helping impoverished female handicraft workers. She pointed out that the extension will only apply to women in the formal sector, which amounts to just 5% of India’s working women.

India’s prime minister, Narendra Modi, hailed the bill as “a step forward for Indian women” when he introduced details of the legislation on his monthly radio address this week.

“The basic aim is to ensure proper care of the newborn, the future citizen of India, from the time of birth,” he said. “The newborn should get the complete love and attention of the mother. That is how these children will become true assets of the country when they grow up. Mothers too will remain healthy.”

Internationally, the bill has been touted as a success for India, which has one of the world’s lowest female employment rates – 25% – and where mothers often feel under pressure to leave their jobs after having children. A headline in Fortune magazine said India’s move “puts the US to absolute shame”.

But most Indian women will never reap the benefits, according to the International Labour Organisation. “India’s informal economy is huge, it employs over 435 million men and women who never see the benefits of government laws,” said Aya Matsuura of the ILO.

“In the informal sector, you never have to sign a formal employment contract and your relationship with the employer is unclear. For example if women work as maids – and up to 10 million Indian women work as domestic cleaners or cooks – they will not have signed a contract. They have a verbal agreement, so in reality they are not really covered by formal rules and are not recognised by law.”

Those working in the informal industries are among the most vulnerable, Matsuura said: “They have problems. If a woman gets pregnant, she has to find a temporary replacement for herself, like a sister or a sister-in-law. Otherwise, she loses the job.”

Pratibha R, of the Garment and Textile Workers Union in Bangalore, said the bill did little to resolve the problems of working mothers. “Our members are entitled to the 26 weeks, but what happens after? According to the new law, workplaces are supposed to provide creches on site, and women are supposed to be able to go see their babies four times a day, but in practice that doesn’t happen.

“The facilities provided are unclean and low quality, women don’t feel comfortable leaving their babies there. Women are very afraid to leave small babies there, and so they just leave after pregnancy.”

A pregnant female worker at a construction site in Ahmedabad, in India’s Gujarat state. Photograph: Dinodia Photos/Alamy Stock Photo

A survey by the Associated Chambers of Commerce and Industry suggests that a quarter of women in India don’t return to work after having their babies.

Reducing that number could increase India’s national income by 27%, according to the International Monetary Fund.

But increasing female participation in India is complex, said economist Rupa Subramanya. Maternity benefits may make women more willing to work, but they also make employers less willing to hire them.

“India is still a developing country. Countries like Norway can afford to give mothers a year’s maternity leave now but they didn’t have that while they were still developing,” Subramanya said.

LocalCircles, a citizen engagement organisation that surveyed more than 4,000 small businesses about the new maternity rules, found that 26% of firms said they would favour men over women because of the new rules.

Yatish Rajawat, chief strategy officer for LocalCircles, said: “There is a lot of political correctness on hiring for diversity. Many people say something and do the opposite. The fact is that business dynamics will take over politically ‘right’ things. Now businesses are looking at women and thinking I’ll have to pay two persons’ salary for one person’s work. Now employers will not just look at women’s qualifications and capability but also the fact that they come with an additional cost.”

One solution, according to Naiyya Saggi, founder of BabyChakra, India’s largest online community of mothers, would be to introduce paid paternity leave. “When an employer is deciding between a man and a woman, the burden of parental leave should be equally shared,” said Saggi. “The government hasn’t put in place proper childcare infrastructure for women, and instead has passed that burden on to employers.”

She said women still feel taking any time off would have a negative impact on their careers. “Six months is a long time in today’s world, with automation and artificial intelligence. Mothers already feel they need to be reskilled after taking that much time off.”

But Nidhi Gupta from the Takshashila Institute, a thinktank, said the law was a step in the right direction despite its limitations.

She said: “Women bring as much skill and talent to the table as men do. We go to the best schools, best colleges, as we are as talented and skilled as men are. So why should we be excluded?”

The argument that employers will be reluctant to hire women over maternity leave is unproven. “In the UK, when they introduced the Equal Pay Act, the same argument was made,” said Gupta. “But actually studies have shown that it has not made employers less willing to hire women.”

New rules for Indian mothers – so long as the government accepts they exist

Government plan on childhood obesity very disappointing, say MPs

Tough new measures to tackle childhood obesity – including a restriction on supermarkets offering “deep discounts” on unhealthy foods – must be introduced, according to a committee of MPs.

The Commons health select committee said it was “extremely disappointed” with the government’s current plans to fight obesity, and said ministers had ignored proposals from experts and had failed to go far enough.

In a report published on Monday, there was specific criticism of there being “no mention of price promotions” despite experts recommending there should be controls on supermarkets discounting unhealthy food and drinks aimed at children.

“We are extremely disappointed that the government has rejected a number of our recommendations,” said Dr Sarah Wollaston, the Conservative MP who chairs the committee.

“These omissions mean that the current plan misses important opportunities to tackle childhood obesity.

“Vague statements about seeing how the current plan turns out are inadequate to the seriousness and urgency of this major public health challenge.

“The government must set clear goals for reducing overall levels of childhood obesity as well as goals for reducing the unacceptable and widening levels of inequality.”

The attack on the government’s plan from the influential committee was supported by a number of health bodies, which also condemned the plan as inadequate – in spite of their support for its flagship measure, the sugary drinks tax.

Prof Russell Viner of the Royal College of Paediatrics and Child Health said: “The fight against obesity is going to be long and hard – and the health committee is right: without action across a number of areas, any impact of individual policies will be minimal.”

The British Retail Consortium had told the committee that regulation was needed to ensure that all supermarkets and other shops stop promotions of high-fat and high-sugar foods, but the government ignored that recommendation. Public Health England, the government’s advisory body, also supported it.

“We are extremely disappointed that the government has not regulated to provide the ‘level playing field’ on discounting and price promotions which industry representatives themselves have told us is necessary for the greatest progress,” said the committee’s report.

The Committee of Advertising Practice, a sister organisation of the Advertising Standards Authority, has announced new restrictions on advertisements for high-fat and high-sugar foods on non-broadcast media – such as on smartphones – but the select committee said that was not enough.

“We urge a re-examination of the case for further restrictions on advertising of high fat, salt and sugar food and drink in the light of the most recent research not only on the effect of such advertising, but on the scale and consequences of childhood obesity,” said the report.

The Royal College of Paediatrics and Child Health backed the conclusions.

“We’ve said time and again that it was an error for government to exclude TV junk food advertising restrictions in their obesity plan,” said Viner.

“We know these adverts have an effect on the type of food children consume, and experts from across the health sector, parents and the health select committee agree that a ban prior to the 9pm watershed is vital to help tackle the obesity crisis.”

MPs applauded the announcement of a tax on sugary drinks, but called on the government to monitor whether drinks companies pass on the tax in the form of higher prices and whether they also raise the prices of their unsweetened drinks, such as water, as well. They also call for sweetened milk drinks to be included – at the moment they are exempt.

The Obesity Health Alliance, a coalition of more than 40 health charities, campaign groups and royal medical colleges, said: “It’s reassuring to see the committee reiterate the importance of tackling childhood obesity, which has reached a devastating high. We agree that a range of actions are needed to protect our children’s health.

“Current loopholes in junk food marketing restrictions leave children exposed to unhealthy food and drinks during the programmes they watch the most; so we especially welcome the committee’s recommendations to extend these restrictions to include primetime TV shows.

“We look forward to seeing the government adopt further measures to help fight the obesity crisis.”

Government plan on childhood obesity very disappointing, say MPs

Mexican government accused of torture by ex-patients of disabled care home

For decades, disabled children and adults living in institutions worldwide have suffered abuse of all kinds – from deprivation and solitary confinement in miniature cells, to sexual abuse and forced sterilisation.

Now a charity which has documented this abuse for more than 20 years is bringing a landmark legal case against the Mexican government, with the intention of laying down a new line in international law.

Throughout their years of research, Disability Rights International (DRI) has found sickening abuse in donor, state-funded and private institutions for people with disabilities across the world. A three-year investigation in Ukraine revealed that children detained in institutions without “adequate government oversight” were at risk of being trafficked for sex, pornography, or organs. At a psychiatric asylum in Argentina in the early 2000s, DRI (then known as Mental Disability Rights International) documented patients locked naked in tiny isolation cells. When people with psychosocial disabilities are subjected to social and sensory isolation like this, it is classed as degrading treatment or torture, according to the UN special rapporteur on torture.

They’re not protecting the women from getting raped by sterilising them, they’re protecting them from getting pregnant

Eric Rosenthal, executive director of DRI

The institutions that house children and adults in Mexico have been one of DRI’s principal focuses since 2000. Their first groundbreaking report documenting abuse in the Samuel Ramirez hospital in Mexico City contributed to the landmark 2006 UN convention on the rights of persons with disabilities.

In 2014, a two-year investigation into the state of facilities for people with disabilities in Mexico City found residents were sexually abused, locked in cages, left permanently in cribs, and overall detained in “dehumanising conditions”, as the charity described it. “People with disabilities have the right to stay in society and not be locked up,” said Eric Rosenthal, executive director of DRI. In Mexico he witnessed “effectively no community services; a total system of segregation”.

The case that DRI is now bringing centres on children and adults detained at Casa Esperanza institution in Mexico City. Casa Esperanza featured on a list compiled by Mexico City authorities of facilities for people with disabilities that were particularly abusive that was passed to DRI in May 2014 by an anonymous source.

In repeated visits to Casa Esperanza in 2014 and 2015 carried out by representatives from DRI, who were open about their intentions to investigate the facility, 37 people were found to be held in “dangerous, violent, degrading and unhygienic conditions”.

In one interview with the director of the institution in 2014, which is recorded on video, he states that the forced sterilisation of some of the women in the home is standard policy as a precautionary measure against pregnancy, in reference to the risk of sexual abuse (a resident told DRI that a repairman had raped her). “They’re not protecting them from getting raped, they’re protecting them from getting pregnant,” said Rosenthal.

Interviews conducted by DRI with patients at Casa Esperanza who were able to communicate disclosed harrowing tales of assault. Five women revealed they were being sexually abused by a relative of a senior staff member, and a workman.

Disability Rights International has documented the abuse of people in institutions for more than 20 years Photograph: Alamy Stock Photo

DRI met with the Mexico City System for Integral Family Development (DIF-DF) in June 2014 to make them aware of the abuses, including forced sterilisation and isolation, and later sent a formal letter with photographic evidence, but it was not until September 2015 that Casa Esperanza was closed.

In the timeline of events which DRI outlines in their legal petition, DIF-DF visited Casa Esperanza in January 2015 and witnessed the same abuses DRI had recorded. “The facility was known to be abusive and allowed to continue as such,” said Rosenthal.

Once Casa Esperanza was shut down by Mexico City authorities, many of the residents were moved to different facilities. The charity followed up with some of the young people after they left Casa Esperanza. “We know that at least two people have died [since moving from Casa Esperanza]; we know that one woman was systematically raped, and I read the testimonies from the rape she suffered in the new institution, and it was even worse,” said Priscila Rodríguez, DRI’s associate director.

The case which DRI is bringing against the Mexican government under international law seeks reparation for the residents who were detained in these conditions. It calls for Mexico to provide full community integration for not only the survivors of Casa Esperanza, but for all people with disabilities who are institutionalised. To do this, Mexico must provide housing and other support services for disabled people to live in the community. The Inter-American Court has granted financial reparations to victims of torture in some previous cases, so there may be a possibility of compensation.

An investigation into the state of facilities for people with disabilities in Mexico City found residents were sexually abused, locked in cages, and overall detained in “dehumanising conditions” Photograph: Sasa Stankovic/EPA

The charity claims the Mexican government had knowledge of the abuses taking place at the institution. They argue that the abuses constitute torture, contrary to Mexico’s obligations under international human rights law. Accordingly, in January this year DRI and the O’Neill Institute for National and Global Health Law filed a case at the Inter-American Commission on Human Rights, and are calling for deinstitutionalisation across the country. They aim to get recognition under international law that disabled people have the right to live in the community. If the commission decides that they have a case, it will go before the Inter-American court. The government is legally bound to accept the court’s decision.

The Olmstead case was a historic breakthrough throughout the world and drove a lot of deinstitutionalisation in the US

Professor Gerard Quinn, disability law specialist

The Mexico City authorities say that after learning about the matter in 2014, they “undertook various inter-institutional actions to address the issues… initiating supervision and follow-up work… A series of joint operations were carried out between the Human Rights Commission of Mexico City, DRI, and the DIF of Mexico City, aimed at protecting the rights of the disabled population that were in [Casa Esperanza], with the aim of taking them out of that home and placing them in the care of other social organisations that provide alternative care, follow up and accompaniment to persons with disabilities.”

They state that the state authorities took the necessary steps in order to make sure that the institution was closed down, and to this day continue to work on behalf of of the persons that were removed from [Casa Esperanza], “in order to guarantee the enjoyment and exercise of their human rights, as well as to promote the development of their autonomy. These are fundamental for the strengthening of the agenda of Persons with Disabilities deprived of family care, in which the main objective is to promote their inclusion in the community”.

“Survivors of Casa Esperanza committed no crime, yet they are serving a life sentence in Mexico’s mental health institutions,” says Rosenthal. “The case presents a new legal claim that has never been before established under international law; that is the idea of a right to community integration.”

It is based on the case of Olmstead v LC in 1999, which is seen as one of the most important civil rights cases for people with disabilities in the US. A lawsuit was filed on behalf of two women with mental health conditions and intellectual disabilities in Georgia for support to be provided in the community, after they had spent their lives continuously moving in and out of state psychiatric hospitals. The lawsuit went to the supreme court, which held that people with disabilities have a right to receive state-funded support and services in the community, rather than institutions.

“The Olmstead decision had crystal clarity in terms of inappropriate institutionalisation amounting to discrimination. It was a huge historic breakthrough throughout the world; it has had really huge impact, [and] it has been driving a lot of deinstitutionalisation in the US,” said Prof Gerard Quinn who specialises in disability law at NUI Galway, “[The Mexico case] has the potential for having an impact in Latin America if it goes further.”

“Historically, disability rights have been ignored,” said Rodríguez. “Segregation is a practice that’s been systematically used for people with disabilities, and it’s important to change that mindset. We are saying that to segregate a person on the basis of their disability is one of the most aggressive forms of discrimination.”

“[This] will be the first case about community integration in Latin America, and we are very keen to have that precedent established not only in Mexico, but in the whole continent,” Rodríguez said. “We do hope that similar action can take place somewhere else. For instance, the European Human Rights System and the Inter-American Human Rights system rely on each other for standard-setting, a case before the European Court can be used as an international standard before the Inter-American Court and vice-versa. This case could thus also be used as a standard in other human rights system, such as the European and also at the International level, such as before UN Committees.”

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Mexican government accused of torture by ex-patients of disabled care home

Government finances face near-£6bn hit over changes to personal injury payouts

The government’s finances will take a near-£6bn hit as a result of the increased bill faced by the NHS and other parts of the public sector as a result of changes made to the way compensation awards for botched operations and other errors are calculated.

The lord chancellor, Liz Truss, announced a cut to the so-called Ogden discount rate last month which is pushing up the payouts to claimants but increasing the cost to organisations such as the NHS.

The Office for Budget Responsibility said the government was now setting aside an extra £1.2bn a year to meet the expected costs to the public sector – and it would push up car insurance premiums by around 10% .

Robert Chote, chair of the OBR forecasting unit, said: “The overall effect is to increase borrowing by £1.8bn this year and around £1bn each year thereafter.”

The Association of British Insurers, which wants an overhaul of the system, described the costs as extraordinary.

Huw Evans, ABI director general, said: “Today’s budget confirms a massive £6bn hit to the NHS caused by the lord chancellor’s decision to cut the personal injury discount rate to -0.75%”.

The rate was previously 2%. “This extraordinary bill for taxpayers – bigger than any other in this budget – shows how absurd this avoidable decision was,” he added.

Government finances face near-£6bn hit over changes to personal injury payouts

Government abdicating responsibility for social care, say providers

The head of the organisation that represents adult care providers in England has accused the government of abdicating responsibility for social care and claimed that ageism is affecting treatment of the elderly.

Speaking to the Guardian, Martin Green, the chief executive of Care England, warned the care home sector is at a tipping point and accused the government of lacking leadership on the issue. .

Philip Hammond, the chancellor, has bowed to widespread pressure over funding and will use Wednesday’s budget to invest an extra £1.3bn over two years in social care, including care homes. However, the spending gap in social care is expected to reach at least £2.6bn by 2020, according to the Local Government Association. Record numbers of care homes are already closing and more than 400 care home businesses have been declared insolvent since 2010, official figures show.

Critics of the industry claim it is financial difficultly due to private companies racking up huge debts and failing to invest. However, Green blamed the government for the crisis facing the sector.

“The government is abdicating responsibilities for social care to local authorities,” he said. “I think it owes more to the protection of vulnerable politicians than it does to the protection of vulnerable adults. My view is that if you ask me who is to blame it is the government. The government should be delivering a very clear vision for what social care is, they should be giving clear expectations to citizens about what they should expect from the system and what they should expect to pay for and none of that is happening.”

Green warned that the small businesses in the sector – the so-called “mom and pop” operations which account for the majority of homes in the UK – are under unprecedented pressure due to a rise in costs and a fall in the price that local authorities pay towards caring for residents, which can now be as little as £2.24 per hour. Care England’s members include independent care providers ranging from single care homes, voluntary organisations providing homecare, and multinational companies such as Bupa.

Green claimed that a culture of ageism has become a serious problem for social care. He said that the care for the elderly is treated differently to other health issues.

“The amount of ageism in the system is quite outrageous,” he said. “I was giving a talk to some older people and a lady said a really killer question to me: ‘Can you explain to me why my husband’s disease, Alzheimer’s, has been classed as a social care problem while my brother-in-law who has got cancer gets everything from the NHS?’ My answer to her was ‘I will tell you why, because your husband is old and because they want you to pay for it’.”

He added: “Remember we have an equality and human rights act where age is a protected characteristic. What has the Equality and Human Rights Commission done on this issue? They have done very little on age. They are obsessed with race, gender, sexuality and disability and they completely ignore age. Actually I would say ageism is probably the most prevalent form of discrimination in our society today.”

Green said that the government needed to ensure that any financial support for the sector in the budget made its way to care providers, rather than getting stuck inside local authorities. He claimed that some of the cash raised by local authorities through a council tax precept last year has not made its way to care providers, despite the government insisting that social care should be the recipient of the tax hike. “They need to have an mechanism to absolutely be clear that it goes to the frontline,” he said.

Green, who has run Care England since 2015, said he agreed with the warning last year by the Care Quality Commission, the industry regulator, that the industry is at a tipping point. “What we will start to see is far less services at a time when we have got far more need,” he added.

Despite the pressure on the sector, Green defended the large companies in the industry, such as private equity-owned Four Seasons, which have significant debts and are paying millions of pounds in interest ever year.

“I have politicians that sneer at me about venture capital taking over the sector. My response is ‘Well, it’s a good job someone is because the government is not putting any money in’.”

Hammond is expected to say that the £1.3bn for social care should directly benefit the NHS, by reducing the number of patients who end up stuck in hospital despite being medically fit to leave, because social care in their area is unavailable.

It is likely to be directed at schemes that aim to tackle what the NHS calls delayed transfers of care, or “bedblocking”, and the risk of mainly older patients being admitted or readmitted to hospital.

However, the chancellor is set to face down demands from Labour, the British Medical Association and many NHS bodies by refusing to increase the health service’s budget beyond the sums already agreed.

The BMA has called for an extra £10bn a year for the NHS, while Labour has demanded £12bn for health and social care. Hammond will trigger claims that neither he nor Theresa May appreciate the full extent of the NHS crisis, which saw unprecedented numbers of hospitals declare themselves unable to cope over the recent winter.

But he is expected to make an extra £200m available for NHS capital projects in 2017-18, after warnings from NHS England chief executive Simon Stevens that his planned “transformation” of the health service in England would struggle unless local NHS bodies had more money to spend building and repairing premises.

Jeremy Hunt, the health secretary, controversially moved more than £1bn from the NHS’s capital budget to its revenue budget in an attempt to give hospitals more money to spend amid an unprecedented financial squeeze.

Government abdicating responsibility for social care, say providers