The Shadow of Secretary of State for Health, Andy Burnham MP, says that he has tried to produce an answer ‘which people can believe in, and which people can buy into’.
This is particularly timely, as it is well known that Labour intend to make the NHS a major general election issue next year.
The Conservatives and Liberal Democrats are now deeply unpopular over their management of the NHS, as evidenced, for example, by the campaigners who converged on Trafalgar Square recently on behalf of the “Darlo Mums”.
Over successive governments and most recently, the finances of social care have suffered massively.
Speaking at a fringe event for the Fabian Society in Manchester yesterday, Burnham felt that things are not satisfactory as the response to an ageing society has been through a medical model.
Burnham’s problem is that he is about to be bequeathed a fragmented illness service, not a national health service; and that the system is patient-focused on ill people not person-focused on people through health and illness. Burnham feels that focusing on people will enable a greater focus on friends and families too.
Burnham feels that the “ever-increasing hospitalisation” of an ill ageing population will not work, and that hospitals are becoming increasingly dysfunction all the year round due to a social care system which has been malnourished over successive governments.
“This failure piles pressure on the acute system”.
Burnham further adds that people “are battling in caring for people with complex needs”, and that “these silos are not ones which can afford any more”.
This policy is anticipated to bring in housing, education, and leisure strands in due course.
But the urgency for Burnham is to deal with people having to avoid recounting their personal stories repeatedly to different people; and that professionals are often making clinical decisions on the basis of incomplete information.
The intention is, ultimately, to bring together systems for physical health, mental health and care. Sir John Oldham had earlier in the fringe event observed that the general public can have a poor understanding of the word “social” in relation to ‘social care’.
Burnham intends to set out a ten year plan for a whole person care, fully accepting the findings of the Oldham Commission, and which “endorses” the findings of the Barker Commission from the King’s Fund.
Such a plan will be strongly attractive to those vociferous critics, such as Sir David Nicholson the immediate predecessor of Simon Stevens as the CEO of NHS England, that health policy has traditionally been adopted on the basis of the electoral cycle.
This system will be a “National Health and Care Service”, which will realign an activity-based tariff for episodes of illness to produce a single ‘year of care’ budget for each person covering his or her physical, mental or social meeds. This, Burnham feels, will support prevention and wellbeing.
At first the idea was to have a pooled integrated budget across health and care, but, in the subsequent question/answer session, Burnham made extremely clear that he was mindful of the need to move away from privatised fragmented care; and to move away from compulsory personal health budgets which had not been proven to work well.
Burnham, instead, signposted plans to be announced later this week that he would instead advocate a general ‘rights based approach’, where citizens could be given realistic expectations of the development of personal care plans according to their needs.
Burnham emphasised that he remained unconvinced that personal budgets were the sole instrument that could achieve this aim.
He is of course extremely mindful of the public’s overwhelming lack of appetite for the marketisation, outsourcing or privatisation of the NHS.
As an example of ‘market failure’, Burnham cites how councils in their wish to compete to keep council tax bills low end up failing on high quality care.
Interestingly, he also feels that this plan has the potential to be ‘radical’, allowing people can be supported to care, enabling full personalisation.
Such a system will involve a “care coordinator”. This has already been mooted publicly very recently by the Shadow Minister for Care, Liz Kendall MP, as a point of contact for the elderly to navigate themselves through the maze of information including care information.
Such a rôle, it is felt, might not be for general practitioners, but possibly for specialist nurses. The voluntary sector, such as Dementia(UK) which developed the innovative specialist “Admiral” nurses programme, might be well placed to act as these coordinators.
In the alternative, social care practitioners might be particularly well suited for a care coordination rôle for people with dementia, as they command expertise in decision-making and capacity. Social care practitioner leads in this context would help to overcome a barrier to cultural integration, furthermore; this is especially important given the often perceived hierarchies of the professions involved.
“Carers will no longer be peripheral to the system, but central to the development of a care plan.”
This plan would be established over a ten year period to integrate services around the individual, not through a sudden ‘top down reorganisation’.
A potent steer for this would come from the Health and Wellbeing Boards.
It is expected that the Labour Party will also use their party conference this year in Manchester to emphasise its intention to repeal the Health and Social Care Act (2012) in the first Queen’s Speech of an incoming government in 2015.
Jackie Ashley, Sir John Oldham, who chaired the Oldham Commission, and Kate Barker, who chaired the Barker Commission of the King’s Fund, panel members yesterday evening, all agreed that it was unlikely that politicians would openly wish to pledge to raise taxes for health and care. The way in which this had been politically debated in the 2010 UK general election, it is felt, had been unimpressive.
Nonetheless, the general sentiment was that the public would appreciate an open discussion of how sustainable funding for health and care systems could be achieved.
Jackie Ashley, who writes for the Guardian, explained the difficulties in the news media approaching this topic, when headlines consistently remained fixated on crises in the NHS.
The general policy trend has been try to support people who wish to live and to be cared for at home independently.
However, Ashley alluded to the need to avoid a narrative that hospitals are necessarily bad and non-hospitals are necessarily good.
It is felt that when the NHS was originally set up it was not designed to be catering for people in their 90s with their multiple clinical care needs.
Nonetheless, Oldham urged the need for NHS England to move away from the needs of hospitals, and urged, as an example, a greater number of representatives from local authorities (currently involved in commissioning social care) on NHS England.
For a condition such as one of the dementias, citizens have the perception of their care needs being financially punished through the need to pay for care; this is, for example, in contrast to a condition such as one of the cancers, where the NHS appears willing to pay for expensive medications often.
Equity, equality, fairness and justice will therefore be key aims of this new National Health and Care Service.
“These are some silos which we desperately must get rid of”, exhorts Burnham passionately.
Finally, Burnham wishes this to be a plan for the National Health and Care Service fit for purpose for a 21st century, synchronising at last the wishes of the public, professionals and politicians.
