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Benn, Bevan and Burnham: continuity of care?
One of the lasting legacies of the introduction of the Andrew Lansley Health and Social Care Act (2012) is that it was a massive betrayal of trust. It explicitly did not appear in the Conservative manifesto. It was clearly a Lansley ‘vanity project’ which cost billions to implement.
While the purpose of this Act was promoted in a number of different marketing ways, the Act, nearing five hundred pages, is in fact incredibly simple.
It sets up a market based on competitive tenders. It sets up a beefed up economic regulator. It sets up the climate for ‘liquidation camps’ that only Frederich Hayek could have been truly proud of.
That was basically not a vision that most people had for the NHS in these demanding times.
With not a single clause on patient safety, save for abolition of the National Patient Safety Agency, it was clearly not drafted to prevent another Mid Staffs.
With this level of mistrust, there are people who think integrated care is a shoehorn for a private insurance system.
And yet paradoxically the latest NHS reforms seems to have taken a lot of wind out of the sails of a move towards an insurance-based system as proposed by Reform a few years ago. Whilst Kaiser Permanente seems to still quite chummy with certain think tanks, it’s clear the voters in majority want a properly funded national health service funded out of taxation.
Against this backdrop, care of older people is possibly not what anyone would want it to be currently.
Labour has indeed a long legacy in the NHS history, but is clearly now looking to the future. It is argued that ‘whole person care’ can complete Bevan’s vision, uniting the NHS with social care. This would mean one service looking after the whole person – physical, mental and social. Indeed Andy Burnham at this year’s Party conference recalled the “spirit of 45″. This vision would be symbolic for beginning to bring to a close the marketisation and privatisation of the health service.
Labour have pledged to repeal the Health and Social Care Act 2012, which is fragmenting the service.
And yet a decade ago the Health and Social Care (Community Health and Standards) Act 2003 Commencement (No. 1) Order 2003 was the most controversial piece of legislation to come out of the then government’s 10 year strategy for the NHS in England. This piece of legislation, which abolished government control of NHS trusts by turning them into competing independent corporations called foundation trusts, was a major policy reversal. The concern then was it could lead to considerable local variation in services and endangers one of the NHS’s founding principles–to provide equal care for equal need.
Beep, beep – this vehicle is reversing.
Labour has set up an independent commission under Sir John Oldham to examine how health and social care can be integrated. Ed Miliband feels that this is is the biggest challenge in the history of the NHS. This in part addresses the gap between NHS and care demand which is expected in coming years, and current funding.
There is absolutely no doubt that integration is being damaged by the government’s “free market ideology”, a point freely conceded by the corporate competition lawyers.
The great attraction of the Whole-Person approach, with the NHS taking responsibility for coordination, is that it can be in a position to raise the standards and horizons of social care, lifting it out of today’s cut-price, minimum wage business.
It is clear from Tony Benn’s brief interview with Emma Crosby that Benn has concerns. Benn in his latest diaries, “Autumn blaze of sunshine”, talks of various medical issues which have caused him to come into contact with the caring professions. Benn most obviously feels that valuing care workers has not been a priority of English society by any stretch of the imagination. Benn most obviously wants this to be addressed in some form in a future Labour government.
There has been much said about valuing social workers, but the profession of social care work have been equally vocal about voicing their hard-felt concerns. It is possible that social care careers could be more valued and young people able to progress as part of an integrated Whole-Person workforce. This is yet to be seen.
So an NHS providing all care – physical, mental and social – could be held to account by powerful “patient rights”.
The approach, unlike the Health and Social Care Act (with the exception of the surgeons), has been welcomed by professionals in the Royal Colleges. For example, the Royal College of Psychiatrists has argued that ‘a parity approach’ should enable NHS and local authority health and social care services to provide a holistic, ‘whole person’ response to each individual, whatever their needs. They have also argued that this should ensure that all publicly funded services, including those provided by private organisations, give people’s mental health equal status to their physical health needs.
Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa.
And it’s clear that ‘whole person care’ is not some weird science fiction. A number of local authorities have already signed up to become “whole person care innovation councils” in a programme led by Labour’s shadow health secretary Andy Burnham. The councils are already taking the first steps towards turning into reality Mr Burnham’s vision of a single health and social care service. Under these Labour plans more care will be provided directly in people’s homes, there will be a greater focus on prevention and better co-ordination between different branches of the system.
In the 21st Century, the challenge is to organise services around the needs of patients, rather than patients around the needs of services. That means teams of doctors, nurses, social workers and therapists all working together. This ideally means care being arranged by a single person who you know – ending the frustration of families being passed around between different organisations and having to repeat the same information over and over again.
This seems to be the sort of thing which Tony Benn would like too.
But it is a marked shift in gear. It means a greater focus on preventing people getting ill and more care being provided directly in people’s homes so they avoid unnecessary hospital visits. Keeping frail individuals out of hospital will clearly be one of the ‘next big things’ in English health policy, whoever is in government after May 7th 2015.
It will be quite a culture shock to move the NHS from an organisation being pump-primed for global multi-national expansion. But the NHS has been through worse changes. This one might actually be useful.
Will the catalysmic implosion of the market ideology now move onto the NHS?
This week, David Cameron MP mocked Ed Miliband MP for sounding like a person who’d rung up a radio show whingeing.
Cameron replied, “And your problem is caller?”
The problem is a complete collapse of ideological position which has lasted decades.
Ed Miliband keeps up the moment today with the market failure of the energy oligopoly (see article by Patrick Wintour in the Guardian.)
It is argued that one of the precursors of Thatcherism was a revival of interest in Britain and worldwide in the work of the Austrian economist and political philosopher, Friedrich Hayek, who won the Nobel Prize for economics in 1974.
Alongside Milton Friedman, who won his Nobel Prize in 1976, Hayek lent great prestige to the cause of economic liberalism, helping to create the sense of a rightward shift in the intellectual climate, complementing the approach of Ronald Reagan across the pond.
These principles of dogma have seen successive Conservative and Labour governments reaching for the drug of privatisation and outsourcing.
But these drugs are not only failing to work. They are having devestating side effects which are killing the patient.
The markets have been outed for being far from liberalising. They create inequality. It is alleged that the austerity-based policies have led to a marked decline in mental health and rates of suicide even.
But it’s not the shocking Gas bill which has delivered the knock-out blow for the Conservatives’ religion.
“Here is the reality. This is not a minor policy adjustment—it is an intellectual collapse of the Government’s position.”
This was Ed Miliband’s verdict in Wednesday’s Prime Minister’s Questions.
Only a day previously, BBC Radio 4’s had played a voxpop of various members of the public speaking about ‘payday loans’ as a prelude to interviewing George Osborne MP.
“I don’t accept it’s a departure from any philosophy. The philosophy is we want markets to for people. People who believe in the markets like myself want the market regulated. The next logical step is to cap the cost of credit. It’s working in other countries. In fixing the banks, we need to fix all parts of the banks and the banking system. It helps all hard-working people.”
During the time of the previous Labour government, the King’s Fund was head-over-heels promoting competition.
It was known that, by shoehorning competition as a policy, private providers would make a killing.
All you had to do was to bring in a £3bn ‘top down reorganisation’, a 500 page Act of parliament containing no clause on patient safety apart from the abolition of the National Patient Safety Agency, and beef up a new consumer regulator (“Monitor”).
But meanwhile back to payday lending, an evidenced case of market failure.
“We’ve always believed in properly regulated free markets, where there’s competition, but where the market is properly regulated. That’s why we created a new consumer regulator.”
Far from being a loveable buffoon Boris Johnson, Johnson has revealed himself to be the toxic political mess he is.
Suzanne Moore, at the risk of being hyperbolic, called out Johnson as ‘sinister’.
Johnson had launched this week a bold bid to claim the mantle of Margaret Thatcher by declaring that inequality is essential to fostering “the spirit of envy” and hailed greed as a “valuable spur to economic activity”.
In an attempt to shore up his support on the Tory right, as he positions himself as the natural successor to David Cameron, the London mayor called for the “Gordon Gekkos of London” to display their greed to promote economic growth.
He qualified his unabashed admiration for the “hedge fund kings” by saying they should do more to help poorer people who have suffered a real fall in income in recent years.
And what’s wrong with greed being good if this improves patient care in the NHS?
The issue always remains ‘zero sum gain’. It’s a problem as it diverts tax-funded resources directly in the coffers of the private sector.
Arguably, it’s not just the failure of the market which is the problem, but ‘the undeserving rich’ who have never ‘seen it so good’ since Tony Blair’s New Labour period of government.
In August 2009, the then leader of the Opposition and Conservative leader, David Cameron, MP defended a shadow health minister for advising a firm which offers customers an alternative to NHS doctors.
Lord McColl was on the advisory board of Endeavour Health, which promised a quick and convenient access to a network of “top” private GPs.
It was claimed then that Endeavour Health is a company set up by two hedge fund advisers which purported to be Britain’s first comprehensive private GP network.
In a video yet to be deleted off You Tube, David Cameron argued that there was nothing ‘improper’.
This was interpreted at the time that the Conservatives “favoured private alternatives”.
Nonetheless, David Cameron claimed that the Conservatives was ‘totally dedicated to the NHS’, but he wished ‘to expand the NHS so that people don’t have to use the private sector’.
What actually happened was the Health and Social Care Act (2012).
In July 2013 in the British Medical Journal, it was reported that the private sector is in line to secure hundreds of millions in NHS funding from services placed out to the open market under the UK government’s latest competition regulations, a study has shown.
Research by the pressure group the NHS Support Federation found that contracts for around 100 NHS clinical services totalling almost £1.5bn (€1.7bn; $2.2bn) have been advertised since 1 April 2013, with commercial companies winning the lion’s share of those awarded to date.
Data from official tenders websites showed that only two of 16 contracts awarded since the government’s section 75 regulations of the Health and Social Care Act came into force have gone to NHS providers, with the remaining 14 going to the private sector.
A few days ago, it was reported tonight that David Cameron is intending to ban branded cigarette cartons, having originally decided last July not to proceed with the plans.
In the summer the Government said it was waiting to see how plain packaging worked in Australia, which introduced the measures a year ago, before making any changes. It has since maintained it is monitoring the situation.
That is the spin. Behind the scenes, it is well known that tobacco corporates have throttled public health policy.
In the third volume of Law, Legislation and Liberty, Hayek argued that there are not two but three kinds of human values: those that are “genetically ordered and therefore innate”; those that are “products of rational thought”; and values that had triumphed in the course of cultural evolution by demonstrating their suitability to the successful organization of social life.
Hayek believed that these values were a cultural inheritance, survivors of a competitive struggle, and essential conditions for the successful evolution of our society.
David Cameron is indeed right to be worried.
There has been a collapse of the ideological position that he and his predecessors, Margaret Thatcher and Tony Blair, stood for.
This is in relation to the markets.
This fundamentally changes the terms of reference for a market-based NHS.
Contagion is likely politically.
If payday lending or the energy markets are anything to go by, there could be trouble ahead.
So what’s the issue? The caller’s problem is that “the markets don’t work”, “they only make you feel worse again”.
And now the caller’s finally worried about the NHS.
My blog on dementia is here: http://livingwelldementia.org
