After Brighton – the Hard Work

Labour Health Policy

In Brighton Ed Milliband and Andy Burnham (together with his excellent team) set out more about the emerging policy for an integrated care system providing whole person care.  As they have said this represents the rebirth of the NHS and the next major step on the journey started by Labour in 1937.  Changes rooted in Labour values, changes which will win widespread support.  Changes supported by the SHA.

We know the framework to enable whole person care.  Putting people before profits with competition and markets removed.  Healthcare once more predominately publicly delivered and public provision defended.  With planning replacing commissioning and health joined up to other public services through local authorities.  With healthcare, for the first time, being properly publicly accountable. Building up from dealing with the social determinants of poor health with a key role for Public Health throughout the public sector.  Ending the scandal of malnourished, zero hours, 15 mins slots social care.  Having a well paid, well trained workforce across all of care, in the right numbers to do the job properly.  Repealing the H&SC Act – a necessary but far from sufficient condition for change.

Through many random conversations and many fringe meetings, not all of which were with those who are generally supportive, there was an overwhelming sense that this approach was right from those who work in the various services and those that use them.

The contrast with the Cameron/Lansley idiocy is stark. Labour has listened and is setting out its plans at the earliest stage; welcoming and inviting the widest consultation and engagement. Long before the 2015 election Labour will have set out what it proposes. And unlike the Cameron approach there will not be a ludicrously expensive and disruptive top down redisorganisation.

With the key themes established the hard work follows.  How can the transition to a much better integrated system be achieved without a reorganisation and without the benefit of significant real terms growth in funding?  What can be developed to bring genuine accountability and involvement and ensure patients and communities are viewed as assets?  How must the roles of professionals and others in the workforce change?  How can “free” health be merged with “means tested” social care?  What evidence we have about where integrated care works appears to show that relationships and local leadership are far more important than structures so how can these be fostered?

The challenge is daunting and suggests that an incoming Labour administration may have to think much longer term.  It could start by setting out its broad vision in something like a Green Paper before the election and start serious discussions with patients groups, local authorities, Royal Colleges and Trade Unions.

An initial Bill could repeal the Health & Social Care Act, restore the powers and duties of the Secretary of State to ensure a comprehensive and universal health service, extend the scope and powers vested in Health and Wellbeing Boards, change the weak governance around Clinical Commissioning Groups, strengthen the role of public health, and set out measures to enable improvements rather than inhibit them.  Clear direction could be set by the Secretary of State and appropriate appointments (and removals!) made to key positions.  There could be local freedoms to try different approaches; a ban on top down changes, guidance and directions; and major restrictions on the use of the big consultancy companies who appear to be present whenever expensive (and usually botched) changes are made. The disruption and waste caused by the market system could be stopped and local initiatives towards integration supported rather than being blocked by competition rules or the Office of Fair Trading!  Royal Colleges could be asked to work together!  Organisations could be encouraged to collaborate not compete.

Then take a year to work towards a 10 year plan for care – a plan with the widest possible support – even offering to include other parties.  And build public support so we never again see the “save our xxx” campaigns and have the genuinely and rightly concerned public as allies rather than portraying them as enemies.  And we can lift staff morale by protecting terms and conditions and by not constantly denigrating them.  We can deal with problems that arise by making sure they don’t happen again not by using them as an excuse to attack the whole NHS.

If we can deal with “culture”, “leadership” and “relationships” then the only problem will be the money.  Now it gets even harder.

Whatever is claimed the reality is that funding for care has been decreasing in real terms putting impossible strains on social care and the NHS.  It is possible to take some costs out of the system through integration, through consolidation and by taking out the market mechanisms but it won’t be enough.  Moving care out of hospitals and building up primary and community care is essential for better care but may not be cheaper care and investment will have to precede any savings.

If we truly want a 21st century care system, amongst the best in the world on outcomes and quality of experience, and which is universal and comprehensive then it has to be paid for.  If we want social care on the same “free at the point of need” basis as health care (and we do!) that too requires funding.

So alongside discussion around whole person care we have to discuss how to raise additional tax funding to pay for good care.  And that too could even be a popular campaign; the voting public are probably way ahead of the political classes.