What Plan?

Labour Health Policy

Those who listened to Andy Burnham’s Kings Fund speech can only have been encouraged and even a bit excited – but remember it only becomes real if Labour wins the election and probably only if Andy is the Secretary of State.

The Ten Year Plan announced elsewhere is a political document as much concerned with bashing the Tories, making the mandatory bullet point pledges and pushing the usual buttons about management and bureaucracy and GP appointments and sheds little light on anything. In fact much of its tone and style is in direct conflict with the messages Andy Burnham sends out about building consensus around long term solutions. There is to be freedom over how things are done but a plan that sets out how many nurses are needed.

Anyway so far as I can see nobody at the Kings Fund disagreed with the vison for whole person care and service integration that Andy described so well; even Reform agreed!

A few key points show the approach fits well with much of what the SHA has advocated:

  • Taking a long term view; being clear on what the long terms aims are
  • Secretary of State accountable for the whole system with powers to intervene
  • Looking at the system as a whole nationally and locally
  • Ending enforced competition; introducing preferred provider and a predominantly publicly provided system
  • More staff, better paid and more opportunities and incentives for recruitment and training of staff
  • New approach to care staff and to the allied professions
  • More care closer to home and out-of-hospital when appropriate
  • Better defined role for voluntary sector and support for it when it adds value and capacity
  • A rights approach backed up by an effective Constitution – not post code lotteries
  • Nationally determined entitlement (what) locally deliver (how)
  • Moves to integrated commissioning – single budget with democratic accountability for the major decisions
  • Using existing structure but making them work in different ways – no top down reorganisation
  • Move to integrated provision through lead provider, accountable care organisation, integrated care organisations or whatever else works – but led by public provider.

This is a sound and credible set of ideas and over time would deliver both stability and worthwhile improvements in the quality of care and wellbeing.  It is brave enough to challenge long established barriers and obstacles to change.

The biggest issue is of course the money.  The injections of an additional £2.5bn early on will help of course but may not even be enough to deal with the crisis in social care let alone do anything as regards healthcare.  And there is an impending winter crisis to be bought off.

Let’s be honest.  Even with quite heroic assumptions about efficiencies and productivity within the NHS funding for care will have to increase at a rate above inflation and almost certainly above the rate of GDP growth, for the whole ten years! And that is what all the (respected) commentators are telling us.  The percentage of care costs to GDP has to increase and so we have to find ways to achieve this with the SHA strongly behind increases in progressive general taxation.

The costs savings touched on in the Ten Year Plan are made to sound huge but were tiny in comparison to the scale of the gap.

More problematic is that the suggestion that integration of care brings savings is more about faith than evidence; better identification of problems and better management of these might drive up ‘demand’ and so costs.  With staff numbers increasing and pay and conditions improving it is hard to see where savings are going to come from.

There are still a few other major issues to be worked on – but there is time for that:

  • How do CCGs merge into the wider commissioning structure?
  • Will CCGs walk away rather than engage with local authorities?
  • Can Local Authorities and Health and Well being Boards really rise to the new challenges?
  • What to do with Monitor? CQC? Healthwatch?
  • How do we develop the new methods of funding?
  • What do we do about the 20 off ‘failing’ localities – just more money?
  • Do we keep Foundation Trusts and what about non FTs?
  • Do we allow Better Care Fund to continue?
  • What about personal budgets?
  • Can politicians ever really devolve power?
  • How do we get the necessary IT systems?
  • What role for community development?
  • Etc

Long way to go, lucky it’s a ten year plan.  More important might have to be a 10 day plan to get over the major challenges presented by a system in crisis.