I am very excited actually.
Why?
Today’s the day it’s likely one of my Twitter followers becomes Labour’s new mayor. Time to draw a line under Boris Johnson’s suffocating air quality, and the perennial roadworks on the embankment meaning it takes me hours to trek across SE1.
I am loath to use the word ‘radical’ in relation to something about Sadiq Khan, in case it looks as if I’ve taken a leaf out of Zac Goldsmith’s dogwhistle divisive offensive rulebook. But Sadiq Khan has a chance to help as London’s new mayor (and the result has not been announced yet at the time of writing) with dementia policy in London: a ‘radical system innovation’.
The Alzheimer’s Society, to which I am not in any way linked, have made great progress in ‘Dementia United’, in producing a Manchester-based coherent dementia policy for the working people of Manchester.
It is easy to get totally tangled up in the discussion about whether services for working people should be owned in entirety by the working people, in the true tradition of “socialism” (howeversodefined). Or whether there is a rôle for any private sector involvement at all, ranging from small social enterprises to large global multinationals.
But the political climate is changing, and this has to be taken into account by policy strategies nationally for dementia. For a start, it’s been widely briefed that, even though endorsed by David Cameron, Hollande is vehemently opposed to TTIP as presently drafted. This means that moves to sell off the NHS to corporate investors in the US might be severely hampered after all.
The late great Tony Benn used to argue consistently that the Labour Party was great for introducing right wing policies under the RADAR, some even which would have been too ambitious for the Conservatives to introduce.
The Act of parliament was much despised, and the Socialist Health Association were ‘late to the party’. The Health and Social Care Act (2012) was different to previous legislation in launching “section 75”, in making competitive tendering in private markets a must unless there was only one bidder. This made the NHS into a free for all market, with the Secretary of State for health no longer responsible for it.
And the facts speak for themselves – the outsourcing of NHS services has been given a massive turboboost following this legislation. But Labour, it is argued, helped to set the mood music quite early, in talk about the private sector ‘increasing the capacity’ of the NHS through independent sector treatment centres, accelerating PFI contracts, privatisation of NHS Logistics, and the NHS legislation of around 2006.
Devolution of dementia services in London is a golden opportunity for Sadiq Khan MP, but it is also a threat. The state of play is that social services funding is on its knees, despite Cameron’s cuckoo land aspiration to make the UK ‘the best place to have dementia by 2020’.
There are many who will concerned that devolution is yet another ‘trojan horse’ for transfer of assets from the public to the private sector, aka privatisation. This would be one of a complete portfolio designed by Letwin, Redwood and others, including PFI, selling of property, outsourcing and personal budgets.
But there is actually no justification for the arbitrary distinction between “health” and “social care” for dementia. The social care profession have a pivotal position in enabling and protecting people with dementia. Improved health is essential for improved wellbeing, and improving wellbeing is the first statutory clause of the Care Act (2014).
And yet the distinction can have profound implications for people living with dementia after their diagnosis, and their closest.
The ‘new models of care’ in the Five Year Forward View from NHS England are simply an experiment. Some vanguards will work, others won’t. Somewhere there’s an in-between to be decided between letting a thousand flowers blooming and ‘one size does not fit all’.
I think London is far from ‘socialism in one city’, but this discredited phrase from Stalin is perhaps best forgotten about in any case. At the moment, many of us are simply hoping that England does not become one country operating against strong headwinds in a ‘global market’ where some markets can undercut England and generate an unfair advantage, whether through dumping or sweatshops.
But there is scope for improved planning in a place-defined way, i.e. London. There is a case for pooling resources. Also, there is a case for pooling risk across the entire local population, or else we run the risk of impaired equity based on, for example, social inequalities. We need a well funded NHS through general taxation to make it work.
I hope Sadiq Khan can rise to the challenge in an open way with all stakeholders, not excluding anyway. It’s important for co-production that “all people are in the room”.
This is now a great opportunity for Sadiq Khan. And I wish him well, of course.