Guest post from David Boot, Editor, Healthcare and life sciences, at Novares
The focus at Labour Party conference was all about Andy Burnham’s speech on the Wednesday – the graveyard slot when many members and lobbyists have already left Brighton. Throughout the week there were teasers about what it would contain: Burnham declaring at a fringe meeting on Monday that Labour would provide free care for those on the end of life care pathway, Andrew Gwynne on Tuesday adding that Burnham would confirm Labour’s commitment to repeal the Health and Social Care Act.
When it came, Burnham’s speech called on party members to endorse his plans to ‘find our own spirit of ’45’ and complete the job Aneurin Bevan had started when founding the NHS by integrating health and social care. As a precursor to this, he confirmed that 25 councils will be working as Labour’s Whole Person Care Innovation areas. Perhaps the biggest cheer for Burnham’s speech came when he confirmed that Labour’s first Queen’s Speech would repeal the Health and Social Care Act – although during fringe debates earlier in the week he confirmed that Labour would retain the bodies this act created, but would ask them to perform differently with an eye to integration.
Labour’s big idea on social care dominates the health debate, but questions around this main theme remain. Partly this is deliberate by Labour – it awaits the findings of the Oldham review into social care early next year, and Burnham used his annual appearance before the Health debate to call for people to engage with the party on its consultation on social care.
Three broad themes emanate from the social care debate: funding, commissioning and demand in the NHS. Many of those at conference, including from the voluntary and charitable sectors, welcome moves to integrate health and social care. However, funding is the key question mark. In an age of austerity, can money be found for such a wide ranging move?
For Burnham, the answer is two-pronged. Firstly, the system has to spend what it has more efficiently before taxpayers can be asked for more. Integration would bring about savings through better management of what is spent already. Secondly, he states that he would not rule out a future tax rise, citing the national insurance increase following the Wanless report as an example of when Labour initiated a tax rise to pay for extra NHS funding. This tax increase received public support; the question remains if the public would support a tax rise in a more fragile economy today and whether Labour has the stomach for such a fight.
Secondly, commissioning represents a further challenge within the debate. Burnham has stated that the 21st century is asking questions of the service that marketization cannot answer; competition provides disintegration and is more costly. He has stated that other organisations can play a supporting role, not a core role in providing services – comments that have made many in the voluntary and charitable sectors jittery through a fear that they would be locked out of providing services, including in key areas such as hospice provision. The challenge for Labour is having a balanced position on commissioning that allows for different providers, without accepting the vicissitudes of the market.
Thirdly, demand in the wider NHS is seen through the prism of whole person care. Debates at Labour’s conference have been around such issues as patient care, innovation and long term conditions, but the Labour response is clear: demand in the NHS would lessen through integrating health and social care as this would speed up the discharge of elderly patients and free up hospital beds. This leads to an inevitable conclusion – hospital beds would have to be lost to pay for more community care. This presents a challenge to Labour in getting public backing for such a move and in providing community services prior to such beds being lost. Such an overlap of provision might be economically prohibitive.
Burnham admits that he has skewed the debate on social care towards the elderly, at the exclusion of adults and children. In order to sell whole person care, Burnham’s narrative will have to include all sectors of the population, with more community and home-based care part of a new cradle to grave theme – from home births to the choice to die at home. Only then will people be willing to pay for it.