Before I give you the complete low down, there were some exceptional comments that came midway and at the end of Andy Burnham’s speech on Labour’s ten year plan for health and social care today. Midway through, he spoke about a ‘national entitlement’ to end the postcode lottery of care. If a service was available in one area, it would be available in every area. This is a significant promise which repudiates the current direction of travel: no more local decision making on what is provided, only on how. We called last year for a National Service Guarantee that would give that same certainty to everyone. The challenge is deciding what is left out.
The second comment of note was at the end and built on the one above: “The NHS can’t do everything”, he said, “we have to do more for ourselves, our families, our neighbours. Taking out of the NHS only what we need” and “reset our expectations”. “We need a national debate over which direction the NHS takes”. I do believe that this is a political first. For all else that was said, and what was omitted (IT infrastructure; the effect of rapidly growing digital health and diagnostic technologies; research, innovation & growth; personal healthcare records under our control, how to integrate a means tested service with a free-at-the-point-of-use service), this is the conversation we have been calling for. Anyone who looks at the predicted growth in funding that the NHS will need – driven by more people living longer with long-term conditions, a higher prevalence of complex needs, exponential growth in medical and digital technology capabilities & personalised genomic medicine – and takes the bigger economic picture into account (falling earner to over 70s ratio, balance of payments deficit etc), will know that the NHS cannot go on promising everything to everyone.
Andy Burnham is to be commended for being so frank. The sooner we can begin to review the growing demands against realistic budgets, the sooner the public will be able to partake in an informed discussion on what the NHS in the 21st century is for, how it can be fair, what we must do for ourselves, and what the choices are before us. The NHS is too precious for us not to be having these discussions.
The low down as I heard it….
Sir John Oldham kicked off Labour’s 10 year plan for health and social care this morning, but not before King’s Fund chief Chris Ham had said all (three?) political parties had been invited to set out their stalls – and implied only Labour had taken up the offer so far.
Joint commissioning is essential for integrated care Sir John said, and joint leadership development too. He asked (rhetorically) why there were no local authority representatives on the NHS England Board, and why there were umpteen different national clinical directors for different body parts…NCDs take note!
Fiona Philips introduced Andy Burnham who immediately quoted our by-line as his ambition: Making Health Personal, which was very kind of him, although he didn’t credit us. Andy talked about what he has learned, both from Sir John’s and other reports, but also while listening to the front-line over the past two years citing four themes:
- Clarity – hence his emphasis on person centred care facilitated by one team
- Stability – so he has set the path to integration as a ten year journey with no new structural reorganisation
- Flexibility – he knows integration can’t be mandated from on high but relationships need to be built at the coal face
- Consensus – getting the right values at the centre and a focus on whole person care is essential
He then went on to give more detail in five areas: Competition, National vs local health, Money, Organisations and Empowering professionals and people, although there were the recurrent themes throughout of integration, personalisation and bringing mental, social and physical care together.
On Competition, Andy said he would call time on the market experiment “market forces will break the NHS apart” and that NHS as “preferred provider” would provide stability during a time of substantial service delivery change. The private sector has a role he conceded, and he would want to see long term contracts where given, with a distinction drawn between the not-for-profit and for-profit organisations and the same standards expected of all. This would include the private sector being subject to FOIs and being charged a ‘training’ levy.
A “national health entitlement” would be set out so it’s clear what people are eligible for (this is the first time I have heard this articulated) and this would include re-establishing the authority of NICE to get rid of the postcode lottery. We called for something similar in our ‘National Health Guarantee’ in our Going with the Flow report (see above). He emphasised that the National focus should be on what is delivered, and local should be the ‘how’. The health and wellbeing board with the local authority would increase their focus on public health and the wellbeing of their population achieving Sir Michael Marmot’s ‘health equity every policy‘ goal.
The existing financial framework rewards the treatment of illness with no incentive for prevention. Although Andy talked about money and that the Year of Care payment programme for e.g. frail elderly would be the new system for payment, with care in the home incentivised, there was little other detail and nothing on the projected NHS budget deficit.
The whole person care approach would only work if there is an accountable organisation, he said. All local health economies need to create an integrated care organisation. Alongside this there would be a new role for Monitor, they wouldn’t focus on competition but on financial viability of whole health economies. Andy said he wanted to see shared loyalty to local population rather than to the employer’s organisation. There should be a new role for the ambulance service too – less about emergency journeys and more about out-of-hours care. NHS 111 would be re-visioned and beefed up.
Empowering those who give and receive care was the last subject. With fewer providers, bringing social, mental and physical care together, he espoused new rights: a single point of care, single care plan, the right to counselling and therapy and to respite care. The NHS would be involved in training social care staff, with common standards for them and NHS staff.
There was a lot of detail covered, with as much missing, particularly on the financing, even for a transition period during which new models of care are put in place. As with all policy announcements, there is always much detail still to be worked through. No Party can claim the moral high ground on NHS reforms of the past, but at least Andy Burnham seems to be asking the right questions for the future.