Andy Burnham set out a bold vision for an integrated physical, mental and social care system as he launched Labour’s health and care policy review yesterday.
He said he wanted to change the terms of the debate, from technical discussions about commissioning and regulation, to looking at the fundamental question: what do we want from a 21st century health and social care system? Health and social care professionals listening to the speech spoke of their excitement about the ambition he set out to truly integrate health and social care so people live healthier and more independent lives for longer.
But the government is taking things in the opposite direction – fragmenting the system through open-tender competitive markets, encouraging organisations to compete not collaborate, and at the same time – despite promises to the contrary – driving an unnecessary top-down reorganisation that takes over £3 billion away from the front-line.
As cabinet member for health and social care in the London borough of Southwark, people tell me that they want to have their physical health, mental health and social care services provided in a way that puts them and their needs at the centre – not a system that makes them fit their needs to our different organisational silos. They want a single point of contact who will consider their needs in the round, and who will coordinate the right mix of services to help them most effectively.
People want to stay living independently at home, connected to their communities, for as long as possible. They want to avoid going into hospital or residential care unnecessarily. This issue is becoming more urgent as more of us are living longer, meaning increasing numbers of people with a complex mix of health and social care needs.
Yet, as Andy Burnham pointed out yesterday, current funding models and conditions make this difficult. Local authorities – suffering huge cuts from eantral government to our own budgets – fund preventative measures like grab rails and adapted bathrooms, not the NHS. And it is not generally in hospitals’ financial interests to invest in things that would lead to fewer patients being admitted. A ‘year of care’ funding approach, as Andy Burnham suggested, would incentivise collaboration.
In Southwark we are developing better integration, through a collaboration of Southwark council, Lambeth council, Guy’s & St Thomas’ Hospital, King’s College Hospital and South London and the Maudsley Mental Health Foundation Trust. People will be offered ‘whole-person’ GP assessments of their mental and physical health. There will be better early diagnosis, and new multi-disciplinary teams will identify and coordinate health and social care support to help prevent accidents and health conditions that require admission to hospital or residential care. The programme is starting with older people, but we hope to extend to other age groups.
We are also investing in a new ‘older people’s centre of excellence’ with cutting-edge services for older people with dementia and other complex needs, helping delay the need for residential care.
In the immediate term there is more we can do in every borough. Health and wellbeing boards formally come into being in April, and at their best will fundamentally join up the way organisations work, to make best use of limited resources to deliver real health and care benefits. I hope each board’s local health and wellbeing strategy will be ambitious, looking at the system as a whole and from a user’s perspective. They should have prevention as a key focus – incorporating the fundamental role of social care, as well as public health and the wider determinants of health, in helping people stay healthy and independent for longer. And I think lessons can be learnt from children’s trusts, where organisations set formal, shared objectives through a children and young people’s plan, to help ensure organisations collaborate for the benefit of our communities.
It is in all our interests to join up the way services are provided, to recognise that people have health and social care needs that are often complex and intertwined. It is better for people who have health and social care needs, and is better for the public purse. The vision Andy Burnham launched yesterday is ambitious, but we should all rise to the challenge of making it happen.
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Catherine McDonald is cabinet member for health and adult social care in Southwark. She is also a member of the LGA health and community wellbeing board. She tweets at @cath_mcdonald
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