When Labour was elected in 1997, the top National Health Service priority for patients and the public was waiting times.
Back then, people were being forced to wait 18 months or more for their operation. While those with enough money had the choice of opting to pay to go private, patients without the necessary means were left to languish on waiting lists, often in terrible distress and pain. Some even died waiting for vital treatment like heart operations. Many commentators seriously questioned whether a universal, free at the point of need NHS could survive.
Through unprecedented increases in investment and reforms, Labour transformed a service that had been on its knees. We left office with the lowest-ever waiting times – down from 18 months to a maximum of 18 weeks – and the highest-ever levels of public satisfaction with the NHS.
The situation Labour will face in 2015 is very different. While in 1997 ending unacceptably long waits for operations was the key health issue, the biggest challenge now is improving care and support for older people and those with long-term lifestyle-related conditions like diabetes, heart disease and dementia.
Public expectations are changing too. People increasingly want more choice, say and control over their health and care – just as they do over many other aspects of their lives.
We also face a dramatically different financial climate from that of 1997. While the NHS will always be a priority for investment under Labour, the kind of double-digit increases in spending we made when we were last in government simply will not be available, whatever the state of the economy and whichever decisions are taken about the public finances. So we will need to get the most out of every pound spent on the NHS and deliver the best possible value for taxpayers’ money.
Ensuring our care system keeps pace with changing needs and expectations, within extremely tough financial constraints, cannot be achieved through continuing to ‘salami slice’ existing services. Instead, these need wholesale reform.
As people are living far longer, their needs often become a complex blur of the physical, mental and social. Yet we are still trying to meet these needs in three essentially separate systems: physical health, predominantly through acute hospitals; mental health in often separate services on the fringes of the NHS; and social care in council-run services.
The result is a system that works for Whitehall, but not for people, and that wastes billions of pounds of taxpayers’ money paying for the costs of failure rather than preventing problems from happening in the first place. Too many older people are left isolated in their own homes, their families struggling between all the different NHS and social care services to get the support they need for their loved ones.
Without preventative care in the community or at home, elderly people and those with long-term conditions end up going into more hospital or getting stuck in hospital when they do not need to. Once there, many older people go downhill fast. Although their physical needs may be being addressed, their mental and social needs can be neglected if they are suffering from a condition like dementia or need help getting up, washed and fed. People with serious mental health problems, meanwhile, see their physical health needs neglected, dying on average 15 years earlier than everyone else.
Labour’s solution to these problems – ‘whole person care’ – is a radical shift to bring our health and care services into the 21st century.
Rather than three separate services treating different parts of a person, there would be a single service meeting all of a person’s care needs, integrating health and social care and breaking down the barriers between physical and mental health. A single budget for the NHS and social care would help shift the focus of services towards preventing people becoming ill and avoiding unnecessary hospital visits, with more care delivered in the community and at home.
In practice, whole person care means having integrated teams of NHS and social care staff – doctors, district nurses, community matrons, pharmacists, social workers, physiotherapists and occupational therapists – as is already happening in places like Torbay, Greenwich, and Edwinstowe in Nottinghamshire.
Instead of having to repeat their story to lots of different people, a single care coordinator makes sure people’s needs are assessed and a package of support put in place quickly and effectively. Some areas are going a step further, introducing a single phone number for people to ring if they or their elderly relative need care and support.
The experience of places like Torbay shows integrated care can achieve great benefits for users and taxpayers. Emergency bed day use for people aged 75 and over in Torbay fell by 24 per cent between 2003 and 2008 and by 32 per cent for people aged 85 and over. Delayed transfers of care from hospital have been reduced to a negligible number, and this has been sustained over a number of years.
However, integrating budgets, teams and services for the NHS and social care will not – on its own – be sufficient. Individuals, families and communities must have more say and more control over their care and support. This is crucial to ensuring that services are more responsive and personalised, and retain public support over the longer term.
People with long-term illnesses can play a major role in managing their own condition in the community or at home. Specialist nurses and new technologies can help patients take their medicines properly, eat the right diet, exercise, and check for early signs their condition is worsening before a crisis point is reached.
Personal budgets and direct payments also have a crucial role to play. Labour introduced these when we were last in government to give people more choice and a greater say over their social care, and between half and three-quarters of users say they have had a positive impact on most aspects of their daily lives.
However, there are still barriers to making personal budgets genuinely effective. Budget-holders often say the kinds of services and support they would really like are not available in their area. Some Labour councils like Lambeth in London are seeking to tackle this problem by bringing budget holders with similar needs together, so they can shape what is on offer from local providers. The council can then influence existing providers, or support start-up enterprises to meet new care and support needs, including in the voluntary and community sector.
There are also significant untapped resources in local communities that could be released with the right backing and support. Membership organisations like Circle and Shared Lives Plus help older and disabled people stay living independently in the community and at home. Circle members can call on a network of paid and unpaid volunteers to provide practical help with everyday tasks like shopping or DIY, and get involved with social events and activities. Shared Lives carers take people who need care and support into their homes and lives, either permanently, for short periods or during the day.
There is increasing evidence that boosting these kinds of local, trusted, neighbourhood relationships can make a real difference in tackling social isolation, improving people’s health and wellbeing, and provide more efficient services too.
Labour’s empowerment agenda must be for care staff as well as care users. Mutual organisations like Sunderland Home Care Associates have shown it is possible to boost skills and training, and reduce staff turnover and sick leave by giving employees a say through a share in the ownership of the company they work for.
Whole person care is Labour’s vision for an effective and sustainable 21st century care system. Integration, personalisation and empowerment are the means by which it will be delivered. This is a radical agenda, which offers people practical solutions to issues which are essential to their daily lives – and genuine hope for the future.
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Liz Kendall MP is shadow minister for care. She tweets @LeicesterLiz
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This article is taken from The Politics of Solutions, edited by Alison McGovern MP and Phil Wilson MP
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