This week Andy Burnham published Labour’s 10-year plan for health and care. While warmly welcomed by professionals in both fields, there were some murmurs of criticism that Labour’s approach to health was not sufficiently radical and a rather sterile media debate about the precise level of private sector involvement in a Labour National Health Service.
The size of the private sector playing a supporting role in a Labour NHS is not the big issue at stake. The core challenge is integration. The challenge has always been to define what integration of health and social care really means, what tangible patient benefits it will bring and how it can be delivered. Labour’s 10-year plan for health and care is really about confronting this and it’s a shame that commentators are getting bogged down in the wrong debate.
The real policy leap outlined this week is to aspire to a social care system that works seamlessly with the NHS for people who are old and frail or who have complex long term conditions. The 10-year plan rightly focuses on those groups of patients for whom a fragmented approach most fails, and where costs of this failure are tied up. Year of care budgets are designed to shift the way the money flows in the system from picking up crisis costs towards preventative and effective care.
It also plots a new journey towards parity of esteem for social care, for so long starved of adequate funding and little understood by the public. Crucially, the proposals set out that the precise design of new systems and the pace of change must be driven locally in response to local needs with responsibility resting with health and wellbeing boards. This fits with the direction of travel set by NHS England’s five-year forward view that argues for different models of care to match local circumstances. It also echoes the new relationship between local areas and the centre that local government is trying to broker with Public Health England – clear national ambitions for health but real local autonomy over how to deliver.
The transfer of public health responsibility to local government is already leading to more joined-up working and an emphasis on equity of access and rigour in contracting that needs to spread throughout our health and care system. In addressing the health of the public, councils are demonstrating, not asserting, that local relationships, knowledge and ambition are key to effective public service delivery. Some have expressed reservations about the ability of health and wellbeing boards to take on this sort of whole system commissioning. The evidence shows that when local government is given new responsibilities, it takes them seriously and it does them well. In truth, where health and wellbeing boards could be doing more to drive integration effectively it is because they lack the levers to do so as commissioning is currently held by the clinal commissioning groups, who must simply ‘have regard’ to needs assessments. The better care fund has proved a distraction that brings no new money and pools sums too small to catalyse fundamentally new integrated ways of working.
For people with the most complex needs including people with a number of conditions and frail older people, the way we have run things for the last 60 years has made less and less sense. Avoidable waste and human misery has been caused through a failure to invest in prevention and a system that means people have to deal with a range of different professionals all reporting to different organisations and driven by conflicting incentives.
It will not be easy and at this stage we cannot expect every detail to be ironed out but at last a credible road map for integration of health and social care has moved from the pages of a think tank report to the manifesto of a party preparing for government. If that is not radical change I do not know what is.
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Jonathan McShane is cabinet member for social care on Hackney Council and is on the LGA Community Wellbeing board. He tweets @jonathanmcshane
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