In July we celebrated the 65th Birthday of the NHS, established by Labour on 5th July 1948. On 5th July 1948 all households received a leaflet informing them about the new NHS, and advised that “everyone-rich or poor, man, woman or child can use any part of it.
There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness”.
The 1948 “settlement”, groundbreaking though it was, did not include social care and could not have anticipated a population living longer, and advances in treatments.
A 21st Century NHS and Social Care –delivering Integration
The Labour Party has undertaken a root and branch review of its health and care policy, consulting about the vision of a fully integrated health and social care service – based on the tighter fiscal climate and that there is no capacity or desire for further top down reorganisation. It’s clear therefore that any changes will need to be delivered through the organisations and structures we inherit in 2015.
Whilst the Commonwealth Fund – the independent US based health policy think tank rated the NHS as one of the best, most efficient health services in the world, [The only health system in the G8 providing health care to a whole population for under 10% of GDP] the health service can only deal with part, not all of a persons needs.
People are living longer, more with long term conditions, chronic disease and mental health problems. Currently physical, mental health and social care needs are treated separately.
Labours “new settlement” proposes a single service that sees the whole person, uniting physical, mental and social. Labour has led this call and many commentators now echo the drive for integration between services. Labour has made it clear that it will repeal the Health and Social Care Act 2012, which currently would block this integration as “anti-competitive “.
Whole Person care starts with the individual and the support they need to keep them where they want to be –at home with the family, where possible.
Currently there are perverse incentives in the system – with care failing at home the NHS has to pick up the bill. Can we move to an all in system, extending the NHS principle to all care?
Labour has proposed initially using half of any NHS under spend -recently this amounted to £1.2bn – to ease the crisis in social care, a root cause of current A&E problems.
This under spend would allow 70 million extra hours of home care for next two years, or home care for an extra 65,000 older people each year.
Some 70% of the cost and activity in the system is from people with multiple conditions which cross organizational boundaries, they are the people who most frequently end up as emergency admissions and it is just not great for them, their families, or their care.
Labour`s plans to draw health and care together would help provide a more sustainable service, reducing demand for hospital services by offering care and support in the home, whilst critical of the terms, conditions and status of staff working in social care settings, including zero hours contracts.
The Shadow Health Team has held Regional Policy events in all ten English Health Regions with feedback provided as submissions going to our Health and Care Policy review., and “21st Century NHS and Social Care : Delivering Integration” has been produced as a policy paper by Labours Health and Care Policy Commission, following consultation on the challenge paper.
Questions asked include:
-do you see merit in this vision of Whole-Person Care, & support the proposals for the full integration of health and social care?
– If you do, how far down this path of integration do you think we should go-is it time for full integration of health and social care?
– How do we tackle the issue of funding for social care-a voluntary or all-in option and how could we do this?
– What should be the role for local government, working in partnership with CCGs on commissioning with a single budget?
Submissions to the challenge paper show that the direction of travel is the right one. There is clearly more discussion to be had on how a future social care system should be funded, on the role of local government, and on the link between housing as a determinant of health and other issues.
What’s not in doubt is that health and social care will look very different at the 75th Birthday of the National Health Service.
Harry Clarke is an Executive member of LFIG; Chair LFIG Health Policy Group; A Vice-Chair of the SHA and a Friend of the Aneurin Bevan Society
Note: Our October issue will feature a post-Labour Party Annual conference article on a 21st Century NHS by the Rt.Hon Andy Burnham MP, Shadow Secretary of State for Health