Published by David Prior on 4 December 2014
- Our Work
- The Reformer Blog
3 December 2014
As we approach the end of this Parliament, the Opposition is leading the wider debate about the future of health and care. By endorsing full integration of the NHS and social care, Labour has opened up an enticing possibility: a single service for the whole person, meeting all of their needs – physical, mental and social.
With “whole person care”, we can start where people and their families want to be – in their own homes – and build out from there. This is a big change from the 20th century when we thought of health in terms of buildings and institutions. In the 21st century, the home and not the hospital should be the default setting for care. Wherever possible, people should be supported by a single team providing high quality, personalised care with the aim of helping them get the most out of life. It will finally make a preventative service a reality.
Of course, this is some way from where we are today. England has a fragmented health and care system, where physical, mental and social needs are met through separate, disjointed services. This disempowers people and is wasteful of resources.
People’s common experience is of a series of disconnected encounters with professionals, and the frustration of telling the same story to every person who comes through the door. As no one is accountable for the totality of one person’s care, people fall between the gaps and true accountability is hard to achieve.
A single service for the whole person opens up the possibility of a simple, but revolutionary, answer to this common problem: a single named contact for the coordination of all care needs. It is also one easy way to explain the difference that “whole person care” could make: for the increasing number of people in their 40s, 50s or 60s who live away from their parents and face the anxiety of making multiple phone calls to arrange their care, it will make a great deal of sense.
We need to look at powerful rights for individuals to pull the system towards a person-centred service, with more options for care in the home, with carers supported not ignored, and with equal value placed on mental and physical health.
The NHS Constitution already affords people some limited rights on waiting times and treatments. Various ideas have been suggested for how it could be updated. For example: the right to a single named contact for the coordination of all care; the right to an individual, integrated care plan agreed jointly between individuals, their families and professionals; the right for your carers to receive an assessment of their needs and to have respite care; and the right to give birth or to end life at home.
These ideas begin to illustrate the kind of changes that “whole person care” could make possible and what that might look and feel like to the public. And it also gets Labour’s focus where it needs to be – on services not structures. We don’t need new organisations; we simply need them to work together in a new way.
People will rightly question whether a system offering this degree of personalisation can be afforded. My response is that it is the status quo which can no longer be afforded. Today’s silo-based approach to the provision of public services is a luxury we can no longer sustain. Such is the medium term outlook for public spending that all professionals will need to open their minds to working differently and with fewer organisational boundaries. The simple premise behind “whole person care” and full personalisation is that the more we give people the support they are asking for – when and where they need it – the more likely it is to work and, therefore, be better value for money. It is providing care in an uncoordinated way that is so wasteful of public resources and is leaving increasing numbers of elderly people trapped in expensive hospital beds.
The biggest barrier standing in the way of Labour’s vision of a public, integrated health and care service is the Health and Social Care Act 2012. When the future demands integration, the Government has placed the NHS on a path towards fragmentation and privatisation.
The NHS is approaching a fork in the road. It either continues to embrace marketisation and fragmentation, with all the threats that entails, or it goes in the opposite direction and becomes more collaborative and integrated, so it can meet the challenges of the 21st century. The next election will decide which path it takes, and the decision will have irreversible consequences.
Rt Hon Andy Burnham MP, Shadow Secretary of State for Health
This blog was taken from an article written for the brochure that accompanied Reform’s major health conference on the 2 December 2014.