Last week was a dramatic one in British politics, and one in which a number of major events and announcements did not get the publicity they deserve. One such event was shadow Health Secretary Andy Burnham’s speech to the King’s Fund, which represented a groundbreaking change in Labour’s health policy. In the speech, Burnham said that a Labour government would seek to combine budgets for and delivery of physical health, mental health and social care services. The integrated approach- termed “whole person care”- would see a £119 Billion budget being allocated to institutions with much greater input from local councils, which currently have responsibility for social care. The stated logic behind the concept is that the artificial separation of these three services is becoming increasingly untenable as demographic change pressurise the three. An aging population needs joined up thinking to care for growing numbers of patients.
The proposals have attracted criticism from the Government, which says that they would undermine the newly established Clinical Commissioning Groups- the consortia of GPs which now “purchase” health services for their patients under the deeply unpopular Health and Social Care Act, criticised as representing “NHS privatisation by the back door”. However, with Labour adopting a much trumpeted policy of repealing the Act as soon as possible, such groups will cease to exist. The matter is somewhat confused by Burnham’s assurance that “our fragile NHS has no capacity for further top-down reorganisation”. Undoing the largest step towards marketization of the NHS and the institution of whole person care are both, by definition, re-organisation. And finally, they are welcome re-organisations designed to benefit patients, not corporations or managers.
Labour has said that it wants to view health and care “from first principles”. That is, the principle that the best care possible should be provided to British citizens regardless of their ability to pay. It is therefore right to question, through that prism, if the complex system of commissioning groups, hospital trusts, quangos and outsourcing firms is a system that is as patient-centric as it ought to be. Above all, the role of for-profit service firms in the NHS should be scaled back as much as possible.
When making his leadership bid for the Labour Party, Andy Burnham’s key policy was a manifesto commitment to introduce a National Care Service: an organisation providing free universal care to the elderly. Two and a half years later, in a less senior role than he once sought, Andy Burnham adopted a more cautious tone. Under whole person care, the NHS would be likely to run some care homes, for example. But he said that his party would consider the extension of the universal principle to social care, challenging supporters of the idea to explain how it should be paid for.
If the “artificial” boundary between health and social care is to be abolished, then how can we defend the outright medieval notion that the vulnerable elderly, often people who have worked hard to raise a family and to pay their pay for 40,50, or even 60 years should be liable for their care needs? In his speech, Andy Burnham delivered a message of hope, something that is all too rare when the future of our public services is discussed. He can go even further and promise that our NHS, an institution of which we can be intensely proud of as a nation, will extend free assistance to all who are in need in the form of social care as well. One more great injustice can be corrected by a society with a caring philosophy, a society prepared to contribute a little more so that we’ve all less to worry about in our old age. Whole person care is about more than health.
