Under Labour’s plans, acute hospitals would be the lead providers of integrated care in many communities. Burnham’s ambition is to reverse the incentive to provide care in hospitals and care homes by giving integrated providers budgets that can be used flexibly to provide care in more appropriate settings. His vision is that hospitals would work closely with GPs, community health and care providers, and others to deliver more care closer to home.
The speech drew on the experience of integrated care in Torbay to illustrate the benefits of moving in this direction. As the Fund's work on integrating health and social care has shown, over a period of years Torbay has been able to shift care closer to home through greater integration of health and social care and the pooling of budgets. The core building block is the integrated health and social care team, which intervenes early to prevent inappropriate hospital admissions by providing access to enhanced intermediate care services.
The direction set out by Burnham echoes many of the Fund's views on the changes needed to build a health and care system that is fit for the future. The task now is to fill in the missing details in the speech and justify the claim that Labour’s plans will not involve major organisational changes.
One obvious question is where the NHS Commissioning Board – not mentioned at all in the speech – will fit into a system in which local authorities, advised by clinical commissioning groups, take the lead on commissioning. Will the Board’s responsibility for commissioning primary care and specialised services transfer to local authorities or Whitehall? And if so will it be abolished alongside Monitor to fulfil the commitment to ‘repeal the Health and Social Care Act 2012 and the rules of the market’? What then the price of no further structural reorganisations?
A further question is whether asking acute hospitals to lead the development of care that is based more in the community is the right way forward? The obvious risk is that hospital managers use their control over budgets and services to protect the status quo rather than to develop new models of care to support people in their homes. Torbay’s experience suggests that building integrated care around community teams aligned with general practices may be a better approach in some areas.
Two other challenges in taking forward the policy review will be fulfilling the promise to define the national entitlement to health and care and deciding how to fund social care on a sustainable basis. On social care, Burnham signalled that Labour is thinking beyond the proposals made in the Dilnot report and is considering both voluntary and compulsory alternatives. These include a compulsory levy on people’s estates – the so-called ‘death tax’ – as proposed at the last election.
Taken as a whole, the principles outlined in the speech bear many similarities to the position taken by the Liberal Democrats before the election. The question this raises is whether Labour’s policy review is the first step on the road to building bridges with the Liberal Democrats and creating strains in the government. Viewed from this perspective, the review has implications not just for the future of health and care but for potential coalition-building after the next election.
- Read our press release: The King's Fund responds to Andy Burnham's speech launching the Labour Party's health and care policy review
- See more of our thinking on NHS reform and integrated care
- Catch up with our Time to Think Differently debates and analysis