Labour's 10-year plan for health and social care: a bold and compelling vision?

The launch of Labour’s 10-year plan for health and social care by Andy Burnham, Shadow Secretary of State for Health, at The King’s Fund yesterday was a totemic moment. Almost two years to the day that, in the same room, he first outlined his vision for whole-person care, his speech was warmly received, with most questions seeking more clarity and detail rather than challenging the fundamental principles behind the plan.

Much of the plan is not new – the idea of a national care and health service can be traced back to the 2010 White Paper on the same subject, when Andy Burnham was in the driving seat as Secretary of State for Health. And the main planks of whole-person care have not changed since his 2013 speech, notably the development of local authority-led health and wellbeing boards as the single commissioner overseeing a single health and care budget, and the encouragement of local integrated care organisations.

But the thinking has moved on – Andy acknowledged the influence of a number of reports in shaping the plan, notably two independent commissions led by Sir John Oldham, and the Commission on the Future of Health and Social Care in England led by Dame Kate Barker. But in several respects Labour’s plan marks a decisive break, not only from the policies of other political parties, but from Labour’s approach when in government.

This is most striking in the unequivocal rejection of markets in the NHS – though not apparently the separation of commissioning and provider roles. The role of NHS bodies as preferred provider will be restored, and new legislation to replace the Health and Social Care Act 2012 will seek to exempt the NHS from European Union procurement and competition law and from international trade treaties such as the Transatlantic Trade and Investment Partnership (TTIP). This will mean a different role for Monitor (but clearly not its abolition). There was a fresh emphasis on locally driven ways of achieving whole-person care – the role of the government and the centre is to spell out the ‘what’ not to prescribe the ‘how’. Local government will like that.

There are specific proposals for the introduction of ‘year of care’ budgets for people most at risk of hospital admission and a new role for the ambulance service as an integrated provider of emergency and out-of-hours care, taking on NHS 111 contracts as they expire. An amended NHS constitution will give people new rights – to care co-ordination, a personal care plan, better support for carers and to give birth at home or to die at home. The absence of any reference to personal budgets in the speech suggests Andy does not share Labour health team colleague Liz Kendall’s support for this aspect of personalisation. The social care world will be heartened by the recognition of its centrality in delivering good health and care and the unacceptability of the low pay, low skill, casualised employment practices that besmirch the reputation of the care sector.

But there are vital elements of Labour’s vision that still remain cloudy. If the intention is to de-clutter the organisational landscape by having fewer (but more integrated) organisations, how will be that achieved without further reorganisation? If health and wellbeing boards evolve into the single commissioner, what role does that leave for CCGs? It defies credulity that change on the scale implied by the plan can be achieved with no organisational change at all. The definition of ‘reorganisation’ looks set to acquire unprecedented elasticity. The creation of a universal re-ablement service staffed by 5,000 new home care workers employed by the NHS begs many questions about how this will co-ordinate with burgeoning and increasingly effective re-ablement services offered by local authorities. There are a myriad of other questions of this sort.

The biggest elephant in the room is how Labour’s vision will be paid for. Labour’s proposed £2.5 billion Time to Care Fund gets nowhere near the funding gaps facing the NHS (£8 billion) and social care (£4 billion) by 2020. And although the commitment to tackle low pay in social care by the end of the next parliament will be warmly welcomed by commissioners and care providers, this too will come with a hefty price tag.

These are serious questions; nevertheless, the speech described a bold and compelling vision of a different kind of health and care service fit for the 21st century, delivered with conviction and passion. The direction of travel towards integrated care is undoubtedly right. Whatever its imperfections and gaps, it throws down the gauntlet to other political parties to set out their own prospectus and policies. We will be pleased to offer them a platform to do so.

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Comments

#511414 mike tremblay
health policy advisor
Cassis Limited

Hardly bold and definitely not compelling. Just more of the same statist logic that gets in the way of people solving problems. Greater organisational flexibility, ability to move money and resources across service boundaries (check how other countries integrate health and social care for instance) with less overhang from hyperactive politicians would go a long way.

I doubt Labour will accept the What/How dichotomy. They use this as a bludgeon in the House to find nails to hammer down with their one trick policy hammer. Until they lose their nervous twitching to new providers challenging legacy providers or existing provides trying to escape the box the NHS rules keep them in, evolutionary and responsive new forms of care won't take root and we won't get integrated care in any form that will provide long term benefits to patients.

The solutions are out there.

#516301 Jane
member of the public
England

" If the intention is to de-clutter the organisational landscape by having fewer (but more integrated) organisations, how will be that achieved without further reorganisation?"

Of course some reorganisation to roll back the worst of the damage put in place by the HSCA will be needed.

And it is disingenuous to suggest that only Labour would reorganise given what Simon Stevens wants to do with the Five Year Forward View.

In view of the undisputed financial and organisational crisis which now besets the NHS as a direct result of the coalition's failed market experiment, the repeal of the Health and Social Care Act 2012 cannot come a day too soon.

#543490 Joan Smith
carer to my husband John 15 years
none

Why are they putting people into boxes? asking them to take on all the responsibilities of employing and paying for care. This is wrong to make people do this. No one talks about continuing health care here! Managing budgets and finding and employing carers is a mine field. Most families members have their own money worries too, this can only break up families. Or is it to wear them down and our loved ones end up in care homes, and treated and killed off before their time, a lot of that goes on in this country! All it seems to me is the authorities are just passing the butt!!!
I would like to see a discussion about vioxx and it's connection with dementia, no one seems to have heard of it.

Mrs Joan Smith

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