Labour has proposed the merger of health and social care budgets to stop patients “falling through the cracks”.
Shadow health secretary Andy Burnham outlined the party’s new vision saying the fragmented system was no longer fit-for-purpose and pledged to consolidate health, social care and mental health services.
Speaking at the King’s Fund, he launched a consultation on how to tackle the key challenges facing the system including an ageing society, rising numbers of people with co-morbidities and financial pressures.
“The exclusion of the social side of care from the NHS settlement explains why it has never been able to break out of a ‘treatment service’ mentality and truly embrace prevention. It is a medical model; patient-centred, not person-centred,” he said.
In government, Labour would “legislate for a one budget, one service approach” and extend the integrated model used in Torbay.
In time, local authorities would take over more responsibility for commissioning health through HWBs, overseeing over £60bn. Health and Wellbeing Boards would become the “pre-eminent” decision making bodies for health and social care; CCGs would be advisors only.
Burnham said: “The challenges of the 21st century are such that we need to make a shift to commissioning for good population health, making the link with housing, planning, employment, leisure and education. This approach to commissioning, particularly in the early years, begins to make a reality of the Marmot vision, where all the determinants of health are in play. Improving publich health will not be a fringe pursuit for councils but central to everything that they do.”
Local authorities will have the flexibility to spend their funds as they wish but will have to meet national standards and entitlements set out by the Department of Health, and underpinned by the NHS Constitution.
He said: “In the same way that Andrew Lansley should have refocused PCTs and put doctors in charge, I will simply re-focus the organisations I inherit to deliver this vision of whole-person care. Health and Well-Being Boards could come to the fore, with CCGs supporting them with technical advice. While we retain the organisations, we will repeal the Health and Social Care Act 2012 and the rules of the market.”
He added: “It is a confused, sub-optimal piece of legislation not worthy of the NHS and which fails to give the clarity respective bodies need about their role.”
Integrated care organisations could be created by either acute trusts being commissioned to provide whole person care or by primary care services evolving into the role. And the reins would be placed back on private sector competition, with local trusts being the ‘preferred provider’ for hospital, community and social care services.
Burnham said: “If we look around the world, market-based health systems cost more per person not less than the NHS. The planned nature of our system, under attack from the current government’s reforms, is its most precious strength in facing a century when demand will ratchet up. Rather than allowing the NHS model to be gradually eroded, we should be protecting it and extending it as the most efficient way of meeting this century’s pressures.”
Long-term conditions or complex case needs would receive ‘year of care’ funding rather than payment by results to shift the incentive from treatment to prevention.
Furthermore, Labour would lower the cap on proposed social care expenditure by individuals from the Coalition’s £75,000 per person to something nearer Dilnot’s proposals i.e. £35,000.
Read the speech.