Nick Clegg is a very nice person. He is very loyal to people (which is probably why he puts up with me!) But he is ever so wrong about Lansley. Lansley must go because he has failed to explain his ideas and crucially has failed to start the strategic debate on the Health Service that this country needs. To be fair to Lansley this is not easy. For years politicians of all parties have failed to look at the looming problems overshadowing the Health service caused by increased demand; increased expectation; increasing numbers of elderly; and increasing cost of technically advanced treatment.
The only ways that all these increase can be dealt with is either by a massively increased tax bill with the cost of the Health Service rising to 50% of all current tax take by about 2030 or by massive changes in the way it does business.
So what are the details of some of the problems?
- We are living longer and longer but not healthier and healthier. 25% of all people in hospital over the age of 60 are suffering from dementia. That is not necessarily why they are in hospital but it makes a major change to the way that they are treated and the cost of that treatment. That is almost entirely caused by the fact that we are living a lot longer than our once allotted 2three score years and ten”.
- We could say that we don’t really have a National Health Service but much more a National Illness Service. Investing money in stopping people becoming ill is better for them and cheaper for the tax payer. We already know that costs will rise because of the increase in teenage obesity and young people binge drinking. Their bodies are already badly damaged and no wonder medicine will put them right.
- Linked to this is the need to put Public Health firmly back where it belongs as part of a suite of activity provided by local councils and their local partners. Public Health is not just about vaccinations and pandemics. It is about education, housing, parks, fitness centres, youth centres and all the work that we do.
- We have to deal with the centralisation issue. If the general aim is to get people to live longer and live healthier then we need to let local decision making decide how to achieve that because local circumstances differ so much. Of course we need to spend more on some things than others if people are dying of different things.
- We need to look at health in the round. Some major health gains and cost saving can be made by doing things like imposing a decent minimum pricing policy for alcohol and controlling advertising of unhealthy foods to children. Governments of all, persuasions have done far too little, far too late in such matters and are clearly in thrall to the money of the big producers.
- Lastly we all need to be more honest. There is not a politician in the country unless they are very new to the business that has not campaigned to keep open facilities that are old, broken, and expensive to put right and delivering poor clinical outcomes. In London alone there are 17 hospitals that fit the bill.
We are where we are. Much of the politics about this Bill has been dishonest. It will, not for example, lead to more privatisation any more than the last 3 reforms were undertaken under Labour with similar suggestions of privatisation. The private sector is already a major part of the Health Service. I pay for my glasses and for my teeth to be done.
Unusually many of the changes that will be required by the Act have already been carried out whilst it is still a Bill. People have left the Health Service, departments and bodies have been closed down, budgets have been reallocated and increasingly people are saying that the point of no return has been passed. It would now cause more damage to withdraw the Bill than pursue it so let us prepare for the future.
Councils should be in the lead of making sure that things happen to give us good outcomes. They:
- Are responsible for the Joint Strategic Needs Assessment which they should be pushing across all providers of public health and not just the pure health sector
- Should be joining up providers around the needs of the community through strong action within the shadow Health and Well being Boards
- Should be working with the Clinical Commissioning teams to ensure that these are functioning well and able to take a wide range of decisions to join up commissioned services better for the patients
- Should be working inside individual neighbourhoods to ensure that GPs and other local health providers work in partnership with the public, private and third sector organisations also working with patients.
Whether we like it or not we have to make the Act work. The time for talking, fighting and politicking is over. The time for action is upon us.
Oh and as Andrew Lansley leaves the office could he leave a note for a new competent and fluent Health Secretary like David Laws to wish him well!!