Can we learn from this loathsome reptile the way to have a debate on health by doing the exact opposite of what he does?!
No, I haven’t quite taken leave of the few senses that I have when I suggest that we can look at the United States and learn from the way they are conducting their health debate! The way they are handling it is so bad that perhaps we can hope that by doing the exact opposite we might find a British way forward.
In a nail-biting vote last Friday morning the US Senate voted against a move to scrap Obamacare. Much attention was focused on Senator John McCain. But his vote was the final one of three that kept Obamacare in place. With the Democrats voting 100% for the retention of Obamacare it was the two women senators from Alaska and Maine that really advanced the arguments for good health care for all. They pointed out that it is the poor and especially women who suffer when the state fails to provide health care. They pointed out that planned parenthood activities would particularly suffer.
They argued against an ideology about health which threatened any logical debate about health itself. Significantly the USA is the only developed country where the state does not take the lead in providing health care for all its citizens. The biggest argument seemed to be whether or not Obamacare is damaging the health insurance market. Markets should not be the prime consideration or even a consideration when looking at health issues. The USA spends far more of its GDP in health but has one of the worst outcomes in the developed world.
There are many reasons for this but one of the main reasons is the cost of the bureaucracy, the cost of running parallel services and the cost of claims and litigation. It is difficult to work out how much money actually gets spent on health and how much is drained out of the system by hangers-on and profit.
In many ways, the level of debate in this Country is little better. We argue about the amount of money that needs to go into the health and social system. Every election we conduct an ‘arms race’ to try and show how our lot will try and spend more than their lot! But there is very little discussion of the changes that need to be undertaken to improve a system which is creaking at the seams, which needs change more than it needs more money and where society as a whole has failed to come to terms with what increased life-spans mean to the way that society run.
The Community Wellbeing Board of the Local Government Association Board recently received a personation about the financing of the Health & Social Care Services. The presentation showed that since the financial year 2003/04 the spending in the NHS had increased in real terms by 71% whilst spending on Public Health and Adult Social Care had flatlined. The flat lining includes the recently announced extra £2 billion and the precepts which English Councils have been a lowed to raise. Even allowing for the next precept rise next year there will still be a £2.1-£2.3 billion social care deficit by 2020/21.
It seems obvious that the solution lies not in putting more money into the health services but intervening differently in the health/social care life continuum. Looking at two facts from the NHS. At any one time about 10% of beds in hospitals are occupied by people with type II diabetes. This is almost entirely avoidable and is caused by people eating and drinking either the wrong stuff or the wrong amounts and/or not taking enough exercise. Obesity itself costs the NHS £6.1 billion each year. This is entirely avoidable for the same reasons as Diabetes II
At the other end of the spectrum it costs about £550 to keep someone in a hospital bed for one night. Yet it only costs about £650 a week to provide top quality care in a residential home or less for good quality domiciliary care. It is blindingly obvious that huge amounts can be saved, over time, by stopping people becoming ill and getting them out of hospital quickly. Yet these are the areas that have been least supported by Government.
Putting more money into the NHS is needed in the short term but only if it is to give a respite for demand whilst attending to the two local government priorities. Yet it is not only money that is required but a culture change. We need to engage intelligently with the public about the life long social care/health care continuum. We need to establish new grounds and levels at which we take responsibility for our own lives, our children’s lives; our relations’ lives and our community’s lives. We must do more to help ourselves and each other and not rely on an NHS which will run out of money or a new pill or procedure which will become ever more difficult to find.
In the short-term we need to increase the money we pay for adult social care in both residential and domiciliary care. That will deal with poor conditions, chronic under investment and the poor pay for staff which leads to a huge staff turnover (which will get worse because of Brexit for several reasons). In the longer-term innovation is required in the way that we support families at crucial life-changing points; provide housing that is appropriate for all needs and look at the social interactions which can make a person’s life passable or great.
None of this can take place without having a great debate with the people of the Country. We need to show how current perceptions of what the NHS and councils can do is unsustainable given the changing demographics. We need to help people understand their roles and responsibilities. We need to support them with laws and regulations which will limit access to products, practices and lifestyles which ultimately cause them harm and wreck our financial systems.
The Parties in parliament are too myopic and inward looking to retreat from hard ideological nonsense and false promises to always fund everything that is needed and possible. If we cannot expect all-Party co-operation from them then the LGA must provide the necessary leadership. I believe that the Local Government Association must take the lead in raising the standards of national debate. We work across Party in what is for the most part a pragmatic way looking for practical solutions. Our Councillors and our Councils must become the agents for change without which our much-loved health service will inevitably crumble. We can do this in three ways:
- Offer to work with the Health and DCLG Select Committees to examine and spread the message of the need for change.
- Offer to work with the 20 MPs of all Parties brought together by Norman Lamb who together went to meet the Prime Minister.
- Campaign within our communities for a full and long-term debate about the health and social care continuum and how every single one of us must play our part in doing things differently to care for ourselves, our family, our community and our locality.
Some may say that this is not the job of local councils and their councillors. I disagree. The Health Service was able to get going so quickly in 1948 because it brought together many initiatives that were already being run by local government. For decades, local government was the National Health Service. If the national parties cannot work together for the public good to change our health and social care culture then local government must step into the breach. We have the experience, pragmatism and local knowledge to do this and to do it well. Let’s get on with the job.
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