When Liberal MP William Beveridge wrote the seminal report on the development of a National Health Service, which Labour then implemented, the health conditions and the type of society were very different from those of today
The Prime Minister has basically said two things two weeks ago about the NHS but crucially left unanswered questions about social care last week.
- She has said that there will be £20 billion more and appears to have dropped the claim that some of it (or any of it) will be a BREXIT dividend. She has not said where the money will come from.
- There will be a rolling back of many of the Lansley elements of localism including CCGs that were contained in the 2012 Act. She has not said what will come in their place.
The money is, of course, very welcome but we all know that unless there are system and cultural changes the money will be swallowed up. Since she announced it the suggestions as to the source of the funding have unravelled. The idea that it would come, in part, from a Brexit premium were rejected by everyone within minutes. One part of the Tory Party has said that it cannot come from increased taxes whilst another part of the Tory Party has said that I can only come from increased taxes! The Labour Party sits there like three unwise monkeys and just says more money is needed but like the Tories does not say where it should come from or how it should be spent.
There is a general agreement changes need to be made in the way the NHS is run because it is not efficient in itself and it does not efficiently provide a care pathway which involves the other players. So, all in all there are more questions than answers in the Tory announcements. The fact that the Adult Social Care Green Paper that was promised for last summer and then this summer is now being postponed until the autumn means that the Government has either failed to see or is ducking the challenges of the care pathway. It all looks too difficult for them.
Both the Government and the Labour Party have also failed to say how the NHS will staff both the services given the reduction in the number of health professionals wanting to come here and the increasing numbers wishing to go home.
My challenge to the Liberal democrats and anyone else reading this blog is, “are we bold enough to challenge the way that the NHS is being run and the way it allocates money”.
Good health involves three sections:
Keeping People Healthy – the role of Public Health and Primary Health Care. This gets about 15% of the health budget. But these areas of work get a lot more support than that. People’s encounters with the NHS are massively educed by the social determinants of health such as poor housing; poverty; lack of exercise; poor food and drink.
Healing the Sick. The role of acute care hospitals which are output and not outcome driven and which consume 80% of the cash. This is the NHS function which most people think about.
Preventing recurring illness and keeping people out of hospital. Largely the responsibility of Councils accounting for some 5% of NHS budgets but almost all the adult social care budgets of councils.
I believe the Lib Dems need to make three statements:
- That the prime responsibility of a civilised country is not to make people better but to stop them becoming ill.
- It will therefore:
- shift money within the system towards public health and primary health care to improve the health of the populations as a whole.
- Invest more in actions to improve the social determinants of health such as housing, the environment and employment.
- It believes that the only way to tame the NHS behemoth is to localise decision making using parameters of the NHS but making decisions within a democratic structure provided through councils and/or regional mayors and authorities .
I think that our Party and the people of the UK more generally urgently needs to consider this because;
At present no-one has a persuasive long-term strategy respond to needs of the challenges of health and social care; and
Lib Dems are about to produce a policy paper related to devolution which could really be strengthened by the inclusion of a move towards the Manchester model of health service control. Manchester is an exemplar of what could and should be done (You will appreciate that this is not something that is easy for a Scouser to write!!)
In the mayoral and combined authority model unique to Greater Manchester many of the decisions on the application of money within the NHS and its linkages to social care are made locally. To make the changes necessary they received £0.5billion to transform services with up front investment. This is leading to better decisions with better outcomes for patients and the community generally and an increased efficiency in the NHS. Crucially, there is a much greater acceptance of the need to keep people healthy by concentrating on the social determinants of health and the upstream provision of series that keep patients out of acute institutions.
You might not agree with these conclusions. That’s fine but if you don’t you have a responsibility to put forward alternatives to them. Society has change dramatically in the 70 years since the NHS was established. We are less likely to live in family groups and more likely to live much longer. We are less likely to die from industrial disease; injuries and smoking and more likely to die from obesity and cancer.
As the needs change so must the model. If we just spend £20 billion doing more of the same it will run out – it will never be enough. If we could use the money instead as a transformation fund to keep well and get them home again quickly when they have been ill there is just a small chance that the principles behind the health service can be saved and with it the health of the people of the UK.