Andy Burnham's plan

This is a summary of our view of Andy Burnham’s proposals for health and social care. It isn’t authorised by him, or anyone else, so it may not be a fair representation of what he means.

  1.  We should start with the WHO definition of health . There should be better focus on prevention.Andy never really develops this idea, but we could and should – but the debate needs to be wider than the health community and talk about the determinants of health.
  • In the short term we should focus on housing for older/disabled people – something that he does mention
  • Economic inequality – is the Labour Party up for this?

We should no longer deliver mental health, physical health and social care separately.

    • Does this mean abolishing mental health and care trusts?

And social service departments?

  1. We will continue to have an internal market, but we may change the currency to move away from the reimbursement of episodes to other methods such as a year of care. We will create incentives for integration. We will move away from compulsory competition and Any Qualified Provider.
  1. Local Authorities will commission health as well as social care out of an integrated budget. Clinical Commissioning Groups will advise local authorities. There will be a national specification of what people are entitled to. It will be down to councils to decide how it should be provided in their area.
  • Will GPs be prepared to do this? They like being in charge. They didn’t much like the advisory role they had in the past
  • Are Local Authorities up for this?
  • Can this be done, given the EU rules about markets?
  • Definitional uncertainty is widespread in mental health and social care – can entitlements be defined?
  • The claims of acute medicine are very loud and compelling. Can we protect social care from the demands of the acute sector?
  1. We will move more care out of hospitals into people’s homes. District general hospitals will move into a new role as co-ordinators of care in their community.
  • Does this mean DGHs will employ all social services staff?  Most people using social care are not hospital patients. Is local government signed up to this?
  • If DGHs do this they are clearly not freestanding organisations, liable to commercial failure – so are they still to be Foundation Trusts?
  1. We will avoid as far as possible any more structural reorganization. We will ask the organisations we find in 2015 to work in different ways.
  2. The NHS will be the preferred provider of healthcare (he doesn’t say much about providers of social care) but there will still be a role for voluntary and commercial providers. This is a can of worms we have explored a  lot.
  3. Social Care should be free at the point of need. This should be financed by charges on the estate of the care user.
  • Are we just talking about residential and nursing care here, or is all social care for everyone to be free?
  • Even people who are cared for by the Ritz Hotel?  Or do they have to top up what the National Social Care Service will pay for?
  1. So long as there are separate financing arrangements there will be boundary disputes. Setting up an integrated health and social care budget creates new boundaries between social care and other aspects of LA funding responsibilities

21st Century NHS and social care: Delivering integration

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  1. John Band says:

    Andy Burnham’s ideas are far too vague to be credible. The role of GP’s and Social Services need to be spelled out. Taking responsibility for social care away from Social Services and giving it to local hospitals looks like a foolish leap into the unknown when most social care recipients have not been hospital patients. The whole thing is depressingly Blairite – good soundbites about democratic control, but no real substance.

    The 2000 pound number may be too low in areas with social deprivation or lots of old people and unnecessarily generous to prosperous areas. Maybe it should be flexible up to 2500 based on need, but “Means Tested” against local authority revenue bases. So a North East England district with many old people and social deprivation would get the full 2500 with no claw back. Eastbourne, with old people and little social deprivation might have an “Entitlement” of 2250 pounds, of which the government funds 1750 and the local authority 500 because of its strong revenue base.

  2. Martin Rathfelder says:

    The figures are just illustrating scale of the operation. £2000 per head is approximately the NHS budget in England.

  3. Matthew Prior says:

    This is a great set of values to work with. Andy’s hands are tied as he doesn’t want to reorganise again even after the mess the Health and Socal Care Act has left us with. The philosophy of care being physical, mental and social should be at the heart of medicine and therefore the system should reflect this and it is a good example of integrated care. Abolishion of the tariff and PBR in my opinion is the only way to driive an improvement in whole person care rather than payment for number of operations, but we need to consider its impact on efficiency.

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