The chickens have well and truly come home to roost. It is hardly surprising with an ageing population that demand for health and care would grow. Coupled with increasing expectations and rising costs, the growing demand has led to a crisis in both the NHS and social care.

The problems are now well known. But the government response has been pitiful.

The consequence of massive spending cuts by local authorities was bound to be huge cuts in care. There are more older people but significantly fewer older people are getting any care and support as councils tighten eligibility criteria. Help is now focused on crisis intervention and the government has shifted responsibility onto older people and their families.

At the same time the NHS is facing a crisis in emergency care, triggered by the lack of support in the community, from GPs and in older people’s homes.

So what has the government been doing over the last five years, apart from cutting funding? Fiddling while Rome burns, it seems.

On the NHS, the government’s big solution was clinical commissioning groups. On care, it has been the cap on care costs alongside a raft of measures in the Care Act, most of which have yet to come into effect. Even the Better Care fund has been slow in taking off.

The government has not addressed the real issues which in short are: under-resourcing (funding and human); lack of integration between health and care; and failure to bring services much closer to where people live.

The solutions are also inter-linked. The whole system has to be addressed to make real progress.

More funding is crucial. But we also need to ensure that health and care are funded in the same way, through taxation with services delivered free at the point of need. If this doesn’t happen integration will always be hampered.

Integration has to cover physical, mental and social needs, as Andy Burnham has argued. One body locally has to lead on planning and commissioning care and health services for the local population.

The focus has to shift to how we help and support people, particularly older people, to stay in their own home, rather than hospital or residential care. We have to help people much earlier and we have to help them take control of their own health and care.

Just one example. In North Norfolk we have seen a consistently under-performing ambulance service which with tightening resources can’t deliver the response times that our ageing, rural communities need let alone meet national targets. The answer is not just more ambulances to take more people to the region’s major hospitals. We need better access to GPs, better support in the community to prevent greater needs and support people socially, and better local urgent minor treatment centres.

There is a wide-ranging consensus for integration, but it needs to be local and it needs to be under-pinned by integrated funding. This of course is still quite a technocratic debate.

The challenge for Labour in the run up to the election is about communicating a clear narrative along these lines: the NHS is under huge pressure because of growing demand, higher expectations and rising costs; it needs to be better funded, we can afford it and it is a Labour priority to do so, but the NHS and care systems also need to change to support more, particularly older, people at or closer to their home and not in expensive hospital/residential care.

Finally, of course Labour needs to say how it can be afforded. We are still one of the richest countries in the world. With effective and fairer taxation and different priorities, we can find the resources to create an enduring national health and care service fit for the 21st century.


Stephen Burke is director of United for All Ages and and vice-chair, North Norfolk Labour Party

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  1. This may throw some light on the chaos created by politicians since the seventies.

    Closure of 22 hospitals cause of Gloucestershire A&E crisis – says activists 38 Degrees
    By CitizenNews | Posted: February 02, 2015

    Gloucestershire Royal Hospital
    Gloucestershire Royal Hospital
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    THE closure of 22 of the county’s hospitals is responsible for the recent crisis at Gloucestershire’s A&E department, according to campaign group 38 Degrees.

    Gloucestershire Royal and Cheltenham General Hospitals declared a 10-day major incident on January 4 due to an influx of patients during the festive period and a lack of beds.

    According to 38 Degrees activists, more than half of these delays were caused by beds not being available at acute trust hospitals, community hospitals and nursing or care homes where patients were waiting to be transferred.

    An investigation carried out by the group suggests the reason for the lack of beds in the county is a direct result of the closure of 22 hospitals in the area in the last 40 years.

    David Perry, of 38 Degrees, said: “Is it any wonder that patients are stuck in the few remaining hospitals?

    “NHS authorities repeatedly tell us that bigger hospitals are more efficient, but how can this be true if it results in exit queues at A&E and the whole hospital intake and transfer system seizing up as a result.

    “The hospital’s trust has avoided challenge from the public by naming wards in the large hospitals after the hospitals they are closing to make out that they have only been ‘transferred’.

    “At other times, as with Battledown in Cheltenham, they have simply bulldozed through closures ignoring public warnings of the consequences.

    “If the political parties talking about integrating the NHS and social care really mean what they say then bring back our small convalescent hospitals and homes.”

    A joint statement from NHS Gloucestershire Clinical Commissioning Group, Gloucestershire Care Services NHS Trust and Gloucestershire Hospitals NHS Foundation Trust said: “It is important to stress that the way healthcare is provided has changed over the years with many more procedures now carried out as day cases and many more services provided in the patient’s own home with the support of highly skilled health and social care community teams.

    “Substantial investment of nearly £4million has gone in to these community teams this year.

    “Some of the specialist hospital services described have been brought together on single sites.

    “But we have also seen a huge investment in community hospital services with three new hospitals and a community clinic built and opened in the county since 2011.

    “During periods of high demand, such as winter, additional beds can be made available in local hospitals or commissioned from other providers to ensure we meet the needs of patients.”

    Read more:
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