Why Andy Burnham is Right about an integrated Health and Social Care

This rather excellent article in the Telegraph of all places, bravely tackles the real issues facing the NHS, free from spin and political point scoring.

It highlights Andy Burnham’s driving passion to integrate Health and Social Care in the UK. A genuine perusal of the OECD health stats released last week make challenging reading for proponents of both private and public healthcare. There are no easy answers neither solution offers a golden promise of a better tomorrow. What shines through however, as Mary Riddell rightly points out, is that the NHS does what is does remarkably well for less money than most developed nations. Not even in the Top 10 for Health spending, with fewer hospital beds and staff, the NHS manages to be the most equitable health service in the world and one of the most efficient.

How has the NHS pulled off this extraordinary challenge, repeatedly through decades of underfunding and ill thought through “reforms”?

It can only be attributed to the unfailing loyalty and support shown by staff and patients alike. We WANT the NHS to succeed. We work harder, cram in more and at times seem to pull off a miracle close to feeding the five thousand with a few loaves and fishes.

Burnham’s plan to integrate Health and Social Care might just be the salvation the NHS has been creakingly waiting for.

Academics and politicians will no doubt argue the merits and drawbacks of the idea and according to Riddell, the main objections from the Labour front bench is cost.

As a patient and soon to be Social Care user, perhaps a little real insight from one at mercy of the status quo might help.

Imagine living with a long term health condition of disability that requires regular and expensive healthcare interventions. There is a pattern, and excuse me if I focus on what I know best – long term illness.

You are well for a while. Or at least not as grindingly unwell as usual. you manage fairly well alone, doing all you can to avoid hospital and incapacity. But as symptoms worsen, you are often left utterly stranded. Not quite ill enough yet for the endgame of in-patient care and possibly surgery or intensive treatment, you are not well enough to cope at home.

So begins an endless round of interviews, assessments, more interviews, financial analysis, endless forms and a permanent place on the end of a phone trying to navigate the endlessly frustrating maze of possible support.

In my case, I’ve never actually managed to arranged help from social services before my health has descended into crisis and I join a waiting list for acute care.

Once the NHS has picked up the pieces, thousands and thousands of patients spend weeks longer than necessary waiting to go home or the halfway house of a convalescent home or residential care. A recent study showed the average wait for an elderly patient is 28 days. 28 days of unnecessary bed blocking, unnecessary in-patient care and frustrated lives.

Now imagine that as your health deteriorates, your consultant can contact the local social services, arrange necessary care and support easily and quickly, based on need – and above all – prevention.

A carer comes daily to help you wash or move about, to prepare a nutritious meal and ease the burdens of running a home and possibly a family. You have the chance to rest, eat well, someone helps you to manage and access treatments from home that would otherwise involve a hospital stay and with a little luck and some genuine support you avoid crisis altogether.

If the two systems become one, they can communicate more efficiently. Their budgets will be intertwined, so prevention becomes as important as cure. At my last hospital, a team of specially trained bowel nurses would be able to arrange high level interventions from home, supported by a district nurse, but all too often the process took far too long.

Far too many vulnerable patients become in-patients for want of the correct support at home. Chronic illness and mental health conditions will become by far the biggest burdens on 21st century health around the world and in so many cases, this need not be the case.

Currently, with local authorities facing eye watering cuts of over 25% over the course of the parliament, social care has been cut back drastically, with many cutting “moderate” care needs altogether. However, as campaigners have argued, for all the reasons I list above, this is a totally false economy. Needs that were “moderate” (and therefore less costly to the taxpayer) soon become “substantial” or “critical” through neglect and the only place left to turn is the NHS. The pointless waste is heartbreaking as almost anyone actually at the mercy of the system could tell you.

Our entire emphasis (and indeed, the emphasis of all healthcare systems around the developed world) needs to shift from cure to prevention. Any reform will only succeed if this is the case. Obesity, smoking, drinking alcohol, increasing long term illness and mental health crisis ALL reduce with efficient and genuinely enabling support structures.

So my message to the two Ed’s is Burnham is right. His plan to integrate health and social care could genuinely revolutionise the way we treat our population, saving billions in pointless interventions and unnecessary and traumatic in-patient stays. We don’t just need to consider his plan, we need to stretch every sinew to make sure that it comes into being. Only by reversing the swingeing cuts to care can we re-balance the system towards prevention. The rewards would certainly be astonishing.


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