Tomorrow's world - Labour's big NHS idea?

Labour's 'big idea' on health is to merge it with social care and maybe even benefits. It calls it 'whole person care'. But has it thought through the implications?

Shibley Rahman
5 December 2013
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'Whole Person Care' is shadow health secretary Andy Burnham’s ‘big idea’.

He's tasked Sir John Oldham with chairing a ‘Commission on Whole Person Care’, due to report to the shadow cabinet early in the New Year. It will make policy recommendations on how the party’s aim of integrating heath and social care can be achieved.

In explaining what ‘Whole Person Care’ actually means, Burnham’s message so far has somewhat been ‘all things to all men’.

One is left scrambling around for clues mainly from the think tanks in Labour’s orbit. There is a flurry of recent reports from these think tanks, all vying for Oldham’s attention. 

In a recent pamphlet for the Fabian Society ’A vision of whole person care for a 21st century health and social care service’, Andy Burnham says,

“The challenge becomes not how to patch two conflicting worlds together but how to make the most of a single budget.”

The rose garden might already be growing some weeds.

This week, the IPPR think tank took a bite from the cherry with its report, “Towards whole person care”.

The report passed largely unnoticed by the media, who saw the report as mostly about technology (with the report claiming “The US systems are ahead of the NHS in their use of technology.”).

The report also talks of ‘benefits from developing systems that allow patients and carers to access their records’. As if on cue, Burnham in the Guardian on 1 December 2013 was reported as wishing NHS patients to have “the right to see their records”.

The “bombshell”, however, comes on page 12 of the IPPR report:

“Integrating health and social care personal budgets removes the organisational barriers completely, and allows people to arrange the care they want to meet their needs, regardless of where it comes from or who is paying for it.

Personal budgets can also help to break down barriers between those who receive state-funded social care and those who self-fund, ensuring that everyone receives the support they need to arrange the right care for them.

This does raise the question of ‘topping-up’ public funding, which is currently prohibited in the NHS although allowed in social care; if personal health and social care budgets are integrated it is hard to see how to avoid individuals topping these up should they choose to.”

One should be worried about being sold something as “control”, if you end up running out of money for one bit of care when you’ve overspent it in another bit of care.

One should be worried that the “principle of universality” is being chipped away with the creep of “means testing” from another part of the system.

One should be worried about money from the NHS being used to subsidise the infrastructure for private providers to milk the system with a provision for ‘top up payments’.

The question is therefore how genuinely attractive these proposals are to Labour.

Will they pause to ask - whither universal, taxpayer funded healthcare - before throwing the NHS’s lot in with means-tested social care provision and the extension of personal budgets?

Or will they push social care integration regardless - or perhaps even throw the entire benefits system into the mix?

Liam Byrne MP, shortly before he left the Shadow Cabinet, announced that Labour would be looking at how Labour take the radical ideas of “whole person care” to bring services and back to work benefits together to support disabled people in a new way.

According to Byrne the plan was, learning from Disability Care Australia, that

“Australians with significant and permanent disabilities would have more power to choose their support and more control over how that support is provided. The programme, … is creating personal plans that put the goals and aspirations of individuals at the centre of the support they will receive.”

And Liam Byrne MP, it seems, was not a lone voice.

The Demos think tank published on 30 January 2013 their own contribution to conflating benefits and budgets, supported by Mastercard:

 “These … transformations will mean that service budgets and benefits are increasingly being paid directly to the user – with inevitable overlap between those receiving different payments. Some people have suggested that a single pot of money paid to an individual – rolling up all of the various benefits and different service budgets – will be the ‘gold standard’ of a personalised, integrated, empowering state.”

The commercialisation of care, under the guise of control and budgets, is of course an anethema to genuine principles of professional person-centred care.

And merging a universal system which has lots of highly personal data (NHS) with one that is heavily conditional (benefits) has all kinds of risks. In the long run it could make it still easier to restrict access to healthcare on the basis of economic status or behaviour. Or to deny benefits to someone on the basis of personal information on a whole person care record.

That would be political dynamite. And it might happen. Already the Department for Work and Pensions has been trying - unsuccessfully so far - to get its hands on people’s confidential medical data on drug and alcohol use and treatment. Only for research purposes, it tells us.

Even the government doesn’t get its technological act together enough to deliver this ‘tomorrow’s world’ policy, for some ‘whole-person care’ will take on an uncanny resemblance to the past: Thatcher’s favourite policy, vouchers.

As the Tories struggle to 'detoxify' their brand, will Labour cling to the vestiges of neoliberalism?

The outcome of the Oldham Commission (and possible future Green Paper) will provide further clues as to whether whole-person care is more than you budgeted for.

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