The Burnham Vision - A Collective Endeavour for Time to Care
By shalondon, Jan 30 2015 12:43AM
It is a truism that post WW2 there was none of the defeatism which those who currently do-down the public sector exhibit – now Andy Burnham speaks out to the younger generation in a career defining speech to ‘ come and build an NHS for the future - your future!’
The Burnham Vision is designed to offer both a message of hope to the younger generation and a message of reassurance to those concerned for a secure old age.
‘It is borne out of deep reflection, honest assessment of our mistakes but huge optimism for what the NHS can be in the future.’
So does it fit the bill?
Sir John Oldham provided the fitting prequel to the Shadow Secretary of State’s 10 Year Plan speech on Tuesday 27th, which he put to an assembled audience at the Kings Fund, most of whom -judging by the warm applause he generated, hoped that he will soon be able to ditch the Shadow tag ( please take note Ed ).
Oldham’s work forms a significant part of the new model for the future of the NHS and social care and he was clearly very proud of what was in store for both the gathered audience, as well as the country at large, if the result of the 2015 General Election goes the Labour way - and indeed the only way to secure a national health service for the future.
Andy Burnham’s passion for his work is well known. On this occasion it was palpable.
From the top of his burnished head to the tips of his extraordinarily shiny shoes, every inch of the SSOS seeks to lift the NHS and poor battered social care 'out of the downward spiral to the position of his aspirational vision’ which he sees as an offer of hope 'something for people to believe in' – and we could add - as opposed to the current climate of fear.
Despite the BBC and 95% of the national press’ attempts to obliterate the detail for what these days passes for news (yes - hang your heads in shame Grauniad & Newsnight), the plan stands as one which is not another imposed reorganisation, but one where everyone is invited to participate.
As opposed to the H&SCA - which Burnham calls a 'contested piece of legislation with no democratic accountability – putting a political agenda at heart of the NHS and which goes entirely against its grain...this vision puts the right values back at the heart of the NHS going beyond tariffs and targets’. The idea is to use existing structures, but very differently.
‘One person! One team! One system! - looking at each person's state of physical, social and mental wellbeing - not dropped on from a great height but worked on by everyone’.
The Burnham vision is based, he told us 'on the simple notion that where care starts in home it is more likely to work for the person' (not patient) - with one professional as the key point of contact, doing away with crude 15 minute slots and supporting the needs of those with complex conditions from dementia and autism to cancer.
Citing the A&E barometer with 2015 showing record numbers of frail elderly trapped in hospital - and in one case a whole year for one Lincoln woman, as the warning of severe storms ahead - 'which have indeed been warned of time and time again.... cancelled operations at the last minute including cancer.... cuts to GPs and mental health provision leaving hospitals close to being overwhelmed and creating a vicious circle' – which we now know is of the governments making in a deliberate drive to destabilise & destroy the NHS. Weaponise? The Tories are the party who have launched a full out attack on the service.
It is the job of the Opposition to counter attack – and were Burnham et al simply to say ‘fine - on you go Hunt’ and kick back, where exactly would we be?
We know that further planned cuts by Osborne will mean more cuts to social care to form what Burnham calls ‘a toxic mix of cuts, crisis and privatisation’ which many of us also know could – or even would, see the NHS sunk without trace,
Andy confirmed that he had spent the past 2 years since he first proposed full integration consulting across the country, visiting teams and speaking to as many health workers as possible, taking on board the views of experts – several of whom he listed : the Oldham Commission , Kingsmill, Kate Barker, the Fabians, IPPR and the NHS England 5 Year Forward View – all of which contributed to his plan.
We were also told that the plan is also a substantive response to the Francis report ( with absolutely no vases in sight Julie ) – which Hunt surely mutters about in his sleep, yet has serially failed to implement - and ‘a move away from the hospital based production line approach to a care model where mental and emotional needs are not sufficiently looked at’ - and in particular looking after the needs of children and adults with complex physical disabilities who with the right support are now able to live longer and more productive lives.
On Tuesday evening at the wonderful Prof Geof Rayner & family’s book launch I met therapy professionals whose work has been halted by one of the most pressurised hospitals in London – as they said, this will only result in people remaining in-patients for longer periods of valuable time. A trend which needs to be reversed.
This is a 10 year journey in search of stability for services which were set up to support each of us from cradle to grave and which are now so sadly in increasing disarray.
As Andy had explained to SHALondon last week, he realises that Integration needs to be worked at - so this journey will be built upon relationships which recognise local cultural needs and solutions which are right for each individual area. We also know from what he said to us on 13th January, that the ‘brutal change’ approach currently being taken by the NW London and Imperial Trusts is not his approved mode of service shift.
The Burnham hope is that local authorities and CCGs along with the general population will get behind his new approach so that a consensus can be achieved. ‘We need to get right the things that truly matter.’
Thinking of national initiatives past, it is to be hoped that examples of best practice are at the ready for sharing with those areas who may struggle with innovation.
Then onto the element which has caused Milburn to explode and Kirsty Wark to talk over her guest far more than is acceptable from any interviewer and subsequently leave viewers little more informed than before they tuned in.
“ Today Labour calls time on the market - it is not the answer - and if we allow it to continue it will eventually take hold of the and finish it off. The market only serves to increase costs and complexity and undermine care, conflicting care with the profit motive!... we need freedom to collaborate without competition law blocking our plans.” Indeed Alan Milburn. Indeed.
The key difference is of course that the Tories have let in the external market rampant with an intent to destabilise and destroy, whereas Labour increased the internal market to reduce 2/3yr waiting lists and operated an av 3% rather than 49% cap on private provision. No matter what the BBC 'Vision On' graph says, the Tories have accelerated the privatisation process far more speedily p/a since Section ’75 in 2013, compared to the 13 years of Labour. Even if your own care may be with PrivateEyeHealth.com, 70% of the last contracts round going to the private sector, including for core services, is just the alarm call we need, thankyou Kirsty.
Next on TTIP – and more. Based upon personal assurances from both the EU Commissioners and the work of David Lock QC, the Shadow Secretary of State was adamant that he would ensure that the NHS would be exempt from not just TTIP, but also other trade agreements which could destabilise the service via Competition Law. In this, he said, the Lisbon Treaty and the sovereignty rule are supreme. ( see past blog July '14 for detail ).
In answer to ACEVO's Sir Stephen Bubb ( my fomer colleague from the National Lottery Charities Board who had far too warmly embraced the H&SCA ! ), he confirmed that his vision will also include voluntary organisations as key partners. As Shadow Health Minister Andrew Gwynne afterwards told me - the Red Cross are already offering us excellent examples of home care packages which are succeeding in keeping the elderly out of hospital. Coincidentally, you may have seen my former housemate Andrew Mullan, now a Red Cross manager in Derbyshire, explaining this in a Channel 4 News A&E piece last week.
For those who fear the involvement of the voluntary sector - this has formed a key part of British culture and skill for longer than living memory and can continue to work in complimentary fashion with statutory bodies - however we also need to be sure that those essential core costs are met in order to support the necessary infrastructure. The plus side is that the Third Sector operates without the profit motive skewing the manner of its use.
It was positive to hear that the primacy role of NICE will be re-established and detrimental approaches of partial treatments ( 1 cataract only ) will be barred - nor will the criminal justice system be disadvantaged as has increasingly been the case, with the vicious help of Failing Grayling.
We were then offered an overview of the other 4 stages of the Burnham Vision
If NATIONAL is the what, Andy Burnham told us - the LOCAL is the how.... and for me, this is where it gets really exciting. Health is to be formally linked across the piece with housing, education, leisure and transport, ‘with the aim of breaking out of the confines of silos where services don’t relate to each other and children in particular lose out’. Music to my ears! The innovative work of Children’s Trusts and Sure Starts which have taken such a battering under Gove and Morgan now have a chance of being revived, but as a mainstream approach to encouraging positive health messages and practice in every aspect of life, including for adults.
The logical rationale is that the more quickly the new model is embraced, the sooner local services will be on the right path – so this is not a policy for the hesitant and best practice examples will need to be reaily shared. Integrated local budgets for children will mean that all the long term savings for that child will return to same pot. This is an authentic early intervention cost saving investment model.
The Year of Care model will be a fundamental shift away from a hospital-centric approach, helping those who would otherwise be stuck in wards for weeks and months on end to be home-based with decent and reliable care packages.
Each health economy ( yet to be defined in legislative terms ) will be required to develop an accountable integrated body which will link into a new role for that most contentious of quangoes Monitor, turning it away from driving through the privatisation agenda to promoting the viability of the NHS and decent standards of social care.
A single point of contact, a personal care plan, therapies and counselling plus care in the place of choice – including for childbirth and end of life, 48hrs GP and 1 week cancer test minimum wait guarantees sit well in a list of quality promises.
The first point of contact mechanisms will change into what seems to be an eminently sensible model, combining out of hours GP provision with ambulance services which will take over and enhance the substandard 111 call centres to offer a new multi-functioning body which will not just carry the sick and injured to hosp but also treat at home. This re-alignment does not need new funding, just better use of existing budgets.
The aim and the intent is to change the care culture and value those in it - valuing staff and valuing people as more than patients through the Year of Care model ( so eloquently explained here by delighted dementia expert Dr Shibley Rahman ), with recognised training paths for both staff and outsourced personnel and a ban zero hours lift the care field out of the desperate morass in which Lamb and Burstow have dumped it.
The dearth of ‘home grown staff’ caused by swingeing cuts to training programmes (despite queues of those with a vocation), will be reversed by investment in new training pathways – including a new apprenticeship portfolio, which will be an integral part of the integrated model.
The big question in the midst of all this is - how can we be sure that no one will be stuck at home with poor care? I have to confess this has happened to me a few years ago after a too-early hospital discharge and I would not wish it on anyone.
Although we already have less hospital beds per population head it seems we must accept that home based care is to be a reality - and the hope is this ‘less patient and more person-centred’ remodelling will be exactly what Andy Burnham sincerely hopes it will be.
The SSOS told us that he would ensure as many safeguards as possible which will be a core part of both a cultural and service delivery shift. New rights will empower people through person centred rights with tougher penalties for those in breach underpinned by amendments to the NHS Constitution.
In recognition that the state will offer a person-centred service, the expectation will be that people will have to do more for themselves in order to stay as physically active as possible by following public health advice and stay as healthy as possible.
Never again should the public’s most valued institution be at mercy of those who seek to do it down. 'Given the current circumstances we urgently need a consensus' says Burnham, challenging other parties to sign up to this ( hello you Greens? ) or if not produce their own – which it seems to Lib Dems are busily doing in a desperate attempt to re-invent themselves
In a clarion call finale – the Shadow Secretary of State speech culminated with a personal plea -
‘Nothing matters more to me and I know what it means to millions of others – we may not agree with everything but if you agree with the broad direction please get behind it.
It can be what we want it to be – as good as we all want to make it.’’
We now have less than 100 days to rescue our NHS from the brink and breathe new life into social care. Let us view this as more than a last ditch rescue attempt but more an opportunity to build a comprehensive & holistic healthcare system, fit for future generations.
We really had better stick with team Andy.
For those who might like to explore the initial predictions about the Health & Social Care Act – which as Andy says, have sadly come home to roost – the 2012 document I wrote for Lewisham SOS NHS ‘Breaking the NHS through Reckless Reforms’ has been re-posted