I was in Manchester this morning, attending an NHS Policy Forum with Andy Burnham. He gave us a fascinating lesson in political matchmaking, which clearly serves to cement his position as a tactician of considerable importance in Labour’s chances at the 2015 general election. My objective in this post is to explain why I believe this to be the case.
Most of what he said today, and it took nigh on fifty minutes to do so, can be found here at the moment over at the Labour Party website, in a speech he gave previously to the King’s Fund in January of this year. I suggest you read this before we continue.
Essentially, he proposes pulling together physical, mental and social care into one £120 billion integrated and unified budget. He referred early on to the World Health Organisation definition of health, and it bears quoting again:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The correct bibliographic citation for the definition is:
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
The Definition has not been amended since 1948.
In order to make this “whole person” approach work in a free-at-point-of-use dynamic, he suggests bringing together not only what we might term as the “medical” professionals and services in the three areas mentioned but also other areas of specialist support such as housing, early years’ delivery and infrastructures etc, under the umbrella of single point-of-contact access. And in a sense, this does makes sense: anyone who’s had to live in mould-ridden poor quality housing for example, whether social or private, will have experienced having their confidence undermined; their health attacked; and their sense of autonomy diminished – all of which lead to physical, mental and broader social care challenges likely to generate costs and fracture in these latter areas.
What better way, then, to deal with an ageing population and its very special social care needs (Alzheimer’s, physical infirmity, reduced mobility, mental unhappiness and so forth) than to take the bull by the horns, make a virtue of a necessity and suggest we extend, not reduce, the reach of the National Health Service? In essence, re-engineer its original values for a 21st century of quite different circumstances, where a care crisis of unhappy proportions is advancing on us all.
Now there was little detail, it must be said, in the proposals themselves: but that wasn’t the purpose of the process in question at this stage. As he clearly flagged up, he was looking to provide a framework and see how Party input could then flesh out such details. One thing he did suggest was a, say, ten percent levy (I’m sure this was a bit back-of-the-envelope, but no less interesting for that) on people’s estates to pay for that free-at-point-of-use social care late in life – and it’s not as if this isn’t already happening via the private sector, as our grandparents struggle to fund rising healthcare, accommodation and general living costs, especially as pensions and savings are hit from all sorts of economic broadsides.
In a round-table discussion, held afterwards in groups across this extremely well-attended policy forum, someone suggested Burnham was doing little more than give priority to a highly fragmented social care provision as it currently stands: given that it’s the responsibility of councils, this view of Burnham’s real drivers would argue he had identified a highly powerful constituency – the greying group of citizens we are all becoming – and was looking to prioritise the needs of such a constituency for general electoral reasons. If this were true, of course, we’d have a politician of Mandelson-like proportions: the Machiavellian nature of this approach could hardly contrast more fiercely with the straightforward and straight-talking image Burnham has I think quite rightly acquired.
And I don’t think Burnham is only playing politics here. Of course, he’s looking for big and bold policy to lever Labour’s return to power – and who wouldn’t? Especially with the complex brief – at the centre of the Labour Party’s very soul, as I think he alluded to – which he is having to sustain and drive forward in a political environment clearly infused by a savage, cunning and long-planned privatisation already well in hand.
I think he truly believes in a more humanistic medicine – a more holistic national support system for all our needs, in fact. And I think the ambition is well worth pursuing too. I do have some initial reservations, of course:
- a single-point-of-contact for all our “whole person” services would require the sharing of vast amounts of parallel data with the implications this might have for our data security and privacy
- such a system of access would require a whole new level of professionals upskilled in coordinating vastly different specialisations – and in truth, throwing even more managerialism and support services at the NHS would hardly be the first thing to make you popular in the eyes of the public
- for patients, service-users, children, parents, tenants and “customers” various to perceive the services thus delivered in a seamless way would require those delivering the services behind the scenes to acquire similar cultures – not an easy thing in times of crisis or massive change as anyone who has been through, for example, a corporate merger will bear witness to
- homing in – as I think was also suggested – on the home as the unit of primary focus, instead of on the hospital as the significant and principle local infrastructure, could lead to the withdrawal of such community-based delivery some way down the line, where any change of political colours in local or national government took place, or when any rising political star needed to make a name for themselves: in much the same way as it’s easier to remove a bus service than it is to remove a tram, so a hospital would almost certainly remain where a fleet-of-foot “whole person” approach could simply end up dismantled by the next cohort of bushy-tailed Tories
- finally, the NHS is hardly known for democratic accountability: putting the “whole person” budget into one massive pot would, therefore, require very careful analysis – a priori, surely – of how to ensure useful democratic oversight in a meaningful way without incurring, once again, those top-down New Labour managerialist tendencies of overarching targets and tick-box exercises at the expense of the more humane approach I think Burnham wishes to pursue
There is, in fact, a sense that the cradle-to-grave aspect of the proposal could simply reignite fears about Blair’s nanny state: inspecting the health of your children from the day they are born; inspecting the food you give your children; inspecting the schools that deliver the education judged appropriate; inspecting the degree to which you as an adult follow the rules of good personal healthcare; inspecting the degree to which you are properly housed; inspecting the moment at which you are considered worthy of preventative medicalisation; inspecting and acquiring the resource to give everyone the right to social care.
But what are the alternatives to such a proposal? Burnham, after all, proposes nothing less than the socialisation of health: the opportunity not to be fearful of old age but to live it for as long as possible with points of familial reference in one’s own home and surroundings. The opportunity, if you like, to die in one’s home wherever humanly possible – without being abandoned to the vagaries of lonely decay.
For it is surely clear that social care, right now, in its fragmented state, is too much a case of “malnourished users” and “minimum-waged workforces”. And this will be the future of the NHS too, if we don’t do something now to correct the errors of the ways of too many governments past.
And if we choose not to run with this socialisation of health I perceive in Burnham’s proposals? Then we will run the risk of the reverse happening anyway: via the corporate forces that wish to medicalise us everywhere: in everything we do, in the costly services they sell us, in the residential homes they build empires on the backs of, in the outsourcing agreements they wrench from their commissioning groups, in the tendency modern medical mindsets and infrastructures have when they make so grand and big and imposingly different the first, second, third, fourth and last ages of all our lives.
If for no other reasons than these, then, Burnham’s “whole person” approach – even with the caveats I mention above – does sincerely deserve both our attention and our time. To make the support of our wider humanity the flagship of Labour thought over the cruel and deliberate monetisation of suffering – its turning of human beings into little more than units of profit-generating resource – is surely both a vote-winner as well as a re-establishment of key beliefs too many of us have carelessly unattended to in sad recent times.
One final thought. Whatever you do, however you structure it, let this be the clearest clarion call Labour makes: free-at-point-of-access support for every key definer of equal opportunity in our often kindly, occasionally cruel and generally variegated lives.
We cannot completely eliminate risk from our lives – but we should do everything we can to eliminate fear.
And so that is where we’re at: a 21st century reworking of socialism itself – driven by a strikingly self-effacing top-flight politician such as Andy Burnham – which just might end up dropping into the lap of a furiously modernising Labour Party.
A Labour Party – barely five years since it showed signs of an awful creeping political amnesia – just looking for a way to prove itself healthy and fighting fit all over again.
And able to do so with a long-term strategy which just might do the same for the rest of us too.