The path to the best care

Last week, Andy Burnham outlined Labour’s vision for a ‘whole person approach’ to patient care as the foundation for the future of health care under the next Labour government.

Under the stewardship of the last Labour government the NHS began the focus toward a patient-centred approach to healthcare. We delivered historic levels of investment after decades of underinvestment and neglect by the Thatcher and Major governments.

In my view, where Labour went wrong in the past was to use an internal market within the NHS as the mechanism to deliver health quality through patient choice. As an unfortunate consequence, this has led to financially stable  hospitals in some communities, financially failing hospitals in others, with patients still preferring to use the services closest to them regardless of how good or bad the health outcomes. But Labour’s momentary lapse of judgement in government cannot compare to the opening up of the NHS by the coalition government to private sector speculators keen to generate profits by cherry-picking services. The unleashing of competition within the NHS to “any qualified provider” is set to fragment healthcare even further and can only make delivering whole person care even more difficult.

Labour’s vision for a whole person approach is for an integrated NHS that brings together care providers with hospitals and GP practices. Joining carers and healthcare professionals together to ensure the care needs of each and every patient  are met at any given time. Our challenge is to ensure that we also deliver care from cradle to grave, addressing preventative care and public health together.

The patients I meet every week at my GP surgeries in west London want the best care, by the right person, in the appropriate setting delivered in a seamless manner all the time and every time. It’s not too much to ask, after all that is what we all want for ourselves and our loved ones.

They are not concerned about how the care is organised and who employs whom. ‘Primary care’, ‘community care’, ‘secondary care’, ‘tertiary care’ and ‘social care’ are all terms that are alien to them, but they do understand ‘care’.  Yet these terms represent the organisational barriers and complexity of the system that makes care more difficult to deliver, less efficient and more fragmented.

If we can address the issue of making care seamless, we will drive up quality, improve patient experience and get better value for money from the nation’s investment in the NHS. We will also manage the patient as a whole person rather than a collection of medical conditions and social needs each treated by different people who don’t interact with each other.

Integrating carers with neighbours, communities, voluntary organisations, primary care, secondary care, community health services, schools and social services can deliver a seamless whole person care package.  The less organisational boundaries there are between the different organisations that deliver care, alongside better equipped, well-paid and well-respected care professionals, the easier it will be to deliver.

But if integration is the key to a more seamless healthcare and the whole person approach, how do we ensure we can deliver it, without another round of top-down reorganisation of an NHS near the end of its breaking point, within a tough economic climate. And what has prevented it happening so far? If we can correctly diagnose the barriers that have held the NHS back, treatment will be more effective.

Firstly, Andy Burnham has set a clear direction of travel in laying out the case for integrating the health and social services budgets. In the foreseeable future, public sector finances will remain constrained and we need to extract the most we can from the £104bn NHS budget and the £36bn social services budget.

Secondly, by bringing together the existing health and wellbeing boards with clinical support from the clinical commissioning groups, services can be planned that prevent illness, promote healthiness and deliver chronic disease management in the community. Greater integrated working between health professionals and social services in the community can better look after the increasing elderly population and a renewed focus on preventative and public health. Hospital admissions can be prevented by better care in the community and when admission is needed it can be delivered as a short episode of treatment in the hospital with a seamless discharge back into the community.

Thirdly, the introduction of directly accountable elected representatives with responsibility for delivering health and care can restore faith in local communities that their needs are reflected in local services, and free already overburdened clinicians to spend more time with their patients.

To deliver the whole person approach, there has to be integration between the trio of social services, health services and local authority public health functions. But we can go a step even further to deliver even better care.

My view is that we need financial and organisational integration between the acute trust, the community services and general practices into a single entity if we are to deliver sustainable integration with social services and other local authority functions for the whole person approach.

Currently general practice is required, through commissioning, to keep patients out of the hospital and shift money from NHS hospitals  through competitive tendering of services leading to their financial instability. This has huge transactional costs in terms of emotional costs, financial costs and medical time way from patient care.  In other words, GPs and hospitals are not acting co-operatively but against each other, which is not in the best interest of the patient. If GPs, acute trusts and community services were financially integrated within a single organisation, they would act in a way as to deliver the best care for the patient in the most appropriate clinical environment.

As efforts are made to shift work from hospitals to primary care. GP practices are independent businesses in the NHS and are increasingly frustrated that this increase in workload isnt being matched by proper resourcing. This leads to the public expecting the level of service promised by the government but one that GPs cannot or will not deliver. There are two solutions to this: to make GPs salaried (as they are increasingly choosing to do) or to create a profit sharing basis for GPs in the integrated organisations. With 70 per cent of GPs in London now directly salaried, it may well be the right time to have an honest debate within the profession over whether independent practice is sustainable in the long term, and whether we should not just integrate heath with social care, but primary care and hospitals.

The whole person approach in healthcare is fundamentally about knocking down professional and organisational boundaries to deliver the best care at the best time by the best people in the best place. In a patient-centred one nation NHS, Labour can deliver a better, universal national health that not only treats illness, but prevents it and keep our nation fitter and healthier in the long term.