Two years before the election, the NHS is under attack. A&E delivery is falling apart: 11 hospital trusts joining those of us in special measures and 20 more in financial crisis, while the NHS has been told to find £24.25bn of recurrent savings by 2016 – almost a 25 per cent reduction.
In my home town of Stafford, we’re watching our core services being packed up. The draft plan produced by special administrators working at Mid-Staffs requires the loss of an intensive care unit, maternity and paediatric services; the permanent downgrade of our accident and emergency.
We’re an easy target: the history of our hospital is held not just against us but against the NHS across country. But that Stafford Hospital is not our Stafford Hospital. Following years of work and community commitment, our Stafford Hospital is one of the best performers in the West Midlands: fifth in the country for patient satisfaction and a valued community resource.
As we fight to keep services here in Stafford, we’re coming up against the great repetitive question: ‘Well, what would you do differently?’
In Stafford the integration of health and social care gives us an answer. Better, it gives us an answer which passes the test for instant recognition of value, setting people nodding.
For many of us, the distinction between services designed to support the whole care of the person already feels unnatural. Changes to our environment, relationships, finances and mental health, or those encountered naturally in our ageing and dying, all are intimately related to our health and part of a whole.
Those of us who see the needs of an ageing population forcing clinical demand upwards, while services are reeling from increasing pressure on acute and emergency services, believe access to hospital beds must be protected. For others, accessible integrated care supported by communities and families is a kinder way through difficulty.
Like many families, we’ve seen the difference that could be made in our own home.
Before my grandmother died, she remembered everything about making dinner for my grandfather except to turn off the gas; everything about making a cup of tea but to boil the water.
Struggling to accept help, she went into a secure dementia unit, my physically frail grandfather into hospital earlier than any of us would have wished. In the months before he died, he contracted measles, pneumonia, recurring colds: all of the painful and debilitating infections against which a compromised immune system has no defence.
The care offered to my grandmother was in a form that was hard for her to accept. For my grandmother, to be involved with social services was an admission that she was struggling with the tasks she saw as the responsibilities of a lifetime. Care badged as medical or integrated support would have been not just more appropriate, but more tolerable.
And it would have been easier to understand. Without family support, my grandmother would simply have shut the door on public care, confused and overwhelmed by the complexity of my grandfather’s needs; the need to understand new financial arrangements; the intricacy of support applications and assessments; the unaccustomed visitors to her home.
Our systems are too difficult to navigate. The barriers to understandable and accessible care too high.
Simpler integrated services will make life easier at the times when it is difficult enough. As a policy, ‘whole person care’ could make a real difference not just for people like my grandparents, but for the families and the people who support them. In the two years to 2015, that’s got to be worth campaigning for.