The reforms the NHS really needs make a rubbish election strategy

http://www.theguardian.com/commentisfree/2013/dec/02/reforms-nhs-needs-rubbish-election-strategy

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Something very big is about to happen in the National Health Service debate. But if you just concentrate on the headlines, and think about NHS reform in the old, conventional ways, you won't understand it. After a generation during which the right, broadly speaking, thought you could change the NHS by creating markets and the left by supporting NHS staff, we are finally breaking through to new thinking.

Andy Burnham, Labour's health spokesman, should get a lot of the credit for this, though I don't suppose he will. But before we plunge into the details, let's consider what kind of ideal health service we would like.

First, why will we need the NHS? Not, in most cases, because of a stabbing or a horrific road accident but because of cancer, stroke, diabetes or mental illness. Statistically, as an ageing country, the longer-term conditions of ageing and of bad lifestyles are what plague us. A Casualty view of the NHS makes for good television but it has very little to do with the real challenges and the real health service.

Second, what about that feeling of being passed around like a human pass-the-parcel inside the health service – of not being in control, from the inability to see the same GP, to the cluster of medical students at the foot of the bed? Again and again, surveys show that we want control, to have some say over what happens to us, and that we want consistency – a friendly face, a familiar voice, somebody who knows us with all our "ways", not just our passing clinical problems.

Third and finally, how many of us want to be institutionalised? Hands up? No, almost all of us prefer to stay at home for as long as that is safe and possible. We don't want to end up lying in a hospital bed or a care home.

So that's it. Not really that complicated, is it? I strongly suspect most people would prefer a health service where they were treated through a single, reliable contact; where they felt more in control and were able to stay at home; and where the focus was on the longer-term diseases most of us suffer from, or will do.

But though it may not seem much to ask, it is a horrendously complicated challenge to get from the NHS and care services we have today, to that simpler-seeming and more patient-focused vision. One of the biggest problems is that the NHS is funded one way – through general taxation – while most social care is funded differently, through local authorities block contracts and a mix of means-testing and private money. Meshing the two will be very difficult.

Politically, too, this is not an easy idea. You won't get the big health bodies marching enthusiastically alongside you, because it will mean a huge shake-up in the pay and conditions of many people. The private health industry, looking for rich pickings, will come away confused and disappointed. And the inevitable jargon surrounding it will confuse the public.

Yet the implications are enormous. As winter crisis succeeds winter crisis, and the rightwing press stokes up hysteria about the NHS, we can no longer depend on a stable cross-party defence of the biggest postwar achievement of British politics. The health service has to do even better in terms of patient experience because its enemies are always there, flapping their black wings and cawing as they circle. And, whoever wins the election, the money isn't there for another Blair-scale increase in funding.

All this is why a new Institute for Public Policy Research (IPPR) report, Towards Whole Person Care, deserves to be taken far more seriously than most of the output of thinktankery. It makes an unanswerable case for reform and doesn't dodge the difficulties of it.

One crucial recommendation is that patients must own their own records. That means it will become much easier to share records across different organisations – hospitals, GPs and local authorities – so everyone can see what needs to be done. That, in turn, allows joint care planning, something that is very difficult today. It may also allow personal budgets. If you read the bumf behind previous attempts to reform the NHS, you might think that all this was already common. Believe me, it isn't.

It will also mean, with some investment in the technology, that home monitoring or telemonitoring can become more widespread, saving hospital visits, lengthy journeys and, of course, money. Britain lags way behind the US and Japan on this.

The other crucial change is that everybody should have a single point of contact for all their needs. Surveys find that this is what people want. And a "care co-ordinator" can end the absurdity of people being discharged from hospital still unable to look after themselves, but without proper community support; or of people being admitted to hospital and then suffering from malnutrition.

Who might these paragons be? In some parts of the country, district general hospitals are already stepping into the role – South Warwickshire and Northumbria are examples. In other places, it can be GPs themselves. Lincolnshire, Cumbria and Southwark and Lambeth in London have already started down this route.

Elsewhere, it will be "health and wellbeing boards". In Scotland, at a stroke conference last week, I met Gail, a human dynamo and clinical services development manager for Tayside who chides and chivvies the relevant people to make sure that no patient leaving hospital is abandoned by the system – certainly on this issue the Scots do it better. The IPPR report rightly stresses that the changes must fit the local area, rather than being prescribed nationally.

They do not, it seems, require a major new injection of money. The new injection is in terms of thinking, breaking down institutional barriers, and really meaning it when you say "the patient comes first".

The more I look at this, the more I think it seems an absolutely rubbish strategy for trying to win a general election. It's non-confrontational, it's very complicated, it will be run differently in different parts of the country, and it's hard to sum up in crisp, headline-friendly terms. Yet it's also by far the biggest and most hopeful thing happening in the health service today. Andy Burnham is taking a huge risk to be putting his shirt on this. A rousing three cheers for him.

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