My Manifesto for the UK Post Brexit (part 4 – Health and Social Care)

Health and Social Care

The UK is facing an existential crisis, especially when it comes to healthcare. I think it is part of the reason why the Labour party are in such appalling disarray at the moment. When the nation state as we have known it is beginning to fall apart, what is the role of the state? The question comes into sharp focus when it comes to our beloved NHS. The financial nightmare facing the NHS is in the press everyday. How much of this has been orchestrated by a bureaucratic system that wishes to see its demise we may never know. But the fact remains, there is a whole lot of debt, an ageing population with increasingly complex health and social needs and a significant underspend in terms of GDP on health compared to most of the other ‘developed’ nations.

Although I believe that we will (and need to) see increased localism, especially when it comes to political participation and economic alternatives, discovering together entirely alternative ways of being and organising ourselves, I still believe in a more national approach to health and social care, as for me, one of the roles of leadership is to ensure provision for those most easily forgotten about or marginalised in society.

Obviously this subject matter is far vaster than a short blog can offer, but here is a starter for ten:

I would therefore increase spending on health in line with need and GDP. I would support moves through partnerships between health and education to encourage our children and young people, in particular, to exercise and eat healthily, therefore breaking some of the health inequalities we see presently in the years ahead. I would look to improve the overall wellbeing of society, as we know that both extreme poverty and extreme wealth is bad for our health. We need to talk about physical, mental, social, spiritual and systemic health. We need a 70 year vision for healthcare, not something that changes with the wind of each new parliament. People would be empowered to care for their own wellbeing and look after one another, because where people are connected to one another, they flourish more readily. I would not privatise the NHS, but keep it public, learning lessons from around the world, ensuring our systems are continually improving and accountable but providing kind and compassionate health and social care to everyone in our communities. I would amalgamate the health and social care budgets. I would invest in measures to improve the overall mental health of the nation by looking at the root causes of our unhappiness and disconnectedness, ensuring those who need psychological therapies and psychiatric expertise are able to access this. I would ensure our staff are appropriately paid and would create a culture of participatory leadership, where we care for the health and wellbeing of those who work in the system. I recognise that health is best provided in the local community and will support the growth of integrated care communities, like those in Morecambe Bay. General Practice is the bedrock of such communities and will therefore be funded appropriately. Communication training, led by patient-experience, would be compulsory. All training would be integrative, problem based and solution focussed (that could do with some unpacking – maybe another time!).

I would break the negative cycle caused by the economics of ‘payment by results (PBR)’ and create participatory shared budgets, breaking down the walls of competition between segments of the system that need to collaborate. I would create emergency care hubs, co-locating services that need to work in an integrative manor. We have to face the fact, that it would take an enormous cultural shift to stop people walking through the doors of the ED, so let’s work with it, rather than trying to change the tide. I would want to see the 5 ways to wellbeing as part of every work place environment. In hospitals, there needs to be a focus on faster discharges (something the dreadful cuts to social care budgets across our county councils will only worsen), working with community teams to enable people to be cared for in their own homes. We need a complete overhaul of our residential and nursing home sector, finding areas of best practice and raising the bar significantly in terms of how we honour and care for our elderly citizens. We need to have a philosophical shift in our approach to death – it is an emotive subject and I have vlogged on it previously on my other blog http://www.reimagininghealth.com People need to be able to die well, and far too often they die in the strange surroundings of a hospital, cared for by people they do not know, when they could have died at home or in their nursing home, surrounded by people who love them. If only we could face up to the difficulties of death, we would embrace it in a much more healthy way…..(again I recommend Atul Gawande’s book ‘Being Mortal’).

Food Banks

I had a fascinating conversation this week with a lady who was telling me she doesn’t really like food banks. It’s not because she thinks they are unnecessary or has some dimwitted view of the world. It’s because she realised that in the one she works in, most of the food handed out is processed, high in salt content and generally bad for people.

Instead she has started doing something, which I think is remarkable. She is befriending everyone who comes to the food bank, putting together a parcel, including a knife, a potato peeler, some washing up liquid and a scrubbing-brush/cloth and she goes to their house with them. She helps them clean their kitchen, has an honest chat about money, works out the most basic of shopping budgets, takes them to a supermarket and then teaches them to cook some cheap but nutritious meals. She’s not a superhero, she knows what it is to have very little and to be a single mum with significant health problems, but she’s determined that life at the bottom does not have to be lonely and it does not have to be full of dregs. On the contrary it can become a place of great creativity and love!

Healthcare Politics 2b

2b) I do believe “all knowledge is relational”. On a completely separate tack, I am passionate to see the hierarchy created by knowledge within the NHS broken down. The managment restructuring within the NHS had some great potential to create a more level paying field. But it has amazed me to see the CCG’s in England created with a dominance from doctors, only one nurse on the panel and no other therapists…..

Within general practice, it is rare to find practices where all the partners are not doctors, or if there are others, it is usually senior nurses or practice mangers. There are some exciting models where all members of a practice are partners (Bolton/Tower Hamlets in East London). Such models break down the hierarchies of money and knowledge as power and recognise the amazing contributions and to be made from across a team. Not only so, but data from these places indicates high staff morale, high patient satisfaction rates and good clinical results – a pretty awesome combination! This can work in hospital settings also and gives the hospital team and potentially the wider community the chance to participate in their workplace/heath service more holistically. It brings the possibility of participatory budgeting to the fore which is really exciting model for budgeting and corporate financial responsibility.

To flip power on its head and make it that which allows the mountains to be made low and the valleys to be raised up is at the very heart of kenarchy. Level playing fields – make for a better game!