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We need to fight for the NHS like never before

Shadow health secretary Andy Burnham sets out his vision of an alternative health service fit for the 21st century

This year, the National Health Service turned 65.

It should have marked a moment of national celebration. Instead, we have a government which has spent most of this anniversary year running the NHS down.

It is not hard to see the political strategy — undermine public confidence to prepare the ground for more privatisation.

So what is the right response to this attack for people who passionately believe in the NHS and what it stands for?

First, it means working hard to correct the misleading spin coming from Tory HQ and giving people the facts.

For instance, we should point to the finding of the Keogh report — conveniently ignored by ministers — that mortality rates in NHS hospitals dropped by around 30 per cent in the last decade.

But, as well as defending the record, it is equally if not more important that supporters of the NHS face up fully to its failings and act on them.

That is the only way that we will help the NHS to continue to improve and maintain public confidence.

Where the NHS has fallen short, we do not help it by explaining its failings away.

Following recent failures, the question people are legitimately asking is whether the NHS can continue to give all people safe and personal care in a century when an ageing population is the greatest challenge.

My answer is an emphatic yes — but it depends on striking a new settlement for the NHS for the 21st century and rethinking how we care for older people.

Back in 1948, the World Health Organisation made this definition of health — “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

For all that the NHS was a huge step forward, it wasn’t set up to deliver this vision.

Social care was not part of the NHS settlement probably because, back then, helping people with daily living wasn’t the big challenge.

It is now but we still have a health service that can only deal with some, not all, of one person’s needs.

As we live into our late eighties and nineties, our needs become a complex blur of the physical, mental and social.

And yet our 20th century care system still gives a third of one older person’s needs to the council and two-thirds to the NHS.

Increasingly, this fractured system is struggling to answer the questions being asked of it by the 21st century to the public’s satisfaction.

The gaps are getting dangerous. In any given care setting, it is likely that some of one person’s needs are being neglected.

This begins to explain the recurrent and now familiar story of the older people lost on the acute ward, disorientated and dehydrated.

Our hospitals are geared up to operate on a production-line model, able to see the immediate problem — the broken hip, the stroke — but not the whole person behind it. They do not have enough staff to provide fully for people’s social care needs.

Back at home, families are crying out for co-ordination of care — a single point of contact for all of mum or dad’s needs — but find themselves passed from pillar to post in the daily battle for help.

This system is not only struggling to provide the care people want, it is also unlikely to be financially sustainable.

It is now costing us £4 million a week to keep older people in hospital unnecessarily because we are failing to spend a much smaller amount of money properly supporting them at home.

Right now, all the incentives are working in the wrong direction — the gravitational pull is towards hospitals and care homes.

Councils are cutting preventative social care as they have an incentive to keep the council tax down. And the NHS still gets paid by every person who comes through the door of the hospital.

Since the election, £1.8 billion has been cut from council budgets for older people’s care.

The loss of simple support in the home means that hospitals have seen a shocking 66 per cent increase in the number of patients over the age of 90 being rushed to A&E.

In human terms, this means an extra 110,000 very frail and very frightened people in the backs of ambulances — the worst place for them to be.

We are paying for failure on a grand scale — allowing people to struggle at home, drift into expensive hospital beds and from there into expensive care homes.

I believe the only answer is to turn this system on its head. We should have a system that prioritises prevention and keeps people where they want to be — at home.

For that to happen, we must unite the physical, mental and social. One service able to deal with the whole person. A national health and care service.

Later this month I will ask the Labour conference to endorse my plan for the full integration of health and social care.

What better way for the party that created the NHS to mark its 65th year than to complete the job that Bevan started?

By going down this path, the NHS will be able to begin to lift standards in social care.

I am very clear — we will never, ever get the care we aspire to for our parents, indeed everyone’s parents, from a malnourished, minimum-wage social care service.

Governments of all shades have failed to invest in social care and, in the end, you get what you pay for.

Years of cut-price contracts have left us with an adult social care workforce with 307,000 people on zero-hours contracts.

How can people who don’t have the security of knowing what they will earn from week to week pass on a sense of security to those they care for?

Looking after someone else’s parents is the highest calling a young person can answer, not the lowest.

Until we send the opposite signal, we won’t build a care system ready for this century.

I want Labour’s Whole Person Care policy to give people a real choice at the next election.

It is a policy built on the core principles of the NHS — collaboration over competition, integration over fragmentation, people before profits.

I am clear that the next election, unlike the last, has to offer people a fundamental choice about the kind of health and care system they want in this century. We are at a fork in the road.

If we carry on in the way we are heading, down the path marked “competition and markets,” I believe we will eventually destroy what is precious about the NHS.

That path is taking us to the wrong destination. The 21st century demands integration, markets deliver fragmentation.

But make no mistake — if the NHS is to survive in the 21st century, services will need to undergo radical reform.

My plan is not a plan to keep things as they are. Hospitals will have to change as the home becomes the default setting for care.

People must have control and services built around them. This is what 21st century care must look like.

My argument is that we will get the quality services we need more quickly and more sustainably through a planned, integrated and public NHS system rather than through the coalition’s market-based approach.

Whole Person Care is a practical expression of what “one nation” Labour means — protecting the NHS in an era when money is tight and building a society that cares for everyone and leaves no-one behind.

Our NHS has served us well. In its 65th year, we now need to fight for it like we’ve never done before.

I hope the wider labour movement, party and unions together, will leave this TUC conference ready to fight for the NHS on every single doorstep — clear about the damage this government is doing and confident that our alternative vision is right.


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