Health Act Rag Bag
Almost unremarked in the rush of bills getting the Royal Nod on Friday the 13th was the rag bag of measures collectively known as the Health Act 2009. Tucked away among new powers to strengthen tobacco control; to place a duty on all NHS bodies, private sector and third sector providers of NHS services to have regard to the NHS Constitution (more on that in a later blog); to deal with (whisper it) failing Foundation Trusts; to require (largely meaningless) “quality accounts” from NHS bodies and to reform pharmacy services is the provision to give money directly to certain patients so they can obtain their own health care.
It’s Getting Personal
But it isn’t as simple as it looks – the consultation on the regulations and guidance is pretty daunting. The real problem is that this will deliver only half of the prize that should really be on offer:integrated health and social care individual budgets reflecting the real level of user and carer need. This is going to be big in coming years given an ageing population and more people with long term conditions surviving for longer periods with better quality of life. How many? The think tank Demos At Your Service report estimates 1.5m people in five years will be controlling personal budgets for health and social care. When this happens, public services will never be the same.
The progress in freeing up NHS money so it can flow direct to individuals for this purpose is welcome (NHS money can already be handed to third party organisations to spend on behalf of individuals) and it evens the scorecard with what is increasingly common practice in social care. In fact, the consultation on the health care budget regulations largely proposes to mirror existing good social care practice. If this is a hint that the two channels of care services are converging then we welcome it.
If our public services could just get their acts together about this we might see some progress towards the real prize. David Cameron had the right idea in his recent statement on health priorities earlier this month when he included as part of a reform of long term care that “budgets combining social care and health care funding for people with long-term conditions will be rolled out.”
People Powered Public Services
The latest report from NESTA* The Human Factor provides the evidence about moving to “people powered public services” which could save billions. It should be required reading in PCT and Local Authority boardrooms as well as by political party strategists. The word is that Andrew Lansley likes this approach. Both parties are making noises that the boundaries between health and social care services are going to be intentionally blurred in the near future. In that light, keeping separate budgets for healthcare and for social care is simply perverse and discriminatory against the very groups who are meant to benefit. It perpetuates an impediment to integrated services which goes back to 1948. It really is time to come into the 21st century with how we commission and provide public health and social care services for our increasingly complex and diverse population. That’s the challenge MAC would like to see all parties grasp as the election temperature starts to rise.
*NESTA is the National Endowment for Science, Technology and the Arts