It must by
now be a given that integrated, whole person care is the vision for the future
of Local Authority Adult Social Services and the NHS. Reducing hospital admissions and stays is essential, in fewer
centres of excellence but with wider community outreach. Having a single nominee to
whom all issues relating to wellbeing can be referred by each patient, with the
authority to channel resources and with home as the default point of delivery
is an idea which must be brought to fruition. But how? Demands on medical and
care resources already exceed supply and will continue to grow. With current
budgets for adult care and health in separate hands all clinging
onto every penny they can in the face of cuts; with hospital, GP and care
priorities varying in different parts of the country; with gaps in skills and
capacity required to fulfil the required roles; with the need for a change in
culture across tens of thousands of healthcare professionals; and with the
problem of defining care vs subsistence costs, this transition cannot be easy
or rapid. Labour is however a party with a value of long-termism.
So what
would we have a Labour Government promise by way of steps towards the vision?
First, it
has to redefine the nation’s priorities. Just what is the role of the State?
How much tax income should be raised and what are the priorities for its use?
Labour must ignore the Right’s sneering accusations that it will merely borrow
or tax more. Within existing financial resources, responsible application of
funds does not need merely to reflect the current Government’s choices. Nor, we
argue, does the economic policy have to reflect the constraints applied by
Osborne. This is a wealthy country which has used its credit to refinance banks
and stimulate house-buying. It can do the same to rebuild those aspects of the
State being wrecked for the sake of neoliberal ideology. If the economy is
about people as well as finance, the building of integrated care must have
precedence over debt repayment, low taxes for the wealth, and unjustified
vanity projects like HS2 and Trident replacement. This need not only entail
direct taxation as its source. Equity release on existing homes; loans against
the collateral of estates after death; housing bonds purchased earlier in life
backed by a State bank are all options which the State can facilitate to avoid
having to levy excessive new taxes. It can no longer be taboo to require people
with wealth to apply this to their own care rather than to bequeathing it to
their descendents and depending on others’ taxes.
How,
specifically, is this money to be directed? Local authorities must be given the
duty to meet the care needs of their senior and disabled populations to a
decent standard, backed by central Government guarantees for the financing.
First, encouraging people to elect to live where they can obtain integrated
care is highly desirable but requires enabling. Meeting the increasing demand
for single-person, independent living is crucial. Building complexes whether
rented or owned, houses or flats, in which shared skilled care can be available
to people as needed, will create jobs while offering people the best chance of
staying out of hospital. Consistent with our conclusions on both economic
growth and the environment, home-building should be a major plank of the future
of healthcare in this country. Second, it must fund the recruitment, training
and proper remuneration and management of professional care workers, both
residential and community-based, in sufficient quantity to provide the levels
of care any person would wish for their own family member, regardless of
wealth.
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