NHS and Social Care need to be a single, joined up system. And the Ombudsman needs to own up, learn and apologize to the Titcombes.
The annual conference of the NHS Confederation is where politicians of all sides present their big ideas for health and social care. In the one before an election, there is usually tedious point scoring but this year Jeremy Hunt, Andy Burnham and Norman Lamb all agreed that the service faces massive challenges, that health and social care need to be joined up as a single system and – having just gone through the biggest reforms in NHS history – it will require further massive reforms to do this.
When the NHS was founded in 1948, half the population died before the age of 65. Now, the average life expectancy is 80, with the rich living 15 years longer than the poor and having 20 more years of healthy living. Inequalities in health and truly staggering. One in three children born today will live to 100, but one in four boys born in Glasgow still won’t make it to 65. One in three people will get cancer, one in three will get diabetes and nearly everyone will get heart disease. Obesity appears unstoppable. Liver disease, kidney disease, musculoskeletal disease, depression and anxiety are all on the increase. Mental illness currently costs the UK over £70 billion a year and one in three people over 65 will die with dementia. Many people with dementia live for many years, even if they haven’t been properly diagnosed and treated. Dementia alone already costs the economy more than cancer and heart disease put together. Some patients have three of more incurable diseases, and are on multiple medications the combined effects of which are unknown.
The NHS and social care system is crucially dependent on millions of unpaid carers and the round-the-clock pressures and responsibilities they face are huge. If carers went on strike, the NHS and social care service would collapse overnight. Already the NHS is unable to provide safe staffing levels and care around the clock. Staff recruitment and retention is critical in some areas and some specialties. Your ability to access care and the standard of care you get across the NHS is hugely variable as are the outcomes for just about every disease. Your chances of survival even depend on what day, and time of the day time of the day, you get sick.
Every other western country is facing similar problems and the NHS at least has the potential to properly coordinate care in one single, joined up system had it not been forced down the route of marketization. Burnham has said Labour will repeal the competitive element of the Health and Social Care Bill, and make the NHS the preferred provider of services. Both he and Norman Lamb spoke of a single health and social care system with a single budget, with patients having ‘whole person care’ delivered by single team. Burnham believes this will be ‘a 10 year journey’. Lamb wants immediate action now to legally oblige health and social care commissioners to pool their budgets. The theory is that elderly patients with high medical needs also have high social care needs, so there is currently a lot of duplication of effort, miscommunication and patients falling down the cracks between services.
Nobody is promising extra money, despite the ever increasing demand, and it’s likely the NHS may hit a wall before the election. Hunt is hoping to kickstart integration with ‘a better care fund’, which transfers £3.8 billion of existing NHS money to social care services in the hope that it will pay for itself by reducing emergency admissions. However, cuts in existing social services have been so savage it may only just keep social care afloat and not keep patients out of hospital. And it seems inconceivable the NHS could lose so much money without affecting patient care. Hunt has publicly promised an end to NHS cover-ups and to support whistleblowers and carers who speak up, which could come back to haunt him before the election were it not for the monstrous back log of unresolved tragedies still awaiting truth and reconciliation.
At Morecambe Bay, the role of the Parliamentary and Health Service Ombudsman (PHSO) has at least moved a step closer to proper scrutiny. The PHSO have been subject to wide spread criticism following the revelation that they refused to investigate the death of Joshua Titcombe in 2008(Eyes passim). The PHSO stated at the time that there would be ‘no worthwhile outcome’ in pursuing an investigation. Years later, in 2011, Joshua’s death was eventually subject to an inquest which revealed serious failures in his care and triggered a review by Monitor which found 119 serious risks to mothers and babies in the unit.
Information obtained under the Data Protection Act by Joshua’s father shows that the case advisor at the time had recommended an investigation but the former Ombudsman, Ann Abraham declined to investigate following non documented meetings with Cynthia Bower, the former CEO of the Care Quality Commission (CQC), in months before the last general election. Mr Titcombe wrote to request an internal review of these circumstances in July 2013 but the new Ombudsman, Dame Julie Mellor refused the request. The events at Morecambe Bay are now subject to an independent investigation led by Bill Kirkup, but the Ombudsman initially refused to participate in this process too. The Eye has learned that Mellor has now made a u-turn and agreed to ‘fully cooperate’ with Dr Kirkup’s investigation. But why have the PHSO gone to such lengths to avoid proper scrutiny of its actions at Morecambe Bay? All eyes are now on Dr Kirkup to provide the answer. Hopefully before May.