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Health Business talks to Norman Lamb, Liberal Democrat MP for North Norfolk and former Minister of State for Care & Support, about NHS funding, mental health, innovation and hopes for the NHS in 2017
Given that funding is so tight, what opportunities are there to make savings within the current framework of the NHS?
Everybody agrees that the health and care system could be run far more effectively and efficiently than it currently is. It ultimately boils down to the fact that the system we have is too reactive and fragmented, which doesn’t work for patients or the taxpayer.
The NHS was set up to treat ill health, rather than to think about how we can stop people from getting ill in the first place and keep them out of hospital. That was the case in the 1940s and it’s still the case today. We know that prevention is always better than cure, but this principle has never been the foundation of our healthcare service.
Perverse financial incentives in the NHS, such as incentivising activity in acute hospitals, mean that resources are constantly being pumped into acute hospitals while primary care, mental health and other preventive services lose out. The NHS also suffers the consequences of cuts to social care. Record numbers of people are stuck in hospital beds when many of them shouldn’t be there at all – but there’s often no care available in the community. It’s a ridiculous false economy, and completely unsustainable in the context of an ageing population and a rapidly growing number of people with multiple long-term conditions.
So there’s huge scope for doing things differently so that we’re more focused on prevention, integrated care and supporting people out of hospital. That was the original intention of the much-maligned Sustainability and Transformation Plans (STPs). The idea was to pull the different parts of the system together in each locality – physical health, mental health and community care and social care.
But in reality, the STPs have been developed behind closed doors with an excessive focus on cost savings rather than delivering better patient care. What had the potential to encourage closer integration and collaboration has, in too many places, ended up being a fig-leaf for cutbacks to services, and money that should have been used for transforming care models has instead been used to keep a failing show on the road. Mental health services also seem to be very peripheral to the focus of many of these plans, despite the rhetoric of parity of esteem. It’s a golden opportunity wasted.
In 2013, as Minister of State for Care and Support, you made a commitment to achieving 'joined up care' by 2018. Where has this fallen short, and what can be done to aid the process of integrating the two?
The Better Care Fund, which was a brainchild of the Liberal Democrats, was set up to pool NHS and social care budgets locally to support the integration of services and more joined-up care. This should have been the mechanism for bringing health and care spending together over the longer-term. I envisaged a process of pooling more and more of NHS and social care funds in the BCF until, by 2018, you ended up with a single, integrated, pooled budget.
But instead, the Better Care Fund has been starved of cash and we’ve seen only incremental increases in funding. Although an extra £1.5 billion has been promised, most of this won’t come through until the back end of the Parliament. In the meantime, with the government chipping away at local government funding, the Better Care Fund is just plugging the gaps in social care provision rather than delivering more integrated care.
It’s a great shame, because pooled budgets and joint, coordinated commissioning would go a long way to solving the problems in the current system. Getting more money into the Better Care Fund is an absolute must. But given what we are witnessing with the STPs, the prospects for bridging the divide between health and social care is looking increasingly bleak.
Where are the current deficiencies in mental health care, why do they exist, and how in your view can progress be made?
The bottom line is that there is a complete imbalance of rights of access to treatment between physical health and mental health in the NHS. National standards like the four-hour A&E waiting target and the 18-week referral to treatment are politically very potent in affecting where the money goes. But when Labour introduced these standards, mental health was left out completely. It’s a historic discrimination at the heart of our health service. Mental health remains chronically under-funded, so many people don’t get any help when they need it. How can we possibly tolerate that?
In government, Nick Clegg and I introduced the first ever access and waiting time standards in mental health, focusing on psychological therapies and psychosis treatment. s a first step towards redressing the imbalance, it was a critical moment. But we have to build on this. Theresa May highlighted the lack of mental health support as one of the burning injustices in society she was committed to tackling – if she really intends to deliver on that, she has got to invest in improving access across the board.
Investing in children and young people’s mental health must be a priority, given that mental ill health costs the economy an estimated £105 billion every year and three quarters of mental illness starts before the age of 18. The coalition produced an effective blueprint for modernising these services, with a renewed focus on prevention and early intervention. The government now has to implement that vision, which will mean making sure that the promised extra investment reaches the frontline and ending the scandalous disinvestment in mental health services by CCGs.
There are lots of new innovations in technology that have tangible benefits, both financial and clinical, that are becoming more readily available and cost effective, but the NHS struggles to adopt them and take advantage. How can that be changed?
The NHS has generally been poor at making the most of novel medical technologies and devices which could promote faster diagnosis, earlier intervention and support people to take control of their own healthcare. I think this is partly a cultural reluctance to change old practices and embrace new ways of doing things, but it’s also a symptom of short-term thinking on cost. We often hesitate to pay for new tech, even when doing so has potential to bring dramatic benefits further down the line in terms of patient care, efficiency and overall cost to the taxpayer.
We need to break free from that mentality, but it’s very difficult when commissioners and providers are under such intense pressure to make immediate savings. The Department of Health and NHS England have to give local services room to innovate. The Accelerated Access Review has looked at new ways of getting diagnostics and medical technologies to patients more quickly, and what we need to see now is a focus on translating those ideas into reality.
Diabetes care is one area that has benefited from self-care devices and digital apps, and there are exciting opportunities for other conditions. In Norfolk, for example, the community care trust recently launched a new self-monitoring service supporting patients with heart and lung problems to check their vital signs at home. The information gets transmitted directly to the clinician, who can intervene quickly if the readings give any cause for concern and prevent unnecessary admissions to hospital. Proactive approaches like this should be a model for the whole NHS.
What are the main trends in healthcare to look out for next year?
The fact that health and social care didn’t even get a mention in the Autumn Statement was astonishing. The system is facing an existential crisis, and there is no doubt that access to treatment and care will be increasingly rationed next year if the government fails to act quickly.
We can expect to see more vulnerable elderly and disabled people left without publicly-funded social care. The sad reality is that only those who can afford to pay will be able to expect high-quality care, while many others will be left to fend for themselves, with only the support of families and other unpaid carers.
And the recent sobering assessment of the National Audit Office was clear: the financial problems in the NHS are endemic and unsustainable. Longer waiting times are inevitable, and CCGs will be on the lookout for new ways to restrict treatment.
The public are crying out for an honest assessment of these challenges, and it’s high time that all parties work together to find ways to raise more resources and to make the system more efficient to ensure we have a modern and effective healthcare service. I’ve made repeated calls for the creation of an independent, cross-party commission to examine the challenges facing the NHS and social care, and come up with a new long-term settlement to secure these cherished services for future generations.
The government is confronted with a stark choice. It can agree to these calls, putting partisan politics aside in the interests of the nation; or it can preside over a rapidly disintegrating system which is putting the safety and lives of patients at risk.
Under the coalition government Norman Lamb served as Minister of State for Care and Support in the Department of Health. In January 2015, Norman was appointed to the Liberal Democrat General Election Cabinet as the party's Health spokesperson. He has been the Member of Parliament for North Norfolk since 2001.