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Health and social care budgets will be moved from CCGs under Labour

The NHS and social care budgets will be combined and responsibility for controlling funds will rest with local health and wellbeing boards if Labour takes power, shadow health secretary Andy Burnham said.

In a speech to the King’s Fund today, Mr Burnham proposed to put health and wellbeing boards, which comprise of local authorities and CCG representatives, in charge of a single budget for health and social care in their locality.

Mr Burnham warned that fragmentation of services meant that our health and social care systems were not achieving the World Health Organisation’s definition of health as a state of ‘complete physical mental and social well-being and not merely the absence of disease or infirmity.’  

He said the gaps in physical, mental and social care services were ‘getting dangerous’ and that the NHS remained a ‘treatment’ service rather than breaking out and embracing prevention.

Currently there is no appetite for investing in prevention because the NHS can pick up the slack for ‘whittled down’ care services, which suits hospitals who get paid per patient, he said.

Labour’s solution would be to combine the health and social budgets to create an integrated health and social care services, to be delivered in the home and community wherever possible. Currently PCTs in England control budgets of £60bn.

Mr Burnham said: ‘For 65 years, England has tried to meet one person’s needs not through two but three services: physical, through the mainstream NHS; mental, through a detached system on the fringes of the NHS; and social, through a means-tested and charged-for council service, that varies greatly from one area to the next.

‘For most of the 20th century, we just about managed to make it work for most people…Now, in the century of the ageing society, the gaps between our three services are getting dangerous. The 21st century is asking questions of our 20th century health and care system that, in its current position, will never be able to answer to the public’s satisfaction.’

He added: ‘So the question I am today putting at the heart of Labour’s policy review is this: is it time for the full integration of health and social care? One budget, one service co-ordinating all of one person’s needs: physical, mental and social. Whole-Person Care.

‘If the NHS was commissioned to provide Whole-Person Care in all settings – physical, mental, social from home to hospital – a decisive shift can be made towards prevention.’

He said under this ‘whole-person care’ system GPs would manage the care of the at-risk older population and lead teams of others professionals such as physiotherapists, occupational therapists and district nurses.

Mr Burnham also re-iterated previous promises that a Labour Government would work with the NHS institutions they inherit, rather than inflict another top-down re-organisation of the health service.

In questions after his speech, RCGP chair professor Claire Gerada said practices could expand. She said: ‘There may be a case for actually morphing GP practices into something that is much bigger. We can be employing hospital consultant specialists into community care. It is really important we don’t fall into the trap of reinventing what we already have.’

Mr Burnham replied:  ‘I will be open to a range of models about how this will be done. What matters to me is whether it is co-ordinated, does it give patients a single point of contact. Those are the things that matter. As long as they are delivered, that is what matters.’

Dr Charles Alessi, interim chair of NHS Clinical Commissioners, welcomed the proposals to merge the budgets but said that clinicians needed to retain influence.

‘At the moment we have CCGs that make decisions around commissioning but those decisions are often seen by and commented on by health and wellbeing boards. It is a very valuable intervention they make. This is adding a structural dimension to what is happening anyway.

‘It’s the detail about how that is implemented that is important. There are discussions that need to take place about the role and influence of CCGs in this process. I would be worried about a system where CCGs are wholly advisory, which means they are ignored.’