The Lib Dems have been burned badly by their support for the coalition’s NHS reforms. A position that leaves care minister Norman Lamb desperately trying to focus on his pet projects of improving mental health and ‘integrated care’.
But for GPs, he has not delivered on his big pre-election idea to have a ‘patient premium’ that would incentivise GPs to work in deprived areas – along similar lines to the pupil premium in schools.
Pulse meets Mr Lamb in a meeting room across from the Houses of Parliament. He is relaxed in talking about his ideas for general practice, despite his adviser repeatedly interrupting to try and end the interview.
The Lib Dem health spokesperson is not afraid to ruffle some feathers in the short time we have with him. He expresses vocal support for rolling out personal health budgets – which would see patients being given NHS cash to spend as they wish – as a ‘good use’ of public money. He also raises the prospect of GPs joining with hospitals to form ‘integrated care organisations’ – another controversial idea.
But whether he will have a receptive audience with the profession is not clear. For many GPs, the Mr Lamb’s promises are contingent on the election arithmetic resulting in another coalition Government. And that prospect seems far from certain.
What are the benefits of personal health budgets?
When I talk about shifting to a system that is much more personal, there is a very strong principle about putting the individual in charge as much as possible, helping them to self-care. In local government, we have witnessed the powerful consequences of personal budgets. And when you survey people’s experience of the care system, it’s massively better as a result of being given the control of the resource. Surely that is a principle that we should try to apply to management of long-term conditions, for example? The pilots of personal health budgets showed very positive evidence, particularly in those with quite acute need.
Didn’t the pilots show some patients were spending the money on theatre tickets and frozen meals?
The critical question you have to ask is about an individual’s well-being. Have you given that person a better life than they had at the start? If their health and well-being have improved, is that not something that we should be supporting?
But is that a good use of taxpayers’ money?
If the analysis shows people having a better experience and improved well-being, would we really say this is not a good use of taxpayers’ money?
My plea is for us to be open-minded on personal budgets and to look at the extraordinary impact they have had for disabled people in social care. For people with a long-term condition, who will have a mix of health and care needs, should we really just close our minds?
I think many GPs see the extraordinary potential value of empowering an individual, both to self-care and improve their life.
Morale is low among GPs, with many moving abroad or leaving the profession altogether. What can be done to fix that?
I absolutely recognise that GPs are under a lot of pressure, the system is dysfunctional and it’s broken. That’s why I have a passion for integrated care and that’s why I established the pioneer integration programme. We all have to think afresh about how we make the system sustainable.
Income for acute hospitals continues to go up, but financial pressures on mental health, primary care and community services have increased. So we have got to change the financial incentives. If you can establish, in effect, an integrated care organisation, or cluster of organisations, with general practice, the community provider and the mental health trust forming a joined-up local system, sharing risk and reward, then I think something very interesting starts to happen. If it’s commissioned as a whole package, you get the incentive to keep people healthier and not increase activity in hospitals. The GPs I have talked to are overwhelmingly in favour of that sort of change.
But doesn’t the funding need to be there in order to enable that?
I would like to see a complete pooling of the budget, but it left to local areas to determine how the commissioning is done. There should be single, integrated commissioning. I would like to see the evolution of integrated care organisations – I say evolution because I don’t want to see anything imposed.
Pulse is campaigning against practice closures. Do you agree practices at risk need emergency support? Do you support the campaign?
I think we have to take it seriously and we have to look at the concerns. The bare figures look extremely disturbing, I fully recognise that, but I think the reality is a bit different to that. The Minimum Practice Income Guarantee (MPIG) was introduced in 2004 as a temporary measure to smooth the introduction of a new contract; 10 years later it’s still here. It surely is a good principle to try to get to the point where all practices are funded in the same way, but you have got to try and avoid unintended consequences.
We have got to make sure local areas have adequate, good general practice support services available. We have to address the under-doctored areas – the disadvantaged communities where there are fewer GPs than in the leafier suburbs. That is a bit of a scandal.
Wasn’t the Carr-Hill formula supposed to be addressing that?
We know it hasn’t been addressed. It’s not right if there are some parts of the country with inadequate general practice, whether as an unintended consequence of the move away from MPIG or because of health inequalities.
You have said that you want parity between physical and mental health. Why hasn’t that happened yet?
Because you have this combination of a lack of waiting time standards and the lack of a tariff. There is an institutional bias in the NHS against mental health. Whenever money is tight, mental health loses out.
The first thing I did as health minister was to establish the principle about waiting time standards in the mandate. But you can’t do it overnight – the system is under a lot of strain.
There’s an enormous political focus from all parties on meeting the A&E target, the cancer target, the 18-week target. That determines where the money goes and that has got to change. I am excited by the opportunity we have to literally change this for good.
What difference will GPs see?
GPs will start to see that people with mental health problems have rights, for the first time. But it will be a process; we start and then we build it up.
The next five years, I think, will be a crunch time for the NHS.
Family: Married to Mary since 1984 and has two sons
Education: Law degree at the University of Leicester
1987 Elected to Norwich City Council
2001 Elected as Lib Dem MP for North Norfolk. Became Lib Dem leader Charles Kennedy’s parliamentary private secretary
2005-2006 Lib Dem trade and industry spokesman
2006-2010 Lib Dem health spokesman
2010-2012 Parliamentary private secretary to Nick Clegg
Feb 2012-Sept 2012 Employment relations minister
Sept 2012-present Minister of state for care and support
Career highs: Developing the Better Care Fund for the integration of health and social care. Working in Government to promote equality between mental and physical health
Interests: Norwich City, cycling, walking