Miliband calls for ‘whole-person care’

People with long-term conditions such as dementia or diabetes should be given “whole-person care”, the Labour leader has said, as a new report calls for the current system which treats “body parts” to be scrapped.

Ed Miliband said millions of people with complex health and social care needs would benefit from a single, co-ordinated care team rather than being passed between different services.

Writing in the Daily Telegraph, Mr Miliband said patients should be instrumental in designing their own tailored care plan, as well as being given access to “a personal care co-ordinator who is on their side and watching their back”.

It comes as a new report commissioned by Labour calls for the current system, which treats and commissions services dealing with “body parts”, to be replaced with one which views a person’s health and social care needs together.

Mr Miliband said 70% of all health and care spending is on treating long-term conditions such as cancer, heart disease or dementia, while large numbers of patients have multiple needs.

“But our health and care services have not yet adjusted to this new reality,” he said. ” Too much money is wasted because our health and care services are fragmented and focus solely on one part of the body – a broken leg or high blood pressure – rather than on the person as a whole.”

This means people often end up having longer stays in hospital, when many – particularly those who are elderly – would prefer to maintain their independence at home.

In his foreword to the report, Sir John Oldham, c hairman of the Independent Commission on Whole Person Care, said there was a need to tackle the current system of ” fragmented health and social care”.

Under the current system, people with multiple conditions are visited by health and social care workers, with each one often performing a separate task. And he said hospitals had become a focus for dealing with people when services were not available at home.

He said: “The current health and care system has been created to respond to single episodes of care – typically involving treatment in hospitals – rather than collectively treating the needs of the whole person across organisational boundaries.

“This provides fragmented care which causes problems for people and their families. Each individual fragmented service also provides problems for every other fragmented service because the handovers between these services are often poorly carried out.”

The report proposes closer integration of health and social care budgets and revamping the current payments system which sees individual “episodes” of care paid for.

Instead, payments should reflect the entire care package given to a person.

Under the proposed changes, a single care co-ordinator would work directly with the patient’s GP to ensure “every health and social care professional works to a proactive plan”.

The GP would then work closely with consultants and specialists to provide an overall package, ” where each specialist knows they have to work with another to deliver the best outcomes”.

There would also be much better sharing of information about patients and their records.

“The default assumption should be of implied consent for people’s information to be shared across health and care providers for their direct care,” the report said. ” People should be able to ‘opt out’ of the automatic sharing of their information.”

Unless action is taken, “by 2020, maintenance of the current level of service provision could require over £30 billion across health and social care”, the study went on.

“This is as much as we spend each year on defence. Status quo is not an option.”

The report sets out how o lder people are heavy users of health and social care, with the over-65s consulting GPs five times more often than the average for the population.

They account for 62% of total bed days in hospitals in England, 68% of emergency bed days and 80% of deaths in hospital.

One in three people in England has at least one long- term condition and the number of people with three or more conditions is expected to increase from 1.9 million in 2008 to 2.9 million in 2018.

The Commission also calls for changes to how public health is managed, adding that more needs to be done to tackle obesity.

It said the “current model of industry self-regulation has failed to adequately address the environment which can encourage unhealthy behaviours”.

Richard Hawkes, chair of the Care and Support Alliance, said: “Chronic underfunding has left older and disabled people who need support to get up or out of the house cut out of the care system.

“Without that support, people become isolated, slip into crisis and often end up in A&E. The impact is being felt throughout the health and care system.

“Looking properly at how to integrate health and care services must be part of a solution to the care crisis.

“Today’s report is an important milestone in what is one of the biggest challenges facing families up and down the country – will they get the care support they need?”

Shadow health secretary Andy Burnham said: “Whole person care starts in the home. We have to make the home the default setting for care – fundamentally rethinking how you care for older people.

“But we don’t need new organisations – just give existing organisations a new job to do.

“The last Government couldn’t give people the fundamental choices they wanted. We might put new rights in the NHS Constitution, like the right to die at home.”

Dr Mark Porter, chairman of the British Medical Association (BMA), said: “The greater integration and co-ordination of health and care services proposed in this report would not only benefit patients by ensuring they have access to the right care for their needs, but might deliver savings to the NHS in the long-run.

“The current fragmentation of services can make it difficult for patients to navigate local health and social care systems and squanders resources.

“Crucially, any new system, however well integrated, would need to ensure the existing funding gap is closed so both the health and social care needs of patients are adequately met. It will not be right to further cut hard-hit health services to backfill and extend social care.

“It is also vital that these reforms are delivered without repeating the wasteful and damaging top-down reorganisation forced on the NHS recently.”

Dr Peter Carter, chief executive of the Royal College of Nursing (RCN), said: “The health service is facing its biggest ever challenge in the form of an ageing population with complex, multiple conditions requiring social as well as health care. This is an important report which contains a number of promising recommendations which deserve serious consideration.

“Nursing staff often tell us that patients find it difficult to navigate the care system, which can cause additional anxiety and health problems.

“With the increasing number of patients with multiple, long-term conditions relying on a greater number of different services, this problem will not solve itself.”

A Conservative health spokesman said: “This is all too little, too late from Labour – they had 13 years to integrate health and care systems, and this Government has already announced a £3.8 billion fund which will do exactly that.

“While Labour take further time to consider how to implement Sir John Oldham’s proposals, we are getting on with giving older people a named accountable GP who will be responsible for co-ordinating their care and support – giving peace of mind to some of our most vulnerable members of society and their families.”