January 18, 2012 by garryk99 First posted at: http://ozzyscorner.wordpress.com/2012/01/18/the-left-must-reform-public-services-too/
The most feared word to our public services is reform.
Reform has become a by-word for cuts and privatisation. Take, for example, the NHS reforms currently going through Parliament, or the changes to DLA. Both are ideological changes designed to privatise one and simply reduce payments to the other.
However, while fighting these reforms, the left cannot rest on their laurels. Our public services do need reforms, but not the ones offered by the Coalition. They are needed to better serve the need of service users, in a way that maximises precious resources. They are needed to reaffirm to the United Kingdom that public services are the most cost effective way of delivering vital services, with the best outcomes for service users. Without changes, those forces that are pushing for privatisation will gain a stronger and stronger voice.
A major issue is the lack of intermediate community care. I have recently experienced this with a relative who is elderly suffering from early dementia and a heart condition. In the last 6 months she has been hospitalised around 10 times. Her heart condition and dementia are beyond the scope of her GP as her needs are complex. However, as there is no provision for community care, this resulted in her worsening on a number of occasions to a degree that required hospitalisation. This is invariably expensive and can result in people getting help when it is too late, so the intervention is less successful.
This is common with conditions like diabetes too. If managed in the community by more specialist community care teams, it is substantially cheaper than hospitalisation with much better patient outcomes. It would preserve hospitals for those matters that only they can handle.
We need to wean ourselves from too much concentration on hospitals. Many local hospitals provide a skeleton service, when nearby there is a larger, more equipped hospital with better specialists available. People do love their local hospital, but I believe diverting resources partially to bigger hospitals and to community services from local skeleton hospitals would result in better health care at a lower price.
Another area where co-ordination is poor is that between the NHS and social services. From September to October 2011 128,000 days delay were incurred by the NHS because of bed-blocking – when patients can’t be discharged as the services they need are not in place in the community  . This figure had been falling, but the impact of cuts to local social services budgets has reversed the figures. Each day in a hospital bed costs an average of £255. Therefore, the cost to the NHS of 128,000 days of delays amounts to nearly £33 million, annualised to nearly £196 million. This far exceeds the cost of providing care in the community.
In the last year or so, my Son has been going through the system for a diagnosis for a condition on the autistic spectrum. Quite frankly, no-one would believe how dreadfully poor this service is, and how badly under funded these services are. In this battle to find the required support at school, we are on our third school in year. Read any of the forums about parents battling this, and you get the same story time after time. It’s a national scandal every bit as poor as our national treatment of the elderly. The reform required here is a large increase in funding, much better training for teachers and a smoother journey between the different professionals involved.
Education services require reform too. Schools are in an excellent position to pick up problems with children who without intervention are likely to grow up into uneducated, workless adults who are at risk of getting involved with crime. Early intervention is far cheaper, as the right investment will be likely to produce a law abiding taxpayer. Without intervention the cost of benefit payments, the cost to the justice system, and most of all the personal cost, it is crazy to not intervene early. The transfer of resources from the justice system to the education system deals with the root cause and not the symptoms. The Coalition have promised to help 120,000 families at most risk, but this is not enough.
All this co-ordination and improvement is impossible with broken up and privatised services. The left should argue that these reforms are required and in the best interests of the country. Only a reformed truly public sector can deliver this.
Introduction of Academies is dividing up professionals. Academies become discrete institutions and strive for their own promotion. The result damage to centralised services which vulnerable children rely upon is the consequence. There is no doubt that the policies being currently implemented by the Coalition government will result in a two or three tier system in education and in health. That the most vulnerable in our society such as those who suffer dementia are a source of profit is immoral. Gove wants every school to have a Bible so perhpas he thinks that is doing good for mankind. All these policies must be overturned. The Opposition must oppose them loudly and critically and return as a government ready to implement socialist policies. Re-election for Labour is most likely by presenting socialist policies which benefit 99% and Labour must speak up and speak up now.
Community health services have for too long been a Cinderella service, few people know what they are, nor their value, however, I think the comments made here are rather naive.
“This is common with conditions like diabetes too. If managed in the community by more specialist community care teams, it is substantially cheaper than hospitalisation with much better patient outcomes. It would preserve hospitals for those matters that only they can handle.”
Ah, this is my specialist subject since I have had diabetes for 35 years. Do I want my care transferred to the “community”? Hell no. I experienced that in the 90s when I moved house and the GP was a “fundholder” which basically meant they decided to “give it a go” and treat my diabetes. They didn’t have a clue and the doctor even said to me “you’ve had diabetes for 17 years, so you know more about it than me”.
The role of community health services is in *prevention*, not shifting care to cheaper (and less qualified) staff. That is not good for the patient. The shift to the community will be more expensive initially, if its not, then it is not being done properly. However, by emphasising *prevention* there will be huge savings in the future, and this not only saves money by not having to replace hips due to fractures from preventable falls, but it is better for the patient too.
I fully agree with what you say about social services. The problem is that there are two budgets, so it is the money, not the patient, that is important. If there is just one budget (and this applies to the hospital/community services issue too) then the funding issue disappears and the patient becomes central.