The shadow health secretary is right. Photo: Getty
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Government NHS reforms adviser: Burnham's plan for patient choice is the right way

A health expert who advised this government during the passage of the Health and Social Care Act in 2012 argues that Labour's plan to integrate health and social care is preferable to the coalition's approach.

Last week, the former Health Secretary Alan Milburn said it would be a "fatal mistake" for Labour to fight the election by spending on, but not reforming, the NHS. He was joined by another Labour luminary – Lord Darzi – on Friday, as a clear group appeared to line up against the shadow health secretary Andy Burnham’s agenda.

These attacks are not just unseemly, but wrong as well. Look behind the headlines and Burnham’s agenda is the right one: to reenvision the National Health Service as a National Health and Care Service. Now we need more detail on how this is to be done.

It’s clear the NHS can’t survive without fundamental reform. As an adviser to this government during the passage of the Health and Social Care Act in 2012, and more recently on care for people with learning disabilities and on winter pressures in Accident and Emergency, I’ve seen the gravity of the situation first hand.

I’ve also seen there are no easy cuts to make. Cuts without strategic thinking have fragmented not only healthcare but also social care across the country. This directly harms our most vulnerable citizens. It means more people falling through the cracks of a breaking structure. We are on borrowed time and on the cusp of a reality where crises like the one we are living through in A&E this winter will become the norm. And it is largely our legislators’ fault.

Poor social care causes more damage every day. Cuts to council budgets have trimmed care for the elderly to the bone. Charity CEOs tell me of reverse auctions for local health contracts being won by the very cheapest service, whatever form it may take. Some private operators – though they are often very effective – may bid so low that they make a loss on social care and recoup the money elsewhere.

In A&E, these cuts send more older people into hospital for preventable problems. Often 20 per cent of beds are filled by elderly people who aren't ill, but end up in hospital because no one else can help. They can't be discharged because there's no social care to help them at home. Cutting costs money; when we run out of beds it can also cost lives.

Burnham's plan is to price in these very real externalities of running a health service. The vision is to change the NHS by replacing competition with integration. When Burnham talks about integrating the work of public, private and third sector providers, he is indicating a situation in which new services are created by new kinds of collaboration.

Collaboration rather than competition becomes the driver of patient choice. This is not merely theoretical. This winter I have chaired an NHS taskforce to get charities in to 29 emergency departments that are under pressure to tackle the immediate problem. We hope to get the charities into action early next week. We will be giving vulnerable patients a choice to receive community care that the market has failed to provide.

No doubt market liberals of the left and right will sniff at this vision of a world of choice beyond how they define it. But politicians of all parties must keep their nerve. The idea of a health service rescued by cuts and efficiencies is debunked. Now they must scale up the radical approach into a sustained plan of action. 

They can build on pilots like the charity intervention into Accident and Emergency, on innovations such as the coalition’s attempts to pilot bringing together budgets for health and social care at a local level, and they can create a new, integrated plan for health and care. The Burnham plan may not be easy to digest or to do – but it is needed.

Sir Stephen Bubb is chief executive of ACEVO and an expert on health and social care. He chaired the Choice and Competition work stream during the 2012 Health and Social Care Act "listening exercise", which lasted from 6 April to 21 June 2011. He presented the group’s findings to cabinet, becoming the first third sector leader to address a session of cabinet

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Our treatment of today's refugees harks back to Europe's darkest hour

We mustn't forget the lessons of the Second World War in the face of today's refugee crisis, says Molly Scott Cato.

In the 1930s, thousands of persecuted people fled Europe. Our own press ignominiously reported these as "Stateless Jews pouring into this country" and various records exist from that time of public officials reassuring readers that no such thing would be allowed under their watch.

With the benefit of historical hindsight we now know what fate awaited many of those Jews who were turned away from sanctuary. Quite rightly, we now express horror about the Holocaust, an iconic example of the most shocking event of human history, and pledge ourselves to stop anything like it happening again. 

Yet as Europe faces its worst refugee crisis since the Second World War we are witnessing a deafening cacophony of xenophobic voices in response to people fleeing their own present-day horror. We must therefore reflect on whether there is an uncomfortable parallel in the language being used to describe those seeking asylum today and the language used to describe Jews seeking refuge in the 1930s.

Our response to the current refugee crisis suggests we feel fearful and threatened by the mass movement of desperate people; fearful not just of sharing what we have but also of the sense of disorganisation and chaos. Does the fact that these refugees are from Syria, Libya, Iraq and Afghanistan, and so not part of our continent, provide an excuse to allow them to be bombed at home or drowned during their desperate journey to safety?

We are not helped by the poorly informed public debate which—perhaps intentionally—conflates three quite different movements of people: free movement within the EU, irregular or unauthorised migration and the plight of the Middle Eastern refugees. While our misguided foreign policy and unwillingness to tackle change may give us a moral responsibility for those fleeing famine and conflict, our responsibility towards refugees from war zones is clear under international law.

Due to our commitments to the UN Refugee Convention, the vast majority of Syrian refugees who reach our territory are given asylum but the UK has taken fewer Syrian refugees than many other European countries. While Germany admitted around 41,000 asylum-seekers in 2014 alone, the UK has taken in fewer than 7000.

The problem is that any sense of compassion we feel conflicts with our perception of the economic constraints we face. In spite of being the fifth largest economy in the world we feel poor and austerity makes us feel insecure. However, when actually confronted with people in crisis our humanity can come to the fore. A friend who spent her holiday in Greece told me that she saw local people who are themselves facing real poverty sharing what they had with the thousands of refugees arriving from Turkey.

A straightforward response to the growing sense of global crisis would be to restore the authority of the UN in managing global conflict, a role fatally undermined by Tony Blair's decision to go to war in Iraq. Our role should be to support UN efforts in bringing about strong governments in the region, not taking the misguided ‘coalition of the willing’ route and running foreign policy based on self-interest and driven by the demands of the oil and arms industries.

We also need EU policy-makers to show leadership in terms of solidarity: to co-operate over the acceptance of refugees and finding them safe routes into asylum, something the European Greens have consistently argued for. The EU Commission and Parliament are in clear agreement about the need for fixed quotas for member states, a plan that is being jeopardised by national government’s responding to right-wing rather than compassionate forces in their own countries.

Refugees from war-torn countries of the Middle East need asylum on a temporary basis, until the countries they call home can re-establish security and guarantee freedom from oppression.

The responsibility of protecting refugees is not being shared fairly and I would appeal to the British people to recall our proud history of offering asylum. Without the benefit of mass media, the excuse of ignorance that can help to explain our failure to act in the 1930s is not available today. We must not repeat the mistakes of that time in the context of today’s crisis, mistakes which led to the deaths of so many Jews in the Nazi death camps. 

Molly Scott Cato is Green MEP for the South West of England.

Molly Scott Cato is Green MEP for the southwest of England, elected in May 2014. She has published widely, particularly on issues related to green economics. Molly was formerly Professor of Strategy and Sustainability at the University of Roehampton.