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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Fears over Notting Hill Carnival reveal more about racism than reality

Statistically, the event is about as safe as Glastonbury.

Notting Hill carnival is terrifying. As soon as the sun sets, gangs emerge ready to prey on unsuspecting attendees with Red Stripe cans fashioned into knives. Children barter for drugs. Dancing is punctuated by ceremonial burials for those killed in between every dancehall tune. And that's just on the kids’ day.

Except, it's not true. Statistically, the event is about as safe as Glastonbury - if not safer, judging by the number of arrests. In 2015, Glasto was praised for its low arrest rate (75 arrests for a crowd of 135,000), but in the same year carnival had ten times the capacity and fewer than ten times the offences.

Despite these statistics, the police, MPs and newspapers seem desperate to paint carnival as a gang-run danger zone. The Met Police recently tweeted about a kilo of heroin seized in the run up to carnival, despite not even knowing whether the perpetrators were going to the event. MPs, such as former Kensington MP Victoria Borwick, are happy to fuel this fire, claiming to be concerned about the supposed “year on year increase in violence and physical harm to our police officers and members of the public”. Newspapers revel in publishing large spreads about the raids in the run up to the two days, despite lacking evidence they’re even connected. Break this down and it’s clear: this dislike towards carnival roots itself in racism - the presumption that a festival celebrating black, West Indian culture, frequented by a higher proportion of black British punters, must inevitably, be violent.

I have been attending carnival since the age of six, when my parents moved to the area (90s gentrification alert). I used to sell Ribena for a markup on my street, took part in the float my primary school ran and every year witnessed the incredible recontextualisation of the area. Gone is the whitewashing for a moment: the streets and houses become splattered in neon paint, jerk chicken boxes and Red Stripe cans. It is one of the best things to happen to the area, and its vast cultural value exceeds the bougie cafes and boutique clothing stalls that span the area.

And yet, every year, I have to dodge questions from relatives and friends about how dangerous it supposedly is. “Ooh, Notting Hill carnival. Bit scary, isn't it? Lots of angry youth who can get quite violent I hear. Didn't someone get stabbed last year?” Perhaps a viable question to ask anyone going to a crowded event. Except, why weren’t they asking me this when I flew to Amsterdam this year to go to a music festival?

There's another side of critiquing carnival that is equally infuriating, and that's that the fact that the event in some ways stands as a consolation prize to the original tenants of the area. In the middle of the 20th Century, Notting Hill was far from the Russian oligarch haven it is today. It was the Windrush Era, when black immigrants began arriving from the Caribbean. They came not out of some overwhelming desire to be freezing for 11 months, but because Britain was struggling after the Second World War, and desperately needed a labour force. Despite the demand, the West Indians were met with hostility and racism, forced to live in the worst areas of London. One of those places was Notting Hill.

Imagine, then, the audacity of shaming carnival. Imagine being forced by racism into a rundown neighbourhood, turning it into something fashionable, and then being priced out by middle-class white people. Imagine on top of that, having your legacy celebration degraded under the guise of safety concerns.

This year will feel different. It will be the first year ever under a Labour MP. It will also come two months and a half months after the Grenfell fire, where many of its residents and victims will have taken part in the event. Whilst there’s something defiant in these parades, it will be hard for the collective joy not to be marred by a knowledge that somewhere in this borough, bodies are being buried because of our council.

We need to see carnival for what it is: a celebration of a culture struggling to stay afloat in the area. Kensington continues to edge out those who may not be living in £2.5m homes - whether it’s with rising house prices, creating anxiety around an event or even putting lives at risk due to sheer disregard and greed. If you’re worried about going, I would avoid all large, crowded events in general, because there’s no use believing the vacuous and racist hype. Beyond getting splattered with paint and dancing too enthusiastically to Bashment, there’s nothing to fear.