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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Just face it, being a parent will never be cool

Traditional parenting terms are being rejected in favour of trendier versions, but it doesn't change the grunt-like nature of the work.

My children call me various things. Mummy. Mum. Poo-Head. One thing they have never called me is mama. This is only to be expected, for I am not cool.

Last year Elisa Strauss reported on the rise of white, middle-class mothers in the US using the term “mama” as “an identity marker, a phrase of distinction, and a way to label the self and designate the group.” Mamas aren’t like mummies or mums (or indeed poo-heads). They’re hip. They’re modern. They’re out there “widen[ing] the horizons of ‘mother,’ without giving up on a mother identity altogether.” And now it’s the turn of the dads.

According to the Daily Beast, the hipster fathers of Brooklyn are asking their children to refer to them as papa. According to one of those interviewed, Justin Underwood, the word “dad” is simply too “bland and drab”:

“There’s no excitement to it, and I feel like the word papa nowadays has so many meanings. We live in an age when fathers are more in touch with their feminine sides and are all right with playing dress-up and putting on makeup with their daughters.”

Underwood describes “dad” as antiquated, whereas “papa” is an “open-minded, liberal term, like dad with a twist” (but evidently not a twist so far that one might consider putting on makeup with one’s sons).

Each to their own, I suppose. Personally I always associate the word “papa” with “Smurf” or “Lazarou.” It does not sound particularly hip to me. Similarly “mama” is a word I cannot hear without thinking of “Bohemian Rhapsody”, hence never without a follow-up “ooo-oo-oo-ooh!” Then again, as a mummy I probably have no idea what I am talking about. If other people think these words are trendy, no doubt they are.

Nonetheless, I am dubious about the potential of such words to transform parenting relationships and identities. In 1975’s Of Woman Born, Adrienne Rich describes how she used to look at her own mother and think “I too shall marry, have children – but not like her. I shall find a way of doing it all differently.” It is, I think, a common sentiment. Rejecting mummy or daddy as an identity, if not as an individual, can feel much the same as rejecting the politics that surrounds gender and parenting. The papas interviewed by The Daily Beast are self-styled feminists, whose hands-on parenting style they wish to differentiate from that of their own fathers. But does a change of title really do that? And even if it does, isn’t this a rather individualistic approach to social change?

There is a part of me that can’t help wondering whether the growing popularity of mama and papa amongst privileged social groups reflects a current preference for changing titles rather than social realities, especially as far as gendered labour is concerned. When I’m changing a nappy, it doesn’t matter at all whether I’m known as Mummy, Mama or God Almighty. I’m still up to my elbows in shit (yes, my baby son is that prolific).

The desire to be known as Papa or Mama lays bare the delusions of new parents. It doesn’t even matter if these titles are cool now. They won’t be soon enough because they’ll be associated with people who do parenting. Because like it or not, parenting is not an identity. It is not something you are, but a position you occupy and a job you do.

I once considered not being called mummy. My partner and I did, briefly, look at the “just get your children to call you by your actual name” approach. On paper it seemed to make sense. If to my sons I am Victoria rather than mummy, then surely they’ll see me as an individual, right? Ha. In practice it felt cold, as though I was trying to set some kind of arbitrary distance between us. And perhaps, as far as my sons are concerned, I shouldn’t be just another person. It is my fault they came into this vale of tears. I owe them, if not anyone else, some degree of non-personhood, a willingness to do things for them that I would not do for others. What I am to them – mummy, mum, mama, whatever one calls it – is not a thing that can be rebranded. It will never be cool because the grunt work of caring never is.

It is not that I do not think we need to change the way in which we parent, but this cannot be achieved by hipster trendsetting alone. Changing how we parent involves changing our most fundamental assumptions about what care work is and how we value the people who do it. And this is change that needs to include all people, even those who go by the old-fashioned titles of mum and dad.

Ultimately, any attempt to remarket parenting as a cool identity smacks of that desperate craving for reinvention that having children instils in a person. The moment you have children you have bumped yourself up the generational ladder. You are no longer the end of your family line. You are – god forbid – at risk of turning into your own parents, the ones who fuck you up, no matter what they do. But you, too, will fuck them up, regardless of whether you do it under the name of daddy, dad or papa. Accept it. Move on (also, you are mortal. Get over it).

Parenting will never be cool. Indeed, humanity will never be cool. We’re all going to get older, more decrepit, closer to death. This is true regardless of whether you do or don’t have kids – but if you do you will always have younger people on hand to remind you of this miserable fact.

Your children might, if you are lucky, grow to respect you, but as far as they are concerned you are the past.  No amount of rebranding is going to solve that. This doesn’t mean we can’t change the way we parent. But as with so much else where gender is concerned, it’s a matter for boring old deeds, not fashionable words.

 

 

 

Glosswitch is a feminist mother of three who works in publishing.