The Liberal Democrats announced promises of sweeping reforms to make the NHS more accountable to local people at the party’s conference in Brighton recently.
An “NHS contribution” derived from National Insurance contributions and buttressed by local income tax will ensure policy decisions on health priorities are devolved away from Westminster.
Burstow says that it makes sense “to go back to the way it was” when things were done locally by those who really understand what their community needs in order to deliver first class hospitals, schools and efficient public transport.
The Government is keen to devolve decision-making as it pours extra billions into health care, but the Lib Dems, perhaps not surprisingly, believe that the “top down” talk of decentralisation from Alan Milburn, the health secretary, will not work.
Burstow talks of the need to be ambitious in order to get things done. Through the All Party Group (which includes cross party support for discussing ideas on back care) that he chairs, employers could be incentivised by tax breaks as well as some form of collaboration with employers and private health providers.
He is very keen to explore these issues to get the Government’s attention and says: “The cost to the NHS and the economy and cost consequences for insurers is enormous. Everyone has a common vested interest in this issue.”
He suggests that local authorities should have access to occupational health services because timing is critical between the diagnosis and treatment of back pain.
He says: “People who have chronic back pain don’t know how to manage it. There are a series of assessments and a long waiting time to get basic good advice like keeping active, visiting a physiotherapist, and being involved in rehabilitation services between each referral.
“I’m still learning about it, meeting professionals in the field like orthopaedic surgeons and physiotherapists and asking them what could be done to transform the situation. It’s about integrating existing services and filling the gaps – the proposals could have a big affect on a large part of the community. It’s important to raise party support to get it onto the political agenda.”
Is there a doctor in the house?
Burstow is concerned that there is a shortage of surgeons, many of whom, he says, are due to retire by 2005.
But he acknowledges that the UK is not alone. There are medical staff shortages in the western world but there are no ground rules to ensure “we don’t poach from one another”, he points out.
He comments: “There are five times as many spinal operations in the US and 2.5 times as many in western Europe and there is not enough capacity to meet the demand within a reasonable timescale. People are waiting six to 18 months for back surgery.
“Private health providers can fit the bill for a system that’s not delivering proper healthcare. Community pharmacists are underused and could actually free up a GP’s time.
“We need to recruit an extra 10,000 GPs to meet the targets set by the Government but we will be well adrift of that because of the numbers that are leaving the profession.
“We have to make use of the current team of health professionals and a commitment to training is a key part of it. There should be a costed programme for funding this over the next four years.”
Ministers in Westminster do not seem able to control health and social care, according to Burstow. He says there is urgent need for a debate and that it makes sense for health and social care to become devolved.
“We need to be ambitious if we are going to move things forward. Pushing down the responsibilities of delivering the services to local level will mean that real choices can be made in a more effective way, such as deciding on the priorities and finding taxation or insurance as a way of funding,” he explains. “We should democratise the commissioning and integration of social care because health and social care departments should be delivering their services jointly.
“If the powers were devolved, local communities could raise local priorities about their own needs and they would be in a better position to make those choices.”
Meanwhile, in the current economic climate, residential and nursing homes are closing. In response, Burstow suggests that care homes should be star rated with a scheme of rewards so that they can earn a higher level of fees.
“This would be a useful way of getting a quid pro quo for the investment because unless there is additional money for the homes, they will close,” he says. z