On Ara Darzi’s plan for the NHS and Social Care – and decision time for the NHS. What legislation does it want to take to Parliament?

Ara Darzi is an excellent public servant. He continues to be one of the best minimally invasive (laparoscopic) gastrointestinal surgeons in the world. He not only plays a major international role in developing new health care practice in several nations, but back in England continually drives improvement and reform in the NHS.

(Very full disclaimer notice:

In June 2007 when I joined NHS London as Director of Strategy and Commissioning Ara Darzi had been working on his plan “Health Care for London” for several months. It was published when I was 4 days into my new job. What does a new Director of Strategy do when someone delivers an entire strategy four days into his job? In 2007 I found out. Your job is to deliver the strategy that’s there and not think up a new one. It taught me that strategy is not an intellectual but a practical implementation task.) 

This week, together with the Institute for Public Policy Research (IPPR), he published his latest report Better Health and Care for All. It’s built around two 10 point plans. One of them is for the NHS and social care but it’s the other offer, for citizens, that is the most striking. Ara recommends that this could be delivered with a 3.5% annual increase in money for the NHS. So he’s not far off having the money that he thinks could deliver this:

  1. Free personal and nursing care for everyone who needs it regardless of your ability to pay- just like the NHS. Growing old shouldn’t mean getting poor
  2. Fast and convenient access to primary care for working families open during the evenings and over the weekend
  3. A digital NHS. An ability to access your medical records, order your prescription and have your consultation with your GP on line
  4. A single named GP, a joint care plan, a personal budget and regular check-up for people with long term conditions
  5. Shorter waiting times and better access to care. No waiting on trolleys. No delays in hospital beds. No cancelled operations
  6. Quality of care in England for people with poor mental health and cancer on a par with the best practice abroad
  7. New knowing understaffed. Enough nurses and doctors in every hospital and GP practice across the country, with time to care not just to treat
  8. Elimination of the post code lottery in treatment. Access to the best treatments, approved by NICE no matter where you live
  9. A reduction in health inequalities. Where you live should not determine how long you live
  10. An NHS that helps to create good jobs at home and increase our earning from exports abroad generating prosperity that good for everyone

It would be really good if whatever the NHS comes up with as its contract with the public in November, could be presented as a contract with citizens. However the NHS financial uplift is to be paid for, it will be paid by citizens not the Government. So they should be seeing what they are going to get for their money.

This 10 point list is a great contribution to this summer’s debate about what the NHS will deliver for its extra money.

Free personal and nursing social care is an eye-catching pledge. This would bring the payment of social care in line with the payment of the NHS (free at the point of need) and make integration of the two much easier.

However – given money is tight – this is in fact a transfer payment, via taxation, from those without a lot of money to those that have it. If I, as a 70-year-old, were to need social care, I would have to pay for it at the moment – and my poorer neighbours would not. If Ara’s plan is adopted I would not have to pay. My political choice for spending a couple of billion pounds would be to spend it on improving care for those who at the moment have their care paid for out of public taxation and not out of their own wallets. The amount of state money that goes into state paid social care is very low. Let’s increase that before we think about paying for the care of the better-off.

The rest of these pledges seem to me to be real plusses in people’s lives. They are something that the public would want  in return for increased taxation.

Simon Stephens spoke at the IPPR launch and used the opportunity to build upon the Prime Minister’s speech on Monday (see here for my thoughts on that). In particular he talked about his response to Theresa May’s offer to the NHS that they draw up the legislation they think they need. Not a long Bill, but a few clauses that would make it easier to move things forward at the moment.

This really is intriguing. For 70 years the NHS has had Governments passing legislation that does things to it. Now it has a Government that is asking what legislation the NHS wants to pass. Just as the delivery of better health care with the extra money will take great discipline from the NHS, so will any development of ideas for legislation. Every NHS leader will have their own idea of what it wants changed -and if it’s left to an Assembly of the NHS it would be an enormous Bill.

Instead it will have to be 10 or so clauses. If this is to take place through the Select Committee, they will know how easy it is for the House of Commons to pull at loose strings in legislation. Both major party whips will have to agree the main thrust of the clauses and the NHS will have to brand all of these clauses as being clearly theirs.

A footnote to last week’s posts about work force and the class ceiling that comes from having so few ladders of opportunity from the bottom to the top. Yesterday there was an opinion poll from Justine Greening about class and people’s perception of who runs their organisation. About a third of people said their boss was from a working-class background. This dropped to just a fifth in the health and social work sector. So here the NHS is one of the few bits of the economy that is growing where very few people feel that their boss is from the working class. Further evidence that the ladders of opportunity that exist in the NHS and social care do not reach far enough down and have too few rungs near the bottom.

2 Replies to “On Ara Darzi’s plan for the NHS and Social Care – and decision time for the NHS. What legislation does it want to take to Parliament?”

  1. thanks Paul,

    Might need a slight edit – Ara is a minimally invasive (laparoscopic) gastrointestinal surgeon. Any vascular work he does would be by mistake!


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