Cllr Jim Dickson is the Cabinet Member for Health and Adult Social Care (job-share), and a councillor in Herne Hill ward.
The NHS White Paper published last week sees a long overdue admission from the government that they have wasted many years, squandered millions of pounds of precious NHS resources and sacrificed huge amounts of staff time in creating a system of bogus and wasteful competition between the NHS, the third sector and private health companies.
The system has not only resulted in long delays in providing the best treatments for patients it has also set different parts of the system against each other with the service users losing out time after time due to delays and waste.
Seven years ago Lambeth Council and our NHS partners including South London and Maudsley and third sector providers including Certitude set up the Living Well Network to redesign our mental health services around the needs of residents for mental health prevention, better treatment and a focus on recovery as opposed to the requirements of existing organisational bureaucracies and budgets. Our mental health service users and an amazing team of clinicians – fired up by the ethos of Lambeth’s co-operative council – had in 2010 created the Lambeth Living Well Collaborative demanding radical service changes and it was time to start delivering.
We proceeded as fast of the evidence would take us – with prototypes including IPSA (integrated personal support alliance) successfully helping patients make the transition from acute mental health settings to supported living and showing us what was possible – so that we could be sure that the changes would work. Commissioners and providers drove hard to agree entirely new relationships, with all parties committing to take a share of the ‘upside’ for positive patient outcomes and the ‘downside’ where there was no progress. The work of Black Thrive to eradicate huge disparities in mental health outcomes for African Caribbean residents would be central to our mission.
Ready to go by early 2017 we then hit the road block that is the S75 regulations on procurement and competition. Our brilliant Lambeth and NHS joint team were forced to spend days in meetings with Whitehall civil servants followed by much writing and rewriting of contracts to conform with the legislation and needing lengthy sign off by NHS England. A nine month external tendering process run on pain of legal challenge from private providers attracted little in the way of plausible alternative providers for such an innovative new arrangement. The process had been a lengthy waste of time. Almost two additional years on from its formation the Alliance could finally begin its work in earnest helping those needing crisis support, encouraging people to self-refer to services, supporting early mental health interventions and helping people with long term conditions into work and housing.
Lambeth is blessed with visionary and determined clinicians, great third sector organisations and superb managers and we got our much needed service changes eventually. But how many other organisations have been discouraged from finding new ways of collaborating by the 2012 Act? How much treatment has been denied to patients by cost and delays.
The government may have accepted the error of its ways and decided now is the time to do away with competition and encourage collaboration. But the gaping holes in the system will never be fixed without the long term solution for adult social care funding first announced in 2011, cancelled in 2016 and then falsely promised by the current prime minister on entering Downing Street in 2019. The 1.5m people denied care under the current system will continue to present as NHS patients requiring expensive interventions, draining away resources from vital cancer, renal and cardiac treatment, if care funding is not addressed.
And just as NHS England appears to be doing a fast and effective job delivering an effective Covid vaccination programme, in stark contrast to the government fiascos on lockdown timing, PPE and Test and Trace, ministers now wish to wrest control of the health service from arm’s length bodies and put themselves in charge. Based on the last decade’s track record, residents in Lambeth will require a lot more convincing that this latest top down reorganisation of their health service won’t be another expensive catalogue of waste and failure.
Cllr Jim Dickson