You are keen to bring health and social care together but given the pressure on budgets how will the costs of integration be met?
I would argue it the other way around – investment in care is the key to the financial problems facing the NHS. The cuts to care are adding to the financial burden of the NHS. It’s leaving record numbers of frail people in hospital and that means the hospitals are struggling.
But there is still a short-term financial hump that needs to be addressed. Where does the money come from for that?
I’m not entirely sure that is the issue. Look at a place like Salford faced with a record number of very elderly people coming into A&E directly from nursing homes. Salford asked that rather than ring 999, the nursing homes ring the GP practice instead. This immediately saved huge amounts of money. I’m not saying [integration] wouldn’t take some extra investment, it may well do, but that comes from funding that we are raising via the Mansion Tax.
Local authorities provide vital services to people with dementia. However, they’ve seen their budgets cut in this Parliament. Will you allocate additional funding for local government social care budgets?
The collapse of social care is dragging down the NHS with it. Let’s stop seeing these two budgets as separate.
That one budget, if it happens, will still take time to implement. In the shorter term will you allocate additional budget for local authority funding of social care?
If you go down the route that I’m proposing you can start to transfer spending from the acute sector to the home.
But it won’t happen on day one
It can happen immediately. I’m looking at developing a ‘Year of Care’ budget. This is a different way of paying for the care of older people. This is a single payment, paid to an NHS service provider, which will cover every element of people care – social, mental, physical, primary care. That can be done straightaway.
The coalition government set itself some exacting targets on dementia diagnosis. Will a future Labour government set equally ambitious targets to increase diagnosis rates across the country?
There has been progress and credit to the government for this. But the challenge is bigger than just diagnosis. The common experience is that people are diagnosed and then there’s no support available for them.
To be clear, in terms of setting targets is that something that you are planning to do?
I’m hesitant about imposing new targets on a system already leaden with targets. I’m not seeking to replicate that approach that people might remember being characteristic of the last [Labour] government. I want general practice to move to the realm of person-centred care and away from patient-centred care.
What does that mean in practice?
It means embracing social prescribing. You make the alternatives to medication as readily available as medication – exercise referral, working groups to tackle isolation, counseling, therapy. There’s brilliant work going on across the country in dementia-friendly communities where people with a common interest work together to support people with dementia. This kind of work needs to go up a whole new level.
Does that require legislation or is that just a case of encouraging people to do more of what they are already doing?
It’s the latter, I think.
Given a lot of this needs to happen from grassroots up, what is the role of the secretary of state when it comes to dealing with dementia?
A different relationship with the voluntary sector is important here. We need to recognise we are living in a century where the NHS won’t be able to do everything and shouldn’t try to do everything. Often we ask the voluntary sector to work on a short-term, project basis. We’ve got to change that relationship. I’m looking at rewriting the contracting rules because the voluntary sector often gets treated in the same way as the private sector. If you’ve got more people volunteering that in itself feels more resilient from a community point of view.
There’s far less research into dementia than there is that into, say, cancer. What would a Labour government do about this?
When I set our ten year plan for a national health and care service, I set out on the very first page of my speech the ambition that we should have a health service that supports people with dementia as well as it supports people with cancer.
David Cameron has promised a further £300m to be spent on dementia research in the next Parliament should he get re-elected. Is that the sort of figure we need?
This is building on something we started that came with our first dementia strategy in 2009. The current government, to be fair, carried it on. And yes, this is an area where we need to carry on piling the resources into. There’s so much more we need to know.
You’ve conceded that in some areas the coalition government has made good progress. How will a Labour government ensure that this momentum is not lost in the next Parliament?
I’m conceding something but I’m not conceding the bigger point. And that is that around half a million people, many with dementia, have lost basic support in their homes under this government. And worse than that, the charges for care have gone up. People who have dementia are paying bigger costs because of these cuts.
The government would point to a cap on costs and a rise in the means testing threshold.
For those on middle incomes it won’t mean anything because the cap is so high. It calculates the local authority average not what people are actually paying. The coalition has just made it more likely that people will be paying right up to the cap. If you look at it human terms, in this Parliament there are an additional 100,000 people aged over ninety coming into A&E by blue light ambulance. Many of those people have got dementia. They are dropped off in A&E and left in a busy ward because they’ve not got the basic requirements in their own home.
Andy Burnham is shadow secretary of state for health and Labour MP for Leigh