In The Loop: the BIG Questions

Jim Blair

Did you know that you are likely to die 20 years younger if you have a learning disability. Did you know that the great 10 year NHS Plan mentions learning disability 0 times? In their latest podcast Niall and Roy seek to understand the dire state of health support for individuals with learning disabilities and their families. Their guest is Professor Jim Blair, a nurse and academic who has campaigned relentlessly for the 1.5 million or so people with a learning disability in the UK. In a fascinating discussion, Jim lets us into a world that is not understood by professionals or the wider public. It is a world where individuals and their families are not seen as having worth and where services are not shaped by those who use them; and where abuse and scandals will persist until this is tackled head on. Jim also highlights those with profound learning disabilities – who cost millions to look after with 24/7 care and who he describes as the hidden among the hidden. Learning disability nursing is in sharp decline yet this champion of change says to improve their health, learning disability patients need these advocates as they need services that are developed by them and their families, and staff who are trained by users and their families.

Greater Manchester Mayor Andy Burnham.

In the latest In the Loop Podcast, Greater Manchester Mayor Andy Burnham reveals that the government has agreed to appoint a new Health Commissioner who will be jointly accountable to the Mayor and to the government for health and social care services.  The Mayor said that the Commissioner would have dual accountability, as the ICB chair for NHS purposes and as a health commissioner to the combined Greater Manchester authority.  “I'm really excited about that.” he says.  “Finally it feels to me we're getting close here to (an integrated) model of commissioning, priority setting and direction setting. The rest of the Greater Manchester system now is highly integrated, our other public service work as one, but the health service has become an outlier. That's been worrying us greatly and we think this might solve it.”  In a wide ranging discussion with Niall and Roy, Andy Burnham says we will never know whether he could have won the Gorton and Denton byelection, but insists he would never asked to stand unless he thought he had a good chance, and he rejected the idea that if he had won, the Mayor role would have been at risk. Instead he suggests that if he had won the byelection that would have created a positive momentum for Labour in any Mayoral election. Among many insights in the podcast, Andy reflects  on how he began to move away from the New Labour health  agenda while serving as a minister in the Blair administration in the mid-2000s. As for the current government, he commends them for starting to get a grip on the challenges facing the NHS but laments the delay in tackling social care. “How much longer can we keep flinching from that challenge? It’s got to be faced. There will no marked improvement until they grasp the nettle of social care reform.”  There is also a frank assessment of the state of current services, in which he points to the vast number of older people trapped in hospital beds, to their and everyone else’s detriment. Andy’s father has dementia and he talks about his frustration at a care system which seems determined to dial 999 at every opportunity and send his father into A and E, when that is the last place where he should be going.  But he is optimistic that his model of integrated services focussed on prevention can in time release resources and create a much more responsive community based set of services.  He claims his ‘LiveWell’ revolution in Greater Manchester will mean doing prevention in a way that has never been tried before, diverting significant resources into voluntary and community organisations and letting them be first port of call. In time he believes it will create services that keep people healthy and create wellbeing, transform health and social care and  take pressure of the NHS and other public services.

Paul Farmer CBE.

Have older people got it too easy? In their latest ‘In the Loop’ podcast, Niall and Roy have a fascinating exchange with Paul Farmer CBE, the leader of Age UK, Britian’s largest charity campaigning and providing services for older people.   Little more than a generation ago, pensioners were seen as among the poorest and most vulnerable groups; today the vast majority have never had it so good. Yet Paul argues that is a dangerous narrative which ignores the two million or so older people who either experience poor health, financial insecurity or loneliness. And he rejects the idea that this is just about deprivation, suggesting we have not faced up to the enormous challenge of living in an ageing society.  When challenged on the cost of the triple lock for pensioners, Paul says he  welcomes the debate about the future of the state pension, including the possibility of means testing. But he warns that successive governments’ record on means testing has been extremely poor.     On social care another warning - because of chronic and persistent underfunding he suggests something terribly bad could easily happen and that solutions offered in the past will need to be revised given the parlous state of services today. Paul argues not only that social care needs significant extra funding but also a long-term view; the question is who is going to play for these reforms?       As for the NHS, he points to fact that in the last year more than fifty thousand patients in their 80s ended up hospital corridors, and that we need to start looking at the health service through the lens of older people. He is challenged on how much of Age UK’s income actually goes to local branches that provide direct services, as opposed to lobbying and other national activities. Paul responds by saying they have begun to give more to local branches and have plans to do more.  Listen too to Niall and Roy’s reflections on this absorbing exchange with one of the most influential leaders advocating for older people in the UK.