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Keep people healthier for longer by giving them more control over the healthcare services they use, writes Patrick Vernon.

London has some significant health and care challenges and inequalities. The healthcare system continues to be poor at preventing ill-health and in diagnosing illness early, and too much care is provided in hospitals instead of in the community.

London has the highest average income but it is also the most polarised in the country, with people in the top 10% of households earning around five and a half times more than those in the bottom 10%. On the whole, people in the more deprived boroughs in London have poorer health. In many London boroughs poverty and affluence and the associated health inequalities exist side by side. In Tower Hamlets women have life expectancy of 54.1 years compared to 72.1 years for women in wealthier Richmond-upon-Thames, a gap of 18 years.

There is growing pressure on health and social care systems. The number of people with multiple long-term conditions is set to grow to 2.9 million by 2018 and the number of older people likely to require care is predicted to rise by over 60 per cent by 2030.

More than 1.5 million Londoners live with mental illness which ranges from anxiety, depression, and bipolar disorder to schizophrenia. Mental ill health is more common in London than in other parts of the country with 18% of people living in the capital having a common mental health problem, compared to 16% nationally. London’s leading causes of premature death are from predominantly treatable conditions such as cardiovascular disease, cancers and respiratory disease. Around 80% of these deaths are attributable to lifestyle factors such as excess alcohol, smoking, lack of physical activity and poor diet. Obesity is a bigger problem in outer London, although inner London has higher rates of early death from heart disease and cancer.

Across London there is a serious shortage of home and community-based care available for patients and carers. Around a quarter of patients who do not need specialist care are admitted to hospital as a result of this, and up to 60% of patients are kept in hospital beyond five days when their needs could be met in more appropriate and cheaper community settings. State-funded social care spending decreased by £1.5 billion between 2006 and 2013 (2012/13 prices). This included a 39% reduction in the use of services for
older people, 48% reduction in the use of services for adults with mental health needs and 33% reduction in the use of services by people with physical disabilities.

Hospital admissions in non-urgent cases could be avoided with better proactive management of patients’ condition in their own home or within a community facility. There is an emerging social enterprise movement of approximately 1000 healthcare co-ops working within the NHS with a combined turnover of £600m. Social enterprises, housing associations and the third sector have developed a range of services to support the marginalised and disadvantaged communities in London in part funded by personalised budgets. We need much more of this approach in London, as it puts more choice in the hands of patients and successfully prevent conditions getting so bad that admission to hospital is required.

Here’s how we could promote more patient power through the use of social enterprise in London’s healthcare system:

  • make third sector, social enterprises, co-operatives and mutals preferred providers in commissioning healthcare, and take action when there is a bias against using these providers;
  • give patients and staff more control over hospitals by changing foundation trusts into co-operatives;
  • increase the use of personalised budgets and allow budget holders to pool funding to increase their purchasing power to help shape the market and develop more choice;
  • charge private-sector NHS providers 5% of gross profit they make from these services to help develop patient-led healthcare social enterprises with a particular focus on the most socially excluded communities.

We need a co-operative healthcare agenda for London to give patients a bigger say over the care they receive, reduce health inequalities, and move towards services that prevent health conditions becoming health crises.

Patrick Vernon OBE
member of Ed Miliband’s Taskforce for Mental Health in Society

 

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