Oldham is a holistic man with a holistic remedy for whole person care

I finally caught up with courteous HSJ contributor Sir John Oldham at a leaving party for fellow NHS knight Sir David Nicholson - one of many I expect - and well attended by junior and senior staff, he told me.

Sir David was always gracious to those who worked for him.

The obvious choice

To provide some context to the wholesome report he just produced for Labour’s Andy Burnham, Sir John was also courteous to me, but firm.

No he wasn’t a Labour party member, nor were any other expert volunteers on the Independent Commission on Whole Person Care that produced One Person, One Team, One System.

I just got asked to do it, he said.

‘A long and distinguished career made Sir John Oldham an obvious choice for Andy Burnham’s report’

It’s not hard to guess why. A long and distinguished career - bureaucratic, academic and medical - made him an obvious choice.

It was reinforced by his growing conviction trumpeted by this pioneer of collaboration on three continents, that hospital based, disease specific pathways to healthcare are the highway to tragedy for individuals and institutional NHS bankruptcy.

Holistic remedy

The “tsunami” (his word) of ageing citizens with multiple conditions makes this conclusion unavoidable, though he also lets slip that the organogram of NHS England’s restructuring with 18 clinical directorships representing the traditional “body parts” view of medicine confirmed his reluctance to stay.

He’s a holistic man with a holistic remedy so budgets are not what drives him.

Concern for people like the report’s Mrs P - widowed, ailing, 85, pushed from pillar to post by a fragmented system - is his driver.

‘Sir John’s emphasis on community based remedies is bound to erode other budgets’

He rejigged his report to push the all too familiar financial arguments about demographic shortfalls back to chapter five to avoid his message being glibly dismissed as more “cuts”.

Even so his emphasis on community based remedies in which a single care coordinator marshals input from all competing health and social service agencies for our Mrs Ps is bound to erode other people’s budgets in tough times, however mildly stated. Hospitals and GPs feel threatened.

After all Sir John - he modestly left his name off the cover - calls for an extra £10bn for community care over the lifetime of the next 2015-20 parliament. It has to come from somewhere.

Some counter intuitive types even fear social care will lose out even more.

Delivering whole person care

How has the Labour leadership reacted, confident as it is of victory in 2015? Ed Miliband launched the report with a blandly positive article in The Daily Telegraph.

Mr Burnham tells me it’s been widely welcomed as a roadmap to deliver whole person care (his big theme for two years now) without another structural reorganisation, allowing financial incentives to be realigned away from the tariff to promote prevention and personalisation.

Markets are not the way to true integration. Actually, as HSJ’s report noted, it gently curbs Burnham’s own ambition to restore local government to a central, shared role with clinical commissioning groups.

‘Markets are not the way to true integration’

Under Sir John they would retain their budgets, working with health and wellbeing boards and other professions like housing, albeit with their local power checked by a beefed up NHS England (Care England) and a merged Care Quality Commission and Monitor at the centre.

When I heard Burnham repeat his “no more top-down reorganisation” pledge at the Nuffield Trust’s recent health summit sceptics muttered that his own words gainsayed the pledge. It sounds like more upheaval to me and even typing up such stuff (again) lowers the spirit.

Labour’s national policy forum will debate all this in July, but whatever tweaking it does will not prevent Sir John’s human and financial imperatives being resisted by powerful vested interests.

On the brighter side his report notes “relationships and culture trump structures”. Quite so.

Michael White writes about politics for The Guardian