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April 6, 2011

A solution to funding crisis in health

Senior health professionals all agree that future funding of health care will have to be turned on its head – away from hospitals and towards community based out-patient units.  But closing hospitals is contentious. Remember Monklands A &E? Perhaps the answer lies not solely in the health budget but also with housing and community care. The impact of one housing cooperative in Whitlawburn suggests it might

Health professionals estimate our ageing population requires the construction of a new hospital every 18 months. That cannot be afforded – and it should not even be contemplated. Margaret Thatcher once said money in the NHS should follow the patient. 40 years later the patient still follows the money. And the money is locked up in hospitals. It’s a terrible Catch 22 – the same kind that kept people with mental illness inside institutions or locked up in jail.

In 2005 the Kerr Report tried to break out of this vicious circle by switching cash from hospital provision to ambulatory care centres – local outpatient units. Lanarkshire was one of the first to attempt the switch and to fund it, one of three fully staffed A&Es in the area would be closed. But which one? The choice was coloured by a political reality.

Senior health professionals agree funding needs to be turned on its head. But which politician has the courage to remove £800 million from hospital budgets and risk the wrath of local voters to make local health care investments which may not visibly yield dividends for a decade? Hospitals are tangible. Services that help diabetics stay out of hospital are not. And yet 40 per cent of people aged 75 or over live with at least two such long term conditions. Audit Scotland projects a rise in the over-75 age group of 75 per cent by 2031, a rise in COPD (respiratory problems) sufferers of 33 per cent and a rise in patients with dementia of 75 per cent.

How will society cope? A solution may lie in housing and community care – not in health. Take Whitlawburn. In 1988, Glasgow Council was given £6.6 million to refurbish this run-down estate on its southern outskirts. West Whitlawburn had hard-to-fix high rise flats. So the council spent the repair money instead on the easier-to-fix low-rise blocks of East Whitlawburn. Outraged, the tenants’ association in the West opted out and set up a co-operative to own, improve and manage their 540 homes. Phil Welsh MBE chaired the first Co-operative; “People fae miles away sit on a Housing Association Board. Only folk fae the neighbourhood sit on a Housing Co-operative. It was an opportunity to do things for ourselves.”

Personal contact replaced distant bureaucracy. Dampness, security and renovation were made priorities. All homes were refurbished, an old school was turned into a healthy living centre and a team of concierges was hired to monitor 28 external and 185 internal CCTV cameras and 70 homes fitted with alarms. Elderly, disabled or vulnerable tenants can buzz down to the concierge base if they’re lonely, frightened or ill, and can have a chat, a basic health check or a cup of tea with company – even in the middle of the night.

Eleven deaths have been averted by swift responses from the camera/concierge team. The Co-op refuses to turn its health success into cash savings.

But they know higher-than-average management costs must be defended in straitened times. So they’ve produced social accounts instead which list the ways in which a well managed, self regulating community protects dignity and saves cash.

The West Whitlawburn Housing Co-operative is the salvation of its tenants and the envy of its council neighbours. It’s also the saviour of local A&E departments – including Monklands. And yet healthcare is not a formal part of housing’s remit.

Two reports will land on the new health minister’s desk in June demanding change. Campbell Christie and Sir John Arbuthnot will both report on better delivery of public services. It’s likely both will back self-management against hospitalisation – and hospital wards will have to close to finance such a shift.

Scottish politicians have just six weeks left to tell voters otherwise. Prepare for U-turns aplenty.