(9 years, 10 months ago)
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Lord Kennedy of Southwark
To ask Her Majesty’s Government what effect the better care fund is having on the ability of the National Health Service to provide services to patients.
Lord Kennedy of Southwark (Lab)
My Lords, I am delighted to have secured this debate today. We are all getting older and living longer, and that is very welcome, as medical and scientific advances make illness and diseases that would have killed us off no longer the threat to us that they were. There is still much to do, although that progress is very welcome.
However, as a consequence, we have an ageing population, which brings its own challenges: how we care for people as they live to a much older age and more people living with long-term conditions. It has long been recognised and has been an aim of Governments to deliver better integration of health and social care and improve people’s health and well-being by ensuring continuity of care while making the best use of resources.
I am sure that, in his response, the noble Earl will tell the House in some detail about the pooling of funds and the plans for local areas, including: the sharing of data and improving continuity of care; the plans for acting earlier so that people can stay healthy and independent at home; and delivering care that is centred on individual needs, with NHS and social care staff working together to deliver better outcomes for individuals.
The King’s Fund has done interesting research in this area and made some predictions about what will be the needs, how we will be living, and the pressures that that will place on the NHS. Those are important considerations in the planning that needs to be undertaken to meet the challenges ahead.
In the next 20 years, the number of people aged over 85 is expected to double. By 2030, the number of older people with care needs is expected to rise by 61%. At the same time, we expect 40% of households to be comprised of people living on their own. The number of people with dementia is expected to more than double in the next 30 years.
It is also a fact that people from the most affluent socioeconomic classes can expect to live as much as seven years longer than those from the poorest socioeconomic classes. Those and similar statistics point to increased pressure and demand on health and social care services, and government at all levels has to respond effectively to that challenge.
The better care fund is a good initiative but, as with many other things that the Government are doing in the area of health, I always have a niggling doubt whether they will put the resources in place to deliver the outcomes that we all want. I do not doubt the noble Earl’s personal commitment but as with many things in the health and social care sector, money more wisely spent at an earlier stage can deliver much better results for the patients and cost much less to the NHS.
I am a diabetic and I declare an interest as an active member of the charity Diabetes UK. I take the example of diabetic foot care and the fact that so many people have unnecessary amputations. Those could so easily be avoided; we are just not dealing with this issue. The cost to the individuals is high and traumatic. Then there is the cost to the NHS for the operations and the aftercare, and of course the projected lifespan after that, too. We need to ensure that people are able to enjoy an active and healthy life within their own communities, thereby reducing the demand for health and social care services. Well over two-thirds of patient bed days are for people with long-term conditions and a greater emphasis on self-management programmes can help to reduce unplanned hospital admissions. Ambulatory care-sensitive conditions accounted for 15.9% of all hospital admissions in England in 2009-10, with an estimated cost to the public purse of £1.42 billion. The rate of admission for those conditions in the most deprived areas was twice that in the least deprived.
Older people who are frail are a key concern for health and social care services and are at risk of sudden decline, including falling or becoming immobile. Identifying those at risk of falls and the setting-up of fracture prevention services for older people has been found to reduce hospital admissions and the need for social care, such as admission to a care home. Care co-ordination and proper case management, if well designed, has the potential to deliver better and more cost-effective care for the individual. However, as I have said, all these things have to be properly resourced to deliver the intended outcomes and savings in the future.
Just look at the whole area of emergency admissions, which can account for 70% of hospital bed days and 80% of stays of two weeks or more. A whole range of factors are at play here for hospital admissions including age, social deprivation, ethnicity and living in an urban area. A lack of alternative options then sees people being admitted to a hospital bed. That might not be the best thing for them but there is no alternative. Then on discharge, the important thing is to have a proper discharge plan in place so that people can remain at home in the long term and regain their independence.
At this point I declare that I am a member of Lewisham Borough Council, which will be involved in delivering services through the fund. The Local Government Association expressed concerns as recently as last month, warning that a larger better care fund is needed for a five-year period, with alongside that a separate transformation fund to ease the impact of these changes. It rightly expressed concern about the lack of clarity on the future of health and social care funding, which could put at risk the efforts to integrate services. The LGA is urging the Government to commit to a five-year plan, taking us to 2020. Can the noble Earl confirm whether this will in fact be delivered? If he cannot, can he tell the House why not? As I said, my worry is that the plan will falter because its provision of resources will be too short-sighted.
I have a number of questions for the noble Earl. If he can answer from the Dispatch Box that would be much appreciated. I do not expect him to do so; all I ask is that he gives a commitment to write to me afterwards and copy that to other noble Lords who speak in the debate today. I will take each question in turn. Will diabetes and diabetes foot care be prioritised as part of the better care fund? Will dementia be prioritised as part of it? Are there any plans to change the procurement rules when implementing the better care fund? What does seven-day working for social care mean? Is it correct that the health and well-being board chairs will have to sign off their local plans? What happens if the parties involved in devising a local plan cannot reach agreement? Is the better care fund’s additional allocation of funding in 2015-16 recurring or non-recurring?
In conclusion, I am delighted to have secured this debate. I look forward to the contributions of all noble Lords, including my noble friend Lord Hunt of Kings Heath and of course the noble Earl.
Viscount Bridgeman (Con)
My Lords, I thank the noble Lord, Lord Kennedy of Southwark, for initiating this very important debate. He has rightly emphasised the need for early treatment of so many of the complaints which he outlined. It has long been recognised that there is a great need for integration of health and social care because this can support people better by improving their health and well-being by ensuring continuity of care while making better use of resources.
The basic mission of the better care fund is for health and care support to work together. From it flows, for instance, acting earlier and improving health education so that people can stay healthy and independent at home, thus easing the strain on hospitals and A&E, and from it also flows care which is tailored to individual needs with NHS and social care staff working together to provide seven-day services with a named co-ordinator.
The better care fund of course faces two challenges coming from very different directions. The first is the funding crisis common to the health sector and local authorities and the second is the increase in life expectancy mentioned by the noble Lord. Nevertheless it is a bold initiative. I welcome the tight but, I hope, not bureaucratic control over the operation of the scheme. One billion pounds of the fund will be tied to local performance. Peer support will be available to those areas which do not perform well. I also welcome the flexibility of the scheme by which £3.8 billion will be pooled in local areas, but the two services will be permitted to go further with additional funding where local conditions make this appropriate. There is a clear mandate for control of the funding to rest with NHS England which in turn will require clinical commissioning groups to use powers under Section 75 of the National Health Service Act 2006 to set up pooled budgets with local authorities. I welcome the checks and balances, for instance, that money from a pooled budget can be spent only with the agreement of both parties, with such spending agreed with the health and well-being board. In cases, which I hope will be rare, where the scheme is manifestly not working, it will be the duty of NHS England to intervene and instruct the CCG to come up with a solution.
Not for the first time, the King’s Fund has come up with a well researched document which draws together a number of studies relevant to the better care fund. It has produced a number of very practical suggestions for making this body viable and effective in its early years. The King’s Fund’s work contains its customary bibliography, and I am sure that the Minister, his department and, indeed, NHS England have taken note of the many constructive suggestions which it contains. The study fully acknowledges that this is a difficult time for the NHS in terms of funding. For instance, of the total of £3.8 billion budgeted for the fund, £1.9 billion will come from allocations to CCGs. It will not be new money. Guidance has come from NHS England that hospital emergency activity will have to reduce by 15%. We are in all-too-familiar territory here. Where patients go, whether to their GP or to A&E, justifies a debate on its own. Suffice it to say here that if the 15% reduction in emergency activity is to be reduced to assist the funding of the BCF, for the hospital it is a matter of considerable urgency.
Many of the recommendations contained in the King’s Fund document are contained in the admirable house of care programme developed by NHS England, which outlines so much of what the BCF should aim to achieve. I shall list only some of them: greater forward planning for LTC patients; involving patients in the self-management of their health; greater access by patients to their health records; agreed common goals for the NHS and care services; and emphasis on staff training. All these are common-sense aspirations—there is no rocket science here—but it is useful to have these brought together in a user-friendly document.
I return to the subject of the 15% reduction in hospital admissions. The Nuffield Trust, in particular, has made a study of more than 30 integrated care programmes, many of which had reducing urgent hospital admissions as a key goal. There have been a number of press reports suggesting that there is a real danger of financial collapse in the hospitals sector. I hope the Minister will confirm that across England there have been a number of pilot operations of the BCF model. I should welcome an update from the Minister on the results of these pilots and his reassurance that this very real problem relating to hospitals is being addressed.
Finally, I think it is true to say that attention has rightly been concentrated on getting the BCF off the ground in 2015-16 and in its first year of operation. Here I take up the point made by the noble Lord. I note that the Local Government Association chairman, Sir Merrick Cockell, while giving his strong support to the BCF is concerned about the longer-term funding, saying:
“Health and social care partners have shown their confidence in joining up their funding by putting in additional money over and above what was required by the Department of Health, but despite this there has still not been any indication that funding will be extended beyond this first year”.
I, too, hope the Minister will be able to say something about the Government’s plans for longer-term funding of the better care fund, the concept of which is welcomed from all quarters.
Lord Turnberg (Lab)
My Lords, there is no doubt that care in the community is grossly underfunded. There are too many elderly people living alone and in need of care that they are being denied. We know that social services are now only able to provide care for urgent cases and then often only a quite inadequate 10-minute visit to help those people get dressed, bathed or fed. We know, too, that GP services are extremely stretched in many parts of the country. I do not think the BMA was simply crying wolf in its recent pronouncements when it said that it is having great difficulty coping with its growing workload. On top of that I hear it is having problems recruiting in general practice, especially in the north.
Now we hear from the Local Government Association that its budgets will have been cut by 15.5% by next year and that it is looking at a black hole of a £5.8 billion deficit by then. It is against this background that we see this inexorable rise in demand for both acute and longer-term care. On the one hand, the increase in numbers of those aged over 80 is heartening and is a tribute, at least in part, to modern medicine, but equally it is troubling that we have to cope with them accumulating multiple illnesses and disabilities. The prospect of dealing with more than 1 million people with dementia by 2030 is not exactly comforting either.
It is irrefutable that social care services need more funding and the Government’s response has been to rob Peter to pay Paul by taking this £3.5 billion out of the NHS and handing it across. Social services certainly need it and the rationale for doing so might seem reasonable on the face of it. After all, the budget for the NHS is so much bigger at more than £100 billion a year and, of course, we know that our hospitals are full of patients who would be much better off at home if care could be provided there. Some 30% of beds are said to be blocked in this way. So let us shift money across. However, that ignores the extreme financial stress that already exists in the NHS, where talk of a looming financial cliff edge in 2015 is commonplace. The impact of the Nicholson challenge with £20 billion savings already made, largely by short-term measures such as wage restraints and redundancies, and predictions of even more stringent savings of some £30 billion by 2020, is sending shivers down the spine of many a trust chief executive when 40% of them are already said to be running a deficit.
I hope the noble Earl will forgive me for introducing a note of aggression in my talk. He knows my normal benign nature does not allow for much aggression but I feel quite strongly about this. There are those who say that we should close some beds or whole hospitals and money will be freed up. That may be true—money will be saved, but at what cost to patient care? We have already heard of the stresses placed on hospitals by rising demands for acute care—that is acute care, not the care of longer-term patients within hospitals. It is the rising tide of acute emergency cases that is taking its toll now on hospital services that is so difficult. These demands are being made now, in the summer, when we have approaching 88% bed occupancy rates. Incidentally, we have the lowest number of beds per head of population in Europe and the shortest length of stay, so we are already pretty efficient.
Of course we should do more to improve efficiency. We should continue the process of focusing specialised services in fewer major centres; we should merge services between small, relatively inefficient hospitals; and of course we should be looking at better models of integrated care across the health and social care divide—that is essential. Today’s publication by the NHS Confederation and the Local Government Association is a step in that direction.
There could be more efficiencies, too, in the bureaucratic machinery that we have set up to run the service. I am struck by the fact that we removed two layers of administration, the SHAs and PCTs, and replaced them with four. We have NHS England with its large staff, the 40 outposts, 27 area teams and of course the 211 CCGs. That says nothing about the clinical senates, of which we hear so little, and the complex network of clinical reference groups. Instead of the promised bonfire of bureaucracy, we have had an explosion of bureaucrats. We could save money here with a closer look at all this superstructure but that is not going to happen any time soon.
Meanwhile, the cash-strapped NHS is being taxed again by the better care fund. To expect to be able to run an acceptable level of integrated care between hospital and community by shifting limited resources from one to the other may be expecting just too much. Yet we are a wealthy country: the fourth wealthiest in the world, according to the ONS, and with more billionaires than anywhere else. In spite of that, we have cut the proportion of GDP that we spend on this from around 8.2% in 2009 to about 7% now, and we are predicted to cut that proportion to about 6% by the end of the decade. I can well understand the Treasury wanting our services to be more efficient, but I cannot see what justification there can be to cut the share of the national cake for the care of our population to just 6%, which is so clearly well behind other OECD countries. The contrast between reports of a country said to be doing so well economically with those that show that at the same time it is starving our vital services is, I find, just too much.
I have a number of questions for the Minister. How is it intended that the money from the NHS will be used for care in the community? Is it to be ring-fenced? Will there be true integration between the NHS trusts and social services in the way that it is spent? Have the Government any plans to encourage recruitment into general practice, particularly in the north, and for A&E consultant posts, two key services at the interface between community and hospital?
Have they given any thought to their predictions for the future funding of health and social care beyond 2015? I know that the Minister will say that future spending plans will have to wait for the next spending review but I fear that the crunch will come rather sooner than that, and probably far sooner than the election. The department must be making contingency plans now about how the service will cope over the winter; I would be surprised if it was not. I wonder if the Minister would be willing to share some of that with us. I look forward to his response.
Baroness Brinton (LD)
My Lords, I congratulate the noble Lord, Lord Kennedy of Southwark, on securing this debate about the better care fund. This is probably a timely moment to pause and reflect on new routes to integration in the health and social care sectors, but we need to do so with some caution. It is too early to see the implementation of the first round of approved projects to its conclusion, and of course both local council and health budgets are under serious pressure, as all speakers so far have indicated. We also cannot expect full integration without being honest about the cost. It will be interesting to see what emerges in the manifestos of all the parties in the run-up to the next general election.
Still, I am pleased that the coalition Government are determined to see a real start to full integration in health and social care. There has been much lip service paid to it over the years but a marked reluctance by everyone, from politicians in Parliament to local authorities, the NHS and front-line staff, to make it happen. I suspect that this has been for a number of reasons.
First, there is the perception that there is financial competition between the two sectors, each worried about not losing funding to the other. Secondly, financial mechanisms are in place that inadvertently discourage integration. Reports from some areas show that this is a serious issue. Thirdly, which is the most important, the two cultures—social care, whether local government or private providers, versus health—could not be more different. I do not think that the NHS would define itself as naturally entrepreneurial; and it takes a long time to change its ways of working. There have been some major crises recently where we are now seeing wholesale changes in the way we work, as exemplified by the Francis report. The social care sector is a mixed economy, with public service providers working alongside large and small businesses and social enterprises—not just a different model to health but a different model within social care. Therefore it is completely understandable that dialogue at the start of this major project is difficult. But there is progress.
Before turning to that progress, I want to give you one story that absolutely illustrates why we need integration. The aunt of a friend of mine, who lives in Bradford, was receiving both health and social care support at home, which was important because it meant she could live independently. One of her issues was ulcerated legs, with one leg much worse than the other. The bad leg was being treated by the district nurse on daily visits. The better leg was checked and put into support tights by her domiciliary care worker. As a result of cuts made by the Labour-controlled council, all domiciliary care classed as moderate needs was cancelled, including hers. Can noble Lords guess what is coming? Under the local PCT rules the district nurse was not allowed to help with the better leg, so this elderly and vulnerable woman had to rely on a male elderly neighbour to put the special support tights on her leg last thing at night. You see, one leg was NHS and one leg was social care. That was until the better leg deteriorated to the point at which the district nurse was permitted to come in and dress that one too. Honestly, you could not make it up.
That is at the front line; it is not the district nurse but the person in the PCT who is setting down the rules. That sort of behaviour in commissioning makes an absolute mockery of integration. That is what I mean by the clash of two cultures. There are other stories of silo thinking. In some areas there is very little discussion between social services staff and health professionals such as physiotherapists and occupational therapists. Patients are referred by physios and OTs, but there is not a continuing dialogue. One physio recommended an electric wheelchair for a patient, on the basis that this would keep her fully independent, but the wheelchair department’s rules are so strict that the patient did not meet the stringent requirements. As a result, the local authority had to offer a carer to come in to help get her up in the morning, costing both the patient and her council much more money than an electric wheelchair would have cost.
That is enough of the difficult stories. Of course, there are shining examples: not just in Torbay, but in Cambridgeshire and other places. I ceased being a councillor in Cambridgeshire 10 years ago, but even then we had a joint trust between health and social services, as it was in those days, to really start to change the funding. The money was pooled and attitudes really started to change.
We need to hear what these good examples are doing, but also to understand why they work. Unless commissioners and finance directors understand the benefits of integration, there will be a reluctance to move away from the current model. The Bradford case illustrates the point perfectly. Three more minutes of the district nurse’s time would have prevented the better leg from deteriorating and thus costing the NHS more in the long run. Therefore, while there are any cases such as the Bradford one we are nowhere near integration. That is why the extra money from the Government for integration—the £2.7 billion to councils to join up with health and social care providers, as well as local authorities’ extra £100 million this year and an extra £200 million next year—is so vital.
I was delighted to learn from Lib Dem councillors at their annual conference last weekend that the LGA estimates that councils have more than match-funded the total money of £3.8 billion for next year, 2015-16, taking it to £5.4 billion. However, the cost of this means that councils are now spending 35% of their total budgets on social care. Therefore support from central government is essential and I do not believe that we can wait until next year for that to happen.
Personally, I somewhat regret the debate about NHS money being taken by local government. I am sorry to disagree with the noble Lord, Lord Turnberg, but I think that changes in practice will reduce the costs of acute care. Indeed, the noble Lord, Lord Kennedy, referred to amputations for diabetes sufferers in this regard. That is exactly the sort of invest-to-save cost that we should be seeing with the better care fund—for example, spending on preventive care to avoid trips and slips, and in ensuring appropriate support at home for patients being discharged to reduce the “revolving door” syndrome whereby patients return to hospital in a few days. Spending on all those initiatives would help to reduce the crisis in acute care and help to reduce the pressures on its budget.
Where integration is working well, there would not even be an issue about whose money it is, not least because the better care fund plans have been jointly signed off by not just local authorities but clinical commissioning groups and health and well-being boards. Plans have also had to demonstrate how local providers have been engaged. Adult social care services have to be at the heart of the integrated system, supporting health in everything they do by improving hospital discharge and bolstering reablement services.
We have to explode the myth that the better care fund was never intended to solve the financial problems in local government and parts of the NHS. That is one of the reasons why population changes are adding £400 million to council social care budgets every year and why, frankly, budgets must be looked at in this current year. Therefore, will my noble friend the Minister say whether the Government are looking at providing support for the health and social care sector before we even get anywhere near winter problems this year? That is absolutely vital.
I believe that the better care fund is right for the nation’s finances. Investing to save rather than saving to invest is the right thing to do. I believe that in the longer run we need a transformation fund to help the culture change and ease the impact of all the changes that we are talking about, but it must have targets, too, and peer support—something which local government is very good at. The introduction by the Labour Government of the Improvement and Development Agency really helped transform councils that were in trouble and helped with the ground-breaking changes in many council services. It would be good to see that stretched into health and other sectors, too.
In conclusion, I am pleased that the better care fund is now getting well and truly under way but am slightly concerned that NHS England seems to be changing the criteria for targets for the first round and hope that that will not delay the implementation of any of the projects. That must not continue. We will be nowhere near full integration until health and social care for older people in this country are fully funded.
Lord Hunt of Kings Heath (Lab)
My Lords, I am indebted to my noble friend Lord Kennedy for raising some real concerns about the way in which the better care fund will impact on the NHS. I thought that his questions went to the heart of the problem. I am grateful also to my noble friend Lord Turnberg for setting the very challenging context in which the fund is to work.
As we have heard, this is a straight transfer of money from the National Health Service to local government. The theory is that this will lead to more community provision, and therefore fewer people will need to go into hospital and it will be easier to discharge patients who have been admitted. The result will be that we need less acute capacity, and therefore the NHS can live on less money. That is the theory. However, there are five or six problems with the way in which this will work out in practice. The first problem is that local authority social care funds have been slashed so much that it is almost inevitable that a substantial portion of this money will be used to shore up their mainstream services. Only yesterday we had a report from the Association of Directors of Adult Social Services saying that these directors have had to cut their care budgets by 26% in the past four years. The budgets are very, very stretched indeed.
The second problem was identified this morning by the Health Select Committee. It described, in particular, managing the care of people with long-term conditions, who are the people we are largely talking about in this debate. It said that moving care for those with long-term conditions to primary community care and self-management—which I am sure we all support—is,
“intended to reduce unplanned admissions to the acute sector”.
That is absolutely right. However, it says:
“Reducing the activity of acute hospitals … and their income from such activity, is bound to have a consequential impact”,
on NHS hospital acute services.
One has to understand, as my noble friend Lord Turnberg said, that although one can certainly find problems with the way in which the health and social care system works at the moment, those who say that the NHS should become more efficient—and of course there are areas where it needs to become more efficient—also have to come back and respond to the point that this country has the lowest bed numbers and the shortest length of stay of any developed country in the world. That is why I certainly have some concern. Obviously, having just given up chairing the board of an acute trust, I come from that angle. But I am concerned whether this will be able to happen in practice.
One of my concerns is the absence of large NHS providers from these discussions. This is a consistent theme in the way in which local authorities, health and well-being boards and clinical commissioning groups have worked over the past years. I think that the reason for this is that they are scared of the acute trusts. They think that they will not be able to withstand the robust argument put forward, and therefore they prefer to exclude them from many of the discussions.
As the King’s Fund said, that is a big mistake. These decisions impact on providers’ existing activity and funding, and the risks arising from that need to be assessed and managed. We have seen it before. Let us take, for example, the four-hour A&E target. Although CCGs and local authorities make decisions that impact on that target, they do not bear the responsibility for it. That is the big problem with the fund that we are talking about. The local authority and the clinical commissioning groups may well make decisions about the fund that will impact on the ability of NHS acute services to do an effective job, but they do not bear the responsibility for it.
I think that the only way to do this would be to give acute trusts a lock on the plans. Unless there is shared ownership, we will not get uniformity in terms of accepting the risk and making sure that the use of this money will indeed drive down the use of acute hospitals. That is where we run into trouble. I am sure that the noble Earl will have seen the recent Nuffield Trust work by Nigel Edwards, who I think everyone agrees is an expert commentator. He says, and I agree absolutely, that,
“nobody can argue with the … sound principle of bringing health and social care closer together”,
as the Labour Party wants to do in its whole person care. However, he says that there is a fatal flaw in that:
“The Fund assumes that hospitals can quickly achieve a 15 per cent reduction in emergency admissions and that these reductions will result in savings in the same year, at full cost”.
The noble Baroness is absolutely right about the need for some kind of transformation fund. Unless you have some kind of double running, you run the terrible risk of money certainly being spent on community provision but acute hospital admissions not reducing, and then the system falling over. That is why we would be very grateful to hear the noble Earl, Lord Howe, respond not only to the questions put to him by my noble friend but also on how the Government will make sure that this community fund is absolutely spent on measures that will actually reduce acute hospital admissions. I hope that he will say—because I believe that this is right—that they should be signed off by the acute hospital providers. This is not an issue where you can simply say, “The commissioners will decide”, because the commissioners do not bear the responsibility. That is often a fatal flaw in the current arrangements. The Government should take a further look to make sure that this system will work effectively.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I join other noble Lords in thanking the noble Lord, Lord Kennedy of Southwark, for enabling us to consider a topic of considerable significance for patients and service users.
In every area of the country, CCGs and local authorities are now planning together to use the better care fund to transform local health and care, to improve outcomes for people and to secure the best possible value for money by pooling resources. This is one part of a wider picture of change for health and social care. We must move away from traditional models if we are to provide responsive, effective services to a changing population.
Noble Lords will remember that the need for greater integration of health and social care has long been a recognised issue. The NHS and the social care system provide some fantastic care for people when they are already experiencing acute poor health and high care needs. We must, however, get better at providing care for those with long-term, chronic conditions by keeping people as healthy and independent as possible, living in their own homes and communities for longer, and going to hospital only when they really need to for specialist medical treatment. People will be supported to return to their homes, and to independence, as soon as possible.
We are living longer now than ever before, which is obviously good news, but we do not live all our lives in good health. As people live longer, we are seeing a corresponding rise in long-term conditions that require regular treatment. A lot of this treatment currently occurs in hospitals when it does not have to. It happens because the NHS was founded to treat episodic cases of sickness in hospitals, but the needs of the people are changing and we as the Government must work with the health and social care sector to adapt.
The noble Lord, Lord Turnberg, gave us some of the statistics. ONS projections show that between 2010 and 2030 the number of people aged 85 and over will increase by 95%. This increase is equivalent to more than 1.1 million people or a local authority the size of Birmingham. By 2030, there will be more than 3 million more people than today with three or more serious, long-term conditions.
Much long-term care can be undertaken in a way that promotes independence, sometimes with family members and carers, or with the support of professionals in people’s own homes and communities. People have told us this is what they want and, yes, it is a more efficient use of resources. As I said, these truths have been recognised for some time, and this Government are the first to address it head on. There is broad consensus that greater co-ordination of health and social care services to enable this kind of home and community-based care for the majority is the right direction in which to go. The better care fund presents a real opportunity for radical change at scale and pace for people to receive the right care in the right place at the right time. Local authorities and CCGs are working together to plan and deliver this shift to a more integrated system, with resources used to best effect where they are needed most. As the noble Lord, Lord Hunt, pointed out, acute trusts should indeed be part of that work.
As my noble friend Lord Bridgeman mentioned, for the first year of the BCF, it will include £1.9 billion of the real cash increase in the NHS budget. This represents 2% of the 2013-14 NHS budget, and it is being redistributed to help fund care in non-NHS parts of the system, which will in turn help to make acute care more efficient.
The noble Lord, Lord Kennedy, asked about funding for the longer term. I cannot yet commit to a five-year plan because we have said that it is for the incoming Government to look at their priorities next year. The 2013 Autumn Statement, however, made it clear that pooled budgets would be an enduring part of the framework for health and social care past 2015-16. While the structure of the fund and the pay-for-performance elements may change as progress is made, the principle is very much here to stay.
The noble Lord, Lord Turnberg, asked a similar question about funding for health and social care generally. We will set out the funding levels for social care from 2015-16 in the future spending review but the Government have already set out their plans for changes in how social care will be funded in the future through the Dilnot reforms.
On the specific issue of winter funding, which my noble friend Lady Brinton put to me, the Department of Health is constantly looking to the future, as she may well be aware. Possible pressures on the NHS and social care are very much part of that thinking. We have considered what pressures there will be in the coming winter and I can assure her we are planning appropriately.
Leading care professionals—hospital staff, care workers, GPs and researchers—all agree on the need for resource to be put into integrating our health and social care services, so that a better service can be provided at the same cost. This will certainly involve changing the way things are currently done. The NHS model is geared toward treating people as they get ill. We must shift our approach to focus increasingly on keeping people well and providing acute care in hospitals for those who unavoidably get sick. Keeping people well and out of hospital for as long as possible, and reducing their length of stay by co-ordinating with social care, will reduce the strain on NHS acute services. It will also improve people’s experience and improve health and well-being. An integrated service would allow this to happen, and that is what the BCF has been formed to do.
The noble Lord, Lord Kennedy, asked me whether dementia will be prioritised in the BCF. Guidance on the better care fund sets out that dementia services provision can be a part of the better care fund. Many area plans already contain good examples of health and social care working better together to provide dementia services. He also asked me what seven-day social working means. It is imperative to see social care working over seven days. Too often people have to stay in hospital because they are unable to leave at the weekend. Seven-day working, which will see social care operate at the weekend, as it already does in many areas, will see people return home at the earliest opportunity.
The noble Lord, Lord Turnberg suggested that all this was about robbing Peter to pay Paul. With respect, I do not see it like that at all. This is not about taking money from one part of the system and giving it to another. The better care fund will be held jointly by CCGs and local authorities for them to decide between them how best to spend it. They will decide how to make best use of the money available across the whole care system. This provides a real opportunity to join up services and transform people’s lives, particularly vulnerable people.
As I have explained, one of the aims of the BCF is to reduce the burden on acute services caused by avoidable admissions to hospitals. The way that funding for acute services works means that hospitals receive a marginal level of funding for unplanned admissions. Using the available budget to fund better-integrated, more proactive services will help hospitals to balance their budgets by reducing the operational and financial burden created by avoidable admissions. I am sure the noble Lord will be familiar with the 30% tariff for emergency admissions above a certain threshold. All this will allow hospitals to focus on providing specialist and trauma services, for which they receive full funding so it will make them more financially viable than they would be if the current system was retained. I say to the noble Lord, Lord Hunt, that evidence suggests around a fifth of all emergency admissions are avoidable in some way. If we get it right, transforming hospital care could therefore prevent these unnecessary admissions, which can be distressing for patients, quite obviously, and are costly to the NHS.
The noble Lord, Lord Turnberg, asked me whether the Government have plans to recruit more doctors into general practice. I am sure he will know from statistics that the number of GPs has increased since 2010, but our mandate to Health Education England requires them to increase the proportion of trainee doctors going into general practice from 40% to 50%. We have also set out our ambition to increase the primary care workforce as a whole—not just doctors, but nurses and other primary care professionals—by 10,000 by 2020.
Using resources to keep people out of hospital, by improving other methods of care—social care and home care—will lead to better use of NHS services, ensuring that services are focused on people who cannot be treated at home or in the community.
That brings me to the issue raised by the noble Lord, Lord Turnberg, of the impact of the BCF on acute care. All areas need to show that they have assessed the impact of their BCF plans on the acute sector—that is, hospitals. No plan will be approved without this. They will need to show that they have considered both the operational and financial implications and how these will be—
Lord Hunt of Kings Heath
My Lords, I realise that the noble Earl does not have much time but can he just answer this point? Why not give the acute trusts the ability to sign up to it, or not, to prove that it will reduce capacity?
Earl Howe
My Lords, we are looking at ways to assure these plans, and to assure them in a way that is satisfactory to the acute sector. At the moment, I cannot tell the noble Lord precisely how that mechanism will work but his central point is well made. I hope that in due course we will be able to share some of our thinking with him. However, the key point is that acute providers must have been consulted in this process.
This sort of approach is being pursued around the country. We know that it can work. For example, a network of 14 pioneer areas around the country are currently working with central government and health sector and third sector organisations to demonstrate the logic of integration and to disseminate what they have learnt to the rest of the country. That includes data-sharing—a point raised by the noble Lord, Lord Kennedy. Areas that have made significant progress in that respect are Southend, Leeds and South Tyneside.
There are other examples, too. In Greenwich, more than £1 million has been saved from the social care budget. In addition, 64% of people who went through their new integrated care pathway required no further services upon completion of the pathway. That has helped to lead to a 50% reduction in the number of people entering full social care.
My noble friend Lord Bridgeman asked whether admissions had been taken into account in the pilot scheme. Greenwich is a good case in point. More than 2,000 patient admissions were avoided there due to immediate intervention from the joint emergency team.
In Northamptonshire, £3.5 million has been saved through prevented admissions, exceeding the target by 14%. In Leeds, children and families now experience one service supporting their health, social care and early educational needs, championing the importance of early intervention. Since the service has been in operation, the increase in face-to-face antenatal contacts has risen from 46% to 94%.
Those examples, along with many others, should demonstrate to noble Lords that the integration of our health and social services can, and indeed has been, achieved in several areas. Integration will not only preserve our ability to provide services but improve them. The better care fund exists to enable all the local areas in England to do what the pioneers and others are doing to move towards a more responsive, effective and sustainable system that makes much better use of the resources available.