Integration of Primary and Community Care (Committee Report)

Baroness Pitkeathley Excerpts
Thursday 9th May 2024

(1 month ago)

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Moved by
Baroness Pitkeathley Portrait Baroness Pitkeathley
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That this House takes note of the Report from the Integration of Primary and Community Care Committee Patients at the centre: integrating primary and community care (HL Paper 18).

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, many of your Lordships will know that for a long time I have been concerned with health and social care principally though the experience of carers. I have lost count of the number of times I have heard carers say something like, “What I don’t understand is why it doesn’t all fit together. How come the GP didn’t know that Mum was being discharged from hospital? Why did the community nurse and the social worker not know each other? Why have I got to give Mum’s details over and over again to different people?”

So when I was asked to chair a House of Lords special inquiry into integrating primary and community care, I was delighted. I express my most sincere thanks to the 12 cross-party members of the inquiry, most of whom are speaking today, for their knowledge, skills, commitment and wisdom. Most unusually, we had—for reasons beyond anyone’s control—three changes of clerk during our deliberations, so I acknowledge the ongoing support of Chris Clarke and, most of all, Matthew Burton, who was and is a shining example as our policy analyst. I am most grateful to our special advisor, Professor Gerald Wistow, whose long experience in both the health and social care fields was invaluable. I welcome, too, the other speakers in our debate and am grateful that the noble Lord, Lord Jamieson, has chosen this one in which to make his maiden speech.

The inquiry took evidence from 70 witnesses, we had 76 written submissions, and we undertook two visits to projects in areas where integration is definitely benefiting patients. Defining integration is not easy, but we took as our definition something from a government policy paper that had been in use for years before that:

“the planning, commissioning and delivery of co-ordinated, joined up … services to support people to live healthy, independent and dignified lives and which improves outcomes for the population as a whole. Everyone should receive the right care, in the right place, at the right time”.

I guess no one in this Chamber will be surprised that our inquiry found that there is a very long way to go to achieve this, and that patients are constantly being inconvenienced or endangered, or missing improved long-term health, because they are not receiving joined-up care in the right place and at the right time. Poorly co-ordinated care significantly undermines the quality of patient experience in the NHS and can have profound consequences for long-term health.

The inquiry heard of patients suffering vision loss, or facing critical delays in treatment, due to the mishandling or loss of records between services. Patients in care homes frequently endured inconvenient and unnecessary trips to see their GPs or to hospital appointments. Consultants did not talk to each other or consult about patients, resulting in the absurdity of a patient seeing three separate consultants for the three injuries sustained in one fall.

Community nurses were unavailable and rarely in contact with other professionals. Complex care is fragmented across various services, which do not co-ordinate with each other to plan overall patient care and recovery, let alone to take responsibility for the preventive services which we all know are the long-term key to a viable NHS. Social care was not actually within the committee’s remit but witnesses frequently referred to the lack of integration between those two elements as an even more serious problem than the intra-NHS difficulties.

The inquiry identified four key obstacles to integration which could be addressed. I will refer briefly to each of them, with our suggestions for tackling them. The first was structures and organisation. The Health and Care Act 2022 encourages local autonomy and subsidiarity to encourage interservice relationships, but designing a universal policy has proved difficult. The imbalance of power and representation in ICBs, ICPs, local authorities and the voluntary and community sectors limits integration. Of course, it is relatively early days, and almost all our witnesses said that they must be given more time to mature.

We do not propose further reorganisation but suggest that the membership of the governing bodies should be widened and accountability enhanced through better inspection. Health, social care and voluntary sector leaders should work together as equal partners, as they are likely to possess a real understanding of their respective communities. This would encourage integrated policy-making and service provision, as well as a more preventive approach to public health. Importantly, there should be a single accountable officer at place level, specifically charged with working with local leaders.

Our second obstacle was contracts and funding. The NHS allocates an excessive amount of funding to reactive hospital care at the expense of preventive primary and community care. That is a strong statement, but it was not our conclusion: it was the opinion expressed by all four former Health Ministers and Secretaries of State who gave evidence to us. They were from different parties and were Ministers in different circumstances, but they were adamant on that point. Too much money goes to hospitals. Service contracts lack incentive for multidisciplinary care and reform is needed to ensure that this is incentivised.

Co-location encourages better communication and easier access for patients, but the existing GP contract and partnership model hinders this, as does the fragmented funding across different health disciplines. Of course, there is the huge divide between local authority-funded care and that funded by the NHS. The better care fund has made attempts to bridge this gap, but joint funded mechanisms need to be significantly enhanced. The better care fund should cover a larger proportion of relevant NHS and local authority expenditure, and the fund’s statutory responsibilities should be devolved to place-based commissions. This would enable decisions on joint funding to be taken by those with a better knowledge of local needs.

The third obstacle we encountered was data sharing. Single patient records have not been universally adopted, and full implementation faces issues of interoperability and widespread IT inadequacies. For example, we came across people putting the same data into three separate computers because the machines do not talk to each other and the systems are not connected. More frustration was expressed by our witnesses on the inadequacy of connectivity than almost anything else. As well as the technical issues, data sharing is hindered by cultural and perceived legal obstacles. The DHSC should publish guidance that clarifies how data and privacy laws apply to patient data, so that everybody is clear about their responsibilities.

Our fourth obstacle was workforce and training. Staff shortages make integration more difficult; of that, there is no doubt. When you are up to your eyes on the front line, have you time to develop new ideas for integrating? Specialised staff are not trained sufficiently in the work of other disciplines, and there are of course hierarchies of professions and services. Integration needs to be included in all initial clinical training, and clinicians should be introduced to other services by job rotations. Better training for social care workers would enable them to work more effectively with primary and community care workers, and social care must be included in the NHS long-term workforce plan.

Mindful always of the current problems faced by the NHS, we were aware of the shortages of people and resources that undermine integration, however good the intentions of individuals. We emphasise that better integration will reduce the long-term stress on the NHS, as it leads to more holistic and preventive care over time and encourages a problem-solving approach to work that ignores or bypasses artificial professional divisions. Our visits to Coventry and Pimlico provided us with evidence that real integration happens where you cannot see the joins between the professions.

In summary, trusting and constructive working relationships are essential for integration, together with aligned contracts and funding, as well as seamless data sharing. These were the focus of the 16 recommendations that we made to the Government as our inquiry ended. The Government’s response was delayed and when it came, it was very disappointing. In fact, it did not even give the usual “accept” or “reject” response to the individual recommendations, apart from one very lukewarm acceptance. In short, the Government’s response says that everything is under control and all the issues we raised are being addressed.

I will give an example. We found co-location to be extremely beneficial for integration and recommended that the Government should

“investigate different ownership models for GP practices”

and

“their co-location with other community services”.

The Government’s response concedes that co-location can be good but is not required. Although the Government say that NHSE and the DHSC are investigating

“new models of primary care estates”

there is no further information about that, and no timescale is given.

On another of our recommendations—for a single accountable officer—all the Government say in response is that some progress has been made and that a single accountable officer is “one way” of ensuring integration. That is another lukewarm response, which is in direct contradiction to the Government’s previous statements and commitment in the integration White Paper that a single accountable officer must be appointed.

For social care, we make what seem to us to be very sensible, cost-effective suggestions about multidisciplinary teams and joint training, as well as amending the workforce plan to include

“a strategy for increasing the size of the social care workforce”

so that it is sustainable in the future. Again, the Government’s response is immensely disappointing, merely saying that they will “consider” how they will

“support better integration of health and care to create a more flexible, agile workforce”.

In conclusion, I emphasise that the special inquiry was very clear about the purpose of integration: it is not an end in itself, but a means of achieving patient-centred care, reducing inequalities and getting a better balance between community-based care and hospital-based care. Despite endless commitments over many years to the importance of integration, I am sorry to say that the Government’s response to our report is a missed opportunity to show commitment and to bring about important changes, many of which are simple and virtually cost free—I emphasise: they are simple and virtually cost free.

The Government merely fudged their response. They lack any sense of urgency to deal with problems that will only become more urgent as our population ages and lives longer, with more comorbidities. We called our report Patients at the Centre. I am yet to be convinced—although I hope that the Minister may prove me wrong—that the Government are really committed to ensuring that patients are at the centre of primary and community care. I beg to move.

--- Later in debate ---
Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, it is the end of a long day, and I will be brief. I thank everybody who has spoken. It was a particular pleasure to hear the maiden speech of the noble Lord, Lord Jamieson, and I look forward to hearing from him a great deal more in the future. I said that I remain to be convinced by the Minister, and I must say that he has made a good fist of it: I feel a bit more convinced now than I did by the Government’s response about the commitment to integration.

What I do not think that he or the Government, or perhaps many other people, have yet done is make this crucial leap of thinking: integration is not an end in itself but only a means to give patients a better experience. If that sounds a bit vague, let us also remember the practical outcomes which come from giving patients a better experience: you prevent unnecessary hospital admissions, as noble Lords have heard; you head off at the pass preventable illnesses, so you save money, and it is a very good investment; and you make use of the most precious of all resources, the patient’s own experience. Nobody knows better about their health than the patient, but they so often feel disempowered because no one listens to them. I hope my colleagues on the committee will remember the nameless professional who said to us that it really did not matter if patients had to tell their story lots of times to lots of different people, because it helped them get their story straight—come on. Those are the kinds of attitudes that we have to overcome. Integrated working in productive teams helps staff retention because staff are happier and more satisfied; integrated training spreads skills and knowledge in a very cost-effective way. I hope the Minister and his colleagues will keep our recommendations under review. Many of them are, as we have emphasised, easily done and at low cost.

We have talked about integration for so many years—for too long. As one of my colleagues said, it is not rocket science but it does require changes. These are not only changes in the way we distribute resources but changes in the mindsets of professionals at all levels in ICBs, in NHSE, in the DHSC and in political parties. The matter is urgent: with every day that goes past, the health of our nation becomes worse. The rewards are great for everyone, but most of all for patients, if we really do manage to put them at the centre.

Motion agreed.

NHS: Long-term Sustainability

Baroness Pitkeathley Excerpts
Thursday 18th April 2024

(1 month, 3 weeks ago)

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Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, it is an honour and pleasure to follow my noble friend Lady Ramsey, and to be the first to congratulate her on her truly memorable maiden speech. I should not be surprised that she has made a remarkable speech, because she is a remarkable person who brings a wealth of experience and achievement in public service to your Lordships’ House. As a barrister working in local authorities, as chair and non-exec on many health agencies and as an upholder of standards in public life, she has already achieved a great deal. Indeed, the range and breadth of her experience is so great that she could have made her first contribution in a variety of debates. I am sure your Lordships will be glad that she chose this one. As we have heard, she brings willingness, commitment and enthusiasm to continuing her work in this latest phase of her public service. Her colleagues on these Benches, and throughout your Lordships’ House, will be grateful for her presence, and look forward to many more memorable contributions.

I thank the noble Lord, Lord Patel, for this debate and for his indefatigable pursuit of improvements in health and social care. Like many noble colleagues, I could give examples of where great care is happening, and my own recent experience could not be improved. The use of technology to make appointments and to deliver care was fantastic, as was the skill and understanding of all the professionals with whom I came into contact. However, too often patients report very differently. As we know, 24% satisfaction with the NHS is nothing to be proud of.

I have lost count of the number of health debates in which I have taken part in my 27 years in your Lordships’ House, and in every one there has been agreement about what is needed to provide the comprehensive and timely care that we seek. We always agree on two things—first, that we need more preventive services, as the noble Lord, Lord Patel, and others have reminded us. We treat people too late and allow their conditions to become chronic, so that major interventions are needed when small ones would have sufficed. We do not treat the broader picture: we do not look at the lifestyle issues and diets that cause the conditions or the poverty that is the reason why people eat the wrong food, which in turn causes diabetes, the need for new joints and the disabilities that mean people cannot work or have a tolerable, pain-free life. Still less do we think of surveying living conditions, such as putting in a handrail and getting rid of the rugs that cause falls, which in turn create huge amounts of work for the NHS and distress for an older individual.

The second area on which we have always agreed is that we need more integration. I shall have more to say to your Lordships’ House next month, when the report of my Integration of Primary and Community Care Committee is debated, but, for now, I agree with other noble Lords that the NHS allocates an excessive amount of funding to reactive hospital care at the expense of preventive primary and community care. This was not just the conclusion of my committee but the strong opinion expressed by all former Health Ministers and Secretaries of State who gave evidence to it. They were from different parties and Ministers in different circumstances, but they were all adamant on this point, as many noble Lords will be in today’s debate.

The mismatch in the levels of funding and importance that is so clear in the NHS is even more significant when it comes to social care. We are all victims of the historical accident that means that local authorities fund social care. Nobody knew that we would live so long and have so much need for support in 1948, but we have made only pathetic or failed attempts to rectify that situation. I know that the Minister would not call the better care fund either “pathetic” or “failed”, but it is, at best, a sticking plaster to cover the basic flaw in our funding system.

Unless we get better integration between health and social care, we will never deliver comprehensive care, and the divide will continue. To overcome that divide, we have to address the join between the NHS and local authorities and areas where professional silos and the arrogance that goes with such divides have not been eradicated. We never seem to have found the ability to translate local success into national guidelines. The “not invented here” syndrome stymies all attempts at change.

Do not get me started on the main providers of both health and social care. I am grateful to the noble Baroness, Lady Warwick, for mentioning unpaid carers. It is not the NHS or local authorities but family carers who provide, willingly and with love, billions of pounds of care—estimates vary, but it is well over £150 billion, or the cost of a second NHS. Does it not make sound economics, as well as moral good sense, to support them better than we have ever succeeded in doing? They are the best-value service any nation could want. Yet what do we hear? We hear of carers being persecuted, even prosecuted, for invertedly going £1 over the earnings limit on the derisory amount of the carer’s allowance. We hear of carers being forced to abandon paid employment, building up future poverty for themselves and future liabilities for the state. We hear of carers being ignored, having their skills knowledge and experience dismissed and not being consulted, with their own health needs going unrecognised. Carers are, and will continue to be, the bedrock of health and care services, and I hope that the Minister will confirm the importance of recognising that.

Stroke Treatment

Baroness Pitkeathley Excerpts
Wednesday 27th March 2024

(2 months, 2 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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The noble Lord is right to point that out, and I hope we are correcting it. I have seen the mobile app and digital being used to do all these things—I have even seen applications which can measure your blood pressure and pulse as you look at it. We need to check some of the accuracy around that, but it is all part of the programme. However, we need to make sure that it is in everyday English.

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, many family carers who provide care for stroke patients are also of working age. If they have to give up paid employment, it results often in the kind of debt that is currently in the news as a result of having to pay for care. What help can be given to those carers? I acknowledge that the Carer’s Leave Act was a welcome step forward, but that is only unpaid leave. What else can the Government provide for carers in these circumstances?

Lord Markham Portrait Lord Markham (Con)
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The noble Baroness is right: carers are the hidden army who give so much support, not just in the area of strokes but across the board. As the noble Baroness said, we have put in place some steps, such as enabling leave and enabling people to claim benefits. I accept that that is not the whole enchilada, so to speak, but it is a step along the way.

Mental Health Patients: Discharge

Baroness Pitkeathley Excerpts
Tuesday 5th March 2024

(3 months, 1 week ago)

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Lord Markham Portrait Lord Markham (Con)
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Again, like many noble Lords, I understand the disappointment that there has not been the time for the mental health Bill. This is what the round tables are about: exploring with Maria Caulfield, the Mental Health Minister, how we can ensure that we implement as many of these things as possible. We had round 1 and we will set up round 2 shortly. I suggest we take it up then.

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, one of the problems that carers in these circumstances always report at the point of discharge is that the professionals dealing with the patient are reluctant to share information with the person who is expected to provide care. Although I recognise the sensitivity of these issues and the need for confidentiality, does the Minister agree that if you expect someone to provide care in these circumstances you should at least provide them with the requisite information?

Lord Markham Portrait Lord Markham (Con)
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In a word, yes. We had the rapid review of data in mental health settings. Not surprisingly, in mental health, as in a lot of other settings, ensuring that there is the flow of information so that carers get the right information is paramount.

Care Home Staffing

Baroness Pitkeathley Excerpts
Thursday 18th January 2024

(4 months, 3 weeks ago)

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Asked by
Baroness Pitkeathley Portrait Baroness Pitkeathley
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To ask His Majesty’s Government how they are planning to address current staffing levels in care homes, and any connected delayed discharges from hospital wards and the impact on NHS waiting times.

Lord Markham Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
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We estimate that the number of adult social care filled posts increased by 70,000 in the last 18 months. The Government remain committed to the 10-year vision to put people at the heart of care, making up to £8.1 billion available over two years to strengthen adult social care provision and discharge. Funding is enabling local authorities to buy more care packages, help people leave hospital on time, improve workforce capacity and reduce waiting times.

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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I thank the Minister for that reply, but I am not sure that I find it very reassuring. Your Lordships’ House will know that delayed discharges and long waiting times are largely the result of shortcomings in the care sector, especially the shortage of staff in care homes, where international recruitment has been a lifeline. It was therefore a surprise when the Government elected to put further pressure on this sector by increasing the minimum annual salary required for employees applying for a visa, banning them from bringing dependants to the UK and requiring care firms to be regulated by the CQC if they are to sponsor these visas. Far from being broadly relaxed about these proposals, as the Secretary of State for Health claimed, the care sector is most alarmed about how this will affect recruitment, especially as no consultation at all took place before the policy was announced. Will the Minister please further explain to the House how the Government intend to ensure that there are enough staff in the care sector to cover the enormous and growing need?

Lord Markham Portrait Lord Markham (Con)
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The whole point of the title People at the Heart of Care is the recognition that staffing is critical to this. While it is early days, I believe the 70,000 increase in staff over the last 18 months, as I mentioned in my Answer, is a positive step. We had a very positive announcement just last week about the care pathway, setting out a career structure, which has been welcomed. For instance, ADASS, the Association of Directors of Adult Social Services, said that these are

“positive steps to help make adult social care a real career choice now and in the future”.

We really are making advances in this space.

Dementia

Baroness Pitkeathley Excerpts
Thursday 18th January 2024

(4 months, 3 weeks ago)

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Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, I give my thanks to the noble Baroness, Lady Browning, who, against convention, I should call my noble friend, because we have worked together on these issues for many years. I thank her not only for securing this debate but for hitting the nail on the head when it comes to the situation between health and social care. That lack of parity of esteem is at the root of all the problems she outlined.

Although a health condition and the biggest cause of death in the UK, dementia receives most attention through not the NHS but social care, which has always been the poor relation—the tail-end Charlie—vis-à-vis the NHS. That did not matter in 1948 when it was set up, because we all died much earlier, but as we grow older, with greater incidence of dementia and other comorbidities, it matters hugely. It matters for diagnosis—the noble Baroness mentioned the long waits—or the absence of any diagnosis at all. It matters for services, both the access to services suitable for dementia patients and their carers, and the quality of the services. We heard from the noble Baroness, Lady Browning, about the lack of training of many people who provide those services. It also matters for access to medication, because we hear about the postcode lottery of what dementia medication is available.

Of course, its effect is nowhere more significant than it is on the biggest providers of care for those with dementia: not the NHS or social care but their own families—the spouses, sons, daughters and friends—who are often locked into an intolerable situation by the care they provide, however willing they are to undertake it. They suffer financially—we heard about the enormous costs of care—and they suffer physically, as their physical and mental health is at risk. Three-quarters of all carers report damage to their health as a direct result of their caring. They lose financial security and end up in poor health and often isolated, since their social circle shrinks dramatically. If there were more parity, we might be able to focus more on preventive services for dementia sufferers and their carers. There is no cure, but the progress of the disease can be slowed, or its onset delayed, by such things as exercise, group activities and interest groups—just the sort of things that are cut in times of austerity.

I hope the Minister will assure the Committee that the Government are committed to providing diagnosis and support at the earliest possible stage, and that they will shortly publish a long-term workforce strategy, such as the NHS one, for the social care workforce. I remind your Lordships that one in three of us will get dementia—that is seven people in this Room. We owe it to ourselves as well as future society to make it a priority.

Adult Social Care: Staffing

Baroness Pitkeathley Excerpts
Tuesday 12th December 2023

(6 months ago)

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Asked by
Baroness Pitkeathley Portrait Baroness Pitkeathley
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To ask His Majesty’s Government, further to the report of the National Audit Office Reforming adult social care in England published on 10 November (HC 184), how much of the £265 million allocated to reforming social care staffing between 2022–23 and 2024–25 has been spent so far, and what problems they have encountered in spending the allocated money.

Lord Markham Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
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The Government have made up to £8.1 billion available this and next year to strengthen adult social care provision. Specifically, we have invested over £15 million so far this year in supporting our workforce reform programme. The Government remain committed to our 10-year vision to put people at the heart of care and make long-term sustainable investment to future-proof the sector. Further announcements of support will be made shortly.

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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I thank the Minister for that reply. He will know that the NAO’s report said that only £19 million of the very welcome £265 million that was originally allocated has thus far been spent. Even if the Minister does not agree that this is an utterly inadequate response to the crisis in social care, as the King’s Fund has said, he must admit that the slowness of progress is somewhat frustrating. Is it because there are not enough staff in the DHSC to distribute the money? I understand there are about 100 vacancies. Alternatively, is it because there have been many ministerial changes in his department, or because—as many in your Lordships’ House will suspect—social care is simply not a priority for this Government and, once again, millions of unpaid carers will be left to prop up a crumbling system?

Lord Markham Portrait Lord Markham (Con)
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I share the noble Baroness’s concern about the speed of deployment. At the same time, it is fair to say that we are developing a whole new set of social care qualifications, which we think we can all agree are key to this. We are also developing a whole new payment mechanism, because there are 17,000 independent providers and we need a mechanism to allow payment. It is a complex programme, but I agree that we need to do everything we can to speed it up.

National Health Service: 75th Anniversary

Baroness Pitkeathley Excerpts
Thursday 30th November 2023

(6 months, 2 weeks ago)

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Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, I too thank my noble friend Lord Hunt for introducing this debate in his typically tub-thumping and inspiring manner.

I owe my life to the NHS—quite literally. Without the NHS’s resources and the commitment and skill of those who work in it, I would not be standing here making yet another speech on health in your Lordships’ House to join the many I have made since I became a Member at same time as my noble friend. It is no exaggeration to say that it causes me emotional distress to hear the phrases that people are now using about our beloved NHS—“The NHS is not what it was”, or, “You can’t rely on the NHS now”—or to see friends in my village spending their life savings on paying for surgery in the private sector because they are no longer able to tolerate the pain in their knee, or cope with being off work for a year or even two because they cannot get their hip done. That is what 7 million on the waiting list means.

I will not repeat what other noble Lords have said about the length of the waiting lists. They must be fixed, but we cannot fix them without fixing what causes them. Is it any wonder that you have to wait at the front door of the hospital when you have a traffic jam at the back? The NHS and social care are inextricably bound together—how many times have we said that in your Lordships’ House—yet we are no nearer to solving the problem than we were 25 years ago. In fact, it has only got worse. As we know, people are living longer with more comorbidities. We should rejoice in that because it is an NHS success story, but, as we know, local authority budgets, which have been so constricted for so many years, are unable to provide the services we need. The problems in social care are just the same as they have always been: not enough money, too little integration and fragmented services. That is what a previous Prime Minister promised to fix. As my noble friend said, “That went well, didn’t it?”

I know that the Minister, when he comes to reply, will give us statistics on how much more money this Government have put in, but it is spent on the wrong thing: on hospitals instead of primary, community and social care, which are the services that keep people out of hospital. As the Association of Directors of Adult Social Services reminded us:

“National policy and investment has predominantly focused on addressing issues relating to discharge from hospital”—


there we go with hospitals dominating again. Consequently, people are sicker and have a higher level of need, so more resources are needed. ADASS says that we can fix this system only

“by shifting policy and investment towards early intervention and prevention”.

Hurrah for that, but preventive work—the stuff that keeps people out of hospital—is always the Cinderella when money is being dished out because it is long-term policy.

I have just had the privilege of chairing a special inquiry into integration between community and primary care services. Our report will be published shortly, and I hope it will not only give a useful insight into what the problems are due to a lack of integration are but draw conclusions about how they could be addressed.

Our focus on hospitals as the embodiment of the NHS blinds us to the other services, which are much more important to the patient and much more effective in sorting out the waiting list problem. Primary and community care services are what most people have contact with in the NHS. If we are really serious about improving NHS performance, then that should be our focus. Your community physiotherapist can prevent the need for a knee replacement, and your community occupational therapist can prevent the fall that results in hospital admission. I hope the Minister will assure the House that the Government understand the great importance of prevention in tackling any problems in the NHS.

I will mention two more elements in the NHS that we ignore at our peril when it comes to performance. The first is the voluntary and community sector, which provides so many services that contribute to good health, both mental and physical: the plethora of disease-specific organisations, support groups and information services, which are vital and make such an important contribution in healthcare, as we saw during the pandemic, that are now under threat because of a lack of funding from local authorities and pressure on their volunteers. Only one-third of directors of adult social services were able to invest in community and voluntary services.

Secondly, your Lordships would expect me to flag up the vital contribution of families to health care—those millions of unpaid carers. I quote from the State of Caring 2023 report from Carers UK on carers’ health and well-being. The report shows that

“carers’ mental and physical health is getting worse, and for some it’s at rock bottom”.

It says that

“42% of carers said they needed more support from the NHS or healthcare professionals, and …better recognition from the NHS of their needs as a carer”.

The report also says:

“35% of carers said they were waiting for specialist treatment or assessment, either for themselves or the person they care for”,


and that they were therefore worried about their ability to go on providing that vital amount of care. One carer, talking about the challenges with their mental health, said:

“I know I could ask for counselling, which I’ve had several times over the years through my GP and other organisations. But the waiting lists are very long”—


too long for me.

The Government’s vision should be that we have an NHS which is the most carer-friendly health service in the world, both for the unpaid carers and for the one in three staff who work in the NHS and are juggling caring responsibilities themselves. I hope that when the Minister replies, he will reiterate the Government’s commitment to having a clear and deliverable strategic approach to improving carers’ health and well-being, and the structures which enable carers to get the support that they so much need.

Adult Social Care

Baroness Pitkeathley Excerpts
Wednesday 22nd November 2023

(6 months, 3 weeks ago)

Lords Chamber
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Lord Markham Portrait Lord Markham (Con)
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Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, according to the same survey cited by the right reverend Prelate, 68% of directors reported unpaid carers having break- downs because of burnout from stress, and half a million home care hours had not been delivered because of a lack of staff. Carers UK published a survey showing that 25% of unpaid carers are going without food and heating because of the demands of caring. When will the Government commit to a national strategy for carers to address some of these problems?

Lord Markham Portrait Lord Markham (Con)
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We realise that they are the hidden army, and they are tremendously valued. I think noble Lords know that I have some personal experience of this. We have tried to put some measures in place for payments; I perfectly accept that it is not the same as a full wage, but payments have been put in place. We are also introducing respite care, so we are taking steps in that direction to recognise the vital service they all provide.

Dementia Palliative Care Teams

Baroness Pitkeathley Excerpts
Thursday 15th June 2023

(12 months ago)

Lords Chamber
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Lord Markham Portrait Lord Markham (Con)
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I thank the noble Lord. I have an auntie with dementia in care in Derbyshire. The noble Lord is correct that it is a perfect example of a wraparound service that takes in all the facilities that people need. The intention is that we want to spread that everywhere. It is the responsibility of each ICB to set the right commissions in their local area, but we are spreading knowledge of the dementia model as far as we can. A big example is that we promoted it at the recent national clinical excellence celebration day in the Midlands.

Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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My Lords, I am not sure the Minister actually answered the question about where co-ordination happens, which is the essential part of this. He will know that much care and palliative care for dementia patients and their families is provided in the voluntary sector and by charities. What support can we give to charities, which often are acting in a co-ordinating role? Can the Minister update us on newspaper reports that his department intends to recruit an army of volunteers to help solve the social care crisis?

Lord Markham Portrait Lord Markham (Con)
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The voluntary sector is a key element of this. On behalf of the department, I thank it for all the work it does. The direction of travel is very much to engage the sector and enlist its support as much as possible. The ICBs do the commissioning, and Derbyshire is a fantastic example of commissioning all the different strands, including the voluntary sector, hospices and palliative care to deal with clinical need. It is an excellent example of how to do it well and one that we need to spread everywhere.