Primary and Community Care: Improving Patient Outcomes

Lord Farmer Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Farmer (Con)]

My Lords, it is a pleasure to follow the informative and thoughtful speech of the noble Lord, Lord Kakkar. I too thank the noble Lord, Lord Patel, for securing what is a very timely debate, given the new Health Secretary’s pledge to put patients first, and the opportunity to talk about how community-based care can improve patient outcomes.

I declare my interest as director and controlling shareholder of the Family Hubs Network Ltd, which advocates for family hubs and advises local authorities on how to establish them. Family hubs are well-placed to deliver a broad range of paediatric physical and mental health services that are more accessible for families. The noble Lord, Lord Hunt of Kings Heath, mentioned accessibility. That accessibility, and the integration of health with other family support in a non-stigmatising and parent-educating environment, has the potential to transform outcomes. Paediatric health needs that are psychosocial and practical require a whole-family approach. Moreover, delivering them in hospital settings a couple of bus rides away from where people live makes it far less likely that children will attend.

Watson and Forshaw’s study found that a third of all paediatric hospital appointments were missed over a six-month period. Even more concerningly, a third of those children who were “not brought in” by their parents were known to social services and therefore likely to come from families already struggling greatly with the basics of child-rearing. Distance from home contributes to the social gradient in health and perpetuates the inverse care law that those with the greatest healthcare needs have the poorest access to that care.

Accessibility matters greatly if services are to be delivered for the convenience of hard-pressed parents and their children, rather than the system. I welcome family hubs’ inclusion in the statutory guidance for the preparation of integrated care strategies. These are described as

“a way of joining up locally and bringing existing family services together to improve access, connections between families, professionals, services, and providers, and putting relationships at the heart of family support. The Family hub model brings together services for families with children of all ages (0-19) or up to 25 with special educational needs and disabilities … with a ‘Start for Life offer’ at its core.”

Otherwise, access was not prioritised in this guidance, but it should be.

A provider of healthcare services in one county, contracted to provide similar services in two integrated care systems and in two very different ways, told me:

“In one ICS, our contract to deliver children’s community health provision gives us the autonomy to deliver in the community and close to people’s homes. Where we can, we deliver this in Family Hubs so we can provide education for the parents, early help and appropriate expertise. We provide allergy, continence, perinatal mental health, speech and language and other support, all of which prevents unnecessary attendances in GP practices and A&E. However, in another ICS where we are sub-contracted by an acute hospital, we are required to deliver the same services from a hospital setting. The parent and patient experience differs significantly from one that is educated, empowered and supported to one that is the recipient of a treatment.”


Moving on to how health is described in the DfE’s Family Hubs and Start for Life Programme Guide, the lens always seems to be the very early years. Reference is made, for instance, to

“a clinical setting such as a maternity hub”,

mental health is couched in terms of helping families receive appropriate support for their parent-infant relationship and the specific conditions mentioned, such as neonatal necrotising enterocolitis, infer babies’ health needs. This is an important start, and the Department of Health and Social Care is, at this point, mainly interested in family hubs as the place where start for life services can be delivered, but their potential is so much greater than that, as my earlier example made clear.

Can my noble friend the Minister let me know what encouragement DHSC is giving to the wider provision of health in family hubs? I ask because, at present, the Family Hubs Network and others have found a distinct lack of awareness of their potential to ease the load on health providers. Health professionals tell us that paediatricians at local hospitals still do not know about family hubs, but need to. They often see families with well-established problems, such as obesity and incontinence, which are best treated closer to home with regular contact with early-help practitioners in family hubs. Social prescribers and therefore local GPs, even in areas where there are flagship family hubs, are similarly unaware.

Hubs are also a better place to take on the non-health problems which consume so much of GPs time. In 2015, Citizens Advice’s report, A Very General Practice, itemised how much time GPs spend on various non-health issues and found, unsurprisingly, that 80% of GPs said that such demands cut into their time for meeting patients’ health needs. Citizens Advice called for non-health demands to be met in ways that free up GPs to focus on patients’ health, particularly where they require specialist knowledge. The top three non-health issues that patients raise during consultations could and should be part of the family hub offering: 92% of patients mentioned personal relationship problems, 77% problems with housing and 76% problems with work or unemployment. Only one-third of GPs felt they were advising patients adequately.

Family hubs already join up services, including housing and employment coaching, from a wide range of government departments. DWP runs reducing parental conflict programmes in family hubs, where it is easier and less stigmatising to access relationship support, particularly for low-income families. Similarly, the MoJ’s pilot family hub in Bournemouth links with the family court and enables separating parents to get help earlier, and avoid costly and adversarial court processes.

Last week, the Children’s Commissioner’s Family Review said that every government department should bring forward family-strengthening policies, led strongly from the top. Family hubs should be the key delivery sites for them and expand their remit, for example, to include better support when parents make child maintenance claims, measures to tackle rural loneliness and disadvantage and intergenerational opportunities. A Cabinet-level Minister needs to co-ordinate these across government, backed by the new Prime Minister. Liz Truss pioneered this in government when she commissioned my review into the importance of prisoners’ family ties to prevent re-offending and intergenerational crime. She has also promised to look at family taxation, so I am expecting great things from her.

The Children’s Commissioner also said how important family stability is for children and parents. Profound mental and physical health ramifications flow from family breakdown. In a major study of more than 43,000 children, clinicians said that family relationships problems are the most common reason children and young people access mental health services. Resolving them often requires a whole-family integrated approach that it would be better for the health service to deliver in family hubs rather than secondary or primary care settings, which necessarily individualise conditions. Reform to make this a mainstream, default approach, where appropriate, is urgently needed for better patient outcomes, but it requires leadership from government to divert the NHS away from its well-worn tracks. Will the Minister kindly arrange a meeting for us to discuss this further with his new boss?