The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, to do justice to a subject as vast and crucially important as this one is impossible to achieve during the course of an hour’s debate. However, I thank the noble Lord, Lord Turnberg, for introducing this question so succinctly and capably. I will address as many issues as I can in the time available but I undertake to write to those noble Lords whose questions I do not manage to cover.
We know from listening to care users, their carers and voluntary organisations how care and support needs to change, and how the system has yet to adapt properly to meet the new demands and expectations of modern Britain. I was very struck, as I always am, by the clarion call sounded by the noble Baroness, Lady Pitkeathley, on that theme. As the noble Lord, Lord Turnberg, highlighted, the system will face further demands with an aging population at a time when we face financial constraints.
Last year’s care and support White Paper is an important step in changing that. It will sustain and promote what works and challenge and change what does not. It will promote well-being and independence instead of waiting for people to reach a crisis point. The White Paper, together with the draft Care and Support Bill, will shape the care sector for years to come. The noble Baroness, Lady Greengross, was right to say that this is an opportunity. This is the most comprehensive reform of social care legislation in over 60 years.
We must all welcome the fact that we are living longer but, as the noble Lord, Lord Warner, reminded us, managing the fiscal consequences of this will be a key challenge of the coming years. However, we must recognise that for the foreseeable future government funding will be constrained and we must plan on that basis. We want to get the engine working as efficiently and effectively as possible so that the fuel that we put in gets us to where we need to be.
Effective reform of public services is central to our response if we are to meet the needs of an aging population and ensure long-term sustainability. We have put in place an ambitious programme of reform across a wide range of government policy areas including pensions, health, social care, housing and employment. The Government are providing an extra £7.7 billion over the spending review period to protect access and support vulnerable people.
We know that care and support needs to adapt to respond to changes in demand and expectation. These challenges create an opportunity for local authorities to innovate and explore new ways of working, better meet the needs of their local populations and optimise the use of available resources. Many local authorities are already innovating and we are committed to supporting them to deliver further service improvements and to helping other authorities learn from what works. We want local authorities to maximise the use of reablement services that help older people recover from acute episodes and reinvest money from high-cost residential and nursing home care into other services. We also want local authorities to embrace the potential of new technology because we know that at least 3 million people with long-term conditions and social care needs could benefit from the use of telehealth and telecare services.
One of the biggest changes that the White Paper sets out is moving from the reactive service that we have at the moment to a proactive service that helps people stay healthy and independent in the first place—change that better meets and manages future demand and, as the noble Baroness, Lady Greengross, and my noble friend Lady Jolly emphasised, prevents people needing to go into acute hospitals and supports them to regain independence after they leave. As people live longer, the advantages of that approach, focused on preventing or postponing care needs, are both immense and glaringly obvious. That approach is part of our mission to improve the health of the nation as a whole. That is why we have built an approach that will enable local authorities and GPs to innovate and devise local solutions to tackle not just the symptoms but the wider determinants of health. On my noble friend Lady Jolly’s three questions, the answer in all cases is yes.
To support this, we will include in the Bill a duty on local authorities to take steps to prevent delay and reduce needs for care and support in their area. The noble Lord, Lord Turnberg, mentioned the pooling of budgets between the health service and social care. All too often the discussion on integrated care is focused around the integration of structures, funding streams or processes rather than the perspective of patients and service users. This has led to excessive focus on the means to achieve integrated care rather than the end of a better experience for patients and service users. We want to encourage and support local experimentation to allow local areas to provide integrated care at scale and pace. We are working with the sector to support local initiatives and identify what needs to happen to drive this at a national level. We want to learn what works well, how to overcome barriers and promote best practice. For example, Torbay commissioned and provided care for local areas as a single organisation and has shown comparatively lower levels of emergency admissions, shorter hospital stays and minimal delayed transfers of care.
The noble Lord, Lord Turnberg, talked about the role of GPs in caring for elderly people. The quality outcomes framework, which is part of the contract with GPs, provides incentives that reward practices for how well they care for patients, including for long-term conditions that often affect elderly patients. The Government have proposed changes to the GP contract, and a stakeholder consultation has recently finished. Under these proposals, and in addition to the QOF indicators, we would invite GPs to participate in a new directed enhanced service that would further encourage GP practices to co-ordinate and manage the care of frail older people and other high-risk patients predicted to be at risk of unscheduled hospital admission.
The noble Lord, Lord Turnberg, also spoke about out-of-hours care. Earlier this year, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England including out-of-hours care.
The noble Baroness, Lady Emerton, focused on the social care workforce, its skills and the need to promote leadership. The care and support White Paper recommends increasing capacity, enhancing capability and developing leadership in the social care workforce. The department is working with partners to attract more people to, and increase apprenticeships in, social care, as well as raising standards and improving leadership. Working with the National Skills Academy for Social Care to publish the leadership qualities framework for adult social care is another important aspect of our programme. That framework sets out the attitudes and behaviours needed for high-quality leadership at all levels which, as the noble Baroness rightly said, is rather different from passing an exam. There is no single, definitive model of integrated care and support, as I am sure the noble Baroness will accept. Some localities are further advanced than others. We are developing the concept of pioneers to support rapid dissemination and uptake of lessons learnt, and are keen to maintain momentum and accelerate the adoption of new models of co-ordinated care and support across the country. Our ambition is for person-centred co-ordinated care and support to become the norm over the coming years.
Returning to the draft Care and Support Bill, it will introduce important powers and duties that will further integrated working, including a duty of co-operation, integration and ensuring that people have clearer entitlements. We are also committed to developing a measurement of people’s experience of integrated care to be included in future outcomes frameworks. This has been included as a placeholder in the NHS and Social Care Outcomes Framework 2013-14.
As I have said, we want to encourage local experimentation to allow local areas to provide integrated care tailored to people’s needs and preferences. We are working hard with partner organisations, including the NHS Commissioning Board, Monitor, the Local Government Association and the Association of Directors of Adult Social Services, to support those local initiatives and to identify what still needs to happen to drive this at a national level. This work will in turn be informed by the outcomes of the four community budget sites.
The noble Baroness, Lady Greengross, asked me some specific questions about self-funders. I undertake to look into the issues that she has raised. I certainly will study the Scandinavian model and I undertake to write to her about that.
I finish by reaffirming the Government’s aspiration to make this country one of the best places to grow old in, where older people get excellent treatment, care and support when they need it. Our biggest priority must be to transform what we offer to meet the challenge of an ageing population. If we fail to address this, our health and care system will not be sustainable for older people, or indeed for any of us. We must develop and promote a culture of compassion across the health and social care landscape, where quality of care is considered as important as quality of treatment and where every person can be confident that they will be treated with compassion, dignity and respect by skilled staff who are on top of their game and have time to care.