Care: Budget

Debate between Baroness Greengross and Baroness Jolly

Wednesday 28th January 2015 Lords Chamber

[Baroness Jolly]

A lot of work has gone on in preparing local authorities to give assessments to carers for their needs and support, in exactly the same way as they assess the people they care for. The cost currently being factored in for that is £104.6 million—£31.3 million on assessments and £73.3 million on the provision of support.

[Baroness Greengross (CB)]

My Lords, a couple of days ago, Age UK published its scorecard, which shows that, despite rising numbers of older people and rising demand for services, the amount spent has fallen dramatically over the past few years. In fact, it has gone down by over 40%. There are some shocking figures, for example that half of the people who struggle to get into a bath or to wash do not get any help, and that one in three of those who cannot go to the toilet without help are not getting any help, and preventive services are going down. In the light of that, does the noble Baroness not think that, nationally, it is time for the Government to come in with some direction?

[Baroness Jolly]

The Government have been trying very hard to give direction. One issue that we have been trying to direct is integrated care, joining up care services. However, public finances are in a precarious position. The deficit is still projected to be over £100 billion. The report from Age UK is a very good and interesting read, but I discussed it with officials this morning and we could not follow some of the figures and ways of working from its results.

Unpaid Carers

Debate between Baroness Greengross and Baroness Jolly

Monday 8th December 2014 Lords Chamber

[Baroness Jolly]

I do not think that anybody can underestimate the value of carers. Carers UK, when it did its sum, took from the census the number of carers there were, how many hours they said they worked and multiplied the answer by £18, which is the hourly rate that it worked from, and came up, as the noble Baroness said, with £119 billion per annum. That figure is in the same sort of ballpark as pensioner benefits, which are £112.7 billion, so we certainly do not underestimate the numerical value of carers.

[Baroness Greengross (CB)]

My Lords, there are estimated to be 670,000 unpaid carers working with people with dementia. This saves approximately £11 billion per annum. Does the Minister agree that the Government need to make sure that those carers get continuing support after the person whom they have cared for, often for many years, dies? They are not only bereaved but have lost their job, lost their friends and lost the person they were caring for, and they continue to need support. Will that be available to these carers?

[Baroness Jolly]

The noble Baroness will know about the Care Act 2014, under which local authorities are asked to consider the needs of carers. Part of that was to set up peer support groups. I do not think there is anything in legislation or secondary legislation about what a carer does when the person they care for has died, but I imagine that the support from those peer groups will continue.

Health and Social Care Bill

Debate between Baroness Greengross and Baroness Jolly

Monday 19th December 2011 Lords Chamber

[Baroness Greengross]

My Lords, my Amendment 332A follows well from the previous two speakers. It would ensure that integrated working in health and social care delivery—particularly the latter, which we know from many noble Lords who have spoken, including the noble Lord, Lord Warner, is often very much the junior partner in these discussions—is given an explicit place on the face of the Bill, rather than simply being relegated to regulations and guidelines. In his report on Fairer Care Funding, Andrew Dilnot commented that when someone has a care or support need, they do not really know which part of the range of state funding is going to provide the services that they need. This particularly applies to people with multiple needs and co-morbidities, which is often the majority. We know that there are many different services delivered at national and local level—for example, the NHS, the adult social care system, social security benefits, public health services and housing services. They can all be critical in meeting people’s needs. The problem is that all these elements overlap and interact, sometimes positively but sometimes rather negatively. Dilnot noted forcefully that when services that are shaped around people work well together, outcomes are better; when they do not, people experience very disjointed services and their experiences are poor.

We need a care system that is more consistent, with less variability, and one in which people feel that services are working for them, not against them. In this context, I welcome the Department of Health’s commitment to breaking down the barriers between health and social care to improve the outcomes and experience of users. Having a National Health Service that is free at the point of need, but a shared-responsibility system of social care, means that difficult decisions will continue to be made if this carries on. For example, in response to the Nicholson challenge, how will clinical commissioning groups ensure that the focus stays on the patient and on integration of services and not on contracting and other arrangements? Do we know what type of support managers need to make integrated services a reality? How can staff be encouraged to work collaboratively? Through this process, how can the correct values and ethos concerning the dignity and respect of patients, which we all believe in, be developed and maintained within and across organisations? There are many examples of where the consequences of having different care streams can seem extremely unfair to people. But when streams have been integrated or a more co-ordinated approach is taken, there is evidence of improved outcomes, high-quality services and better value for money, as well as the fostering of innovation. In my view, the powers proposed in Clause 192 for the health and well-being boards to support integrated working should be extended to encourage explicit joint commissioning.

In support for innovation in Part 5, greater regard should be given to the role that service and technology solutions, for example, can have in breaking down traditional boundaries and in encouraging better integration of health and social care services. All generations, including older people, are having their lives transformed by the dramatic changes that we daily witness in communications technology, yet in the UK the adoption of telehealth into health and social care, particularly in prevention and intervention, has sometimes been much slower than in many countries in the industrialised world. In other parts of the world, we have clear evidence of the key role that these systems play in the prevention of ill health, in self-management, in the provision of improved outcomes and in dependence for service users and efficiency savings for the taxpayer. As part of the overall redesign of care, this represents a vital element in the shift towards more preventive care, reducing the imbalance between hospital and primary care spend and making better use of scarce clinical resources. Better integration should facilitate such innovations and would go a long way to making health and social care more self-directed and giving a boost to the personalisation agenda. Integration deserves to be more than a footnote in this Bill. It could be the cornerstone of better quality, value for money and patient-centred care.

[Baroness Jolly]

I have put my name to Amendments 328B and 330ZAA. I send the apologies of the noble Baroness, Lady Tyler, who is not well. She had hoped to be able to speak to these instead of me. First, I should like to make a few general points about health and well-being boards. It should go without saying that the Liberal Democrats really welcome local democracy in health and the far greater involvement of local authorities than is the case at the moment, as well as the use of scrutiny committees. We are somewhat saddened that in the legislation there is only one elected decision-maker on a health and well-being board. I understand the Government’s unwillingness to prescribe, but they have not quite got the balance right. There may be as many elected councillors as other voting stakeholders, with maybe a casting vote given to the chair. That feels much more like localism in action than what we currently have.

Linked with that is the role of district councils, which is not mentioned terribly clearly. Here I have another apology, because I know that the noble Lord, Lord Greaves, had hoped to speak on this point. What we are losing in his eloquence we are probably making up for in brevity, but I still feel as strongly as I am sure he will. I can almost feel him behind me now, as I speak, but he is not well and is not able to be with us.

Where are district councils in this framework? I know that a lot of local authorities have now become unitary, but there are really key parts of England where strong county councils are well underpinned by district councils. They need to be there, because they provide planning, housing, leisure and environmental health—all these things that have to be well woven into the fabric of this Bill and the delivery of services. They are also part of the solution for the big public health issues. Three examples come to mind without even having to think very hard. Wearing their leisure hat, obesity is a very big issue. Some people prescribe exercise for obesity. On housing, in my neck of the woods, with the warm, wet westerlies, housing gets damp very easily. That brings with it chronic heart and lung problems, particularly if you cannot afford to heat. District councils also play a key role in housing on mental health issues. They are often providers for county councils and PCTs and I know that they would hope for a similar relationship with clinical commissioning groups, when things become established. They should be at the table of the health and well-being boards. I appreciate that you cannot have every district council having one representative. In Kent, where there are 16, or in Devon, where there are eight, you cannot bring those in, but there needs to be some arrangement for working together to ensure that district councils should be there.