Integration of Primary and Community Care (Committee Report)

Baroness Redfern Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Redfern (Con)]

My Lords, it is a pleasure to follow my noble friend Lord Jamieson’s excellent maiden speech. I have enjoyed our mentoring discussions since he entered the House. Having served a successful term as chairman of the LGA, he noted in his leaving remarks:

“When we can speak with one voice, and with coherent arguments, we have real strength”.


That is crucial to the LGA’s ongoing success, now and into the future.

My noble friend also held the position of leader of Central Bedfordshire Council. His further interests are, in particular, sustainability, improving the health service, and the levelling-up agenda. I know he is committed to all councils playing their part in improving the health of their residents, meeting their housing needs and providing green spaces, which we all agree are vital to improving well-being and tackling social isolation. Yes, my noble friend certainly has much to contribute to the House and we look forward to his future interventions in the coming months. Finally, I am told that his immediate plan on leaving the LGA was to see Bruce Springsteen, but I do not know whether he managed to do it. He says that he did, so there we go.

It is indeed a privilege to speak in this important debate. I thank the Government for their response on this area of primary and community care. I thank our chair, the noble Baroness, Lady Pitkeathley, for her excellent chairing throughout our meetings, when we had the opportunity to hear from the many witnesses who gave up their valuable time to attend. I also thank our much-valued secretariat.

The value of collocation and multidisciplinary working in primary and community care is unquestionable, but having said that, care will continue to vary, whether in urban, rural or, indeed, coastal communities. It is valuable to pool additional funding into the BCF where that need is greater. I agree with the importance of all local authorities keeping boundaries under review, with support from all affected partner local authorities.

The overwhelming issue is the major barriers arising from the variability of our IT systems. Much work is needed in all areas to bring those systems together so that they are compatible, and to make real and lasting improvements by promoting interoperability between IT systems. That would not only make it easier for people to track information but allow for quicker decision-making, acknowledge patient privacy and, above all, cut bureaucracy. In essence, data sharing must improve so that we can say that data is just one click away, sweeping away the many fragmented systems that ask patients over and over again to supply the same medical information and engulf them in bureaucracy.

I am pleased to note that the Government have emphasised how important it is to provide additional clarity where necessary to support further integrated working practices. They have also acknowledged that the digital transformation of health and social care is a top priority for the DHSC by enforcing these standards through compliance notices, together with financial penalties, in parallel with an accreditation scheme. The framework accreditation programme will simplify procurement and speed up the adoption of innovation through frameworks, so I welcome NHS England changing the NHS standard contract by requiring trusts and foundation trusts to use only accredited frameworks from April 2024.

I turn to the estate. In essence, in many instances the answer to overcrowded hospitals is not building more hospitals but linking with intertwined primary care and social care services, as infrastructure is simply too important and costly to get wrong. If this does not happen, more expensive hospitals will need to be built to manage acute needs that could have been prevented or better managed.

For most people, being treated at or as close as possible to home is best for their health and is how they want to be cared for, rather than leaving their health needs until they require hospital treatment. That is best, and cost-effective for the NHS, but there is a cycle of invisibility of primary and community health and care services, which are hard to quantify and easy to overlook because less data is available.

Equipping our valued staff with improved training, creating opportunities through built-in shift flexibility for health workers, and giving greater responsibility for good career progression will no doubt improve morale and retention. For those reasons, that will attract and interest new employees, making the NHS a serious, attractive proposition now and for their future progression. As ICSs become more involved in education, training and planning, a plus point must be extending the provision of placements across primary, community and social care, in particular the independent and voluntary sectors, so that students can gain valuable experience of care outside hospitals, thereby introducing them to wider career opportunities.

Delivering primary care with the premises and tools needed to keep patients healthier for longer has to be a win-win: reversing the predicted rise in demand for high-cost, reactive, hospital-based care; supporting people in taking care of their health and well-being; and intervening early, keeping people healthy at home for as long as possible, and enabling them to retain their confidence, particularly when they live on their own.

This is against the background of an expected increase of 25% in the number people in the UK aged over 65 by 2050. That is certainly a massive challenge for any Government. I welcome the expansion of community pharmacies, which are showing good signs of integration and co-operation and take significant time away from GPs. The Government are consulting on extending prescribing rights to dental therapists and hygienists; this is hopefully to be concluded soon, ensuring a faster service. Therefore, patients must be given more powers, via the NHS app, to control their own health and NHS services, and to facilitate self-care in collaboration with professionals. Unfortunately, we have low levels of digital literacy among some staff, patients and service users; that is a barrier that must be worked upon and overcome.

Yes, much has to be done. Much more needs to be done if we are to see patients at the very heart of their health journey.