Funding of Care and Support

Baroness Wall of New Barnet Excerpts

Thursday 24th November 2011 Lords Chamber

[Baroness Wall of New Barnet]

My Lords, I, too, congratulate my noble friend Lady Pitkeathley on achieving this opportunity for us to debate a subject that is growing more and more important. There is no doubt that Dilnot is a good thing but I suggest that it is not the complete solution to all the problems faced in the delivery of social care. The problem is a major issue for us all and, I suggest, the responsibility of us all, certainly those of us involved in commissioning and delivering services to people who need this care and are entitled to it.

Although I have suggested that the issues are major, I also think that they can be described simply. There are ever increasing demands on social care budgets as the population ages. A little like the noble Lord, Lord Low, I feel that I am repeating everything that everybody has said, but it is more and more difficult for each speaker not to do so in putting over the context and importance of this debate. Councils face a much tougher funding settlement than the NHS, councils’ eligibility criteria and funding levels vary and the public are confused about charges.

All of the above can lead to an imbalance and dysfunction between the health and social care systems, which need—or ought—to operate seamlessly if patients are to receive joined-up care and travel efficiently and safely from the health to the social care system. Dilnot tackles this in various ways, including by proposing standard eligibility criteria and the transferability of assessments between different local authorities. A number of noble Lords have referred to this, and the evidence is very clear that that can cause a great deal of distress for people.

Dilnot also talks about capping an individual's liability for charges. Again, other noble Lords, including my noble friend Lord Lipsey, have spoken in much more detail on the cost of that. My understanding is that this would require between £1.3 billion and £2.2 billion of central government funding, so that those individuals do not lose their home if, for example, they need continuing care. The report suggests that,

“the Government should review the scope for improving the integration of adult social care”,

and do so with other services involved,

“in the wider care and support system”.

Can the noble Earl please share with us his views on this and how he thinks that the Government, working together with all parties, can achieve this? The report continues:

“In particular, we believe it is important that there is improved integration of health and social care in order to deliver better outcomes for individuals and value for money from the state”.

I shall raise some points in this context. First, this is important because it will stop councils putting in place higher eligibility criteria than their neighbours and ensure a consistent standard of approach across the country. Transfer of assessments is an efficiency gain and will reduce the number of repeat assessments, as patients move to different authorities. My understanding from talking to people is that it would also remove much of the anxiety that people have in repeatedly having to go through those.

Secondly—this is also important, I suggest—it benefits individuals and families rather than the social care system. Although Dilnot says more funding is required for social care, simply replacing co-payments by individuals with government funding does not by itself, in my view, bring additional resources.

My third point, which is important for trusts such as mine in Barnet and Chase Farm, is that we need to work as an integrated health and social care system. That is something I have believed for the past five years as chair of that trust. I have urged it to happen and we still do not get there. If we do not do this, we will end up with people lying in expensive hospital beds who do not want or need to be there and who, through no fault of their own, prevent others being able to receive the treatment that they require, perhaps in that bed.

Integrated health and social care delivery does not necessarily mean single organisations providing health and social care. It can be achieved through joint commissioning, joint planning and, dare I suggest, pooled budgets. I would guess that suggestion is too radical for some people, but I believe it is true. That has been the aim of many Governments, and people have made many suggestions. The previous Government had this aim and worked hard to achieve much of it—other noble Lords have referred to many of our achievements in this area—but, because the health system, and I particularly include PCTs in that, have never worked closely enough with local authorities, we allowed the gap to remain into which many vulnerable and needy people fall. They are still falling into it now, and that is worsening.

I suggest that there are some gaps in Andrew Dilnot’s recommendations, particularly regarding where the extra funding is going to come from—which is a big question—and whether even what he recommends goes far enough. The story is not complete, and some of the issues still remain. However, as others have said, this is the most sensible set of proposals that we have seen for some time. They must be supported and worked on by all involved to ensure as seamless an approach to health and social care delivery as we possibly can for very often the most vulnerable of people whom we are dealing with. We must do this with urgency.