Integration of Primary and Community Care (Committee Report)

Lord Allan of Hallam Excerpts

Thursday 9th May 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, and all the members of the committee for a very useful report on the challenges of integrating primary and community care, and for some potential solutions. I am grateful particularly for an opportunity to talk about data and technology in the health and care system, which is one of my favourite topics. I also congratulate the noble Lord, Lord Jamieson, on a thoughtful maiden speech. I was delighted to hear that he studied and began his career in my home city of Sheffield. Once people have followed the advice of the noble Lord, Lord Altrincham, to get their health sorted out in Greater Manchester, he might agree that they might then want to cross the Pennines to get a decent higher education in Sheffield.

The recommendations in the report on structure were really interesting and substantive. I shall talk about them first, then go on to the data. The report talks about integrated care boards, integrated care services and integrated care partnerships. If I may coin a Latin-based neologism, we could refer to them all as ICXs—integrated care entities. Some valid questions are already being asked about their effectiveness. Having to talk about them in this convoluted way in a sense already indicates that there are some real questions of accountability: who is doing what? To an extent, the thing that is supposed to pull everything together is itself causing some confusion. I read the Government’s response and, on the recommendation on maturity, they said that they were going to start a three-year research programme. This is great and serious, but three years from now will be a long time from when the ICXs were set up.

The Government also talked about the CQC process and about NHS England surveying people to ask about the effects on them in 2025-26. Does the Minister feel there is a sufficient sense of urgency? Trust and morale once lost are very hard to rebuild, and there enough indicators out there. The Government have placed a lot of store on the ICXs delivering all this. If they cannot deliver more quickly, and if we have to wait another three or four years before we really start to understand it, there are some genuine questions to be asked. None of us wants another reorganisation, but we need this thing to work, as the committee’s report has highlighted.

I turn to my favourite subject. Building to some extent on the comments from my noble friend Lady Barker, we need to understand that an interaction with the health and care system is, in technical terms, an event. The real priority is to get a proper record of that event. Three things need to be noted. Who was the person who had the treatment? Which organisation treated them? Ideally, that would go down to the individual, but certainly we want to know the organisation. Furthermore, where did it happen? With these three accurate identifiers, it is possible to start to pull the data together, whichever system it is stored in.

Each person has an NHS number. I shall be interested to hear from the Minister as to how he feels about the rollout of the NHS number. This report talks particularly about NHS organisations. To what extent is this being used within the NHS and other organisations? It is still certainly my experience—and that of others—that hospitals want a hospital number. Why do they want this? Why are they not dealing with the NHS number? It is critical that there is a real push to make sure that the NHS number in which we have invested and which is given to people is being used.

The Government have invested in something called the unique premises reference number—the UPRN. Every single premises in the United Kingdom has its own number. Government policy is to use that everywhere but, again, we are not seeing this happen. I am ready to hear from the Minister about the extent to which this is being pushed out across health and care so that, when talking about where someone is treated, it always means the same place.

Lastly, is there a unique set of basic organisational codes? There are tens of thousands of records so, in that way, it would be possible to identify the organisation that treated someone. Absent all of this, there is something called fuzzy matching. For example, John Smith, who lives in the High Street, was treated at some vaguely named health centre. Humans like that, but computers hate it—computers need precision. Those are the basics. We can then move on to the content of what happened in the interaction. Again, that is complicated. I think we would go a long way and solve a lot of the problems highlighted in the report by just knowing who the person was, uniquely, where they were treated and which organisation dealt with them. That could be done much more quickly.

The report’s recommendation on the data protection guidance was really important. My noble friend Lady Tyler talked about the Government’s response as being vague and technocratic. We end up talking about data protection in these very technical terms, and end up saying that data protection law says no as a default response. If we think about it in much more human and intelligible terms, would anyone be surprised that the data was used in a particular way? This is a basic human test that we can all understand.

If I go to an A&E department, and my medical data goes to the ward then to my GP, I am not going to be surprised—in fact, I will be surprised if it does not make that journey. If you pass it on to a dentist or an optician, I may be okay with that, but I would probably want to have a conversation about it, and say it is fine for some of my medical data to go to dentists and opticians some of the time. If you pass it to a pharma company for something totally unrelated to my own personal care, I might be very surprised and very angry. It is about applying those kinds of human tests.

There is a legal basis behind this that is missing. Will the Minister look at making sure that the people who work in the system are given training to understand the principles behind data protection? I suspect a lot of it is very detailed, telling them what the law says and how to tick the boxes; that is what gets us into this frozen position where data does not flow when it should, and people are surprised it is not flowing. Sometimes data may end up flowing where it should not, because people have not understood that it is happening. In their response, the Government talked about the secure data environment and things like OpenSAFELY. Those are very good solutions for dealing with areas where people would not want data to be flowing freely. We have created a place to deal with that, but let us get the data moving to where we want it to go.

Finally, I wanted to touch on workforce. The NHS workforce plan, which we have all welcomed, rightly focuses on doctors, nurses and other associated medical professions. However, when we are talking about this kind of work, in a lot of cases we need people to be skilled up. We need a very skilled workforce in other disciplines—for example, in change management, which is itself a discipline. Encouraging people to work differently is not something that happens overnight, and it is not necessarily a medical skill. The ICXs would benefit from having a skilled workforce who understand how to do change management.

Contracting is rightly a major feature of the report. It is about writing better contracts and being more insistent with those you are contracting with. It is not just about pounds and pennies and value for money. It is about saying, “We are not going to buy your system if it hasn’t got the right data standard, and I am going to insist on that because I know I can. I am not just going to sign whatever you stick in front me”. That kind of contracting ability is really important. Data analysts, who can look at all the data generated by these systems and figure out what is going on, are highly skilled professionals. I do not think we have got to the point in the workforce plan where we understand that need and how we are going to meet it.

We have an excellent report, and I thank the committee for what they produced. It has zeroed in on some of the real priority areas. The Government’s response is well intentioned but thin, and I hope that the Minister can put a bit more flesh on the bones of what they are going to do in practice.