Integration of Primary and Community Care (Committee Report)

Lord Altrincham Excerpts

Thursday 9th May 2024 Lords Chamber

[Lord Altrincham (Con)]

This was an exceptionally interesting inquiry, which was most skilfully pulled together by our chair, the noble Baroness, Lady Pitkeathley, because the waterfront of the inquiry was very broad. As we were following the Health and Care Act 2022, the Hewitt review and the Fuller report, we started our work quite soon after some initiatives in the health service for integration had just started. In a sense, you do not have to do an inquiry to know that there is a whole lot wrong with the health service.

One might think that everything would be somewhat familiar, but one of the fascinating things about the inquiry was how much was rather new and interesting. The first thing that I comment on was that there was a common understanding in submissions of the problems. We heard from completely different kinds of professionals from across the country who shared again and again the same issues, which the noble Baroness, Lady Pitkeathley, has mentioned. In terms of the understanding of what is wrong, we heard Professor Yeandle talk about the fact that integration had not progressed for 25 years; we heard from others that life expectancy had stalled, that people are living too long with sickness, that health services are incredibly underresourced, and that prevention is being ignored. These issues are everywhere, and they are common. At the same time, we had a strong sense from the submissions of a common understanding of the need for change. That was interesting, because again one might think that surely the health service does not wish to change or somehow that these are institutional situations that cannot be changed. But we heard again and again from professionals who knew that they needed to work differently. That was interesting, because if we combine a willingness to change by people with structures in government and organisations that might make that possible, there might be some cause for optimism in this extremely difficult area of public policy.

Again, the noble Baroness, Lady Pitkeathley, mentioned the common understanding of the importance of integration. Everybody knew that integration needed to be done better. Everybody knew that parts of the health service they were working in were performing poorly. We heard from parts of the health service that are performing extremely well. I did not know before being on this inquiry that, if you get sick, you need to be in Greater Manchester. By far the best outcomes in health are in Greater Manchester; it is a great thing to tip off your neighbours. People talk about health tourism in London, but they are missing the best opportunity. The lessons from integration in Manchester and the co-ordination of the local authorities are not easy to transpose on to other parts of the country. We talk about that in our report, because some of these integrated care systems are not aligned well with local authorities; an extremely consistent part of the feedback we had in the inquiry is that you need to align with the geography and the shape of local authority services. We learned that from Manchester and from elsewhere, and it is what we put into our recommendations. The Government said that they are on to it, but they are not doing anything about it. Those will be the frictional areas where the quite large districts that form these integrated care services or boards will break down. We heard again and again that when it gets to county borders or geographic borders—not just whether you are near a teaching hospital but where you get to organisational frontiers, as it were—service breaks down.

That goes on to the issue of the structures that we were talking about. The integrated care system had only just started when we did our inquiry. In a sense, it is almost too soon for us to comment on it. There has been talk about how it should be reviewed after three years, and that will be very important. But we hope that it does in a sense address some of the issue we were trying to review, which was to try and integrate the service much better. It is only just starting out, however, and the districts concerned are very large. Maybe it is too soon to comment on that. We heard very good progress more with the primary care networks and these health centres and health hubs. That was very encouraging, because if the health service was able to provide multidisciplinary teams in a context where you could divide up medical with semi-medical and with not really medical at all-type services, we heard that it would go very well. Professor Everington speaks very well about the differences between biomedicine and social prescribing and providing a broader service. This is a very encouraging area of health, and it would be interesting if that were to be the model.

We also heard from Professor Fuller, but she makes the comment that in her own experience of trying to do the multidisciplinary thing when she is Dr Fuller, when the practice is full she has to work in a cupboard because they do not have the space. That is why the noble Baroness, Lady Pitkeathley, mentioned the importance of providing space where some of these services could take place. That is what Professor Fuller herself has run into.

In conclusion, there is cause for optimism from the report. There are willing people and there are some structures in the health service that are quite new and which might provide some improvement in this area. It has been a pleasure to work on the report.