NHS: Better Care Fund

Lord Kennedy of Southwark Excerpts

Thursday 3rd July 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what effect the better care fund is having on the ability of the National Health Service to provide services to patients.

[Lord Kennedy of Southwark (Lab)]

My Lords, I am delighted to have secured this debate today. We are all getting older and living longer, and that is very welcome, as medical and scientific advances make illness and diseases that would have killed us off no longer the threat to us that they were. There is still much to do, although that progress is very welcome.

However, as a consequence, we have an ageing population, which brings its own challenges: how we care for people as they live to a much older age and more people living with long-term conditions. It has long been recognised and has been an aim of Governments to deliver better integration of health and social care and improve people’s health and well-being by ensuring continuity of care while making the best use of resources.

I am sure that, in his response, the noble Earl will tell the House in some detail about the pooling of funds and the plans for local areas, including: the sharing of data and improving continuity of care; the plans for acting earlier so that people can stay healthy and independent at home; and delivering care that is centred on individual needs, with NHS and social care staff working together to deliver better outcomes for individuals.

The King’s Fund has done interesting research in this area and made some predictions about what will be the needs, how we will be living, and the pressures that that will place on the NHS. Those are important considerations in the planning that needs to be undertaken to meet the challenges ahead.

In the next 20 years, the number of people aged over 85 is expected to double. By 2030, the number of older people with care needs is expected to rise by 61%. At the same time, we expect 40% of households to be comprised of people living on their own. The number of people with dementia is expected to more than double in the next 30 years.

It is also a fact that people from the most affluent socioeconomic classes can expect to live as much as seven years longer than those from the poorest socioeconomic classes. Those and similar statistics point to increased pressure and demand on health and social care services, and government at all levels has to respond effectively to that challenge.

The better care fund is a good initiative but, as with many other things that the Government are doing in the area of health, I always have a niggling doubt whether they will put the resources in place to deliver the outcomes that we all want. I do not doubt the noble Earl’s personal commitment but as with many things in the health and social care sector, money more wisely spent at an earlier stage can deliver much better results for the patients and cost much less to the NHS.

I am a diabetic and I declare an interest as an active member of the charity Diabetes UK. I take the example of diabetic foot care and the fact that so many people have unnecessary amputations. Those could so easily be avoided; we are just not dealing with this issue. The cost to the individuals is high and traumatic. Then there is the cost to the NHS for the operations and the aftercare, and of course the projected lifespan after that, too. We need to ensure that people are able to enjoy an active and healthy life within their own communities, thereby reducing the demand for health and social care services. Well over two-thirds of patient bed days are for people with long-term conditions and a greater emphasis on self-management programmes can help to reduce unplanned hospital admissions. Ambulatory care-sensitive conditions accounted for 15.9% of all hospital admissions in England in 2009-10, with an estimated cost to the public purse of £1.42 billion. The rate of admission for those conditions in the most deprived areas was twice that in the least deprived.

Older people who are frail are a key concern for health and social care services and are at risk of sudden decline, including falling or becoming immobile. Identifying those at risk of falls and the setting-up of fracture prevention services for older people has been found to reduce hospital admissions and the need for social care, such as admission to a care home. Care co-ordination and proper case management, if well designed, has the potential to deliver better and more cost-effective care for the individual. However, as I have said, all these things have to be properly resourced to deliver the intended outcomes and savings in the future.

Just look at the whole area of emergency admissions, which can account for 70% of hospital bed days and 80% of stays of two weeks or more. A whole range of factors are at play here for hospital admissions including age, social deprivation, ethnicity and living in an urban area. A lack of alternative options then sees people being admitted to a hospital bed. That might not be the best thing for them but there is no alternative. Then on discharge, the important thing is to have a proper discharge plan in place so that people can remain at home in the long term and regain their independence.

At this point I declare that I am a member of Lewisham Borough Council, which will be involved in delivering services through the fund. The Local Government Association expressed concerns as recently as last month, warning that a larger better care fund is needed for a five-year period, with alongside that a separate transformation fund to ease the impact of these changes. It rightly expressed concern about the lack of clarity on the future of health and social care funding, which could put at risk the efforts to integrate services. The LGA is urging the Government to commit to a five-year plan, taking us to 2020. Can the noble Earl confirm whether this will in fact be delivered? If he cannot, can he tell the House why not? As I said, my worry is that the plan will falter because its provision of resources will be too short-sighted.

I have a number of questions for the noble Earl. If he can answer from the Dispatch Box that would be much appreciated. I do not expect him to do so; all I ask is that he gives a commitment to write to me afterwards and copy that to other noble Lords who speak in the debate today. I will take each question in turn. Will diabetes and diabetes foot care be prioritised as part of the better care fund? Will dementia be prioritised as part of it? Are there any plans to change the procurement rules when implementing the better care fund? What does seven-day working for social care mean? Is it correct that the health and well-being board chairs will have to sign off their local plans? What happens if the parties involved in devising a local plan cannot reach agreement? Is the better care fund’s additional allocation of funding in 2015-16 recurring or non-recurring?

In conclusion, I am delighted to have secured this debate. I look forward to the contributions of all noble Lords, including my noble friend Lord Hunt of Kings Heath and of course the noble Earl.