NHS and Social Care Services: Parity of Esteem

Lord Laming Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

I join the noble Baroness in paying tribute to staff, not just across the NHS of course but across all the caring professions. We published the draft strategy and will publish a joint strategy for the health and care workforce precisely for the reasons that she set out. We need to make sure that there is joined-up care across all sectors. That means that we need extra funding—a sustainable funding solution—for the social care sector. We have put in an extra £9 billion over the course of this spending review since 2015 to provide a short-term solution. The Green Paper is about providing a long-term solution. Some of the principles in the Green Paper emphasise the importance of this integration, delivering quality and integration, a valued workforce and sustainable funding. Those are the conditions necessary for what she wants to achieve.

[Lord Laming (CB)]

The Minister will know that in the social care field there are now numerous independent providers. What mechanism is there to ensure parity across the whole sector, including all aspects of social care?

[Lord O'Shaughnessy]

The noble Lord is right to point out that there are differences between the two workforces: clearly the NHS has a largely publicly employed workforce and social care has a largely privately employed one, so there will inevitably be some differences in form. We need to make sure that those workforces work together and are as attractive as one another, which is why finding a sustainable funding solution is so important so that those private contractors have the ability to pay what is necessary to attract the right staff.

Domiciliary Home Care Support

Lord Laming Excerpts

Wednesday 25th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for the opportunity to provide that reassurance for people using and benefiting from the care provided by Allied Healthcare. I want to reassure them that the Care Act 2014, passed by the coalition Government, gives local authorities responsibility for continuity of care if a business were to fail. Of course, we are not in that position with Allied Healthcare, because it still has to go through the CVA process. I can reassure people that the LGA has said that councils have “robust”—its word—plans in place to ensure continuity of care if that is required. I put that on record for those who may be worried about it.

We know that extra funding is needed in the sector. Over three years, through a number of means including extra money through the precept and direct funding to local authorities, the Government have increased by about £9 billion the funding available for social care, which we know is required. I also point out that, if you look at domiciliary care provider numbers, you will see that there are 50% more than there were eight years ago. We know that markets have entrants and that providers are exiting, but we have more providers in the market and more packages being delivered than ever before. Ultimately, the backstop is that local authorities have that responsibility to provide continuity of care.

[Lord Laming (CB)]

My Lords, does the Minister understand the importance of this Question? Imagine being a very vulnerable person living in a residential home with no alternative to go to or being dependent on a home help for the basics of daily living. Now imagine living under the shadow that the company that provides that service is going to go out of business at any time. Nothing could be more anxiety-provoking for these residents. The Care Quality Commission telling the local authority that there is a problem here is of no comfort. I hope that he will take this Question rather more seriously.

[Lord O'Shaughnessy]

I have huge respect for the noble Lord and his expertise in this area. I take this issue very seriously, which is why I used the opportunity in answering the noble Baroness to provide the reassurance that is in law. Local authorities need to step in to provide continuity of care with notice from the CQC, which now has a new responsibility to monitor the financial sustainability of providers and to make sure that that care is provided, whether it is delivered in-house or through contracts with other providers. That reassurance did not exist before it was introduced in the 2014 Act. It ought to provide a degree of reassurance among vulnerable people, who I accept will be anxious. That responsibility is in law.

NHS: Winter 2017-18

Lord Laming Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree that those winter pressures are increasing. One reason that they are doing so, and throughout the year, is that we have a growing and ageing population, as we discuss a lot in this House. It is worth pointing out that the planning guidance for the NHS for 2018-19 talks about not only providing more surgeries but starting to stop the growth in waiting lists and reduce waiting times, as well as halving them for the longest waits. We are focused on this, supported by the extra money that was announced for the NHS in the Budget at the end of last year.

[Lord Laming (CB)]

My Lords, does the Minister agree that the structure of the GP service, settled decades ago at the beginning of the National Health Service, is no longer fit for the current demands on primary care services? Could that be looked at in a serious way?

[Lord O'Shaughnessy]

I think the structure of our GP service and primary care is envied around the world. It has many strengths, such as the partnership model being based in the community, but it is changing. For example, more GPs are employed in hospitals. There is a major programme of investment going into primary care, including new models of care around how GPs are structured, but the presence of primary care doctors in the community is one of the great strengths of the NHS.

Care Homes: Hospital Discharges

Lord Laming Excerpts

Monday 16th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I am glad the noble Lord mentioned the number within a year. He will be interested to know, as other noble Lords will, that the number of delayed transfers of care went down year on year between August 2016 and August 2017. That is good news. That reduction has been caused by greater funding in that period and a greater focus on accountability, particularly for local authorities and trusts together. In terms of acute capacity, the number of beds has been relatively stable recently and NHS England has introduced a new test for any reconfigurations that adds a fifth category, looking at the number of beds available in any given area.

[Lord Laming (CB)]

Does the Minister agree that the position is likely to get more difficult as more care homes are saying that they cannot function on the level of fees being offered by local authorities? They are therefore withdrawing beds that are supported by public funds from this facility. Will the Minister look into that?

[Lord O'Shaughnessy]

I know of the issue that the noble Lord raises about withdrawing beds. As we discussed last week, there has been a small reduction in the number of nursing and residential care home beds. However, there has also been an increase in the number of domiciliary care packages. The noble Lord may also be interested to know that we are creating 6,000 new supported homes through the Care and Support Specialised Housing Fund. It is a changing market. I understand the funding pressures on local authorities, which is why we are putting in more funding.

Older Persons: Care and Human Rights

Lord Laming Excerpts

Tuesday 11th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I will read the report that the noble Baroness mentioned. She is quite right that integration of health and care budgets is the way forward, particularly as the burden of disease changes away from infectious diseases towards lifestyle and complex diseases of old age. The better care fund is beginning to start the kind of integration she is talking about, but of course we need STPs and accountable care systems, as set out in the five-year forward view. We feel there is, at the moment, the legislative freedom we need to move ahead with that.

[Lord Laming (CB)]

My Lords, the Minister will recall that last week there was a question about the number of residential homes for older people that were failing to provide adequate care. The temptation in some circles is simply to say that these homes should be closed down. The human rights of these very vulnerable people are bad enough when they are getting inadequate care; it is even worse when they are threatened with homelessness at this advanced stage in their lives. Will the Minister and his department give some thought to how failing homes could be tackled more effectively without creating homelessness for very vulnerable residents?

[Lord O'Shaughnessy]

The noble Lord makes an excellent point—and with great authority, as ever. The CQC report published last week indicated an improving picture, but clearly too much care is not up to scratch. One of its more heartening findings was that 80% of settings that had been deemed inadequate had improved by the time of the next inspection. It is clearly not right just to go in and start closing these homes: they need support to improve. As we are talking about care, it is worth bearing in mind also that the CQC report indicated that 98% of settings were deemed good or outstanding on caring. That goes to the heart of the fact that the people working in the care sector really do care and have been found to do so.

Mental Health: Children’s Services

Lord Laming Excerpts

Thursday 19th January 2017 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Lord for raising this important issue. I have looked at the YoungMinds research, and who could not agree that the money needs to get through to the front line? Its suggestion of maximising transparency is something with which we wholeheartedly agree. We do not think that ring-fencing is the right approach. It is right that we have a health service in which clinical commissioners, who know their local needs best, take decisions. As he knows, we are trying to redress an historic imbalance in both spending and parity of esteem for services. The approach that NHS England is taking about transparency is improving and working. I think that the YoungMinds research shows an improving picture year on year, although there is a lot to do. Indeed, that is confirmed by data from CCGs themselves on mental health spending, which shows an 8.4% increase year-on-year on money getting through to the front line.

[Lord Laming (CB)]

My Lords, do the Government accept that this is a subject of immense importance? Unless we identify young children with learning difficulties and other problems to do with eating disorders and self-harm, especially in the early years in education, and act quickly and robustly to meet their needs, it will be the beginning of a downward spiral. Society will pay a high cost in terms of both what happens to the individual in the impairment of their development and the costs for society in meeting their needs in their later life.

[Lord O’Shaughnessy]

I could not agree more with the noble Lord. It is significant that the Prime Minister made the announcement on mental health and committed herself to a big improvement in both the amount of funding and the services offered. Part of that is making sure that schools and health work together, with every secondary school in the country being offered mental health and first-aid training, but clearly there is much more to do.

Young People: Self-Harm

Lord Laming Excerpts

Tuesday 6th December 2016 Lords Chamber

[Lord Laming (CB)]

My Lords, the House will know exactly where the Minister stands on this, and I am sure that the House is very grateful to him for that position. Would he accept that this House will do everything that it can to support him in getting the message across that self-harm, particularly in a young person, is a sign of desperation and a sign to be taken that help is needed instantly—and that help needs to be substantial and speedy? We should never be relaxed about self-harm, in any circumstances.

[Lord Prior of Brampton]

I completely agree with the noble Lord. That makes it even more shocking that we do not provide these poor, miserable people, who are suffering horrendously, with even a counselling session. How much is a counselling session—fifty quid; a hundred quid? Maybe it is a series of them and it costs £500: we do not even do that for over 100,000 young people every year.

Adult Social Care Contracts

Lord Laming Excerpts

Wednesday 11th February 2015 Lords Chamber

Asked by

[Lord Laming]

To ask Her Majesty’s Government what assessment they have made of the use of an auction-style process by some local authorities to tender for adult social care contracts.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

The new Care Act directs local authorities to put the well-being of people at the centre of all decisions about care and support. Commissioning high-quality social care is ultimately a matter for local authorities. We are aware of electronic marketplace systems that, together with professional judgments by authority staff, help to embody this well-being principle by prioritising quality above cost while achieving value for money.

[Lord Laming (CB)]

My Lords, I am very grateful to the noble Earl for that thoughtful response. Does he agree that advertising a block of services in an impersonal way is entirely different from advertising a vulnerable individual, stripping them of their humanity and dignity? Would he be willing to take forward the point that he made about the legislation and examine whether these authorities are disregarding the duty placed on them by Parliament to carry out a proper assessment of need for each individual, to produce a care plan and to make sure that that care plan is related to the individual’s developing situation? Will he ask the Care Quality Commission to make unannounced inspections of these authorities to see whether they are complying with the law?

[Earl Howe]

My Lords, I make it clear that the personal details of would-be service users should not be put in the public domain. The purpose of this system is to develop a tailored care plan that best meets the person’s needs and does not undermine their well-being. Where this has been done well, it has resulted in good-quality care while also, as I said, providing value for money for the taxpayer. We would not wish to make provision for spot checks of local authorities by the CQC but, where there is clear evidence that a local authority’s commissioning practices are leading to poor-quality care—which they should not be—the Secretary of State can order the Care Quality Commission to carry out a special review.

Women: Postnatal Depression

Lord Laming Excerpts

Thursday 5th February 2015 Lords Chamber

[Earl Howe]

The role of the father, as well as of course that of the mother, is emphasised in all the guidance—certainly in the healthy child programme but also in the work done under family nurse partnerships, which targets the most vulnerable families. That programme provides intensive support to young first-time mothers and their babies. It explicitly involves fathers—and/or other family members as well—as long as the mother wants the father to take part.

[Lord Laming (CB)]

My Lords, does the Minister agree that two elements need to be addressed? First, there is the safety and well-being of the mother but, secondly, there is the important issue of helping the mother to bond with her new baby. That requires quite intensive work at a critical time in the life of the new baby and of the mother. Could he assure us that these matters are being addressed in these new arrangements?

[Earl Howe]

The noble Lord makes some extremely pertinent points. The family nurse partnership programme that I mentioned is important in this context, and our aim is to expand that to 16,000 places by April 2015. We launched the NHS Start4Life information service for parents. Parenting classes are available through the CANparent network and we are developing a population measure to show child development at two to two and a half years for inclusion in the public health outcomes framework, so that we can measure the progress we are making.

Mental Health Services

Lord Laming Excerpts

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, both of those issues will be looked at by the task force. There have been concerns on both fronts that the noble Lord raises about access to services, and we are clear that the task force must come up with recommendations in those areas.

[Lord Laming (CB)]

My Lords, does the Minister agree that when the state assumes the parenting of a child or young person it takes on an enormous responsibility and a moral commitment to be a good parent to that child? Will the noble Earl assure the House that every effort is made for these children to be given access to all the services, including often some of the basic, ordinary health services that we assume there will be access to?

[Earl Howe]

My Lords, I fully agree with the noble Lord. He may like to know that my department is currently working with the Department for Education to revise the statutory guidance on promoting the health and well-being of looked-after children. We plan to consult on this later this month and to publish the final guidance early next year. It will make it clear that the CCGs and local authorities are responsible for providing services for looked-after children to give equal importance—parity of esteem—to their mental and physical health and to follow the concordat that I referred to.