NHS: Primary and Community Services

Lord Prior of Brampton Excerpts

Monday 7th November 2016 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what is their response to the Carers UK report Pressure Points: carers and the NHS, concerning problems faced by carers in accessing primary and community support services for the people they care for.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we recognise that far too many people who could be treated at home or in their communities attend A&E. Sustainability and transformation plans are bringing together commissioners and providers to deliver the five-year forward view locally and will include radically improved out-of-hospital care through stronger integration and improved access to primary care.

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his response. The report identifies major problems for carers accessing primary and community support services for the people they care for, and who therefore have no real option but to take them to A&E. Many of these emergency hospital admissions could have been avoided with adequate social care support at home, better access to a district nurse or essential local support for carers themselves. On carers’ support, councils across the country are having to cut back on vital services. My own council in Surrey has a programme of cuts of 33% over three years. With the CQC’s dire warning that social care is at a tipping point, is it not time for the Government finally to acknowledge this and use the Autumn Statement to provide the increased funding and investment that is urgently needed for carers and the people they care for to get the support they deserve?

[Lord Prior of Brampton]

My Lords, I acknowledge that there is tremendous pressure in the social care system. Looking back over the last 20 years, not enough support has gone into primary, community and social care relative to what has gone into acute care. The sustainability and transformation plans are designed to bring together social care and healthcare. They are being published intermittently as I speak.

[Baroness Brinton (LD)]

My Lords, the country owes so many carers an enormous debt of gratitude for what amounts to unpaid work they are doing on behalf of the state. The NHS website says to carers:

“If someone you know is in hospital and about to be discharged, you should not be put under pressure to accept a caring role”,

or to take one if you are already doing this as their carer. It continues:

“You should be given adequate time to consider whether or not this is what you want … to do”.

The carers report has found that three out of five carers say they felt they had no choice, and of those not consulted four out of five carers said it was way too early and that there were readmissions as a result. What will the Government do to ensure effective communication between hospitals and carers truly happens, so that there are no more unprepared discharges and carers get the support they need?

[Lord Prior of Brampton]

My Lords, delayed and inappropriate discharges are clearly a huge issue for the whole health and care system. Again, this is something the STPs are designed to address. The five-year forward view is explicit in saying that there are 5.5 million carers in England and their continuation goes to the very sustainability of the NHS. The importance of care is not in dispute. The Care Act, which the noble Baroness’s party and mine put through in the last Government, recognised that so as to give them parity of esteem with those they care for. There is no question but that better communication with carers would go a long way to improving the problems we have with inappropriate discharges.

[Baroness Pitkeathley (Lab)]

My Lords, the Minister has acknowledged that discharge from hospital is an important time for carers. You can literally become a carer overnight when your relative is discharged without warning. The carers strategy is currently being refreshed. Would the Minister consider an input into the carers strategy that meant it was incumbent on the National Health Service to consult carers and get their agreement before discharges are made?

[Lord Prior of Brampton]

My Lords, I am not sure we could go so far as to say that one should always have their agreement—sometimes, discharges from hospital are incredibly complex and difficult—but there is no doubt, arising from the Carers UK report, that where there is proper communication with carers, the discharge procedure is much better for everyone, from the point of view of the carer, the patient and the hospital. If proper arrangements are not put in place, delays arise long after the patient should have been discharged home. It could be to do, for example, with a care package or altering the patient’s home.

[Baroness Howarth of Breckland (CB)]

My Lords, I have recently become a carer myself and therefore have experience of a number of hospitals. Why is there such a postcode lottery in terms of where one finds oneself? West Suffolk Hospital, where my partner found herself, has given excellent service and—we must not run it all down—we have had fantastic aftercare in that area, whereas the London hospital does not even answer the telephone. Why is there such a difference? She was also in a mixed ward, the use of which I thought had already stopped.

[Lord Prior of Brampton]

My Lords, I am surprised that the noble Baroness’s friend was in a mixed ward because their use is supposed to have stopped unless there is an absolute emergency when only one bed is free. Unless there were exceptional circumstances, it is very disappointing to hear that that happened. Perhaps the noble Baroness would like to write to me about it. On her first point, there is variation in pretty much every aspect of health and social care around the country, which is inevitable. To some extent, it is not a bad thing, because it drives up standards if those who are not delivering great care can see how best it can be done. The STP process is designed to build in best practice, but I am afraid that a degree of variation is inevitable.

[Lord Hamilton of Epsom (Con)]

My Lords, following the question asked by the noble Baroness, Lady Brinton, will my noble friend clarify whether everybody in need of care is the responsibility of the Government?

[Lord Prior of Brampton]

The thrust of the Carers UK report is that 5.5 million carers take huge responsibility for their loved ones and that the primary responsibility often falls—I think, rightly—on carers and families rather than on the Government.

[Baroness Farrington of Ribbleton (Lab)]

My Lords, would the Minister care to join me in condemning Members of Parliament who have voted nationally to force local authorities to reduce services but have then attacked the local authorities because they wanted the libraries kept open, the bus services run and the care packages maintained—all of those things—while washing their hands of any responsibility?

[Lord Prior of Brampton]

I think the noble Baroness will agree with me that there are very difficult choices to be made when it comes to public spending. Sometimes, there is perhaps not always a high degree of consistency from our colleagues in the House of Commons.

[Baroness Greengross (CB)]

The Minister mentioned discharge procedures. Unfortunately, carers often do not know about plans for discharge early in the period during which the one they care for is in hospital. As has been said previously, surely the discharge process should start at admission. If the carer is brought in at that point and works with people to make the discharge process work, it will be better. This has never happened. Does the Minister agree that it really must?

[Lord Prior of Brampton]

I entirely agree with the noble Baroness. Good practice means that as soon as a patient comes into a hospital, an estimated date for discharge should be agreed then with the carer, which would enable all the services to come together at the point of discharge. Where that does not happen, one can have long delays.