Greater Manchester Combined Authority (Fire and Rescue Functions) Order 2017

Lord Smith of Leigh Excerpts

Tuesday 21st March 2017 Grand Committee

[Lord Stunell (LD)]

First, I thank the Minister for her introduction to these orders. I agree with her that there has been wide consultation and that it is appropriate for this Committee to bear that in mind when reaching its decision in what I hope will be only a few minutes’ time. I should declare a residency qualification, in that I live in Greater Manchester and for 18 years I was an MP for one of the 27 constituencies. For eight years, I was a member of one of the 10 constituent borough councils—and, to complete the full set, I was a Minister in the Department for Communities and Local Government when the combined authority order was set up in 2011. I know that the city deal that flowed from that was widely welcomed across Greater Manchester, along with the steps that have been taken since to ensure that additional resources—funding what has traditionally been central government, Whitehall-directed services—will be put into the hands of the combined authority from the start of the new regime in May.

The progress made so far has been much envied and imitated around England, where a steady stream of visitors from other cities and for that matter rural and shire areas have been received by the combined authority, asking it how the model has been developed and how it can be copied. All that is positive and very much a direction of travel that my parliamentary colleagues and I believe is right, with more decision-making and discretion over the delivery of public services in a given area in the hands of those who live there and are elected from there.

I have a concern about the mayoral model, but that particular ship has left port. A loss in cross-authority representation and accountability flows from that, but these orders do something to combat or respond to that. Certainly, to replace the police and crime commissioner —somebody who, for all his qualities, was elected on a 14% turnout across Greater Manchester—with somebody elected to be mayor of the combined authority, and with a much more significant and wider role in the delivery of public services, is almost bound to increase the visibility and accountability of the person carrying out that role. I welcome that, as do the constituent authorities.

The police and crime panel, to which the Minister referred, is seen as a way of maintaining or improving the police service’s accountability. There is a way to go in that regard; it is to be hoped that a more visible mayor’s being in charge of the police service may lead to the panel having more visibility and capacity to keep control, or a proper oversight of that service. Nevertheless, it is a good thing to see that incorporated in the proposals.

As for the Greater Manchester Fire and Rescue Authority, there is no equivalent commissioner but rather control by representatives of the 10 local authorities, and there is no doubt that the new arrangements will give more visibility to the leadership of that service. In the longer term, bringing the police and fire services under common management must be a better way to provide a coherent and integrated service. Indeed, my one question to the Minister relates to that. Today, the Care Quality Commission has produced a report on independent ambulance services. The ambulance service in Greater Manchester is provided by an independent body based in Blackpool. Bearing in mind that these orders bring together two of the blue light services in Greater Manchester—and particularly in view of the critical nature of that report, but more generally in any case—have the Government looked at ways the blue light services in Greater Manchester could be brought together? Again, I remind the Minister that the combined authority in Greater Manchester will be taking over a significant amount of NHS commissioning for future years—a step that I very much favour.

With that sole question to the Minister—I dare say she is not equipped to answer it off the top of her head; perhaps she would like to write to us about bringing together the three blue light services—I am certainly happy to support these orders.

[Lord Smith of Leigh (Lab)]

My Lords, I declare my interest not merely as a member of the combined authority and leader of Wigan Council; I am in a position to answer the question asked by the noble Lord, Lord Stunell, on ambulance services because I chair the Greater Manchester health partnership board. The orders are very interesting. I have yet to see in the manifestos of either of the two main mayoral candidates what their policies are on the docking of working dogs’ tails. That obviously is an important consideration.

I not only thank the Minister for introducing the orders, but welcome the fact that the Government have put them together. To add to the points she raised, it is not just about bringing together the blue light services, which is important. We need to see police and fire as part of general public service reform. Many of the issues the services face are related to the fact that people have problems across their lives. We need to get the police and fire services engaged in the work we are doing in Greater Manchester across a wider range of public services, not just in blue light services.

The answer to the question asked by the noble Lord, Lord Stunell, is that the arrangements are currently handled through Blackpool but they are coming back to Greater Manchester. We asked for ambulance service commissioning to come back to Greater Manchester because, as we are now a devolved health area, we need to do this rather than working through CCGs in Blackpool, for example.

There are actually two panels that look after the PCC in Greater Manchester: the scrutiny panel, made up of members of the authorities, and the combined authority itself. We will need to find a mechanism to continue that work, because it is important that the work of the police and crime commissioner, whether exercised by the mayor or anybody else, has consent across the whole of Greater Manchester on major issues.

It may be my ignorance, but the documentation does not make clear the deputy’s role. I would hope that the mayor would appoint a deputy. He or she will have a lot to do generally and we need to supervise what is going on in the police service. A day-to-day role in running the police service would be too much for anybody, and the same is true for the fire service. I hope we will set up the committee to run that, but we need to understand the role of the deputy and how answerable they will be to various public bodies.

As the Minister is probably aware, I regret that the PCC can implement the Greater Manchester precept without really consulting the 10 authorities. That needs to be changed. Unfortunately these orders do not do that; they roll it on. It is also not clear in the fire order whether the fire precept will need to go to the combined authority for approval, or the mayor will simply make a recommendation and we will not have any control over it. There has been a little dispute this year about how much the fire precept should go up by. With the representative of Trafford, I was on the losing side of that argument but we need to do that.

As the Minister said, we consulted on this across Greater Manchester. We welcome the changes. It will be an interesting challenge to have a mayor with the combined authority but I am sure we can all make it work to ensure proper devolution across Greater Manchester.

Cities and Local Government Devolution Bill [HL]

Lord Smith of Leigh Excerpts

Tuesday 12th January 2016 Lords Chamber

[Lord Smith of Leigh (Lab)]

My Lords, I also support the amendments moved by the noble Lord, and I thank him for his explanation. When the noble Lords introduced the amendment in the name of the noble Lord, Lord Warner, they obviously had a suspicion about what was going on in Greater Manchester— understandably so. We heard the phrase “postcode lottery” from the previous noble and learned Lord. One reason why Greater Manchester wants to take control of health is that there is a current postcode lottery. The average outcomes for health in Greater Manchester, despite the efforts of Governments of all persuasions since 1948, have remained doggedly subject to that postcode lottery. We want to use the powers that we can use locally to start to do something about it.

With the permission of your Lordships’ House, I shall try to explain what we are doing in Greater Manchester and why we need not fear. It is only 11 months since we signed the original memorandum of understanding with NHS England to share health. The combined authority has not taken control of health; we share responsibility with our health partners. Our number one achievement is to raise the governance. We have 37 different organisations in Greater Manchester with some responsibility for this agenda. I have the dubious task of chairing the strategic partnership board, but colleagues across the piece are working collectively to achieve an outcome. In our collaboration with NHS England, the regulators are being as sympathetic as possible.

Already we have seen clinical benefits. We have made sure that every area of Greater Manchester has access to a hub seven days a week so that people can receive medical advice—which was not the case before—and that has continued to expand. We have started to commission collectively more work on public health, recognising that this will be a key to achieving significant change in population health. We set up an organisation called Dementia United, which is going to join all the partners together to look at dementia in terms of acute services, primary care services and social care. In December, we agreed a strategic plan to take us forward for the next few years in Greater Manchester. It complies with all national objectives and reflects the needs of Greater Manchester as a sub-region, but also the localities within Greater Manchester.

The focus, first, is on prevention. If we can get people not to need healthcare, that is the best way for people, for the health system and for care. We need to make sure that each locality addresses the issues that exist in those 10 areas of Greater Manchester. There is quite wide variation in provision, as one might expect, between GP services in one area and another. We just got those up to the same level and have made a great improvement. With acute care services, again there is huge variation between the outcomes of hospitals in Greater Manchester. We need to improve that, and we need to give better support both in the clinical and the back-office sense. To fund this, apart from the money we get from the Government, we think we can operate more efficiently and effectively by integrating lots of services; that will be important.

We are also grateful to the Government for allowing us an initial injection of funding from the transformation fund. Skilled negotiation on our part and obviously the generosity of the Government meant that we got £450 million from that fund. That will kick-start some major changes in Greater Manchester. The benefits will include better clinical outcomes; we have targets on those. We will make sure that children get to school at the age of five in better health and are more ready for school than they are at the moment. We are supporting the elderly so that they can live longer in their own homes.

This is not just about health, however. If we can start to improve the health of people in Greater Manchester, it will reduce some of the barriers to employment and help us to get more people into work. The next step, obviously, will be better engagement with the public and, crucially, with the staff across both NHS and social care. We are making sure that we have detailed implementation plans, so that this does not become a dusty strategic report—one that is very worthy but stays on the shelf—but is actually implemented. The strategy will make a difference, we believe, to the lives of people in Greater Manchester.

I should emphasise that, the more I have gone into this, the more I have come to realise that there is no boundary between health and social care. The figures vary, but they say that some 40% of the people who come to see the GP in his surgery are not really seeing him on medical matters but on social matters. For example, they may have housing problems or employment problems, so they are not sleeping at night and need support, and so they come to the doctor for tranquillisers. Some GPs are good at dealing with that; some simply give the tranquillisers. We need to make sure that we start to address the issues that people have and not assume all the time that it must be a medical issue.

My noble friend Lord Beecham asked what happens to the areas around Greater Manchester. Obviously, that is not determined, although we have already made a decision on acute provision in Greater Manchester that reflects Derbyshire, because, clearly, many in north-west Derbyshire—in Glossop and so on—look to Greater Manchester rather than elsewhere, and so we clearly need to reflect that. However, such areas would need their own locality plan for what they are doing in that area, working together with all the local health and social care partners. There is a need to reflect that some stuff is done at the regional level, some stuff is done at the sub-regional level and some stuff is done at the local level.

Social care is an important element of this. In some parts of Greater Manchester, under the locality plan the acute hospital will run the social care services. In other areas, such as Wigan, we will have a care organisation to ensure that everyone looks at how we can stop people getting ill—that is our main intention—rather than treating them once they are ill. That will vary slightly in different areas, but we will reflect those different localities.

We are making good progress and there is great collaboration going on. I thank the Government for the opportunity, and I think we will make a difference.

--- Later in debate ---

[Lord Shipley]

My Lords, first, I thank the Minister for his briefing note, which I received last week, on the proposals in this amendment for sub-national transport bodies. I welcome the switch in emphasis that he has referred to. The noble Lord, Lord Beecham, talked about levels of expenditure and, in particular, the enormous amount that is spent on London and the south-east in comparison with the north of England. Having a sub-national transport body of this kind will be extremely helpful in refocusing the attention of Whitehall on the need to fund the north better than it currently does. Therefore, I thank the Minister for that and I think that the proposals are absolutely right but I want to say two things.

The first concerns the question of to whom the sub-national transport bodies will be accountable—in other words, the extent to which the constituent councils of those sub-national bodies will have a regular reporting mechanism. It seems to me very important that there should be a regular means of providing feedback from those councils to the sub-national transport body. Secondly, I hope that the Minister will agree to a system of annual reporting, which occurs elsewhere in the Bill in relation to combined authorities, elected mayors and other matters. Can he confirm that there will also be annual reporting by the sub-national transport bodies? I would find that extremely helpful.

My last point relates to the use of the negative procedure as opposed to the affirmative procedure. The Minister will have seen the report of the Delegated Powers and Regulatory Reform Committee, which challenges the use of the negative procedure. The grounds are that the powers will exist for a limited period of time. The definition of a “limited period of time” does not appear anywhere. Is it a matter of a few months or of two or three years, or is it a matter of something more significant?

I hope that the Government might be persuaded of the importance of using the affirmative procedure. Given the scale and magnitude that this proposal represents in reality, I think that using the affirmative procedure would be better than using the negative procedure. Does the Minister have any comments on that?

[Lord Smith of Leigh]

My Lords, I also welcome these amendments, and I thank the Minister for the way that he has introduced them. Obviously, this is very important activity, and without statutory backing Transport for the North has already had a major in-fight over agreeing the northern franchises for the rail networks that affect all our northern counties.

In terms of reporting back, I assure the noble Lord, Lord Shipley, that in the process of franchising we in Greater Manchester have had regular reports from our delegates at Transport for the North. There is accountability for what goes on.

I will probably upset the Minister but, while I am on my feet, I will say that one of the great aspects of the deal for devolution in Greater Manchester was the prospect of franchising the buses, which of course account for the vast majority of transport movements in those areas that are involved. I recognise that that will come under separate legislation, a buses Bill, but we still await sight of that Bill and hope that it is not going to be too long.

[Lord Ahmad of Wimbledon]

My Lords, I thank all noble Lords for their contributions.

I want to pick up on the point made by the noble Lord, Lord Smith, in response to the noble Lord, Lord Shipley. There is accountability, and that accountability is very much to the stakeholders that make up the particular STB. As for the limits or extension of these areas, that will very much be dependent on the local authorities themselves and the collaboration that takes place. The key point I emphasise is one of strategic decision-making, which is the intention behind the creation of such bodies, as we are already seeing with the creation of TfN. Indeed, the reason behind putting TfN on a statutory footing is that the very bodies that make it up have also requested this.

I will now pick up some of the questions raised by noble Lords. The noble Lord, Lord Shipley, also asked about annual reporting. The legislation makes it clear that STBs shall produce and publish their strategy and updates to that strategy. That can be seen with TfN, which produced its additional reports in March 2015 and has plans for annual updates, the next being in March 2016.

The noble Lord, Lord Beecham, asked about the extent to which different modes of transport are covered by STBs. The whole essence of sub-national transport bodies will be to cater for all modes of transport within a defined geography, including ports and airports. This can already be seen in the work of TfN, which has set out quite clearly its plans for all modes of transport, including ports and airports. I take on board totally the point the noble Lord made that this is not just about linking up rail and roads; it is about ensuring that, where there are ports and airports, these also form part of the strategic transport strategy for a given geographical region.

The noble Lord, Lord Beecham, also asked about the size of STBs. As I have already said, it is really up to the local areas to come forward with proposals; it is about bringing together local authorities. There may be some traditionally defined areas, but it is about how local authorities can come together and collaborate across traditional borders to ensure the best result for a particular region. In terms of the requirements, there must be two appropriate authorities to form an STB.

--- Later in debate ---

[Lord Ahmad of Wimbledon]

It is dependent on how the STB proposals come back. However, in practice, I cannot see a deterrent to that because this is about providing strategic links. I am sure all noble Lords will welcome a linking up between the noble Lords, Lord Beecham and Lord Smith, on strategic transport arrangements. The idea behind this is to empower local authorities to make the right decisions for their particular area.

As to specific local authorities belonging to two networks through legislation, what would happen in the scenario painted by the noble Lord is that if a local authority is already part of an STB, there is nothing stopping that local authority, after the creation of a new STB, being co-opted on to the other to ensure that that strategic link is operational.

The noble Lord, Lord Shipley, referred to placing a limit on the period for regulations. The very nature of the temporary transfer of functions is that there will be a clearly limited interim time for this. If a temporary transfer of functions works well and there is evidence to show that there would be value in effecting a permanent transfer, there would be further regulations to ensure that that could take place.

I hope I have answered the questions that have been raised.

[Lord Smith of Leigh]

Could the Minister comment on the buses Bill and when we are likely to see it?

[Lord Ahmad of Wimbledon]

I raised the issue of the buses Bill when I was being briefed for this Bill. I know that it is being drafted and we are looking for appropriate parliamentary time to ensure that we can introduce it at the earliest opportunity.

I again thank all noble Lords for their support for the amendment.

North of England: Transport

Lord Smith of Leigh Excerpts

Wednesday 17th June 2015 Lords Chamber

[Lord Smith of Leigh (Lab)]

My Lords, I start by declaring my interests. As you can probably tell, I am from the north too, but my main interest is that I am still leader of Wigan Council, which is a shareholder of Manchester Airport. It is clear that there has been a cross-party welcome for the Minister’s statement, for which I thank him. There are clear economic benefits to the north if we can get the transport system correct. The report from the RSA City Growth Commission, chaired by the recently ennobled noble Lord, Lord O’Neill of Gatley, and practical examples across the continent from the Randstad and the Rhine-Ruhr region show that these things are not just theoretical: they do work. If you get the right transport investment, you can change economic strategy.

I particularly welcome the establishment of Transport for the North. It is a really good idea because it brings together the Government and local authorities. I would like to try to assure sceptical noble Lords that northern local authorities have got together in a good spirit of partnership across the north. The title of their organisation, One North, gives a clue that they have moved away from the parochial thinking which has perhaps mired us in the past, and that we are working together. It is important that Network Rail is now engaged on a proper basis with local authorities. The Minister mentioned the Northern Hub and the need to end the bottleneck in east Manchester to help trans-Pennine trains. Some years ago, we in Greater Manchester had a meeting with Network Rail and they did not have a clue what it meant. We actually had to persuade them that it was a problem.

The northern transport strategy has three parts. Other noble Lords have mentioned HS3—the east-west link—and the HS2 leg up to Leeds is an important part too, as well as the Crossrail corridor. If my noble friend was looking for some cultural links, the noble Lord, Lord Clark of Windermere, gave him a clue. There is already a rugby league connection across the M62 corridor up to Cumbria and now, after the magic weekend, I can assure my noble friend Lord Beecham that it includes Newcastle too. Northern Rail recognises this because they sponsored a rugby league cup, which my own home-town team, Leigh Centurions, hold because they were the last winners.

People are concerned about high-speed trains and perhaps the clue is in the name. High-speed trains are not going to stop everywhere. Speed is important in reducing journey times and improving reliability but the main argument for a high-speed network is about capacity on trains. I once had the misfortune to travel from Hull to Manchester on a train that passed through Leeds in the middle of the rush hour. I do not know how they could get so many people on that train in Leeds and Huddersfield; they were absolutely packed on. I checked with the Health and Safety Executive and there are not really any rules about how many people you can get on a train. It is a potential disaster when all those people are packed on. The real capacity issue is not about trains, it is about the network. The west coast main line is inappropriately named: it was built not as a main line but as a series of different ones. It has been modernised and changed but the money ran out when the last major change was done at Watford, so that bit has never been done. The busiest piece of the line has never been touched. We need to make sure we have the capacity to take advantage of the fact that people are more likely to use trains now.

As well as land links, we need international connectivity. Manchester Airport has been owned by the local authority since 1986, although we took on a private partner recently so we could make an effective deal to expand into Stansted. We already have more international links to destinations than Heathrow, although they are not as frequent. We have more links to the USA, Singapore and Hong Kong. Confidence in the future of the airport is shown, as the Minister said, in the decision to increase investment by £1 billion. At the moment we have just about adequate rail links, which were built without much support from the department. We got them built and they work but there are some problems. Certainly, if we are to take advantage of the impact of the northern transport strategy across the north, we need to improve capacity. That is why a station at Manchester Airport on the high-speed line is crucial. I certainly agree that we need to consider the impact of passenger duty on northern airports and to make sure that we are not uncompetitive with airports in Scotland.

A number of noble Lords have made the point that the big schemes are important but we need to get local connectivity and access to the improved routes. Because they will not stop in every place, we need to make sure that that happens. We need to get underneath the main strategy for the north. There needs to be different transport strategies in the different parts of the north that link in, and we need to make sure that the links are used. In Greater Manchester, we had a bit of an innovation some years ago when we decided on funding transport collectively. We managed to get together a pot of about £1.5 billion. Schemes were put forward for the best part of £20 billion but we allocated funds based on the impact on the economy. That was a different way of doing it.

My home town of Leigh is said to be the largest town in the country that does not have its own railway station. It was not closed by the infamous Lord Beeching but because a motorway was built. It was decided that it was too expensive to build a bridge over the motorway, so the line was closed.

We need to explore some of the technical difficulties. I am not an expert on railways, unlike many noble Lords here. However, I know that there were two obstacles to the Liverpool-Manchester railway being built. One was your Lordships’ House, which turned down the first proposal for that railway. However, it allowed the second route because the landowners did not object as it went across wasteland, Chat Moss, just to the west of Manchester. It was left to the engineer, George Stephenson, to determine how to cross Chat Moss. He had an amazing, innovative, cheap and effective solution. He floated the railway line across the peat bog on timber, brushwood and cotton bales. Of course, there were plenty of cotton bales in Lancashire, so he was okay with that. His solution has lasted for the best part of 200 years.

As a kid, I would cycle to Chat Moss where you can see the trains bouncing on the line because it moves up and down with the weight of the trains. Of course, the weight of the Rocket, which it was planned would take that line, was considerably less than modern trains. We need to make sure that the Stephenson solution continues to work. Our Victorian forebears built the links across the Pennines. They built the Summit Tunnel between 1838 and 1841. It is still going strong, but does it have the capacity to cope with modern vehicles in the number we will want?

I welcome the cross-party consensus that there has been today but there is a danger that it could break down if we do not get two things. First, we want to see progress. I get frustrated, as, I am sure, does the Minister, with the slow speed of the system. Our approval of railways is designed for the 19th century. It is not modern. We are still talking about how we get HS2 through Parliament and its ancient procedures.

In France a TGV link was proposed from Tours to Bordeaux at the same time as the idea of HS2 came up here. That link is now virtually finished and open, while we are miles behind. We have to become speedier than that. We want things to be done in a timely way; we do not want promises that are never kept. If it comes to it, the real key is to ensure that the investment is there. Noble Lords have talked about Crossrail and the ability of London to attract a large amount of money for its investments. Transport investment has been unfair and unbalanced. If we are going to rebalance our economy, we need to rebalance that transport investment so that the schemes the Minister proposes, which we all think are a good idea, are properly funded.

Queen’s Speech

Lord Smith of Leigh Excerpts

Tuesday 15th May 2012 Lords Chamber

[Lord Smith of Leigh]

My Lords, this is the first occasion for more than a year that I have spoken in your Lordships’ House, because in March last year I was taken seriously ill. Thanks to excellent medical care from Wigan Infirmary and particularly the Christie Hospital in Manchester I am back and in reasonably good health. I have always taken an interest in health in your Lordships’ House because of my role as a local authority leader. I declare that interest as well as my vice-presidency of the LGA. Of course, my own experiences have reinforced my belief in the need for good healthcare. This was my first time in hospital since I had my tonsils out at the age of four, and the passion I feel now for the NHS was reinforced by the experience.

I was pleased that the Queen’s Speech had something in it about social care; I thought that at last we were tackling the issue. Of course, when the details came out we saw what was involved in the proposal—a draft Bill on eligibility. We know that it is necessary, but given the scale of the problems and the financial crisis in social care, it is woefully inadequate. I hope that the coalition will not hide behind this approach and try to dodge the issue of long-term funding in healthcare.

The current system of social care is not fit for purpose. As the noble Baroness, Lady Tyler, said, its operation is incoherent and a mystery to many people. Clients and families do not understand the system, what they are entitled to and why there are so many unacceptable variations between different areas. For one in 10 people who need social care, it has a catastrophic financial impact. We need to make sure that we do something about that. The fears that people have about growing old are something that we ought to tackle in a proper manner.

Clearly, the financial squeeze on local authorities is the main problem. The increase in the budget for social care that we have seen over the past decade has lagged well behind the increase in the whole NHS budget. This increase meant that more went to people with physical and learning disabilities—and quite right, too. However, there has been a 6% increase in the number of old people over the period. Therefore, the amount of money available for the care of the elderly has reduced in real terms. As other speakers said, the number of those aged 85 and over has increased by 25%, with associated costs because people have much more complex needs at that age.

Given demand pressures, it has been extrapolated that by 2024, all of local authority budgets will go on care. Clearly, 12 years ahead is a long time for Ministers to think; their timescale is much shorter. However, I hope that your Lordships’ House will still be in operation at that time. We cannot avoid facing up to this financial pressure. Local authorities faced grant reductions of some 25% to 30%. The LGA reckoned that in the past year about £1 billion was taken out of social care budgets. The symptoms of this financial pressure are all around us. We remember the collapse not long ago of the Southern Cross care homes. The fact that local authorities have again not increased the fees they pay to care homes has created huge financial pressures there. The noble Baroness, Lady Tyler, mentioned the home care system. When I got into local government, it was there as a backstop to give support for people to stay in their homes. Now the criteria and the allocated time levels have been reduced and it is inadequate to support many local clients in their own homes.

The greatest danger of the squeeze on social care is its impact on the NHS. If you look at the NHS, you can see an increase in the number of emergency admissions for older people. It is 12% and rising since 2005, but for people over 85, the increase has been 48%. Because people are unable to get proper care support, the length of stay in hospital is increasing. On the acute ward where I was, I observed a patient who was kept there simply because he was unable to feed himself properly. Therefore he was kept on an acute ward—with all its costs—because he could not manage at home.

Over the past decade we made considerable progress with the problem of bed blocking. We are now tipping the other way. My observation was that people are beginning to block beds because the NHS is facing its own financial crisis. Although the settlement in the comprehensive spending review has flat-lined, because of this inexorable rise in the elderly population, the NHS must find productivity savings of some £5 billion a year. Unless we get social care right, the NHS will not be able to achieve those savings. The inadequacy of the treatment of old people already in hospital was revealed by the recent Care Quality Commission report about the poor quality of care that many old people get in the NHS. It will get worse as an increased burden is put on it by the inability of local authorities and others in the social care field to do it.

We cannot continue to patch up this failing system. We have to make radical change. Many noble Lords have mentioned Dilnot and so I will not go into that. More resources are necessary but that is not sufficient to deal with the problem. We have to look at the problem in a different light and in different ways. I have been a councillor for a fair number of years and we have all talked about the need to integrate health and social care. We talk about it, but it has never happened properly. Only 5% of budgets are properly pooled across the NHS and local authorities. We need to do much more about that. We also need much more innovative approaches if we are to deal with the crisis before us.

Integration with health budgets needs to be done. We could have a single pot of health and social care budgets sent to a locality based upon assessment of need, which would not simply be age-related—although that would clearly be an important factor—but also related to the needs of the population. We need a much more joined-up approach in the way we deliver services. I suggest that the NHS needs to engage with local authorities much more in the community budget pilots, which look at innovative ways of delivering. If we want to avoid that meltdown in social care, we all as politicians, whether at national or local level, need to work together to find a solution. It is urgent and cannot go into the long grass.