Integrated Care

Andrew Selous Excerpts

Thursday 6th September 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to contribute to this important short debate this afternoon. As has been said, for most of our constituents, this world of ICPs and various other acronyms is a bit of an enchanted forest or secret garden that they do not really understand—they just want their healthcare to go on being delivered properly and professionally—but it does of course matter. I completely agree with the Chair of the Health and Social Care Committee, my hon. Friend the Member for Totnes (Dr Wollaston); we need to keep seeing this from the patient’s perspective.

Like many others, I was struck by the clarity with which Don Redding, the director of policy at National Voices, explained how this should look from the patient’s perspective. He said that patients

“want to feel that their care is co-ordinated, that the professionals and services they meet join up around them, that they are known where they go, that they do not have to explain themselves every single time, and, therefore, that their records are available and visible.”

That is a succinct, powerful way that encapsulates what we are all trying to achieve—what the Government are doing and the purposes in this debate this afternoon. The last part of that sentence—making sure that their records are available and visible—is highly topical, given what the new Secretary of State for Health and Social Care said this morning. He is absolutely right to make sure that the NHS has the technology so that its brilliant workforce get the information they need to give first-class patient care, and that patients can use that technology to their own benefit and to the benefit of the health service generally.

I remember a Department for Work and Pensions initiative from some time ago that was called “Tell us once”. In terms of benefit claims, all of us as Members of Parliament will have had constituents who come in and recount giving their details, endlessly, to different parts of the Department for Work and Pensions. The principle should be the same in health. Our constituents’ time is precious. It is not just Members of Parliament who are busy people; our constituents lead highly busy, demanding lives, juggling work, family and everything else. The more we can make it simpler to capture what they say once, the better for them and the better for hard-pressed NHS staff, and it has to lead to a better outcome. I hope that is part of what our excellent new Secretary of State, who follows the last excellent Secretary of State, is looking to achieve, in light of his speech in Manchester this morning.

There were various highlights in the Committee’s inquiry. The one that stood out for me above all others was our visit to the Larwood practice in Worksop. I have spent a large part of the summer speaking to every single general practice in my constituency. I asked them to tell me about the pressures they face and what the NHS and the clinical commissioning group can do to help them, because I am very aware that general practice is under a lot of pressure. I know the Government are recruiting 25% more doctors, which is brilliant, and last year 3,157 of those doctors went into general practice, which is also brilliant, but we have to retain them as well and some of the workload pressures are challenging.

When the Committee arrived at the Larwood practice, it was incredibly exciting and invigorating, because we saw a practice that was joining up primary care, secondary care, social care and the voluntary sector. It was using paramedics and had its own pharmacy on site, so that people are not sent down the road in the rain to get their prescriptions. There was a buzz about the place. The GPs who worked there were bright-eyed and bushy-tailed, because I think they knew they were delivering a good service and serving their patients well. I am aware of the variability across general practice. If integrated care is going to mean something, the Larwood practice—which was selected for us by NHS England because it is doing well—and practices like that show the way. My challenge to the Minister is, how do we help all those other GP practices to rise up and perform in the same way?

Although not the direct subject of the report, the other huge area of integration that is so important that I cannot fail to mention it is the join-up between health and social care. The Committee wrote a separate report on that earlier in the summer, jointly with the Housing, Communities and Local Government Committee, which I thought had excellent recommendations. I am absolutely convinced that integrated care providers will not succeed in providing the integrated care we want unless social care has been put on a proper and sustainable financial footing so that it really does work hand in glove with our NHS at every level, primary and secondary.

Our report has been really useful in slaying a few myths about privatisation. Some of those myths have been around for a very long time. When Simon Stevens gave evidence to the Committee, he did a particularly good job—he went back through some of the allegations of privatisation of the past 20 years or so and showed that, over that period, those various allegations had not proved well-founded.

I very much welcome the Government’s commitment to amend the legislation where necessary, and where helpful to provide better-integrated care. That is a sensible and pragmatic step, which I would expect from the Prime Minister and the Government. It is very welcome

I very strongly agree with what the hon. Member for Stockton South (Dr Williams) said about prevention. He said something very true about the Committee that I have never forgotten: he said that we are a Health and Social Care Committee, but sometimes we could be mistaken for an NHS Committee. That is not because he and I do not think that the NHS—the organisation that is there to look after our health—is absolutely brilliant, but because health is wider than the NHS.

Unless we are absolutely passionate about dealing with childhood obesity—I am the chair of the all-party parliamentary group on obesity—and improving air quality levels in our inner cities, where children with asthma and other illnesses are deeply affected by breathing in poor air every day; unless we get more of our fellow countrymen and women walking and cycling; unless we do something about reducing the proliferation of takeaways, which sell highly calorific food; unless we do something about getting our supermarkets and big food producers to do better in producing healthier food, we will not succeed in this key area of prevention.

It comes down to detailed things such as planning policy for local authorities, which should not have to fight a rearguard action against the Planning Inspectorate to limit the number of takeaways in an area. They absolutely need to ensure, as we build new houses—which we desperately need to do—that cycle routes are built into new housing developments so that as many people as possible, including children, can cycle to stay fit and healthy.

It is worth noting that the integrated care partnerships are helping that to happen. The Committee heard from Ian Williamson from Manchester Health & Care Commissioning. When we were in Sheffield, he said that he thought conversations were now starting up about how Manchester could reduce childhood obesity and reduce the emissions and pollution that harm the local population. Such conversations are happening, but we need more than conversations; we need action, and we need to join up these different policy areas and produce results, because they are urgently needed.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome the opening speech of the hon. Member for Totnes (Dr Wollaston), who is a superb Chair of the Committee. The marketisation in NHS England goes back more than 30 years—it has certainly been happening for most of my career. It started with terms such as “resource management”, and in 1990 the internal market—the purchaser-provider split—was introduced. In the early 2000s under Labour, private companies started to introduce independent treatment centres. The Health and Social Care Act 2012 turned it into a massive external market and created the pressure to put all possible contracts out to tender.

The problems are well known. If we base a system on competition and not on collaboration, we inevitably create fragmentation and destroy integration. That has broken up patient pathways and made the system very confusing, to the point that CCGs were looking to employ what they called primary providers, which would have been another layer of cost and health organisation, to try to join things up for patients. Thankfully that has been shelved, because there is a sense of going in a different direction, but up to now there has been a repeated sense that everything can be solved through a healthcare market. That is why, in Scotland, we have grave concerns. One of the 24 powers coming to Scotland is power over public procurement—we do not see the market as the solution to everything.

Just five years on from the actual on-the-ground changes of the Health and Social Care Act, NHS England is facing another big reorganisation. As other Members said, unfortunately the rushed sustainability and transformation plans and the lack of consultation with both the public and staff has created anxiety and fear. As is now recognised, the term “accountable care organisations”, which was copied from the American system, was a PR mistake of the highest order.

In 1999 in Scotland—after devolution—we simply went in a different direction. We merged trusts and then abolished them in 2004. We got rid of primary care trusts in about 2009. We already had an area-based health service for the entire population—not just for people registered with their GP—based on per-capita funding. That meant that we could start to look at how to integrate acute hospitals with community hospitals and even local village hospitals for step up and step down—not everyone who is unwell and cannot be at home needs to be in some big, shiny 10-storey block, and might just need a bit of extra care for a few days, so there is an argument for community hospitals.

In 2014, we started looking at integrating health and social care. Because of the fragmentation in NHS England, it will be necessary to integrate health first, and then integrate social care. Integrating social care is much more challenging because it is made up of different players in the market and is done in a different way. As the hon. Member for Totnes pointed out, the overarching difference between free healthcare and means-tested social care creates major challenges.

[Andrew Selous]

The hon. Lady used the term “village hospital”, as well as the term “community hospital”. “Village hospital” is a new one to me. Could she elaborate on what it means?

[Dr Whitford]

It is not a particularly formal term. I simply mean that there has been a tendency to think that, because community hospitals cannot provide the full range of acute healthcare, they have no place, whereas someone might require only a low-level of in-patient care, such as an elderly person who has a urine infection and lives on their own may need intravenous antibiotics, fluids or extra care. Such hospitals allow us to have much more healthcare—things such as minor injury units—close to the public. The more we take forward to people, the less worried they will be about the fact that we are coalescing specialist services. If they see services coming towards them, they will not have the sense that everything is being taken away. We have utterly failed to impress on the public that healthcare is not about buildings, but very much about people and services. That is what integrated care should be about.