Integration of Primary and Community Care (Committee Report)

Baroness Armstrong of Hill Top Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I too felt very privileged to be a member of this committee and want to extend once again my sincere thanks to my noble friend Lady Pitkeathley. She worked tirelessly and used the knowledge and the commitment that she always shows, even on occasion in difficult circumstances with an unusually high turnover of staff working to her. However, I also want to thank the staff because they always worked in a professional way to support the committee effectively. I knew I could rely on the very good other members of the committee to be detailed about the report. It now seems quite a long time ago, but I do want to take therefore a slightly different approach to my speech, as it is meant to be fairly quick.

When I was chairing the Public Services Committee, particularly during Covid, I got to know National Voices, a charity that works essentially with people with long-term conditions, often more than one; and these are the people that an integrated care system should be measured against. I want to go back to what National Voices said when it worked with the patients it was seeking to represent about what they wanted from what we call an integrated system but what it calls a person-centred, co-ordinated care system. We have different definitions, and we like the sort of rhetoric of integration, but we must never forget what the real purpose of it is, because creating care that is co-ordinated around the needs of the individual, rather than the requirements of the health and social care organisations, seems as far away today as it has ever been.

National Voices asked patients what they wanted from the system—and I shall give noble Lords some quotes. They said:

“My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes”.


I do not think that that is an outlandish demand. However, it recognises that, while we may be trying to patch together different services and feel that we have succeeded when two organisations say that they are talking to each other, the end product of integration for service users is an outcome whereby they feel more in control of what is going on. The outcome of all this co-ordination means that they and their carers understand what they need to do to keep improving and help make things happen. They said that they wanted to be able to say:

“I was supported to set and achieve my own goals. Taken together, my care and support helped me live the life I want to the best of my ability. I was in control of planning my care and support. I could decide the kind of support I needed and how to receive it”.


I am afraid that we are still a long way away from getting professionals to talk to each other about the whole person they are meant to be helping. Even when we get to that, unless that collective voice of professionals puts the service user in control, we will not really get the outcomes that we need. How do service users want communication to take place? Again, they have some simple wishes. They always want to be

“kept informed about what the next steps would be”.

They want to be sure that “the professionals involved” have “talked to each other”, so that they can see that they have “worked as a team”. They want to be able to say:

“I had one first point of contact. They understood both me and my condition(s). I could go to them with questions at any time. That person helped me to get other services and help, and to put everything together”.


People with different needs know that they need different expertise, and they welcome that expertise—but first they want to know first that the professionals will talk to each other and that someone will put everything together.

These statements—and I could go on—are straightforward and moderate wishes. As I understand it, integration has been in the last three NHS plans. There was even an integration White Paper two years ago yet, last year, with all the new structure that the Government say we must wait to see, NHS England and the DHSC issued contradictory instructions to ICBs, ICSs and trusts. That means that, if they take any notice, they will revert to working in silos. We have to move away from the rhetoric and get on with delivering what patients need, when they need it and in the place they need it.