Social Care

Baroness Barker Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Barker]

My Lords, I, too, am one of the usual suspects. I thank the noble Baroness, Lady Pitkeathley, for bringing us back to this subject.

I will start by pointing out the contrast between today and a year ago. A year ago, we were inundated with messages about what people thought about the Health and Social Care Act and their fears for the NHS. Now, when we are talking about social care, which probably has a bigger impact on more people, we have received almost nothing. I know that over recent weeks a number of noble Lords have attended a lot of very good briefings and meetings with some of the more noted social care policy bodies—but apart from that, nothing. That is very telling. The future well-being of many of our citizens relies on the extent to which the NHS engages with, understands and promotes social care, so that fewer people end up going to hospital and those who do quickly return to the place where most healthcare will happen in future—their own homes. That is the debate that we should be having with people in the NHS, and we are not.

It is understandable that people talk in apocalyptic terms about social care. The Barnet graph of doom says it all. I have to say that the LGA laid it on by doing exactly what I would have done in those circumstances, which is to pick the very worst case.

The key issues in social care arise because of the successes of the NHS. The NHS was designed for and spectacularly successful at organising acute care for treatable conditions. As a result, the majority of people now live with long-term care conditions, but we still have a health service based on that old model. We need to work out ways in which the NHS and local authorities together can buy packages of health and social care that enable people to go along a health and care pathway. At the moment most people’s experience of health or social care is that a part of it may work fantastically well but it is not related to any other parts of the pathway of their lives. That experience and the economic models that underlie it are the key things that we have to turn our attention to.

I want to say a little bit about personalisation, a subject that I talk about quite a lot, as the noble Earl, Lord Howe, will know. It is the chosen method of the previous Government and this Government for addressing some of the many deficiencies in social care. I think that the noble Baroness, Lady Campbell of Surbiton, will be delighted when I say that the big problem with personalisation is that it has been taken by many people in its most basic and crude form to mean a direct payment and a list of providers. It is about much more than that. It is about more than disaggregating existing services and giving people money to purchase them. It is about finding new ways to enable people to have the power to shape the services they need. The Housing Learning and Improvement Network is currently engaged in working on some very interesting different forms of collectivisation of personal payments, enabling people, for example, to combine in buying a core housing service and then buying different personal services to turn what was previously residential care into assisted living. That is the sort of work which local authorities and, in future, the NHS need to support so that we can ensure that more older people remain in assisted living for longer, rather than ending up in hospital and acute care.

We have a plethora of examples of how community care can be improved and work very well in preventing people needing higher levels of care. All the usual suspects will recognise Dorset POPP, North East Lincolnshire Care Trust Plus and Southwark Circle—all of them packed with evidence about how older people can thrive in supported settings. However, to the best of my knowledge none of them has a model of economic sustainability. My key question for the Minister is whether, in this coming year—with the potential of health and well-being boards and the potential which arises from some of the changes in the NHS radically to alter the way in which services are commissioned, designed and provided—the Government will continue to work on developing economic models which can show us whether those small localised examples can be either scaled up or replicated in different parts of the country.

We are in danger of missing the point that the creation of health and well-being boards gives us the potential to do what is brought out in the subject of this debate—to create communities in places where older people want to be. They want to be at home; they do not want to be in hospital. It is for the Government to provide these new bodies with research, which so far has been lacking, into the efficacy of social care compared with acute treatment to enable the joint pathways of care that I talked about earlier not only to be real in terms of the services that they give older people but to be viable models in which the NHS feels it can safely invest, as opposed to investing, as it has done, in acute care.

In my remaining final minute, I want to say that so far we have achieved something quite remarkable—a consensus on Andrew Dilnot’s report. I hope that that consensus continues because, whatever one may think of its deficiencies, it is the only game in town. It is important that a form of Dilnot comes about soon and that it should be a compulsory and not a voluntary scheme. If that does not happen, we will never get the economic basis on which to build the new future of health and social care to which we aspire.