Social Care

Baroness Greengross Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Greengross]

My Lords, the reason why we are facing this huge crisis in health and social care is the amazing advance that has been made, mostly in medical care, in controlling a lot of acute conditions that used to kill people. Those people are now able to continue to live and we must celebrate that. However, because we have not changed the systems adequately to cope with that advance, we are in crisis. We should not think of it all negatively, but we should be quicker to change and adapt our systems to cope with what has happened.

Integrating the two funding streams of health and social care seems a huge problem. However, if we take advantage of the localism agenda and the fact that funding from Government is coming down to the clinical commissioning groups and the health and well-being boards at a local level, and if that money can be ring-fenced and secured at that level, the CCGs or the boards can mix the funding and solve that crisis by using it in the best way available to meet the needs of this population. It cannot be difficult to achieve that. Maybe the Minister will tell me whether he thinks that that is nonsense or whether it might be possible; I cannot see why it is not.

We need to get other changes into the system very quickly, including the culture change from a clinically driven focus on acute care to a patient-driven focus on long-term conditions. That is all part of the same change. Because it needs to be managed differently, it is a question of managing it at the different levels—national, regional and local. We must bring more to the forefront of these caring changes. The allied domains of care—housing and welfare benefits, the DLA and attendance allowance—are all part of the changes that have to be incorporated into getting this right.

We must also remember that we are not dealing just with elderly people. As the noble Baroness, Lady Campbell, among others, has reminded us, we are dealing with people with disabilities who now, thankfully, live to a greater age. Their care goes across their life, so we need a pan-age mechanism for treating people on an equal basis. At the moment, that does not happen. Younger people who need long-term care get a breadth of care plans that is not available to older people. Therefore, discrimination is often apparent in the system that we have now.

We have to expand the evidence base for early intervention and really understand the benefits of that. The ILC, with which I work, has done a lot to look at saving money through people going into extra-care housing. It has clearly demonstrated that this saves a huge amount of money because people do not go into much more expensive care in a care home or even in hospital until a much later age. I believe that that is a system change that we can achieve. I hope that the Minister will confirm he feels that this is possible.

We know that by speeding up home adaptations and equipment, we can also help people to stay at home for longer. The city of Hull did something that is purely common sense. It realised that no one would ask for a ramp or a plastic lavatory seat unless they needed it because neither is very decorative in one’s home. It decided that, rather than wait for someone to assess the need and then exchange information, which takes several months, before allocating a ramp or a loo seat to anyone, it would just give them to anyone who asked. Hull has saved a huge amount of money and immediately speeded up the process by doing that. Things can be done.

The goals that the Government have indicated that they want to achieve are achievable if sometimes we just use common sense. We are all determined to speed up the process of what we need to do to make life tolerable for a whole lot of people who at the moment are subject to quite a lot of neglect. There have been many illustrations of that in the speeches made by noble Lords today.

The recent Nuffield Trust report on integrated care for patients and populations gave the Government measures that I hope they will adopt—in fact, I think that they already have. I hope that we will get clear, measurable goals to improve the experience of people; that we will be able to enhance these goals by guaranteeing a certain standard of care for patients with complex needs; and that we, and the Government, will recognise that we are talking about people for whom time is very precious. They do not have that much longer to live, so we have to have timetables that are kept to and we have to understand the complex needs of the population that we are seeking to serve. I hope that the Minister, who I know feels very strongly about these issues, in representing the Government can assure us that he will take into consideration those and the many other points that have been raised today.