Health and Social Care Bill

Baroness Jolly Excerpts

Wednesday 2nd November 2011 Lords Chamber

I make one final comment on integration, but integration of a slightly different kind. The Government are consulting at the moment with a consultation document about the future of social care. I have read that document and responses have been asked for in writing by 2 December. That is extraordinary, is it not? The Government bring forward a new Bill and we are starting the Committee stage, which will probably go on until after 2 December, although I have no idea for how long—none of us does. At the same time, they are consulting on a document about social care. One might think that they would design a new social care system, look at how it needs to be integrated with the rest of healthcare and then come forward with a coherent Bill. Frankly, it is the most extraordinary way of doing anything. It would be the most extraordinary way of running a railway. In my view, it is the most extraordinary way of legislating and the most extraordinary way of running the health service. I hope that the Minister is not too upset by my strictures, which are not personally addressed to him, but an answer does seem to be required as to why these two initiatives seem to be proceeding in parallel with no apparent integration at all.

[Baroness Jolly]

My Lords, I think it is entirely appropriate that integration is included in the Secretary of State’s duty with regard to the improvement of the quality of services. I do not think that anything can improve services more than making them patient-centred, and it is the whole business of integration that will make services focus on the patient. Therefore, we welcome the language. Again, I do not know whether it is in the right place but we welcome the fact that it is there, as well as the definition.

Integration is critical. We have heard about the savings that we need to make, and integrating care is cost-effective as well as being good for patients. I want to talk briefly about social care and the community, and about how the community care too. I come from the south-west, so I will also mention Torbay, which is the jewel in the crown in our neck of the woods. The thing that has worked in Torbay was that when PCTs were set up, the local council decided that, working with the area health board, it did not want a PCT, it wanted to have a care trust. The key to the whole thing was having not only shared governance but a shared budget. There was only one pot of money to fight over and all decisions were made by councillors, non-execs and the executive round the same table. So, in Torbay care is totally integrated.

In Plymouth there is another small integration pilot going on in the DGH whereby many patients from Cornwall go over the border to the acute hospital. Somewhere in the region of a quarter of Cornish patients do not go to Truro; they go to Plymouth. Discharge has historically been a huge problem—bed blocking, Friday afternoons, all the usual sorts of things. It was a joint appointment between the PCT and social services. A social work team was put into the hospital and they liaised with all the right people when discharge was coming along. There was liaison with patients, carers, GPs, social services, care homes, domiciliary, district nurses—the whole thing—to make sure that when the patient was ready to leave the acute service they went to their next port of call and everything was all teed up ready for them to go on. That was effective. It saved time and it was much better for the patient.

I return to the amendments. There is a whole series of interesting additions which are all to be outcomes—but outcomes need measuring. So how do we measure, and what are the indicators for the effectiveness of integration of services, or the equitable provision of care, or the safety of the service? These are good things to achieve and aspire towards but I am not sure how they will be measured. I would like some clarification from the Minister as a general point. Some of the outcomes from the original Bill were added to. How will the success or otherwise of achieving these outcomes be measured and how will it be reported?