Multi-agency Initiatives in Health and Social Care

Baroness Jolly Excerpts

Monday 8th December 2014 Grand Committee

[Baroness Jolly (LD)]

My Lords, I thank the noble Countess for securing this debate. She has raised some important issues. I would particularly like to thank her for providing information to me and my officials in advance of today’s debate. She will understand that I am not able to comment directly on specific cases, save to say how much I sympathise with those afflicted with this terrible condition, and indeed their families supporting them. She is right to emphasise the need for integrated approaches to meet the needs of people with ME or chronic fatigue syndrome. This is a condition that presents in a variety of systems, but the point that she raised is that it remains incompletely and inconsistently understood. Partnership working between different professionals is key to getting a consensual approach to treatment.

I am not able to determine from her speech whether she was talking about one particular geography, or a whole different load of geographies, so what is the common factor? Maybe ME is the common factor of that geography. But certainly, a lot of work has been done very recently to put in place a framework for achieving multi-agency working. There is consensus about the need to better integrate health and care and, in the case of children, education services, too. You need the three services working together. Under the Care Act, the much maligned Health and Social Care Act, and the Children and Families Act, we have made progress in ensuring that the right statutory enablers are there, while allowing local areas the freedom to develop their own accountability mechanisms depending on their local circumstances.

NHS England and clinical commissioning groups are under statutory duties to promote integration. They are required to act with a view to secure that health services are provided in an integrated way, and to secure the provision of health services integrated with the provision of health-related services, or social care services, where this would improve the quality of the services. The better care fund and integration pioneers provide a mechanism for driving the good practice of integration of health and social care for adults. Areas have pooled £5.3 billion of health and social care funding through the better care fund, with each area needing to set out a robust plan to access their share of the fund. Noble Lords are clearly aware that the Government asked areas to revise plans following an initial submission in April. They were asked to resubmit to ensure that their visions for integration, no matter how impressive, were supported by robust governance and accountability that was required to ensure the successful delivery of these joint plans. This included more evidence of how areas would move towards having a single accountable professional for people with the most complex needs, so they do not repeatedly have to tell their story; they know who to turn to when they have questions or concerns about their care. I should highlight that from 1 April 2015, all GP practices will have a named GP for every patient, including the children, taking responsibility for co-ordination for their care, which should help strengthen the links between primary and secondary care, particularly for those with a long-term condition.

For children and young people with special educational needs or disability, we have introduced a statutory framework for integration across health, social care and education. Children in this group usually have complex needs and, too often, families face a battle to get the care they need, having to repeat the same story to different services and professionals. The new framework will change that. The statutory requirements are designed to improve integrated working across health, education and social care, to deliver improved outcomes for children and their carers. Clinical commissioning groups and local authorities will work together to develop for each child an individual education, health and care plan, focused on the outcomes that will make a real difference to the child or their family. It is a statutory framework; its key points set out in the Children and Families Act 2014 and its accompanying code of practice. It requires clinical commissioning groups and local authorities to have formal arrangements in place for working together to secure joint needs assessments and the subsequent care required by the plan, as well as agreeing personal budgets for the child or young person.

Involvement of children, young people or adults in care planning, as well as their families and carers, is essential, and not just for children with special educational needs. It should be fundamental to securing an understanding between professionals and patients. For children, the EHC plan should capture the services that the child is receiving and the specific outcomes that those services will deliver. The plans must be truly person-centred by describing what success looks like in terms of the child’s experience and abilities, and each plan will have a section that allows the child and their family to talk about themselves, their wishes and aspirations. This new approach has been extensively piloted by local authority pathfinders, which have found it a tremendously invigorating way of bringing commissioners together and thinking about provision in integrated ways. I am confident that this new approach will be a powerful exemplar for other services, not just for children, on effective integration.

We should also acknowledge the related issue of getting transition right. We have heard about this through discussions of mental health and disability, when suddenly at 18 one becomes an adult. Moving from children’s to adult services, for both physical and mental health services, is too often a challenge. It is important for services to work together around the needs of young people as well as their families and carers. This is something that necessarily requires the service as a whole to be mobilised to change.

The noble Countess highlighted the CQC’s report, From the Pond into the Sea, which showed how much more we need to do to secure effective transitions. Our system-wide pledge, signed last year by the major health organisations, includes the ambition to secure care co-ordinated around the individual young person with complex needs, to deliver a positive transition to adult services. The partners to this pledge are working to deliver it, not least NHS England, which has a specific mandate commitment to support smooth transitions between children’s and adult services. NICE is developing for publication in 2016 a guideline on transition from children’s to adult services for young people using health or social care services for use in England. This promises to have a big impact on stimulating cultural change.

Our mandate to Health Education England requires it to work with key partners, including the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health to develop a training course to allow GPs to develop a specialist interest in the care of young people with long-term conditions, for introduction by September 2015, which will include particular emphasis on supporting transition from childhood.

Of course, there are cases in which integrated approaches may not work as smoothly as intended, but such disappointments will be fewer in number as we develop the necessary culture and partnership, working across health, social care and other services. I hope that I have provided some reassurance to the noble Countess that we have in place the right national legislative and policy framework.

I would just like to pick up on some points. Both the noble Countess and the noble Lord, Lord Hunt, talked about the funding for the NHS and the social care issue. The care that a person needs must not be held up by disputes over who pays or the distribution between nursing care and social care. The statutory guidance for the Care Act makes that absolutely clear. In the case cited, if discussions had begun earlier, before the young girl’s need for transition, this would have allowed significant differences of opinion to have been resolved.

I can tell the noble Lord, Lord Hunt, that it is not the case that there is a lack of accountability just because we have local commissioners. CCGs remain responsible for the healthcare they commission; local authorities are responsible for social care. In social health and well-being boards, we have a means of unifying local accountability. Health and well-being boards have local members and Healthwatch members. The parents of the children the noble Baroness has been dealing with may be making complaints, and we know from the Francis and Clwyd reports that there is more to do in improving complaints handling for health and social care. However, there is still a duty on all NHS bodies to handle complaints, and obviously the health ombudsman, to whom one can have recourse subsequently, can link up with the Local Government Ombudsman where issues covering health and social care demand it.

This has been a really interesting debate. I am quite happy to have a conversation with the noble Countess afterwards about some of the individual cases, but it is not appropriate to raise them in this context. I hope that she is confident that robust governance and accountability mechanisms are coming down the track and will be in place. They were incorporated in legislation—the Care Act and the Children and Families Act—and we should allow these mechanisms to happen locally.

Committee adjourned at 6.51 pm.