Integration of Primary and Community Care (Committee Report)

Baroness Tyler of Enfield Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, this debate is very timely as it picks up neatly from our recent debate on the long-term sustainability of the NHS. One of the key takeaways from that debate was the urgent need to move to a more preventive model of care, with investment moved upstream. It will be critical if we are to lower waiting times, improve access and reduce health inequalities.

It is indisputable that funding growth in the health and care system is skewed towards the acute sector. Despite the fact that the majority of daily NHS activity happens in general practice in the community, a large proportion of expenditure on health and social care goes towards acute hospital trusts. Community sector funding has grown at only half the rate of hospital trusts in recent years. The answer to overcrowded hospitals is not simply more hospitals; the health and care system must be radically refocused to put primary and community care at its core.

As we have already heard, a more radical shift to a preventive model of health was one of the key findings of our Select Committee, which was so superbly chaired by the noble Baroness, Lady Pitkeathley—whom I always think of as my noble friend. In short, our committee found that a lack of co-ordination between the everyday primary and community services relied on by people using the NHS was leading to substandard care, missed opportunities for home or community-based treatments, and an undue strain on already overstretched hospitals. Our report argued for a healthcare sector where patients were given the type of care they needed, when, where and how they needed it. That might be access to a GP, a pharmacist, a district nurse or a mental health nurse, along with greater focus on more joined-up preventive care. The evidence is quite clear that investing in primary and community care—which includes mental health—results in lower demand in hospital and emergency care. It really is not rocket science.

A wholesale shift in thinking and culture is required, and it goes a lot wider than funding, as our report said. As the King’s Fund has argued, it involves national measures and targets for the health and care system shifting towards longer-term goals to integrate care and ensure that services can focus on population health rather than being focused on short-term acute measures. This approach is very much backed up by the World Health Organization, which has argued that a primary and community care-focused approach is the most effective and sustainable way of improving the health and well-being of our population.

We have already heard about integrated care systems, which have an important role to play in delivering this change, particularly if they focus on population health, as was the original intention. From the evidence we received, it was clear that local leaders know the challenges for their local communities and the local landscape of primary and community care, and they know it best. Leaders of integrated care systems, place-based partnerships, including health and well-being boards, and primary care networks are best placed to design and deliver joined-up primary and community care.

ICBs should be held to account for their achievements in growing primary and community care services rather than for the performance management of hospital systems, and a stronger primary care voice on ICBs and representation from the voluntary sector would undoubtedly help.

It was clear, as we all know, that the workforce is crucial, not just in primary and community health but in adult social care and the voluntary sector. We need a skilled and well-valued workforce to support people to live independent and healthy lives. Surely the Government should now commit to fully funding and delivering the NHS long-term workforce plan, alongside developing an equivalent plan for social care, where workforce shortages are leading the sector to struggle to support those who need social care, in turn placing additional pressures on primary and community care. Can the Minister say when the Government will heed the calls of so many in this Chamber and in the wider sector to produce a workforce strategy for social care?

Other speakers will no doubt focus on the importance of data sharing for successful joined-up services. We must ensure that patient records can be easily accessed across the health and social care system, including in primary and community care. I found the government response to our recommendations on this issue vague and technocratic. Will the Minister please say exactly what the Government are doing to ensure this happens?

I will pick up on a couple of other specific points from the government response. Recommendation 2 of our report said that elected local government officials should be given the right to chair ICBs where that was the will of the board, underlining the truly joint and equal role of NHS bodies and local authorities in producing a holistic health and social care system. The government response did not make clear whether they were prepared to let this happen. Can the Minister please answer this specific point?

Recommendation 5 was for the Secretary of State to instruct the CQC to develop a specific integration index to compare how well ICSs co-ordinated different services in their areas. The government response does not commit to implementing this. Will the Minster say what the Government’s intentions are in this area?

Finally, recommendations 14 and 16 contained important proposals on training and job rotation. We saw a clear tension between our hospital-centric system of health and care, with increased specialism, and people having increasingly complex health and care needs, which need an integrated, holistic response, hence the need for a different approach to training and job rotation. I would like to see clinical and managerial health leaders strongly encouraged to work in community settings and develop experience across a range of sectors. I found the government response on this unsatisfactory—indeed, there was no response to the point about job rotations. I strongly urge the Government to think again.