Health and Social Care Bill

Baroness Wall of New Barnet Excerpts

Monday 27th February 2012 Lords Chamber

[Baroness Wall of New Barnet]

My Lords, I, too, support the amendment. I want to focus particularly on integration in terms of what is provided by an acute hospital, compared with what is provided in the community. The noble Earl will know how many times I have spoken about how important and welcome it is that—as my noble friend Lady Pitkeathley said—the Bill includes social care and the patient pathway. However, the patient pathway does not and will not happen for the very reasons that this amendment identifies. It does not happen because of the integration described in the patient pathway, all parts of which patients are attached to, and all parts of which the providers of care try to work to. It will not happen unless the commissioners ensure two things. First, the tariff must make it happen. A tariff must be developed which says that this should be done somewhere else and we must say what the tariff measurement will be. Secondly, they must account for it. We know that while very often commissioners—certainly in the clusters that I am involved with in north-central London—try hard to prevent patients from going to hospital and to prevent repeat visits to hospital, in reality it does not work.

I am very supportive of this part of this Bill, and very keen on the integrated elements, not just with the local authorities—as has been said—but also within the health provision itself, because it is not happening now. These amendments address just that. Can we please hear from the Minister that he understands that the only way for people to be treated nearer to home is by addressing what the tariff is and how we measure it, as well as through accountability of both of the Commissioning Board and Monitor to ensure that this happens? Even in well intentioned trusts, it does not happen because there is nothing in place to make it happen.

[Lord Sutherland of Houndwood]

My Lords, I support the amendment for three reasons. First, were it to be implemented, the effectiveness of the care provided would be magnified and significantly improved for every individual involved. Secondly, there would be better value for money. Whether we like it or not, the two professions fight with each other over budget: that is the reality. Unless they are pushed towards talking to each other seriously—which this amendment does—that will continue, and we will have the consequence of expensive hospital care militating against the provision of adequate home care. Thirdly, human beings are individuals. Over time especially, they have a number of ailments that need to be seen together, and they need to be treated as individuals. An individual does not break up into bits, going to one institution for part of his or her care and to a second institution for another part. There is a real difficulty here. Previous research shows very clearly that trying to put a dividing line between health and social care does not work.

We hear statements implying that it is going to be really quite difficult. This is not rocket science. It must be based on two professions coming together. This is being done in Scotland at the moment, and they have found ways to move ahead. I understand that there are pilots going on in England at the moment sponsored by the department, and I look forward with great interest to seeing what comes out of these. However, there is a lacuna in the Bill regarding how health and social care integrate. As long as this is so, the amendment would push things forward significantly.