Ageing: Public Services and Demographic Change Committee Report

Lord Bichard Excerpts

Thursday 17th October 2013 Lords Chamber

[Lord Bichard (CB)]

My Lords, I congratulate the noble Lord, Lord Filkin, on the way in which he has led the work of this committee, which has been quite exceptional. I also want to congratulate the noble Lord, Lord Livingston, on a quite outstanding maiden speech. I cannot share the noble Lord’s passion for Glasgow Celtic but I agreed with every other word. The greatest compliment that I can pay is that the noble Lord would have made a quite exceptional member of this Select Committee. I look forward to hearing more from him in the future.

The Select Committee inquiry was not just about ageing but about our public services and how well equipped they are to cope with the major social challenges that we face. I am afraid that I came to the conclusion that they are not well equipped: not because they do not have the resources—although clearly there are problems at the moment—but because somehow we have still not been able to design, build and shape our public services around citizens and clients. Whatever the rhetoric and whatever the good intentions, our focus has continued to be on the providers and their convenience rather than on the needs of clients and citizens.

The evidence for that is very clear. For many years, we have encouraged different agencies to develop plans and objectives in isolation. We have set separate targets for each of them, which have sometimes been in conflict. We have developed different and sometimes contradictory regimes. We have failed to provide support for users seeking to find a way through this increasingly complex system. We have failed to encourage and incentivise collaboration between different agencies.

That has been the case especially in Whitehall, where departments have fought, mostly successfully, to maintain their independence, sometimes reinforcing their empires by building their own inspection and regulation regimes which have made it very difficult, sometimes impossible, for local agencies to work together for the benefit of clients. In addition, we have designed measures of success which have had more to do with bureaucracy and budgets than the needs of clients. We have responded to problems by reorganising structures, not redesigning services. Perhaps most of all, we have consistently failed to involve clients in the design of our public services.

The work of the Select Committee exposed four consequences of these fault lines. First, the failure of departments to work together means that there is still no coherent strategy for ageing in this country, because to have one would need housing through the DCLG and finance through the Treasury, and for health, social care, planning, education and DWP to get together meaningfully to produce a coherent strategy. They have not done it.

Secondly, the fragmentation of the system means that it copes particularly badly with people who have complex problems. Most older people now have what is known as comorbidity—they have complex problems. I am afraid to say that they often find themselves having to go to different providers or agencies to deal with each of their conditions.

The third consequence is that when those on the front line trying to provide joined-up care have succeeded it has been in spite of the system that we have designed and not because of it—they told us that very clearly. Fourthly and worst of all, vulnerable old people, often with long-standing and debilitating conditions, find their final days consumed with stress and bureaucracy. I was hearing yesterday of an old lady—let us call her Mrs Jones—who was in hospital when she was given the news that she was reaching the end of her life. Mrs Jones wanted to end her life, like most people do, at home. The hospital staff, to their credit, wanted to support her in that ambition. In order to realise that single, simple wish required the involvement of 23 different teams, the completion of 25 assessment forms and the convening of two separate funding panels. It took three agonising months and she finally got home two weeks before she died.

I have been speaking about the need for designing around clients and collaboration in our public services for many years. Many people think that you are talking about something dry: the reorganisation of Whitehall or whatever. But you are not. You are talking about the implications for Mrs Jones and the countless people like her for whom this system does not work.

The Minister, who I know shares many of these thoughts, will point to many very good initiatives which are under way. The integration pioneer programme is fantastic and, similarly, much in the care plan. I applaud that; I wish him well with it. But we need even more. We need a crusade to ensure that in future we never design public services for the benefit of providers; we design them for the benefit of clients.