Health and Social Care in England

Lord Bishop of Derby Excerpts

Thursday 11th July 2013 Lords Chamber

[The Lord Bishop of Derby]

My Lords, I, too, congratulate the noble Lord, Lord Patel, on securing the debate. As we have heard from all speakers so far, there is a strong narrative about how precious the NHS is, how high public expectation remains and the problem of rising costs—it’s own health check has just been referred to.

I want to talk a little about care systems and the models that we might need to develop. Experience on the ground tells us that care systems are very fragmented. As systems such as family stability collapse, many people are isolated and struggle to access care and health services. The current system is very skewed towards the delivery of episodic interventions around particular crises. We need to look below that. We need to step back and see how we can create a culture of engagement, support and well-being for people that puts those episodic interventions in a different context and perhaps provides a context in which they would be less necessary and less frequent. I shall raise some questions about models and capacity, not least in relation to the elderly.

I work in the county of Derbyshire. Last year, in the city of Derby, I organised a commission, the Redfern commission, which looked at models of care in our community and how we could contribute alongside the statutory provision. We had a public hearing looking at models of care for the elderly. One of the experts who came as a witness to that public hearing raised three issues. She started by talking about people’s feet and the fact that proper foot care is very important to allow people to continue to have mobility—to be able to shop, do their cleaning and have social intercourse. Very simple things that require microengagement make a huge difference to people’s well-being and health. She also talked about the reluctance of doctors to diagnose depression in elderly patients who suffer a lot of loss. She said that something like 2 million elderly people are diagnosed with clinical depression, but there are probably far more, and it is hard for them to get treatment or even support on the ground. She also raised the lack of provision of advice for elderly people about sexual health.

Many of these things can be dealt with not through episodic major interventions but through a culture on the ground of support, care and contact. It is voluntary groups—churches especially—that in most communities provide lunch clubs, outreach and all the things that allow people who are otherwise isolated and struggling with medical and social care conditions to be supported. However, 87% of local authorities are setting their eligibility criteria at substantial or higher. I think we need models that look below the surface where people need care and can be sustained more realistically. In a parish in a rural group of parishes, the parish, the diocese and the Simeon Trust have brought together resources to appoint a chaplain. In that rural area, that lady visits 140 people regularly to monitor them, to put them in touch with each other, to help to assess them face to face and to know when support from the medical and care system might kick in, so that people do not get to an acute moment. There is a community system of monitoring, care and contact.

That kind of model needs to be developed. The Dilnot report said that there has to be a new relationship between individuals and the care system. Beneath the radar of the formal care system, there are enormous resources in the voluntary community that can allow that to happen. Will the Minister consider how the Government, local government and the framework of formal systems can enable a small amount of investment to encourage voluntary and church groups doing this face-to-face work on the ground that provides the context for care and well-being to flourish and grow so that the demand for the major interventions that are so costly might be more controlled and probably reduced because of a better sense of well-being at grass roots level? I would be interested if the Minister could comment on that model and how it might be encouraged and developed to create greater capacity in our systems of social care and health provision.