Hospitals: Voluntary Sector and Emergency Readmissions

Lord Bradley Excerpts

Monday 1st December 2014 Grand Committee

[Lord Bradley (Lab)]

My Lords, I congratulate the noble Baroness on initiating this debate. Although she said that it was put down some time ago, it could not be more timely with the discussions around the health service being so relevant at the present time, and particularly today. So, although there are few us here, as she pointed out, it is a part of a wider debate and conversation about the development of services within the National Health Service.

I have fond memories of the WRVS as a former MP. We were regularly asked to do, and willingly undertook, voluntary work with it in our local hospitals. Often it was one of the most pleasurable days of the year, going round the wards with tea trolleys and seeing day after day the commitment to and enthusiasm for supporting the professionals within that setting and ensuring a high-quality service to patients within those hospitals.

To add briefly to the context of today’s debate, I looked at the King’s Fund report of 2013, Volunteering in Health and Care. Securing a Sustainable Future, which states:

“The health and social care system is under extreme pressure to improve the quality and efficiency of services. To meet the challenges ahead, service providers will need to think differently about how they work and who they work with … One important group in these debates is the millions of people who volunteer in health and social care, in both the voluntary sector and within public services—an estimated 3 million people across England. These people”—

as the noble Baroness said—

“add significant value to the work of paid professionals, and are a critical but often under-appreciated part of the health and social care workforce”.

The King’s Fund research indicates that,

“volunteers play an important role in improving people’s experience of care, building stronger relationships between services and communities, supporting integrated care, improving public health and reducing health inequalities. The support that volunteers provide can be of particular value to those who rely most heavily on services, such as people with multiple long-term conditions or mental health problems”.

It suggests that, to achieve the best scenario, the critical role of volunteers in building a sustainable approach to health and social care must be acknowledged, and the research recognises five key areas, which I hope we can debate at a future time.

I just want to add topically that, as the noble Baroness pointed out, today the Government are responding to NHS England’s five-year forward plan. In the paragraph on encouraging community volunteering, they acknowledge the importance of volunteers, as I have just described, and they put forward examples of how those volunteers might be utilised most effectively. I hope that the Minister will comment on that. I do not want to stray into the response or the Statement that is to follow but I hope that there will be some recognition of the vital role of volunteers in this country.

As the noble Baroness pointed out, an excellent report on the Hospital 2 Home scheme was produced by the RVS a short while ago. It gave some interesting statistics about the scale of the issue, particularly regarding the over-75s. It is estimated that there are now 5.1 million over-75s in this country, up from 4.4 million in 2010, with there being an estimated 7 million by 2035. Forty-six per cent of those over-75s live alone, and 38% of 75 year-olds now return home from hospital—up from 10% in 2004. The RVS’s report was very timely in showing that a much greater number of over-75s go home from hospital and that they need support to ensure that they are not readmitted, as this debate is about. Before they are discharged, they often feel anxious and not ready to go home. That is often because they know that they are going home alone and that they will not get the support that they require to give them confidence, or may not get the immediate services that are required to ensure that they return home in a satisfactory way and are not looking for early readmission. Early readmission can be a consequence of that anxiety. I am not suggesting that no people in this age group will have to return to hospital, but let us see whether there is a mechanism to ensure that the services that are required to wrap around them at the point of discharge are most satisfactory.

From my experience of working in the voluntary sector with people with mental health problems—particularly those who come into contact with the criminal justice system—I have found that there is very poor evaluation of the cost benefits of the work of the voluntary sector. In the RVS report, it is estimated that savings on readmission are around £40 million a year but there is no solid evidence to support that figure. It is a very good estimation of what those savings can be but the Government should look rigorously at better models for considering outcomes and for assessing the real value to society of volunteers. As I said, from my work with the mental health and criminal justice system, I know that there is a paucity of information about the support that mentoring can give, for example, to people with mental health problems who may come back into the community from the criminal justice system. That value of that to society is completely underestimated. I am not comparing it directly with readmission to hospital but there is a great value to society to be had when we are talking about readmission to the criminal justice system as a result of not having that support. I urge the Government to look very carefully at how we can assess more effectively the savings that can be made through effective mentoring and the use of volunteers.

However, we should never presume that volunteers are in some way a cheap option within the development of public services. They have to be valued as part of the team, and we have to ensure that, when services are commissioned using the voluntary sector, the sector has sufficient support and infrastructure to ensure that it can be an effective part of service delivery. I am always concerned that, as we move into the new contracting arrangements within the commissioning of services, the value of volunteers or the voluntary sector is not adequately taken into account as those contracts are developed to ensure that the high quality and local nature of those services are properly recognised and become integrated into the way in which the 3 million volunteers so willingly give their time and expertise.

I again congratulate the noble Baroness on this debate, and the debate will go forward very effectively now because, as we struggle to ensure that we support people whatever their illnesses or age group, the voluntary sector will become an even more important part of our civic life.