Multi-agency Initiatives in Health and Social Care

Lord Hunt of Kings Heath Excerpts

Monday 8th December 2014 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much welcome the noble Countess securing this debate and what she has to say. She has used examples of a number of young people with CFS/ME and has illustrated some of the issues that arise where it appears that no one person or agency ultimately takes responsibility for the way that they are treated and supported. It would be helpful if the Minister were prepared to have a look at some of the detail of the issues raised by the noble Countess. I understand that Ministers cannot intervene in such cases, but there may be a pattern here which it might be valuable for her department to be prepared to look at.

The question of accountability applies to many aspects of health and social care. Recently, I was reading the National Audit Office report on the better care fund, the fund that has been created, partly from NHS money, to invest in community care in order to reduce some of the pressures on our health service. The Minister will be aware that the original fund ran into trouble and that there was a redesign of the scheme in April this year. Interestingly, the National Audit Office has some concerns about how what should be an integrated approach will actually work. I was also interested to read another report, from the King’s Fund, which was cited in a briefing that I received from the Royal College of Nursing. The King’s Fund looked at common challenges to integrated care. It talked about lack of funding, lack of GP engagement, the inability of wider health systems to innovate effectively, the lack of integrated IT systems and problems caring for people in remote and rural locations.

It is patently obvious that unless you have some agency, or a multi-agency approach, in which someone is held accountable for the way the whole thing works, we are unlikely to see major improvements. My experience in Birmingham, when I chaired the Heart of England NHS Foundation Trust, was of the kind of pressures that you get in the health service: problems with out-of-hours and primary care, and big cutbacks in social care. Demographics mean that more frail and older people go into hospital, and then it is hard to discharge them. There can be any number of meetings, and you can have regulators coming down to beat the acute trust up, but nobody seems to be able to hold the system to account. It is so obvious that these are problems of a collective system.

That is why I think that the noble Countess is absolutely right to ask this Question. My party’s proposal for whole person care is designed to try to deal with those issues by bringing health and social care together under the auspices of the health and well-being board, with an integrated budget and a single point of contact for people with multiple needs. These seem to me to be the essential ingredients. Also, we have to get back to a situation where someone takes responsibility for the way that a local health and care system actually works.

I do not want to reopen our debates on the Health and Social Care Bill in 2012, but it is patently clear that the Government have produced a set of arrangements in which nobody is accountable for anything. That is the huge problem that we face. If we try to raise issues with Ministers on a particular condition—I have three cases running in relation to different medical conditions—essentially, they will say that it is a matter for NHS England. You then go to NHS England, where you find that there is no one responsible for single service areas, because they have the mantra either that it is specialised commissioning or that it is down to clinical commissioning groups.

That is replicated elsewhere. For instance, I ask the Minister: who is responsible for the effectiveness of the Birmingham health system? Nobody is, because it is split between different clinical commissioning groups and a variety of NHS trusts. The local office of NHS England clearly does not have the capacity to exercise leadership, nor do people at the centre think that it should.

One way or another, we have a big problem around the need for integrated services, whether it is services for the community as a whole or services for individuals, in the cases that the noble Countess has cited. At the moment, it seems very difficult to produce a set of arrangements where, in the end, you can finger somebody and actually say, “You are responsible for making this thing work together”. The noble Countess has done us a great service in raising a fundamental issue about the current arrangements. We all look forward to the Minister’s response.