Integration of Primary and Community Care (Committee Report)

Lord Jamieson Excerpts

Thursday 9th May 2024 Lords Chamber

[Lord Jamieson (Con) (Maiden Speech)]

My Lords, I declare my interests as a councillor in Central Bedfordshire and a member of the Government’s Older People’s Housing Taskforce.

I am deeply honoured and proud to be here, making my maiden speech. I am just a little sad as my mother, who was brought up in occupied Holland by a single parent, is no longer with us, but am pleased that my father, who taught me British constitution and about the House of Lords many years ago, was able to see me introduced. I express my huge thanks to all those who have been so helpful and kind, as I go through this astonishing learning curve—Black Rod, the clerks, the doorkeepers, everyone who works in the House and all your Lordships, who have been hugely welcoming. I express a particular thanks to my supporters, my noble friends Lord Porter of Spalding and Lady Scott of Bybrook, and my mentor, my noble friend Lady Redfern, who were all stalwarts in local government before me.

I started life as an engineer in Sheffield, working for British Steel. It is a tragedy in this country that we do not support our engineers enough, and I moved to marketing and banking as I sought to further my career and pay the bills, before getting involved in politics locally, then nationally as chairman of the LGA. Why? Because I, like councillors across the country, just wanted to do something for our communities and get stuff done.

One of the great successes of our society has been increased life expectancy, something I am sure that all noble Lords will be pleased with. In 1970, the average male life expectancy was 69, compared to the average age of a Peer today, which is 71. Today, someone retiring can expect to live to 85—a quadrupling of retirement. This is great news, but it comes with costs, most visibly in health and social care. This is exacerbated by other trends: a declining birth rate, along with people starting their careers later, and smaller and more disparate families. Long gone are the days when we had three generations of one family living in the same street or town, supporting one another. There is a breakdown of our traditional communities as we live more insular and transient lives.

There is one statistic that really brings this home: the proportion of the working population employed in health and social care. Currently, it is around one in seven. A recent Dutch report estimated that it would be one in four by 2040 and, without change, would inexorably rise to one in three. This is simply not sustainable; we need to think radically differently if we are to have a sustainable system and ensure that we all enjoy a fulfilling old age. It will require cultural change and a willingness to embrace the politically difficult. I am an optimist, and I believe this can be done, and we will achieve it.

I welcome this report, and the great work of the committee and the noble Baroness, Lady Pitkeathley, and its recommendations, many of which are in line with the work of the Local Government Association. We need to focus on prevention and early intervention—keeping people healthy for longer and out of hospital—and the crucial roles of primary, community and social care, integration, colocation, data sharing and a genuine, joined-up approach.

There are other key issues, such as housing and community. Living in isolated, inappropriate housing does not work. I saw the difference first hand, when my Dutch grandmother moved to an older person’ apartment in her sixties, next to shops, older people’s clubs and transport, and lived there for more than 30 years, needing virtually no additional help until very late on, and had a great life. My English grandmother continued to live in the family home, and had a very different set of outcomes.

We need homes that are suitable for later living, which are part of a community and in the community. There are many life-changing stories from the extra care housing we built in central Bedfordshire, but we need much more of this. Technology offers the opportunity to deliver so much more—AI, diagnostics, personalised medicines, robotics and health monitoring automation. We need to embrace this, but it will mean a radical change to the way in which our public services are delivered.

Finally, on keeping active, Department of Health figures show that only 17% of men and 13% of women over the age of 65 are sufficiently active. This is not just about exercise. Older people have so much they can contribute to society. We need to include them, and they need to include themselves. The retired can and should be the bedrock of our communities. While there is much that government should do, this is a much broader issue. We personally need to think about what it means to get older, and how we plan for it. We should not abrogate this and rely on others. People think about pensions, but not about housing, personal resilience, building their community networks and ensuring their own fitness and quality of diet. This is what I mean by cultural change. If we are to have a sustainable and positive old age, we as a society need to embrace it, recognise our own responsibilities, build communities and accept a changed public service delivery model.