NHS and Social Care: Winter Service Delivery

Lord O'Shaughnessy Excerpts

Thursday 25th January 2018 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, I begin by congratulating the noble Baroness, Lady Wheeler, on securing this debate and bringing very welcome attention to the interaction between the NHS and social care systems. I am of course speaking on behalf of the newly minted Department of Health and Social Care and I promise that a focus on service integration is one that the Secretary of State and I, as well as Caroline Dinenage—who is Minister of State for Care, just to clarify that question—welcome and embrace. That is not, as we have discussed today, solely to deal with the winter pressures the NHS and social care systems face, but in order to provide a truly world-class health and social care system. Before answering the question that the noble Lord, Lord Hunt, asked about social care policy, this means that the department, through the Secretary of State and the Minister of State, are driving the reform process through the Green Paper, which was previously under the control of the Cabinet Office.

I congratulate all noble Lords on their contributions. I fear that there is sometimes a tendency in these debates—rightly, because we all want to solve problems—to focus on negatives. It was good to hear from the noble Lord, Lord Brooke, and I hope that the family member concerned is in good health now and having a positive experience of their care, even though the situation he describes is rather alarming; it is certainly something I shall look into. We know that the vast majority of care being delivered is of a high quality and of course, that is because of the wonderful health and care staff to whom we all owe so much.

I start where the noble Lord, Lord Desai, started—in the less controversial part of his speech—by recognising that many of our challenges stem from the fact that people are living longer, which of course is very welcome. It is a global phenomenon: worldwide, the population aged 60 or over is growing faster than all younger age groups. In developed countries the proportion of the population aged 65 and over is expected to rise by 10% over the next 40 years. What that means in England is that by 2026 the population aged 75 and over is projected to rise by 1.5 million, from 4.5 million to 6 million, and by 2041 to have nearly doubled to 8.3 million.

Funding social care and health services is of course a challenge that all developed countries face. One issue, as we have said, is longevity; the other is the likelihood of multiple health conditions. An arresting fact is that by 2025, the number of older people living with a disability could increase by 25%, while the number of people with dementia will increase by 50% over the next 10 years. That is one reason why the solutions we come up with in the social care system need to deal with some of the arbitrary distinctions in the way that older people with different conditions get dealt with by the current set-up.

As noble Lords have pointed out, that inevitably means that we must change the way we provide services. The traditional model of healthcare was reactive, set up to deal with infectious diseases. Now, we are dealing with long-term, complex conditions that incorporate not just physical illness, but mental illness, as the noble Baroness, Lady Hollins, pointed out. Equally, the traditional model of social care relies on admissions to care homes, whereas we know that people increasingly want that care to be delivered in their own home. That in itself brings challenges, as the noble Baroness, Lady Watkins, said regarding loneliness and that horrifying statistic of older people suffering malnutrition in the home. These traditional models need to change. They are expensive and tend toward silo working. We need to move to a system in which care is individually tailored to people’s needs.

I will come on to talk about winter, but I want to address the situation regarding social care funding, which has been the topic of so many noble Lords’ speeches today. We know and admit that local authority budgets have faced pressures in recent years. They account for about a quarter of public spending and they had to play their part in dealing with the historic deficit inherited by the coalition Government in 2010. That meant that social care funding was inevitably impacted during the last Parliament, but with the deficit under control, we have turned a corner. There were two Budgets last year. In the March Budget, the Government announced that councils in England would receive an additional £2 billion for social care over the next three years. I understand noble Lords saying that is not enough, but it is important to recognise that that, combined with other measures, gives councils access to over £9 billion over three years in dedicated funding for social care. That gives local authorities the ability to increase spending on adult social care in real terms to support and sustain a more diverse care market. As noble Lords have pointed out, that is incredibly important. The 2014 Care Act places obligations on local authorities and this extra funding is designed to enable them to meet those standards. The funding will also inevitably help to ease pressure on the NHS, including—as many noble Lords have pointed out—by supporting more people to be discharged from hospital as soon as they are ready. That is always important for patient welfare and safety, but never more so than at this time of year.

Winter is always challenging for the NHS in all four countries of the United Kingdom—not just this year, but in other years too. That is of course because cold weather and an increase in flu and other viruses place additional demands on the service. This year, preparations began earlier than ever before. I quote Sir Bruce Keogh, NHS England’s national medical director, who said:

“I think it’s the one that we’re best prepared for. Historically we begin preparing in July/August. This year we started preparing last winter.”


I was pleased to hear the noble Lord, Lord Kerslake, recognise that that preparation—as called for by the right reverend Prelate the Bishop of Carlisle—had taken place. Of course, that means we need to start preparing for next winter now; and indeed, we are.

Ahead of winter, NHS England and NHS Improvement also asked international experts from five leading countries to review how well prepared the NHS was for winter. They complimented the NHS on its state of readiness. In practical terms, they meant that just before Christmas—on Christmas Eve—bed occupancy had been reduced to 84%, helping to free up capacity to deal with the increased demand on services seen following the new year. Similarly, as my noble friend Lady Eaton pointed out, the 20% reduction delivered by local authorities has freed up over 1,400 beds a day.

I should also take this opportunity to reiterate the apology made by the Prime Minister for the cancelling of elective care. It was a difficult but planned-for decision to deal with extra demand as it arose. I should also emphasise that it did not include urgent treatments or treatments related to cancer.

Noble Lords will I hope know, as we have discussed it before, that there has been an unprecedented system-wide push on flu vaccination, including an expansion of the winter GP and national pharmacy programme. For the first time, workers in care homes have been able to access the vaccine free of charge. This has meant over 1 million extra people have been vaccinated, with the highest ever uptake among healthcare workers at 59.3%.

We know that doing things efficiently is one approach but we also know that more money is necessary. The Budget provided an extra £337 million-worth of funding for winter. The noble Baroness, Lady Wheeler, challenged me on whether that money came too late. It is important to point out that at least half that money went to fund plans that were already in place. It is simply not the case that it could be implemented only once it had arrived. I should also point out in response to, the noble Baronesses, Lady Wheeler and Lady Barker, and others that, NHS England will at Easter be reviewing the impact of all the funding and the measures it took to deal with winter. The consequence of that funding is to have helped the NHS to open over 1,300 beds in December. That is on track to rise to 2,700 in February; the latest data shows 3,000 additional beds have been made available since the end of November.

However, I recognise that the preparations and investment have not fully been able to mitigate the enormous pressures on services, including ambulance services, and that in some cases this has led to unacceptable care being delivered. In particular, the rate of flu in hospitals is higher than the peaks reached in the previous seven seasons. The latest data in December showed that emergency admissions had risen by 4.5% compared to last year, so services are extremely busy. Despite that, the NHS treated 55,328 patients every day in A&E within four hours in December—over 1,200 more every day compared to the previous December. Let me use this opportunity to pay tribute again to the incredible work that our NHS workers do in emergency departments across the country.

As the noble Baroness, Lady Barker, reminded us, there have been many well-meaning actions by successive Governments over the years intending to improve our health services, but they have sometimes got in the way of delivering a truly joined-up system. I believe we all know and agree that the only sustainable solution to short and long-term pressures on the NHS is the integration of health and care services. That is the goal set out in NHS England’s five-year forward view, which this Government endorse. Integration is already happening on the ground. Now in its third year, the better care fund is a mandatory, national programme for integrating health and social care, which joins up services so that they are designed around people’s needs and enabling them to manage their own well-being, and to live as independently as possible. By mandating the pooling of funds, the better care fund has helped to join up health and care services, and to incentivise local areas to work together, with increasing amounts of funds used within this process.

The challenge now, which all noble Lords alluded to, is that we need to take that model and spread it into all corners of the health and care system, taking advantage wherever possible of the huge potential of technology to transform the way that care is delivered. The noble Baronesses, Lady Watkins and Lady Jolly, made suggestions about particular pilots and the use of community hospitals for integration. Schemes such as the vanguards scheme and new models of care are doing that, but I shall certainly take away their ideas and write to them to see whether we could do more to hasten that integration.

We all acknowledge that the health and care systems have to work collectively to transform themselves for the future, both in the interests of patient care and to put the system on a financially sustainable footing. The key process for delivering that is through the sustainability and transformation programme. The noble Lord, Lord Hunt, asked whether we were still as committed as we were before to that programme. I can promise him that we are and that it is now evolving into the creation of accountable care systems, which bring every actor in the local area’s health and care system together to deliver the kind of care that we want to see. That was backed by significant capital funding in the Budget.

The first group of designated accountable care systems have agreed to deliver their fast-track improvements as set out in the next steps on the five-year forward view, including taking the strain off A&E, investing in general practice to make it easier to get a GP appointment, and improving access to high-quality cancer and mental health services.

We know that the burden of care cannot simply continue to fall on hospitals. We need to move care into the home and the community. It was instructive to hear from the noble Lord, Lord Smith of Leigh, about how Wigan, as part of devo-Manc, is taking the lead in that initiative. Service integration needs to be underpinned by a joined-up workforce, as many noble Lords have said. That is why it is welcome to see the draft workforce plan launched by Health Education England. It includes the social care workforce, recognising the interdependencies between the two workforces. Many noble Lords, including the noble Baronesses, Lady Watkins and Lady Barker, asked about total staffing numbers. It is a topic we talk about a lot in this House, and I hope they will welcome the increase in training places for doctors and nurses. I should point out to the noble Lord, Lord Smith, that it also includes increased training places for emergency doctors.

I turn to the social care Green Paper. I use this opportunity to reiterate the Government’s commitment to publish a Green Paper by the summer of this year setting out their proposals for the reform of social care. It will be broad in scope and will look at the full range of issues relating to older people’s social care. To answer the noble Lord, Lord Pendry, it is intended to lead to a lasting solution. In developing the Green Paper, it is right that we take the time needed to debate the many complex issues, listen to the perspectives of experts and care users and try to build consensus, which has too often eluded us, so that the reforms can succeed. I look forward to engaging with all noble Lords in that process to take advantage of the golden opportunity to achieve lasting reform, as the noble Lord, Lord Pendry, said. The Green Paper will include action on carers. Many noble Lords asked about that. There will also be a carers action plan. I am not able to give a date on that, but I will write to all noble Lords when I am able to do so.

As well as reforming care, we also understand that the NHS needs to change. The Secretary of State for Health and Social Care said that,

“as we come to the end of the five year forward view, we need to seek consensus on the next stage for the NHS. We will need significantly more funding in the years ahead, and we need to build a national consensus on … that funding”.—[Official Report, Commons, 10/1/18; col. 346.]

The Secretary of State’s view is that we should try to do that for a 10-year period and not a five-year period. He is clear that he is open to all discussions with colleagues about the best ways to do that. I know that he is making that case in government, but we are clear that NHS spending will continue to rise to meet the demographic challenges that we face.

The noble Lord, Lord Macpherson, provided some interesting and well-considered ideas, which were backed up by the noble Lord, Lord Desai, and others, about how things could change. We can and must speculate about different ways of raising revenue for various spending priorities. Of course, taxation is a matter for the Chancellor and the Treasury, but the last Budget shows that when we have been given the opportunity to increase funding for the NHS, we have done so. Indeed, the proportion of public spending taken by the NHS has been increasing over time.

Building a sustainable health and care system will require some big and urgent decisions, but getting this right promises a better service, where people understand their responsibilities, can prepare for the future and know that they will receive care of a high standard that will help them maintain their independence and well-being. We need to create a consensus, by whatever means, in this country behind a plan for change. That has eluded too many Governments in recent years. I hope that, when the chance comes, all noble Lords will make available their expertise and wisdom so that we can deliver a health and social care system that is truly fit for the future.