Health and Social Care

Lord Tunnicliffe Excerpts

Thursday 15th December 2016 Lords Chamber

[Lord Tunnicliffe (Lab)]

My Lords, I, too, would like to be associated with the condolences from all parts of the House to the noble Lord, Lord Prior of Brampton, and his family. Nevertheless, I have utter faith that the noble Baroness, Lady Chisholm, will answer all our questions in her normal, thorough fashion.

I, too, congratulate my noble friend Lord Harris on securing this important debate. He has a long and distinguished record of championing involvement of the public, patients and staff in key decisions about the future of health and social care. He speaks with great authority. It is a timely debate, five years on from the introduction of the Health and Social Care Act 2012. This was a huge Bill, as your Lordships will recall, providing an unnecessary, disruptive and costly reorganisation of the NHS that David Cameron had said his party had no intention of doing. Noble Lords will also recall the Government’s unprecedented “pause” in the face of widespread opposition to the Bill while a full-scale consultation exercise was undertaken through the NHS Future Forum.

It is worth reminding ourselves of the Future Forum’s ambition, which led many to hope that it could mark the start of the sea-change in consultation and involvement, independent scrutiny and shared decision-making that was needed. To quote the forum’s report:

“Involvement must extend beyond the decisions about an individual’s care, and apply to decisions that affect the design and provision of care for communities: as part of designing services for a particular group or condition; in strategic decisions about commissioning of services at the local level; and at a national level, in decisions about commissioning and the operation of the health and wellbeing system … commissioners cannot expect to design integrated, efficient pathways to deliver high quality care if they do not involve the people who will be using the services in their design, as well as patient representatives and patient organisations”.

As we know, the Health and Social Care Act created duties to involve patients and the public at all levels of the health and well-being system. Most importantly, this year’s guidance to CCGs states that they must:

“Involve people early on, not as an afterthought”.

Unfortunately, too few CCGs have put this into practice. As we have heard on sustainability and transformation plans, the “afterthought” approach has sadly dominated in many of the 44 footprints.

I have a number of questions for the Minister. On reporting back to NHS England on their participation approach, can the Minister provide any analysis of the information provided by CCGs? Can she confirm whether there is a breakdown of the best and worst- performing CCGs or areas in this respect? What action is being taken by NHS England to address poor performance and to seek improvements in involving and consulting local patients and communities, including local Healthwatch groups? During the passage of the HSC Act, the noble Earl, Lord Howe, spoke at length about how the legislation would lead to,

“a fundamental shift in the balance of power away from politicians and on to patients themselves”.—[Official Report, 9/11/11; col. 269.]

If this was the case, why has NHS England removed patient groups from membership of the patient and public voice assurance group, leaving only individual members of the public to hold NHS England to account?

The noble Earl said that Healthwatch groups will act as the independent eyes, ears and voice of patients and service users in a local area. The Future Forum was ambitious in the key leadership role it wanted national and local Healthwatch organisations to play. As we have been reminded, there was concern across the House about the authority and independence of Healthwatch England in the light of the Government’s insistence on its relationship to the Care Quality Commission. The Labour Benches strongly supported full independence. The Future Forum clearly saw Healthwatch England, with sufficient funding, as,

“one of the key national players in the new system”.

The extent to which it has been able to fulfil this role so far has to be questioned, given the scale of budget cuts to Healthwatch organisations, the overall funding crisis in the NHS and social care, and the fragmented NHS structures which have made integrated working even more difficult to achieve.

The Healthwatch network received 5.9% less funding this year than last year, and 31.3% less than was given to councils for local Healthwatch groups ahead of their first year in operation. The recent Autumn Statement could have addressed this, or addressed some of the wider funding issues in the health service. Sadly, the Chancellor chose not to act. For the record, under its first chair, Anna Bradley, we felt that a good start was made in establishing and developing Healthwatch England. The Government’s failure to reappoint her when her term of office ended is a mystery. She was an excellent ambassador for the organisation, interacting with the health and social care community to explain the watchdog’s work, meeting local Healthwatch groups and listening to the voices of local people. Some excellent work was undertaken.

The Healthwatch report on hospital discharge, Safely Home, with its particular focus on the elderly, people with mental health conditions and the homeless, was just one example of the strategic overview and scrutiny function that Healthwatch must play if it is to be an effective watchdog of care and performance. However, the Government must give Healthwatch England and the local groups additional support if they are to truly fulfil their role. The King’s Fund has identified local groups’ lack of capability and their need for additional advice and resources as they seek to gain legitimacy and credibility in their communities. How do the Government propose to address the patchy and fragmented local system that has emerged thus far?

Finally, I turn to sustainability and transformation plans. Specifically, I record my concern about the huge inconsistency in the roles and treatment of local Healthwatch groups as these “footprints” are created by health and care organisations across the country. Despite the Government’s commitment that STPs would provide a means for communities to shape their local health and care provision, a number of local Healthwatch groups have reported being frozen out of the decision-making process or involved at only a superficial level at the very latest stages. In light of these concerns, and wider concerns that STPs are merely vehicles for cuts to local services, can the Minister confirm what steps the Government are taking to ensure all local Healthwatch groups are properly consulted on the contents of the STP in their area?

The Labour Party took important steps to promote user participation in local health and social care provision. This Government’s stated intentions on user representation are honourable but, as we have heard in this debate, there is a growing body of evidence that patients’ voices are not being heard and, in some cases, not even being sought. Healthwatch England and local Healthwatch groups have the potential to play a significant role in ensuring that health and social care provision reflects the needs of local communities, but they must step up to the mark and speak out forcefully when needed. Almost five years after the passage of the Health and Social Care Act, the Government must act to deliver on the promises they made to patients. It is incumbent on the Government to provide proper resourcing to Healthwatch and to include other specialist user groups in discussions where they have relevant expertise. Only by properly listening to the views of patients can we have a health and social care service that responds to their needs.