Social Care

Lord Turnberg Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Turnberg]

My Lords, I, too, thank my noble friend Lady Pitkeathley for introducing this timely debate. She made a remarkably robust case and we have had some excellent, well informed speeches today. I imagine that it is very hard for the Minister not to have got the message, even though I suspect he does not need it. I, too, am struck by the faint ring of familiarity about this debate.

I want to focus on just two aspects: standards of care for the elderly and the mentally ill, and the integration of hospital and community services. Last week, we had two important reports. One was on the prosecution of those responsible for maltreating an elephant and the other from the Care Quality Commission about the poor standards of care for the elderly and mentally ill—and here, this elephant in the room, although rather more devastating, disappeared from the news rather too quickly.

The CQC painted a picture in which, faced with a rising demand from increasing numbers of elderly patients suffering from an often complex mixture of diseases, many nursing homes and some NHS hospitals were failing to meet basic standards of care. Failing to treat patients with the dignity that they need, failing to feed them properly and failing to care for their basic needs was just too common for comfort. Very importantly, it also found that management and staff vacancy rates were very high. As a result, poorly trained staff were rushed and asked to take on tasks for which they were ill equipped. Patients with complex multiple diseases need well trained staff, and these are in short supply.

All this may sound familiar and similar to repeated reports going back at least 15 years. We have had Age Concern’s report in 1997, the Healthcare Commission in 2004, its successor in 2007, and now in 2012, with so far not much change. If we do not do something now, it will just get worse. So is there anything we can do, apart from putting more money in? Of course, we need more money. Incidentally, the noble Lord, Lord Shipley, spoke about the valuable contribution that the elderly make to society. I do not think that we should forget that the elderly—that is, those over 65—who are supposed to be retired contribute to the national Exchequer through taxed income, and that needs examining. Apart from putting more money in, though, we could look again at the need for the proper training and registration of healthcare assistants. It was a grave error that we were unable to persuade the Government to include in the recent Health and Social Care Act a requirement for healthcare assistants to be trained and registered. I hope that the Minister will look again at the proposal to wait three years before we can revisit that decision.

I turn to the need to co-ordinate care between hospital and community, which has been the subject of some discussion this afternoon, and the need for the seamless care that we are supposed to provide. The problem has been well rehearsed, with elderly patients sitting in acute hospital beds when they would be better off at home or in accommodation more suited to their needs. There are many causes, including, of course, the lack of resources in the community that we have heard about, but often it is the result of failures in communication between the hospital and social services—and it is particularly bad at weekends and holidays. No one seems to take responsibility for this liaison, which is so essential, yet we know what to do, and indeed it is being done in many places. We do not have to go to Canada, where they have set up a very effective multidisciplinary team devoted to integrating care; we have excellent examples in Torbay, which is always being cited, where they have a single, merged care trust. Hereford and Devon have different but innovative schemes for integration. It is not only in leafy, affluent parts of the country where they are making a change; great work is going on in Bradford, Wolverhampton and South Birmingham.

So we know what to do, and one wonders why it is not being done everywhere. Partly it is a lack of lack of local leadership, and perhaps a touch of NIH syndrome—“not invented here”—that sets up resistance to change. Equally, though, we have not seen enough pressure and incentives from the centre. We need to use more carrots and sticks, as well as local leadership. Perhaps the emphasis in the new NHS mandate on care of the elderly and mentally ill will give us the push that we desperately need, and yesterday’s speech by the Secretary of State shows that it has moved up the agenda. I reiterate that we need action on many fronts: to encourage integration between hospital and social services; to ensure the better training and recruitment of healthcare assistants; and, as the noble Baroness, Lady Pitkeathley, pleaded, to have more resources for community services.