Integrated Care Regulations

Philippa Whitford Excerpts

Monday 18th March 2019 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

As I have said in many debates, I totally support integration. That is the journey we have been on in Scotland for almost 20 years. We amalgamated some trusts after devolution, we got rid of hospital trusts in 2004 and we got rid of primary care trusts in 2009. We had the health side run by health boards, which are statutory bodies that carry out area health and social care planning for a population. The integration between health, which is free, and social care, which is means-tested, was passed in legislation and introduced in 2014.

I warn Members that that is much more difficult than integrating the NHS itself. The NHS in England has become really fragmented. It is important to put that back together before integrating it with social care. What integration stops is the arguments between acute care and social care about which purse the money comes out of to look after a particular patient, but there does have to be money in the purse to start with. In Scotland, we spend £163 a head more on health and £113 a head more on elderly social care. The money is needed to provide the service. Scotland is the one place in the United Kingdom where we provide free personal care, because we think it is cost-effective as a way of allowing people to stay at home.

The Minister says that these will be statutory bodies and that they are unlikely to be private companies. If that is what the Government believe, they should put it in legislation, because that removes any doubt or concern. The response to the consultation says that

“further requirements around financial controls, transparency and accountability will be developed before the ICP Contract is made available for use.”

When will that be? Will it be before contracts are put out? The transparency is critical. If any private companies are running ICPs, they will hide behind commercial sensitivity and will not be open to freedom of information. That would be unacceptable. What about their contracting, which is mentioned in this SI? Will section 75 be revoked so that we do not have a replay of what happened in Surrey, when commissioners tried to bring the new contract back to the NHS, were sued by Virgin for over £2 million and settled out of court?

If outsourcing continues, fragmentation rather than integration will continue. Will tariffs be abandoned because they reward admission to hospital, whereas the aim of this proposal is to support people at home? How will the components of an ICP between a main acute hospital, a small cottage hospital and social care or community services be funded? It may all sound very good if it is a gentleman’s agreement, but if one part of that system goes bankrupt because the financing system has not been changed, all bets will be off and all co-operation will disappear.

Social care is critical to this and Age UK says that well over 1 million people are not getting the social care that they need. It is necessary that the ICPs deliver prevention, early treatment, chronic disease management, acute care, mental health, social care and end of life. That is a lot of different players to bring together and it is important that the Government recognise that the Health and Social Care Act 2012 fragmented and blew apart the whole system. For integration to work, they need to admit that it failed, bring back proper legislation and put the system back together in a way that is wrapped around the patient, so that there is patient-centred, not budget-centred, care.