Health and Social Care Bill

My Lords, the hour is indeed late and I have done my best to cut back on bits of my speech. On behalf of the opposition Front Bench, I commend these amendments for beginning the process of retipping the balance of the Bill from its current predominance of measures dealing with NHS structures, governance and competition. Today’s amendments start to explore ways of addressing in the Bill the need for the NHS, public health and social and community care to work together to achieve improvements in quality of services in diagnosing and treating patients. Integration is a means for achieving this and is not an end in itself. It is worth reminding ourselves of the recent warning from Chris Ham, chief executive of the King’s Fund, of the very real risk in the Bill of integrated care being, "““a sideshow involving small-scale pilots, with competition the main game in town””." He also said: "““If the Government is serious in its endorsement on the Future Forum's advocacy of integrated care, it must demonstrate its commitment by putting the best civil service brains on the case and ensuring that the mandate given to the NHS Commissioning Board has the promotion of integrated care at its heart””." We are certainly not at that stage yet, as the contributions in this debate have demonstrated. The Bill offers the opportunity for the promotion and enabling of integration to be embedded into the work of the Secretary of State, the NHS Commissioning Board, clinical commissioning groups, health and well-being boards and Monitor, and further amendments throughout the Bill will allow for debate and development of these areas. The Royal College of Physicians has referred to these bodies needing to have, under the Bill, an explicit duty of mutual co-operation and collaboration, and this should be the aim. The Secretary of State, the Commissioning Board and Monitor all need to ensure that national policy promotes, not just enables, the supporting context for integration. We support working towards a strategic definition of integration that encompasses the NHS, public health and social and community care. Nuffield, the King’s Fund, National Voices and the Local Government Association are all undertaking comprehensive work on producing clearer definitions, so there is no shortage of expertise in this area. Our hope is that this work will help lead us to a more coherent approach and ensure that current provisions in the Bill can be strengthened. As we know, the Future Forum is currently consulting on what now turn out to be the non-legislative steps that can be undertaken. But whatever recommendations it comes up with need to be in the context of a Bill which provides the strategic context, framework and direction. The National Voices key principles of integration have much to commend them in taking this work forward. Amendment 18A has a particular focus on integrating public health with local authorities. We strongly support the proposed role for local authorities for public health and this amendment would help to address fears of some public health professionals that this might lead to public health becoming divorced from the NHS. Amendments 182 to 184 look to clinical commissioning groups having particular regard for outcomes which show ““effectiveness and integration”” and integrating ““assessment and delivery”” by those who provide health and social care services. CCGs need to demonstrate that their commissioning plans address the physical health, mental health and social care needs of their local population under the joint strategic needs assessment. In this regard, one of the major ways of promoting integration will, as many noble Lords pointed out at Second Reading and today, be by strengthening the powers of health and well-being boards. We strongly support giving health and well-being boards the power to sign off the commissioning plans of CCGs and will be supporting amendments to achieve this later in the Bill. If health and well-being boards own the health and well-being strategy, they must also own the plans to deliver it. Finally, at the beginning of the debate on how we use legislation to promote integration of services and care, as a carer myself perhaps I may endorse noble Lords who have underlined the importance of this issue to carers. Carers, particularly of people with long-term conditions, oversee care packages across the NHS, local authority social care, the independent agency and provider sector and the voluntary sector. Carers are often the principal players in organising the care package and the ones who fight to hold it together. Hours can be spent going over the same information for different parts of the system or ensuring that one part of the system is aware of decisions and developments, and any possible knock-on effects, taken in other parts of the system involved in the care pathway. Joined-up support is the key enabler for people with severe disabilities or long-term health conditions to remain at home and it is crucial that the Bill gets this important issue right.