Health and Social Care Bill

My Lords, I wish to speak to Amendment 79A, to which my name is attached, which is about integration in the broadest sense, including those services delivered by local authorities. The main purpose of the amendment is to probe whether clinical commissioning groups will be expected to demonstrate a real understanding of the wider social determinants of health and to commission broader support services that improve health and well-being. It is a statement of the obvious that improvements in health are not always achieved by clinical interventions alone; they are dependent on wider determinants of health, such as housing, which is a point that has just been made most powerfully by my noble friend Lord Greaves. Therefore, housing and housing-related support deliver very important health interventions and it is important that that is recognised by the clinical commissioning groups. I believe that there is a big opportunity here to realise efficiency savings and to improve health outcomes through better use and integration of community support. Therefore, including housing and community support, transport, education, employment support, access to sports and leisure facilities and the like, alongside clinical services, will help CCGs to prioritise early intervention that prevents more serious health problems arising for a wide range of older and vulnerable people. Noble Lords may wonder why I put the emphasis on education and employment services, but I think that they are particularly important for those with mental health problems. They will help such people to manage their conditions and prevent them from worsening and they will help those people experiencing serious social exclusion, a point that was made very powerfully by the noble Lord, Lord Rooker, earlier. It is undoubtedly the case that truly joined-up commissioning of services can and does happen, but it is also patchy. Therefore, provisions in the Bill should make sure that the best current practice is taken forward everywhere in a way that meets local needs. Research published by the National Housing Federation has recently shown that only 20 out of 152 primary care trusts scored highly on the previous collaborative working competency. Clearly, there is more to do here. The Marmot review, Fair Society, Healthy Lives, noted: "““This link between social conditions and health is not a footnote to the ‘real’ concerns with health—health care and unhealthy behaviours—it should become the main focus””." I also mention the very important role that housing associations and support providers deliver in terms of preventive services and intervening early to prevent more serious problems arising. Housing-related support has been shown to be cost effective and good value for money. An independent national evaluation estimated that investing £1.6 billion annually in housing-related support services can generate savings of £3.4 billion to the public purse by avoiding more costly acute services. That included avoiding costs of £315 million in direct health costs. Housing support services can often effectively reach out to those with little or no access to statutory services. I mention particularly homeless people who are estimated to consume eight times more hospital in-patient services than the general population of similar age and to make five times more accident and emergency visits. I conclude by giving one short case study of a specialist provider of homes, sheltered housing and services for older people in this area. Willow Housing and Care developed a support service to help older people kept in hospital for too long because they lacked appropriate housing. The service was for patients who were ready to leave hospital, but who were not able to return home because that no longer suited their needs. The scheme diverts people away from residential care placements, saves social services delayed discharge fines and helps to free hospital beds. A support worker works with the patient and their family in hospital for two to three weeks, helping them to make choices about returning home or going to alternative accommodation, including arranging things like aids and adaptations, cleaning and ongoing care and support. The Department of Health’s own evaluation of the service has shown that, for a £40,000 investment, the service has saved £400,000 in health and social care expenditure through reducing admissions to residential care and readmissions to hospital. I believe that this powerfully underlines the need for clinical commissioning groups to commission broader support services, both to improve health outcomes and to achieve better value for money.