Health and Social Care Bill

My Lords, with Amendments 244 and 260DA, the noble Lord, Lord Warner, has taken us to the important matter of the relationship between the NHS and social care, and I agree with him that this relationship is in a real sense symbiotic. The noble Lord presented us with some sobering facts and messages about the increasing pressures that are likely to arise in our health and social care services over the next two decades, and it is in large part because of those looming pressures that the Government have brought forward their proposals for health service reform. The noble Lord deserves to be listened to with close attention, and I again pay tribute to his work as a member of the Dilnot commission. Looking first at Amendment 244, we strongly agree that integrated services are important. The noble Baroness, Lady Greengross, brought home that message compellingly. This is why, throughout the Bill, there are duties to promote and encourage the commissioning and provision of integrated services. It is a vital principle. However, sympathetic as I am to the spirit of the amendment, I feel that the Bill’s current wording already provides for what it seeks to achieve. I would already confidently expect the annual report to cover aspects of service integration, and that is because integrating services, both between different parts of the NHS and between the NHS and other public services, would be essential to providing a seamless and high-performing health service. The change of culture that the noble Baroness, Lady Emerton, and my noble friend Lady Barker spoke of will not happen overnight, but it can be encouraged and promoted by shining a bright light on how well or badly the NHS is performing in this area. Turning to Amendment 260DA, the Government are absolutely clear that a key objective of social care reform must be to improve outcomes for individuals and their families and carers using social care. Again, I completely understand why the noble Lord has brought forward this proposal, and I recognise that the amendment has been carefully crafted. In explaining the amendment, the noble Lord expressed worry about whether the Government are serious about pressing ahead with reform. The Government have committed to setting out proposals for the reform of social care in a White Paper and a progress report on funding reform to be published in spring of next year, with legislation to follow at the earliest opportunity. I can confirm to my noble friend Lady Barker that this will include our response not only to Dilnot, but also to the report published earlier this year by the Law Commission. We agree that reform of the system is urgent and we debated these very issues recently and in some depth in a debate led by the noble Baroness, Lady Pitkeathley. If the Committee will forgive me, I will not repeat what I said on that occasion. However, on 15 September, the Government launched Caring for Our Future: Shared Ambitions for Care and Support, which was an engagement seeking views about the priorities for improving care and support. This focused period of engagement has been welcomed by stakeholders and, although it officially concluded on 2 December, we will continue to work closely with the social care sector as we formulate our proposals for reform. The noble Lord proposed that the duty to secure improvement should include efforts to reduce the barriers to integration of health and social care. We are very much aware of the concerns about the integration of services and have asked the NHS Future Forum to consider this in more detail. This work is being undertaken in collaboration with caring for our future, the engagement on social care reform. Appropriately, there is integration of this work on integration. I would say in particular to the noble Baroness, Lady Pitkeathley, that caring for our future has also been considering the recommendations of the Law Commission and the Commission on the Funding of Care and Support, including those on portability, assessment and eligibility for social care. This has highlighted her point about the importance of clarity of the state offer to help people to plan and prepare to meet their own care costs. Given this ongoing work ahead of publication of the White Paper on social care reform, we do not want to pre-empt our consideration of the feedback from the engagement or to make changes to the existing statute when more fundamental reform is already planned. Indeed, the Law Commission’s recommendations seek to address the current piecemeal nature of social care legislation, having noted that social care statute is confusing and unclear. However, I emphasise again that the Government have committed to legislation at the earliest opportunity, which we believe will be the most appropriate vehicle for debating these critical matters. In this context, these amendments are unnecessary at this time, although clearly they have been proposed for the best of motives, which I share. It is our view that proposals for reform of adult social care services, including a continued focus on better integration with health services, should be encompassed within the overall proposals put forward in the White Paper next year, and informed by the work of the Future Forum and the engagement with the social care sector that has been taking place in recent weeks. As long as the noble Lord realises that I am not in any way dismissing the importance or salience of the issues that he has raised, I hope for the reasons I have given, he will feel able to withdraw his amendment.