Health and Social Care Bill

My Lords, there is a clear consensus on the importance of further integration and more services being joined up around patients' needs. The Bill seeks to encourage and enable the delivery of integrated services and contains strong provisions to ensure that this takes place. We are placing a duty of integration on all bodies, including clinical commissioning groups and health and well-being boards, to ensure more joined-up provision of services for patients, social care service users and carers. Furthermore, all NHS bodies and private and third sector providers supplying NHS services are required by the Health Act 2009 to take account of the NHS constitution in their decisions and actions. This includes the principle that the NHS works across organisational boundaries and in partnership with other organisations in the interests of patients, local communities and the wider population. The Bill takes this further by making it clear that, in exercising any of their functions, commissioners must act with a view to securing that services are provided in a way that promotes the NHS constitution; and with a view to securing continuous improvement in outcomes, including effectiveness, safety and quality of patient experience. Commissioners must also exercise their functions with a view to securing that health services are provided in an integrated way where this would improve the quality of those services, including outcomes, and/or reduce inequalities in access to services and outcomes. The intention is, therefore, that it would be for commissioners to drive integration and co-operation between providers in the light of local circumstances and needs, and to enforce this through legally binding contracts. This would apply equally, and perhaps all the more importantly, in relation to the provision of services for long-term conditions where multidisciplinary care is required. As we have heard, the job of Monitor is to protect and promote patients' interests. This will be the guiding principle for Monitor in resolving potential conflicts. However, hugely important as enabling integration is, it is a means to those ends, and we are not convinced that it should supersede all other considerations. In respect of Amendment 174A, to which the noble Baroness, Lady Finlay, has spoken on behalf of the noble Baroness, Lady Young, we feel that the list at Clause 65(5) must relate to Monitor's functions and the impact on its overarching duty. The noble Baroness, Lady Finlay, is absolutely right that decisions on the use of competition should take account of the potential impact on integration where this is needed to improve outcomes for patients, and the noble Baroness, Lady Young, has emphasised the need for this as regards diabetes and other conditions. The Bill would place that responsibility on commissioners while ensuring that they act transparently and can justify their decisions in the best interests of the patients. The amendments in the names of the noble Lord, Lord Northbourne, and the noble Baroness, Lady Finlay, to which the noble Baroness has spoken, raise the wider issue of young people's transition between different services, including to adult services. We agree that all transitions should be managed as effectively as possible, and this is a vital area in which to get integration right. The noble Baroness, Lady Finlay, is absolutely right about that. I am sure that your Lordships are aware that Sir Ian Kennedy's review of children's services highlighted problems in handling the transition from children's to adult care, especially in mental health and services for disabled children. We strongly believe that there is a real opportunity to support young people moving through key transition points and into adult care. There are a range of interlocking policies which we believe will result in more integrated and personalised care for children. I hope that I may explain some of the stages involved in this. Earlier I said that the Bill places integration duties on all bodies. I should have said integration duties across the NHS. Health and well-being boards will have a vital role as regards the stages in children's care. The joint strategic needs assessments and joint health and well-being strategies drawn up by the local health and well-being board will ensure that local commissioners consider the needs of young people as they move into adulthood. The boards will bring together the key agencies when assessing, planning and commissioning local services. For example, in relation to children and young people, each health and well-being board will have the local director of children's services as a statutory member to ensure the needs of children and young people are taken into account. I hope that the noble Baroness, Lady Finlay, and the noble Lord, Lord Northbourne, will find that reassuring. As your Lordships may also be aware, the current draft of the statutory guidance on the preparation of joint strategic needs assessments and joint health and well-being strategies goes some way to highlighting points around integration and the need to provide services for each stage of the life course. I assure the House that we will look to strengthen this further with a specific reference to the importance of considering needs of individuals during key transition points. Your Lordships may also be aware that the Secretary of State has commissioned the development of a children and young people's health outcomes strategy. This strategy will seek to set out the outcomes that matter most to children and young people, and will describe the contribution that the different parts of the system need to make to support their successful implementation. The strategy is being informed through a children and young people's forum, which brings together a wide range of people with a record of expertise and commitment to improving healthcare provision for children and young people. Children and young people, including those with special educational needs and disability, will be asked their views on the outcomes that matter most to them. The transition to adult services has been identified as a key theme that will have a special focus within the strategy's development. The forum will report back to the Secretary of State with its recommendations in the summer. Work is also under way to explore how to develop integration in practice. As part of the special educational needs Green Paper Support and Aspiration, published in March 2011, the Department for Education together with the Department of Health has appointed 20 pathfinder areas covering 31 local authorities, PCT clusters and emerging CCGs to test different ways of improving care for children and young people in this category. Critically, this includes a single assessment process and plan for education, health and care needs from birth up to the age of 25 for children and young people with a disability or special educational need. All the pathfinders will address transition and how children's and young people's needs and support can be joined together across all services. This will, of course, include the transition from children's to adult social care. The learning from the pathfinder programme will be applied across all local areas as quickly as possible. In earlier debates we discussed the social care White Paper. That will address integration and the reaction to that will be coming forward. I understand and accept entirely the spirit of these amendments but I hope that I have demonstrated our commitment to integration. I am entirely certain that our existing proposals and wider programme of work already address the underlying objective of these amendments. I hope I have reassured noble Lords and that they will feel able to withdraw their amendments.