My Lords, the amendment is supported by my noble friends Lord Hunt and Lord Beecham. I shall speak also to our Amendments 81C and 87ZZA, as well as to other amendments in the group.
As my noble friend Lady Pitkeathley showed last week, we on these Benches will never tire of banging the drum for the importance of integration of health and social care—and housing—from the point of view of patients, service users and their carers. Our amendments would include in Clauses 3 and 6 specific reference to the body that stands the best chance locally of making this happen: the health and well-being board. These clauses deal with integration and the duty of local authorities to co-operate with relevant partners. We also stress in respect of these clauses, and Clause 2 under our amendment in an earlier grouping, the importance of the Bill emphasising a joint responsibility for co-operation and collaboration between local authorities and relevant partners, such as NHS bodies in their area.
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We support the view of both ADASS and the Local Government Association that the Bill should include a specific duty on NHS bodies, equivalent to the duty on local authorities, to integrate services, enshrining this shared involvement in legislation.
Joint strategic needs assessments and joint health and well-being strategies should provide a strategic overview of how the health and well-being of local communities can be improved and how health inequalities can be reduced. The noble Baroness, Lady Jolly, suggested earlier that some health and well-being boards have got it and others have not. Amendment 87ZZA would ensure that they all got it, giving health and well-being boards powers in keeping with the duties that the Health and Social Care Act places on them. Amendment 87ZZA also adds health and well-being boards to the list of bodies between which the local authority has to ensure co-operation.
During the passage of the Health and Social Care Bill we argued strongly for health and well-being boards to be the bodies that play the lead strategic role in integrating services. Their role is pivotal to achieving
integration. If they had been given the role of signing off CCGs’ plans, as we and other noble Lords argued, they would have both the power and authority to be the drivers of integrated care and joint budgets across health and social care and public health in their areas.
Joint budgets and ensuring that legislation and regulations support and enable their use across services, including housing, leisure and transport, are the key tool for making integration happen. That is why our independent commission on whole-person care will look at ways of bringing health and social care budgets together. As the shadow Secretary of State for Health announced to the Local Government Association last week, we are working closely with six councils that have agreed to be whole-person care innovation councils. These are Plymouth, Derbyshire, North East Lincolnshire, Lancashire, Islington and Gateshead—a good range of county, unitary and metropolitan councils from different parts of the country. These innovation councils will help to develop and test out the commission’s proposals. We will certainly want to explore how health and well-being boards are developing and how they can be given teeth to do the job that we want them to do.
As my noble friend Lord Hunt stressed in our recent response to the CSR, we welcome the announcement that an additional £2 billion a year from the NHS budget will be joined up with local government health and social care services to help to deliver care. Pooled budgeting was a Labour idea in 2009 and the integration of health and social care is the narrative of our whole-care commission. However, how does it sit with the CSR’s cut of 10% to local authority budgets? Will the £2 billion transfer be ring-fenced? What are the Government doing to tackle the crisis in health and social care that is happening now?
I also support, as part of this group, the intention behind Amendment 87ZB in the name of the noble Lord, Lord Rix, in support of his later proposals on safeguarding adults at risk of abuse and neglect. Clause 6(6) specifies the relevant partners of local authorities, including county and district councils, each NHS body, the police, prison and probation authorities and others specified in regulations. Amendment 87ZB would ensure explicit reference in the Bill to the providers of services being the relevant partner—that is, those which have been commissioned by the authority to provide care and support or other services as part of the individual’s care plan. Subjecting such providers to the same duty to co-operate as other bodies and services specified in this clause will improve accountability and bolster safeguarding and have a major impact in cases where someone has experienced, or is at risk of experiencing, abuse or neglect. We know all too well that, in a number of prominent cases, providers have blocked or impeded safeguarding proceedings by failing to co-operate on request. The refusal of Winterbourne View providers to share information for the serious case review is a stark and serious example of failure to be held accountable for appalling levels of abuse and neglect of vulnerable adults.
Finally under this group, I support the amendments to Clause 6 and Schedule 3 in the name of the noble Baroness, Lady Greengross, which list the purposes for which local authorities undertake their duties.
These include promoting well-being, improving the quality of care and support, safeguarding and, importantly, identifying lessons to be learnt where there is abuse or neglect and applying these lessons in the future.
The noble Baroness’s amendment is right to specify under these clauses the importance of ensuring the early and co-ordinated assessment of an adult with care and support needs following discharge from hospital or other acute settings. Of course, there are many examples of both good and bad practice in this regard, and we heard about them during the earlier debate on housing. With good practice, you will often find a very comprehensive discharge policy in place and the decision being followed or adhered to.
From the point of view of long-term health needs, if you talk to patients and their carers, as I do regularly as a trustee of our local carer support voluntary organisation, they will often cite the hospital discharge process as the next most traumatic experience after the patient initially becomes ill. Often, people with long-term health conditions and their carers are completely new to the social care system, and discharge takes place into an unknown world of agency and voluntary sector providers of services and equipment, and primary and community care involvement. The good practice examples, where patients and carers are involved in and understand the homecare plan, meet the people who are going to help to deliver it and have a full picture of how GP and other community services will support them, stand out. However, with the current staffing and budget pressures on both hospitals and local authorities, the discharge processes all too often become a “fingers crossed that everything comes into place” process.
It is very important that the assessment and care plan are in place before discharge from hospital. Discharge from hospital and other care settings is a period of extreme concern for large numbers of patients and carers. Ensuring that there is an early and co-ordinated assessment of the adult’s and carer’s needs in the community and that a care plan is in place before the discharge is fundamental to the subsequent delivery of good-quality care and support, and I hope that the Minister will recognise the importance of the amendment.
In conclusion, we come back to the importance of underlining integration at every opportunity, and I look forward to the debate.