My Lords, I should remind the House that I am vice-president of the Local Government Association. I want also to congratulate the noble Lord, Lord Stevens of Birmingham, on his maiden speech and on the depth of his analysis, which I hope we will draw on as the Bill progresses.
I want to say at the outset that I support the ambition of this Bill but also that I think it will work only if it is improved at further stages. I welcome the wish to make systems more effective in the delivery of services to patients and clients and more efficient in the use of public resources.
As a council leader some years ago, I knew from officers, from providers, from colleagues who worked in the NHS or in social care, from my own councillor surgeries and from door knocking at election time that there was a huge problem with the integration of health and social care support at the point it reached—or should have reached—individuals. We had growing demand for both residential care and domiciliary services, insufficient supported housing, constant bed blocking, lengthy delays in the installation of aids and adaptions, and worsening public health, not least through levels of smoking, rising alcohol consumption and obesity. All that meant that investing more in public health and in the integration of service provision to reduce the costs of administration became essential. For a while, public health did receive further investment and joint working was certainly encouraged, but I thought then that we would progress integration much faster than we have. Well, we now have another attempt, and the test of the success of this Bill is whether it will help with reducing bed blocking, improving public health, restoring the 25% cuts in spending of the past six years and increasing the number of staff working in social care.
The Bill may aim to level up health outcomes, but structures alone are not a solution in themselves but a means to an end. Poverty, low pay and poor housing all need to be addressed as well, because they contribute to poor health. Prevention of poor health in turn reduces demand for hospital beds.
The Care Quality Commission has said that successful care is when providers work well together in a place. That is right, but it is not just about working well together through the alignment of budgets. It must be about the pooling of those budgets to achieve real integration.
The Government must take care not to end up with just another reorganisation. The test is whether the Bill and related legislation will reduce administrative costs, increase capacity and improve service delivery.
Will it help to reduce alcohol harm? Will it reduce obesity? Will it reduce the health inequalities of the homeless or of those suffering addictions? Place-based planning and budgeting with common administrative systems should be at the heart of this.
The Bill will need to be amended to ensure that we really do have integrated health and care systems founded on place-based partnerships with pooled budgets. I fear that if we do not do this, adult social care will be starved of essential funding, in turn forcing up council tax too much. We have too many regressive taxes in this country. Council tax is one of them, and it should not be used to make up deficiencies in mainline services.
4.40 pm