My Lords, I declare my interests in medicine and physiotherapy and as a Bevan Commissioner. Like others, I welcome the noble Lord, Lord Stevens of Birmingham, who clearly brings a veritable wealth of experience.
In the debates during the previous health and social care Bill, there were two references to the Titanic, and it felt as if we were commissioning different lifeboats. The lifeboats never arrived. We have two separate systems, health and social care, both of which are creaking under current pressures and severe workforce shortages. Integration is essential and complex. Integrated care boards need comprehensive membership, with a broad overview for patients and children.
Specialist palliative care services, like maternity services, must be commissioned as core. Would you depend on fundraising events for a woman to be able to have a caesarean section in obstructed labour? No. So why do we allow distress in severely ill people to go unaddressed because there is no specialist palliative care service commissioned? I do not mean after-care, as was suggested in the other place. Good specialist palliative care must be commissioned to be integrated across the trajectory of a person’s serious illness, to deal with problems in a timely way when the prognosis is unknown, not just when people are actively dying.
Children and young people need to be considered in all parts of the system, with integrated services and early mediation for disputes between clinicians and loving parents. Abuse, alcohol and drug addictions, the promotion of cosmetic procedures, dental caries and nutritional problems are all part of the public health emergency for children and young people we now face. Underpinning all of this for children is data.
There is a desperate need for a unique identifier for a child that goes across health and social care. Some 46 years ago, I admitted a child who had been dipped in boiling water. The case went to the Old Bailey. This week, we heard of a child being brutally assaulted and killed. Has nothing changed? We cannot continue to have social care data kept separate from healthcare and not linkable to education and police records. To improve life chances, we must have relevant information rapidly available. Across the UK, transferable and comparable data is also imperative for decisions in devolved Administrations to be made in the best interests of the patient. This Bill needs to show that.
Seven years after Framework 15, workforce projections remain uncertain. Some 48% of advertised consultant posts went unfulfilled across the UK last year, and there are long-term vacancies on top of that. Unless workforce planning, education and training improve, underpinned by research initiatives and findings, care provision will not improve.
We also need to recognise the appalling work environments, where staff do not feel looked after or valued. Social care will only have the status that it deserves if there is an integrated career path with the NHS, with staff travel time paid for and staff able to access support and advice if they are concerned about someone—with their opinion being valued—without having to go through multiple hoops.
Cancer outcomes at one year are falling behind that of our European colleagues, yet our research is ground-breaking. Sticking with process targets is not good enough. We must not water down the amendments so ably introduced in the other place and accepted by the Government.
Disease does not respect the clock or the calendar. The Bill fails to address the overwhelming number of problems that arise during the three-quarters of the week that is out of hours. The Bill also fails to address the large number of people being treated in inadequate premises because overcrowded emergency units are unable to move sick patients through to wards because there are no beds. Currently, one cannot expect ambulances to offload in a timely way or expect staff to give each patient safe care. Discharging into the community to assess needs in people’s homes makes sense, but where is the workforce to do it? Physiotherapy and occupational therapy are essential in every team to avoid deterioration as well as to restore well-being.
Until health and social care are integrated, we will not solve any of the problems that we face. I believe that the budgetary systems need to be combined. Clause 140 feels like trying to apply an enormous sticking plaster to tackle the underlying chasm: the gap between the current rationing of social care by means-testing versus an NHS free at the point of delivery. The success of the integrated vision in the Bill rests on social care being an equal partner to the NHS, but significant work is required if parity is to be achieved. We have much to do.
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