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Health and Care Integration

Volume 712: debated on Tuesday 19 April 2022

The past few years have shown that we are strongest when we work together. Earlier this year we published the integration White Paper, drawing on our experience of the pandemic to develop a plan that will bring together the NHS and local government to deliver jointly for local communities. We have also created integrated care partnerships, such as the programmes in mid-Nottinghamshire and Northamptonshire, through which we are already showing how we can bring together health and local social care services.

As covid regulations come to an end, I understand that the discharge fund is also set to end. This could leave local government vulnerable where there are no formal procedures locally to pass funding from the NHS to local government services and local authorities. Particularly as we seek to reduce hospital backlogs, it is vital that we get people out of hospital and into appropriate care settings. Will my right hon. Friend assure me that, where local authorities seek to tackle such backlogs, they will have access to appropriate funding?

I can give my hon. Friend that assurance. Of course, we are already putting in record funding for local authorities and the NHS to deal with backlogs. I believe the plan we set out earlier this month for the integration of NHS and local authority care services will make a real difference.

I thank the Secretary of State for referring to the work in Northamptonshire to integrate health and social care. Can he assure me that the central role of local government in ensuring that health and social care services work together to make the most efficient use of local resources will continue? And will he give me a clear guarantee that adult social care will not be taken over by the NHS?

I am pleased to give my hon. Friend the assurance he seeks. The integration White Paper signals our intention to go further and faster on health and care integration, building on the work already being done by the NHS, adult social care and local government to deliver services jointly. The plan will lead to better collaboration, and we want to make sure that overall responsibility is still shared between local authorities and the NHS.

The Secretary of State will know that Walsall Manor has been merged with the Royal Wolverhampton—they share a chief executive and chairman—without consultation with local people. How on earth can integration take place when Walsall Manor does not have a full-time chief executive to ensure that it happens? Will the Secretary of State please ensure that Walsall Manor gets its own chief executive?

I understand the right hon. Lady’s point, but it is about what works on the ground. My understanding is that what is happening in her area is about a shared management team that shares best practice and tries to address challenges together, rather than any kind of formal merger.

Across the country, tens of thousands of people sitting in hospital are medically fit to go home but cannot do so due to a lack of social care. The Health and Care Bill should have addressed that, but it does not. Rather than making us wait for more legislation, will the Secretary of State at least concede that local health leaders, be they in clinical commissioning groups or in integrated care systems in shadow form, should be driving this locally as a matter of urgency?

That is exactly what the new integrated care systems are all about. My understanding is that the hon. Gentleman sat on the Health and Care Public Bill Committee, which made it a reality.

Thank you, Mr Speaker. You have clearly had a happy Easter.

The fact is that the Government’s failure to fix the social care crisis is causing huge pressures on the NHS. As of last week, more than 20,000 patients were fit to leave hospital but could not be discharged because the care was not available, which means that 22,000 patients each month are waiting more than 12 hours in A&E and that heart attack and stroke victims have to wait more than an hour for an ambulance. We are used to hearing about winter crises, but is it not the case that, after more than a decade of underinvestment in the NHS, a failure to fix social care and the absence of a plan even to address the staffing challenge in the NHS and social care, we have not just a winter crisis but a permanent crisis in the NHS?<

That is not the case at all. The hon. Gentleman knows, although he pretends not to, that the NHS and social care are facing unprecedented pressure because of the pandemic. He will know that as a result of the pandemic, both in NHS settings and in adult social care there has been a necessity for infection and protection controls. He will know that, sadly, staff absences are higher than they have been in normal times. But the NHS is stepping forward, with its colleagues in adult social care, to provide whatever support it can bring, especially with the record funding the Government are providing, both to the NHS and to adult social care.

My hon. Friend the Member for Hyndburn (Sara Britcliffe) and I have been working with east Lancashire local authorities and our GP services to see whether we can increase the number of face-to-face GP appointments. Will the Secretary of State say what action he and the Government are taking to ensure that people in east Lancashire can see their general practitioner face to face?

My right hon. Friend is absolutely right to raise this issue. We have heard time and time again in this Chamber about the pressures our constituents are facing in order to get that kind of face-to-face access to their GPs. We all know why the situation was particularly bad at the height of the pandemic, but we expect it to improve rapidly. The percentage of people being seen face to face is increasing substantially, in large part because of the measures the Government have taken, including the £250 million access fund that was announced a few months ago.

Thank you, Mr Speaker.

Integration and service improvement cannot be delivered without sufficient staff, and the only way to attract people to a career in social care is by valuing them. In Scotland, they are already paid better than those in England and Wales, and through the national care service the Scottish Government will improve terms and conditions for care workers, through the introduction of national pay bargaining. Have the UK Government considered following the Scottish Government’s approach and commitments?

Integration between the NHS and social care requires the right level and quality of workforce, both in the NHS and in adult social care. In the NHS in England, we have more doctors and nurses—more people working than ever before. In adult social care, we are recruiting at high levels, not least because of the huge recruitment campaign we ran with the sector, and some of the other changes we made, including the £400 million- plus of retention funding over the winter period. In addition, the support for the workforce more generally is making a real difference.

In north Northamptonshire, integration is getting on very well, with Councillor Helen Harrison heading the adult social services. However, going back to what my hon. Friend the Member for Northampton South (Andrew Lewer) said, there is the worry that because the NHS is so big it will overwhelm local government. I have told the Secretary of State that they do not want to mess with Helen Harrison, but can he ensure that there is a mechanism for reviewing that?

I know that my hon. Friend knows Helen Harrison extremely well, but he is right to talk about the importance of the NHS and the adult social care sector and local authorities working together. We must make sure that it is a true partnership, where one does not overwhelm the other and they work together towards their shared interests.

One key cause of the urgent care crisis in Shropshire, in the Shrewsbury and Telford Hospital NHS Trust, is the inability to discharge patients who are medically fit to go home into social care in the community. Shropshire Council’s resource challenges in that area are well known. Will the Secretary of State commit to putting extra resource into social care in Shropshire so that the medically fit can be discharged into the community when they are ready?

The hon. Lady is absolutely right to raise this issue, and the whole House heard just before the recess the results of the independent work done by Donna Ockenden. The hon. Lady is right to talk about that and the pressure that has been faced locally. I understand that she has already reached out to my hon. Friend the Minister for Health and that he will be meeting her to discuss just that.