Social Care: Integrated
Care Systems
Asked by
To ask His Majesty’s Government what plans they have to ensure
that social care is sufficiently represented within Integrated
Care Systems.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
ICSs need to include social care fully in planning and strategic
decision-making. Local authorities are responsible for social
care and have a clearly defined role within ICSs. The Health and
Care Act 2022 includes local authorities in its minimum
membership requirements for ICBs, giving local government a
greater voice in NHS decision-making than ever before. In July
2022, we also published guidance on how ICPs and adult social
care providers should work together.
(Lab)
I thank the Minister for his response but ICBs and ICSs have been
fully operational only since last July—less than six months. The
Minister is quite right that, when they were being set up, we
argued strongly for the need for effective social care
representation in both bodies to ensure that health and social
care are integrated and fully embedded in both. However, this
just is not happening. The ADASS spring survey found 73% of
directors reporting that ICS management has had little impact on
local investment in adult social care to date; some even said
that ICSs were reducing investment. How does this help ICSs play
a key role in their respective areas in, for example, tackling
the staffing crisis in both services, prioritising adult social
care and producing the urgently needed ICP integrated care
strategies, which are due in June?
(Con)
First, I think we can all agree on the necessity of making sure
that these are integrated and the vital role that social care
plays in all this. I must say, my experience from the places I
have visited is that they are well integrated, but I will take
that point back and would be pleased to look at any particular
examples of where we feel that is not the case because, as I
think the whole House will agree, it is vital that they are
completely integrated.
(Non-Afl)
My Lords, I believe that six integrated care boards have been
selected as national front-runners on innovations that will help
move patients from hospital to their home. Can my noble friend
the Minister confirm that these are going ahead, give examples
and reassure us that they will be properly monitored, with data
being collected? I have just realised that I called the Minister
“my noble friend” but, due to my new role, all noble Lords are
now my noble friends.
(Con)
Replying on behalf of all noble friends, let me say that I am
particularly pleased to see this scheme go ahead. Just yesterday,
Members of the House were talking about whether we should have
full-time contracted dom care people because they know their
patients best. That is exactly what these front-runner pilots are
designed to do: to try out these new ways of working and heavily
invest in areas, which you probably cannot justify on a national
level until you know that it really works. Leeds, for instance,
is developing a transfer of care hub, while the Northern Care
Alliance is focusing on dementia. This is all about seeing what
works and then, when we know what works, scaling it up very
quickly.
(CB)
My Lords, I hope the Minister can assure the House that he has
had an opportunity to read the Adult Social Care Committee’s
report, which was published in December. The report makes it
abundantly clear that the NHS will not achieve its
objectives—some might even say its survival—unless social care is
integrated at every level and includes the voice of unpaid
carers. Can the Minister assure the House that these matters will
be taken seriously?
(Con)
Absolutely. It strikes me—again, I mentioned this yesterday—that
less than 10% of the 13,000 so-called blocked beds contain people
who will need to be in social care full-time in future. Most of
them need short-term support and, once they have it, will be able
to go back to living in their home, which is the best place for
them to be.
(LD)
My Lords, as the Minister has recognised, social care provision
is largely in the domain of local authorities. The level of local
authority representation on integrated care boards is therefore
likely to have an impact on how powerful the social care voice is
in integrated care system decision-making. Does the Minister have
any information to share with the House about local authority
representation across the 42 integrated care boards, including
whether it goes beyond the statutory minimum, so that we can
understand whether it is sufficient and likely to lead to the
step change that I think we all want to see?
(Con)
It is, as the noble Lord says, a statutory requirement that the
local authorities are represented on the ICBs. In the last few
months, I and other Ministers have met and had discussions with
all the ICBs. Every ICB is asked to put up a few people. I have
had the local authority representative there as one of only three
or four people in the meeting—that is key to all of this. They
have been critical participants. They are very involved, and it
is vital that they remain so.
(Lab)
My Lords, the Government are to be congratulated on amending the
Health and Care Act to ensure that responsibility for integrated
care systems addresses the needs of children and young people
under the age of 25. However, children with special educational
needs or disabilities have lifelong problems. How will providers
ensure that there will be integrated health and social care for
disabled children and their families?
(Con)
This is the whole point and the way that we are moving; the real
decision-makers running their local areas should be the ICBs.
They know their areas and the needs of the people—including
people with special needs and learning disabilities—more than
anyone. It is absolutely their responsibility to understand the
needs in their areas and to ensure that they are provided for
under the commissions.
(Con)
My Lords, unpaid carers throughout the country are, more than
often, working 24/7. The Care Act 2014 requires local authorities
to deliver this high-quality care, including support for unpaid
carers. How confident are my noble friend the Minister and his
department that local authorities will undertake carers’
assessments for unpaid carers?
(Con)
From my experience I understand that this is a very important
part of their remit and role. As we are all aware, the unpaid
carer role is vital and historically has probably not been
recognised as much as it should have been.
(Lab)
My Lords, following on from the question asked by the noble Lord,
, what plans has the Minister to
encourage ICSs to embed co-production in the design and delivery
of adult social care at the local level?
(Con)
Each ICB has a slightly different approach to ensuring that it is
there and ensuring the kind of co-production with these
front-runners that I talked about earlier. It is about trying to
see whether there are new and better ways of doing it. Maybe at
another time I can talk to the House in more detail about what
those six different pilots are doing. It is about taking the
comments that I have heard here over the last few weeks about
what works and trying to scale them up.
(CB)
My Lords, I draw attention to my registered interests. Is the
Minister content that the current approach to institutional and
professional regulation will foster effective integrated care
across institutional boundaries, secondary care, primary care and
the broader community?
(Con)
Clearly, it is early days. These were set up last summer and we
must ensure that they bed in properly and learn. I am confident
that that is the right approach, but, as the noble Lord
mentioned, we must make sure that regulators in this space ensure
that that is the case. It is probably a question for a few
months’ time, when we can be sure.
(CB)
My Lords, according to Hospice UK, of which I am a
vice-president, up to half a million people last year had a
palliative care phase before they died. In many of those cases, a
failure of social care resulted in a breakdown of care in the
community and hospital admission. Following on from the question
asked by the noble Lord, , when these patients are
seriously ill or disabled children, they need access to respite
care during their illness, as well as at the end, with rapidly
responsive care. How are the Government monitoring whether the
needs of these people are being met and that the timeframe to put
in place the social care that they need does not just slip to the
point of becoming a meaningless exercise?
(Con)
Those monitoring processes are in place, but to give sufficient
detail, it is best that I write.
Care Homes:
Staffing
Asked by
To ask His Majesty’s Government how they will ensure that care
homes where they block-buy places to assist with hospital
discharges are adequately staffed.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
On Monday, this Government announced an additional £200 million
of funding for short-term NHS step-down care packages to help
ease the pressure on local hospital beds. ICBs will work closely
with local authorities to purchase places in care homes and other
settings. Using their knowledge, they will commission appropriate
beds where there is sufficient capacity, including workforce
capacity, to meet patient needs.
(Lab)
I thank the Minister for that response, although it seems a bit
more knee-jerk than it does a coherent strategy and it poses as
many questions as it answers. For example, are the Government
planning to pay care homes directly to pay recruited staff or to
work through ICBs and local authorities only? What rates are to
be paid? Will it be more than care workers currently earn, so as
to compete with the retail sector? Given that there are 160,000
vacancies in the care workforce currently, where are those
workers to come from, without pulling staff away from an already
understaffed NHS?
(Con)
Before we went ahead with this, we spoke to many care providers
to make sure that there was capacity within the system to do it.
It was understood that the capacity is there. In fact, there is
potential underused capacity of as much as 40,000. We are
confident that the staffing is in place and that the care
packages are there to really make a difference.
(Con)
My Lords, is the Minister aware that a lot of homes across
Norfolk are complaining that they cannot sponsor more overseas
members of staff? At a time when there are not enough locally
trained and motivated staff, surely there should be more
flexibility for those quality homes that want to sponsor more
overseas members of staff.
(Con)
Yes, this is absolutely something that we talk to our Home Office
colleagues about all the time. I believe that 15,000 people have
already come through on this route in the last nine months or so;
we are seeing a rate of about 1,500 a month. It is very important
and something on which we are focused.
(Lab)
My Lords, rather than bringing in people from abroad, would it
not be more effective to pay our own people proper wages with
proper conditions, so that they want to work in this sector?
(Con)
We absolutely need both. For years, ever since the NHS was
founded, we have had international workers. It is a very
important part of it now. Of the funding going in—up to £2.8
billion next year and up to £4.7 billion the year after—70% will
translate into wages, because this is a staff-based business.
That is a huge injection of money into the sector, and it will go
into staff, salaries and welfare.
(LD)
My Lords, we know from surveys by the Association of Directors of
Adult Social Services that there is already a shortfall in
domiciliary care capacity, such that people are not getting the
services they need at home. While additional, funded care home
places are welcome, we need to ensure that this does not worsen
the domiciliary care situation by drawing staff away from other
vital roles. I raised this question on yesterday’s Statement, but
I think it important enough to come back to. Will the Government
monitor workforce changes to ensure that both residential and
domiciliary care capacity benefit from any new funding?
(Con)
Since the question yesterday, I have had a chance to talk to
colleagues further about domiciliary care and understand its
vital role. I talked to one ICB today, which has its own
arm’s-length body, set up by the local authority, which does
exactly what was suggested by employing domiciliary care staff
full-time. They know the patient best and are ready to take them
back out of hospital and put them in place. This is central to
what we are doing.
(Con)
When people are transferred, either to home or residential care
places, part of the delay is caused by the need, quite rightly,
for a proper and appropriate assessment of their needs before a
transfer is made. What work have the Government done to assess
who is going to carry out those proper assessments, either at the
hospital or the care home end, and what the likely delay at that
stage will be? It is delaying a lot of people now and no doubt
will continue to do so.
(Con)
That is absolutely right. In our weekly meetings as Ministers, we
look at the reason for the delays in terms of the 13,000 beds.
That assessment of delay is one of the key criteria that we
monitor each week. The best ICBs that I have seen have teams on
this—they are absolutely SWAT teams—who make sure that they do
it, and measure the time in which they can do it; for example,
they have got to have that assessment within 24 hours. When the
patient goes in, they have an estimate of the day that they are
leaving, which they will target and work towards. The best do
that, and the task force is set up to make sure that it is rolled
out to all the other places.
(Lab)
My Lords, the question has been put to the Minister already, but
I want to put it again. Has he read the report of the Adult
Social Care Select Committee, published in December, which has a
raft of challenges and very good ideas on social care? I look
forward to discussing it with the Minister. Specifically, does he
agree that as long as we characterise adult social care workers
as unskilled and pay them, quite often, below the minimum wage,
we are never going to build the capacity that we need? That is a
huge challenge. If he were to read the report, he would find that
what we recommend is so evidently simple: we need a national
workforce plan for adult social care, to raise standards,
incentives, status and pay.
(Con)
I thank the noble Baroness. I think that the House will recall
that I have mentioned on a number of occasions that this is a
critical part of the workforce plan. What has become clear, even
in the short time that I have been at this box, is that social
care is a vital cog in the whole chain, so to speak, which goes
right back to ambulance wait times and A&E, because if we do
not get the flow going out of the system, we have got problems
there. So I can assure the noble Baroness that it is key to my
thinking, and to all our thinking.
(CB)
My Lords, I declare my interest as a future member of the NHSE
board. I want to ask how we are going to monitor the advancement
from care homes back into domiciliary care, in order to ensure
that we do not just move the problem from the hospital to care
homes so that, very quickly, there are no beds left in care homes
to continue this transfer system. In particular, who is going to
pay for the residents in those care homes, and for how long?
(Con)
The question is absolutely correct: as I said earlier, less than
10% of these 13,000 people need to be in care homes full-time.
The danger is often that once you put them there, they remain.
That is why the package is focused on stays of up to four weeks,
and absolutely making sure that they are monitored through,
because it is vital. It is a step-down situation to help people
ease from the acute—where they need a bit of extra support—so
that, most importantly, they can get back home as soon as
possible.
(Lab)
My Lords, does the Minister agree that some of the best examples
of care are provided by charities and faith-based organisations
which pay more than the minimum wage? Is that not an example to
be encouraged if we really want to improve the recognition of
carers in the care sector?
(Con)
Yes, absolutely. I find—and I talk as a businessman of 30-odd
years—that by paying people well, you attract and retain the most
motivated staff. It is the best way to run an organisation.
(LD)
My Lords, is it not the case that there will be sufficient staff
in the social care sector—both care homes and domiciliary
care—only when we have a truly integrated approach to workforce
planning across both health and social care? Yes, pay will be
absolutely critical, but so will progression and career
development opportunities, and opportunities for things like
joint posts and rotational arrangements between the two sectors.
What plans do the Government have to look seriously at this
critical workforce issue?
(Con)
Absolutely; it is an integration issue. Noble Lords will have
heard me say just yesterday that our plan is for a modular system
of development, so that someone in social care has the modules to
go on to become a nurse. It is integrated in that way so that it
is seen as a career path for all those people. It is fundamental
to all our thinking.
