My Lords, as a member of the scrutiny committee on the Bill, I welcome the inclusion of the Care Bill in the gracious Speech. The fact that the Bill was published so quickly afterwards gives me confidence that at last we will see some long overdue progress made in improving the well-being of some of the most vulnerable among us, particularly disabled and older people.
I also welcome yesterday’s announcement of the first ever system-wide shared commitment in which 12 national health and care leaders have indicated how they will help local areas to integrate services. I hope that will include housing and prevent the most vulnerable among us being passed around health and care systems in the future. I have also heard that the Government plan to launch a review into all aspects of later life care, which is very welcome. However, without being too cynical, we have had lots of reviews over the past 20 years or so and none of them has resolved the key problem that there is not enough money in the system to provide even a basic level of acceptable quality care, as the Association of Directors of Adult Social Services has confirmed.
Regarding the Care Bill, can the noble Earl tell us when the new care funding eligibility criteria framework will be published? In the new framework it is most important that having moderate care needs is recognised as being relevant and appropriate for initiating the provision of preventive services. The care Bill mandates that a local authority has to exercise its functions with a view to ensuring the integration of care and support provision with health provision and health-related provision. Does the noble Earl agree that encouraging local authorities to lengthen their budget cycles to at least four years would encourage the necessary investment in prevention and intervention in year one? That will pay back only later, with delayed and reduced care needs and costs, and perhaps compressed morbidity.
The annual report from the Prime Minister’s “challenge on dementia” is also due soon. Then we will learn how much progress is being made on making the quality of care as important as the quality of treatment. The prevalence of dementia is growing, and there is often a need for its management to be part of public health responsibility. It should include well-being, the design of the built environment and preventive care. If we are to get dementia-friendly communities, all those aspects need to be looked at. Public health inclusion would be welcome.
I support the view of Macmillan Cancer Care that, at the end of life, social care should be free and appropriate. People dread being in an inappropriate care setting, with a loss of dignity and respect as their final days approach. I get so many heartfelt pleas from the family and friends of people in care, both young and old, about the difficulties they have in finding out who is responsible for their care and, above all, how they can make a complaint. I know that the new clinical reference groups are supposed to meet regularly with patient representative groups but it is most important that dementia and end-of-life care are not forgotten.
On the new CCGs, I am concerned that in some localities, with their smaller management teams, they will not have the resources to fulfil their twin responsibilities of transactional management—such as A&E, NHS 111, contract negotiation and so forth—and the transformational relationship management, in areas like long-term improvement in dementia and end-of-life care, that they need to take on board; and that a disconnect may develop in terms of accountability for both these important areas.
We are seeing increasing costly bed-blocking as older people wait for care home places and clog up acute hospitals. I hope this can be dealt with, but Age UK has today reported that many patients have a 30-day wait to leave hospital. This is totally unacceptable. We need to look across the board at many types of initiatives and bring them together to solve some of these problems. Perhaps, in the end, innovation will be the key. Could we not look, for example, in quality and provision of services, at something like the “patient hotel”-type concept which is de rigueur in Scandinavia? I stress that I see this as an extension of NHS-provided services, and not privatisation.
In another initiative, the think tank with which I am involved, the International Longevity Centre, is coming forward in the next few weeks with a proposal for a more affordable savings product which might appeal to people of modest means who would not normally be able to afford an insurance product, and about whom the noble Lord, Lord Hunt, has understandable concerns.
Perhaps we could think more broadly about how we organise our services. For example, perhaps it would make sense if the social care elements of the DWP were merged with the Department of Health—a bit like the old DHSS but with the pension element hived off to employment. We look across the board at all sorts of ideas. Obviously, the DCLG would have to be involved because of local authority care-funding responsibilities. I believe that the current cross-departmental arrangements for the oversight of care funding and provision are one of the main reasons for the lack of joined-up thinking that we see all the time. It seems impossible to bridge these divides, so why not move some of them together and see if that works better? It is only by people with differing skills and sectoral responsibilities coming together that we can benefit from the necessary transformational plans to meet the needs of our ageing population in the years to come.