I thank the noble Lord, Lord Darzi of Denham, for introducing this debate and for his excellent speech. I also thank the noble Baroness, Lady Verma, whose eloquence on social care and the need for investment in it I wholeheartedly support. I declare my interests as in the register, most specifically as a mental health nurse of some 40 years’ standing.
There is a clear case for further integration of physical and mental health and community and social care provision if we are to meet the needs of our citizens and promote healthy living and, where necessary, treatment intervention. I am involved with the social movement Nursing Now, working with policymakers and senior nurses from several continents.
In Africa, a phrase is used: “Health is made in the home and communities and hospitals are for repairs”. We need to adopt this approach in our communities to serve our citizens as cost-effectively as is feasible. We are celebrating our investment in 70 years of the NHS, which has resulted in people living longer and healthier lives. However, this has brought the challenges associated with many older people having several complex health and social needs, a situation that was not fully anticipated in 1948. The challenges facing our young people in terms of mental problems and the increasing prevalence of non-communicable diseases associated with lifestyle are resulting in higher demand for healthcare intervention.
The demands on the NHS will continue to rise unless we focus on public health policies that encourage citizens to become more responsible for their own health. With the access we all now have to digital data, why should we not be more responsible for our own health records and monitor our responses to exercise, diet and medication? If our citizens are to be more accountable for their own health and well-being, they will still need health education, support and guidance to do so. Families need help in the early years of their children’s lives through effective health visitor interventions combined, where necessary, with structured support from social services and mental health interventions for families with experience of anxiety, depression or severe and enduring mental health conditions. Yet we know that these services are under considerable strain and that, even when sufficient resources are available, families and individual citizens complain that different workers often fail to work collegiately to provide coherent packages of care. If community-based health and social services were better integrated, it would be easier for individual providers of care to deliver appropriate services, as indicated in some of the vanguard sites. This also includes successfully reducing delayed transfers of care.
I have two further suggestions that I would like the Minister to consider. First, there should be a move towards more clinical treatments for people in their own homes, care homes and nursing homes. In Spain, it is not uncommon for a person with pneumonia to be treated with intravenous fluids and antibiotics in a nursing home, and even occasionally in their own home, without the need for hospital admission. Serious consideration of more simple treatments being given outside acute hospitals needs to be undertaken. This would reduce the need for more hospital beds and allow a redistribution of resources towards community-based interventions.
Secondly, all healthcare workers should be expected to be proficient in coronary pulmonary resuscitation and physical first aid. The APPG recently heard, when reviewing progress against the five-year mental health strategy, that there is a real need to increase training in acute in-patient first aid across society. I very much hope that we will do this.