My Lords, in moving Amendment 11, I wish to speak also to Amendment 30. I also support the amendments in this group tabled by the noble Lord, Lord Best, but may respond to those later.
In Committee, we debated amendments promoting further integration of health and social care. As my noble friend Lady Wheeler said, we supported the view of the Association of Directors of Adult Social Services and the Local Government Association that the Bill should include a specific duty on NHS bodies equivalent to the duty on local authorities to integrate services and that this shared involvement should be enshrined in the Bill. Joint strategic needs assessments and joint health and well-being strategies should provide a strategic overview of how the health and well-being of local communities can be improved and health inequalities reduced. ADASS has long maintained that local health and well-being boards are pivotal in the delivery model in this respect and that the Bill must reflect this to bring about a wholly integrated accountable system that meets identified local needs and objectives.
The noble Earl, Lord Howe, said in Committee that he had no argument with the sentiments expressed by my noble friend and relied on Clauses 3 and 6 of the Bill and various other pieces of legislation, including Section 116 of the Local Government and Public Involvement in Health Act, which requires local authorities and clinical commissioning groups to have regard to the relevant joint strategic needs assessment and joint health and well-being strategy in exercising any of their functions, which would include their duty to co-operate and promote integration. The noble Earl also prayed in aid the prominence of health and well-being boards being strengthened through their role in signing off joint plans required as part of the £3.8 billion pooled fund between local authorities and the NHS to support joined-up and integrated working.
I certainly accept and understand those points but I would like us to go further. I argue that the measure should be much more explicit in the Bill in relation to the National Health Service’s duty of co-operation. We know that the current crisis in accident and emergency services which seems to be extending through the early autumn period is symptomatic of a health and social care system that is under huge pressure. If reductions in social care funding and support for the third sector mean that patients cannot be discharged from hospital that has a knock-on impact throughout the whole system. This Bill places major responsibilities on local authorities. Without the full co-operation of the National Health Service they will be very hard pressed to discharge those responsibilities.
The noble Earl is relying on this Bill and existing legislation but the fact is that so far this has not been sufficient. I refer him to a report published today by the University of Birmingham and Birmingham City Council entitled Turning the Welfare State Upside Down? The report says that our social care system is broken and increasingly unfit for purpose and that we need a big and bold response to tackle the crisis and ensure a decent and fair system for the future. The report is right to emphasise the need for close co-operation between social care and the NHS and to shape services around the needs of the individual. The problem is that the Government through their 2012 Act have created a disintegrated system instead of an integrated one and a system where fragmentation is rejoiced at and where the operation of a market is meant to drive a wedge between people who ought to be co-operating together.
I do not want to go back over this afternoon’s Oral Question, but clinical commissioning groups would have been surprised to hear the noble Earl suggest that it was entirely up to them whether or not services were put out to tender. They have been absolutely pressurised by NHS England to do that. NHS England is clearly under the direction of the Secretary of State: how could it not be when, according to government briefings over the last two weeks, the appointment of its chief executive is going to be the Prime Minister’s decision?
There is real concern that we have conjured up a very fragmented sector. As the noble Earl knows, we already have a system where physical health, mental health and social care have found it very difficult to integrate their services. As we have more older people
with vulnerabilities and co-morbidities, the need for the systems to work together becomes ever more paramount.
Amendment 11 would put in the Bill an explicit requirement for the NHS, through the health and well-being boards, to play its full part in the integration of services. In Committee, the noble Earl was sympathetic to these sentiments but not to the amendment. I hope that, in the spirit of accepting wise words in this House, he will be prepared to be more sympathetic on this occasion. I beg to move.