George Freeman highlights importance of better integration of health and social care

George Freeman outlines the importance of work to reform and better integrate the health and social care sectors to meet the needs of a population living longer and healthier lives.

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): I thank the hon. Member for Leeds East (Mr Mudie) for raising the important issue of the reorganisation of care pathways in Leeds. I prepared a speech dealing with the reorganisation of health and care and their integration in the town, but I only have nine minutes left and I need to deal with the questions raised by the hon. Gentleman. Perhaps I can write to him with the detail of some important reforms going on in the city.

First, I want to take on the hon. Gentleman’s questions. I reassure him that the reforms in the city are absolutely not the result of any diktat by Ministers. They are in fact being led by hard-working and pioneering health, NHS and social care leaders in Leeds, to whom I pay tribute. My right hon. Friend the Minister of State, who is responsible for care, has publicly commended the work that they are doing locally. They are doing pioneering work in the important mission of integration.

In much the same way that NHS England is autonomous and responsible for delivering health services locally, local authorities are responsible for providing social care services for their communities. As autonomous public bodies, they are best placed to decide the needs of local people. I support the work done insofar as it encourages people locally to contribute to that democratic process.

The hon. Gentleman made some important points. First, he asked whether the proposed closure is due to cuts in Government funding. The answer is no. Public finances are in a precarious position. This year the deficit is still, despite the best efforts of this Government, projected to be over £100 billion. I remind him that when we came to office, debt interest alone was running at £70 billion a year. In Labour’s last year, one in every four pounds spent by the Government was borrowed. We had to get that under control.

It is true that priorities have to be set across the local authority system, but the vast majority of local authorities have prioritised social care. Indeed, in Leeds, work has been done to allocate priorities appropriately. The evidence is encouraging. Despite difficult public spending constraints, spending in Leeds on adult social care is up 3% in cash terms. Importantly, satisfaction with levels of care and support is up 10.8%. I do not recognise the picture of catastrophic collapse that the hon. Gentleman painted.

Secondly, the hon. Gentleman asked whether the Government are doing enough on accident and emergency and about the extent to which that is being driven by the problem in social care. The truth is that we ring-fenced a grant for £25 million to help councils with hard-pressed hospitals. An ageing population—there are 1 million more pensioners this year—is driving increased pressure on A and E. We have set up the Better Care Fund, which I will say a little bit about later.

I cannot let the allegation about privatisation go without a response. Labour’s scaremongering about privatisation has been discredited as a myth by just about every health commentator, including the King’s Fund. Our Health and Social Care Act 2012 made it illegal for any Government to drive the private sector into the NHS, as happened under the Labour Government. It was Labour, actually, that was prepared to pay private sector providers 11% more than NHS providers, and under this Government, led by my right hon. Friend the Secretary of State for Health, that has been made illegal. Under Labour, independent provision comprised 5% of the NHS, but under this Government it is now 6%, which is not an increase of the order that the hon. Gentleman described. Spending on private providers for general and acute secondary care increased by twice as much under Labour as it has under the coalition.

The health service has always been a mixture of private, public and voluntary providers. It ill behoves the Opposition, just before the election, to scaremonger on privatisation. That does not support patients and it is not what the people who work in the health service want to see.

In the few minutes I have left, I want to say something about the reforms to adult social care and the integration of care, and about the work that Leeds has been doing. I know how difficult it can be for elderly patients when health and care services are reformed and changed. That is why it is important that it is done locally, with consultation and led by local professionals.

This morning, I spoke to the interim director of adult social services for Leeds, who assured me that no decision has been made on these proposals. They are still being consulted on and they are part of the council’s wider six-year programme to move more services into the community. I understand that there is plenty of alternative capacity in the area: 123 independent sector care homes in the Leeds area alone would be able to accommodate anybody moving. Furthermore, he tells me that the council has successfully closed a number of its care homes, so, if a decision is made to close other care homes, it will use that previous experience to handle those closures sensitively and appropriately.

I want to say something about the context of and pressure on social care and how it is changing. Above all, I emphasise the importance of all services, not just social care, adapting and working together to meet the needs of an elderly population in the 21st century. We are living longer, healthier lives and that is something to be celebrated. The fact that many of us can look forward to reaching 85 and over and many of us—perhaps not me, but perhaps the hon. Gentleman—will live to be 100 is a fantastic achievement. However, it puts pressure on the system. Historically, health and care costs have risen by about 4% every year in real terms. The number of people living with three or more long-term conditions is set to increase from 1.9 million in 2008 to 2.9 million in 2018. One of my former ministerial colleagues, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow),has talked about how care homes need to be made

“fit for the rock and roll generation”.

That is why we have been pushing the integration of health and care and the changes set out in the Care Act 2014.

It would be remiss of me not to admit that in recent decades we have allowed ourselves to tolerate a care system that too often steps in too late and picks up when there is a crisis, rather than acting to prevent one; a system in which there are still too many barriers stopping people getting the integrated care they need; and a society, for which we all take responsibility, that, despite the best efforts of those working in the care sector—professional and voluntary—increasingly has tolerated too much loneliness and isolation.

The case for reform and integration of the care system is not just serious, it is overwhelming. That is why this Government have put such emphasis on integration. People worry that care services will not help them regain their independence and maintain a decent quality of life. It is in all our interests to integrate health and care better. That is why we created the Better Care Fund, the biggest ever financial incentive for the integration of health and social care, providing £5.4 billion of investment in better integrated care from 1 April 2015. Never before has there been a clear legal duty to focus on prevention. The Care Act fills that gap.

I pay tribute to the leaders in social care and health in Leeds, because they are doing great work as a pathfinder area and the Government have supported them. It is a Labour-run council, but it is doing good work in the integration process. I understand that Leeds is opening 37 open access neighbourhood networks. Those schemes are helping around 22,000 older people every year with a range of activities; they have prevented 1,400 older people from going into hospital; and they have supported over 600 older people when discharged from hospital.

Time is against me. I want to close by highlighting the fact that these are not easy issues. The integration of NHS and care services is a challenge across the country, in my constituency as well as the hon. Gentleman’s. The Government have inherited a legacy of neglect in recent decades: I do not just blame the Opposition. We have not integrated properly and we have allowed this problem to go on too long. I believe this Government have attempted to tackle the deficit responsibly. Of course, we all have to tighten our belts.

We have ring-fenced health expenditure. In an integrated system, putting more money into health and driving integration means that there is more money indirectly for social care. The statistics in Leeds simply do not represent this catastrophic picture of privatisation, which has been discredited, or of crisis in the system. I do not pretend for a minute that everything is perfect, but I do believe that we, working with local authorities, are putting the right solution in place for the longer term.

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