Norman Lamb on the Better Care Fund

I'm delighted to be here and The King’s Fund has done extraordinarily important work in getting us to where we are now and personally Chris has been an enormous influence on me and my thinking as a Shadow Secretary of State for Health for the Lib Dems. I read and listened to what he was saying and developed my sort of passion for integrated care. We went to Kaiser and a few other integrated care organisations back in May and June. It was very striking actually, he mentioned about, you know, every unplanned admission to a hospital is regarded as a failure of the system and of course they do still have failures, but the hospital, the Kaiser hospital we visited in San Francisco had 200 beds in San Francisco serving a very substantial population and the fact is that they use hospital beds far, far less than us because they manage much better to keep people out of hospital and in better health. So Chris, thank you for everything you’ve done. We were last together on Radio Somerset talking about fantastic work that’s being done there. Is there anyone from Somerset here? No. Well they’ve got, it’s a symphony project I think, isn’t it? And it’s fantastic. It was one of the applicants for the pioneer programme and they are demonstrating on the ground what’s possible.

So I think we all know the challenges that we face, the extent to which we’re all living much longer, the fact that we’re often living with more than one chronic condition, often actually a mix of physical and mental health problems, and if we ask the question does the current system serve those patients well? I think if we’re honest about it we have to say no it doesn’t always serve those patients well and that change is absolutely necessary.

And I talk about four big shifts that I think have to happen to meet this extraordinary change that’s happening demographically and the fact that we’re moving from, I think at the moment, 1.9 million people living with three or more chronic conditions to 3 million people by 2025. I mean this is an extraordinary extra pressure on the system and if any of you can tell me where a whole load extra money can come from to deal with those people, then I’d be really interested to hear from you. As far as I can see, it dictates the need for change and these 4 big shifts that I talk about are as follows.

First of all, a shift of emphasis from repair to prevention. Over the last decade we’ve spent a very substantial amount of extra money on our health service and I've supported that, but the bulk of that investment has been at the acute end, the repair end. We’ve had Payment by Results which is incentivised activity in our acute hospitals. We haven't invested emphasised sufficiently in my view preventing ill health and preventing a deterioration of health to prevent those crises from occurring in the first place. So that is a fundamental shift that I think has to happen and the better care fund is central to that. The second big shift is from a horribly fragmented system to one that is really joined-up, integrated, shaped around the needs of the individual patient. If you think about what has happened over many years, we’ve institutionally separated mental health from physical health. That makes no sense to me from the patient’s point of view. We’ve institutionally separated primary care from secondary care and health care from social care. All of these institutional fragmentation developments in my view have not helped the cause of joining up care and serving the needs of the patient well and it has to change.

The third big shift for me is from a very paternalistic system - and I think that applies to both the NHS and the social care system - to one that is acutely personal and there’s lots of fantastic things happening around the country, I know that and many of you will be involved in that work but the systems are very paternalistic and that needs to change to something that absolutely focuses on the individual, gives them power to determine what happens to them.

And the fourth big shift, which I think is equally critical, is moving from what I would describe as a very exclusive system where the statutory services, or indeed other providers on their behalf, do things to people that don’t engage nearly sufficiently with the wider world, the society in which they operate. And if we are to have a sustainable system, and one that actually focuses on what we should all be interested in and that is giving people better lives, wellbeing, it’s the heart of the care bill that I'm currently taking through committee and parliament.

There has to be I think a much richer collaboration between statutory services and the wider community. The voluntary sector and volunteers, people in their communities, doing things to support others. The idea of neighbourliness and recognising that we have, in my view, a crisis of, I know it’s a very over-used term at the moment, but of loneliness. Of people living very lonely and miserable lives and when I went out with a care workers in London recently and saw what it’s like to live alone and to see no one else in your life apart from the formal care worker who comes to see you, it’s a pretty miserable existence when all your life consists of is being got out of bed in the morning, washed and fed, sitting in front of a television and then put back to bed in the evening and never seeing another human being. That’s a miserable existence and statutory services can’t deal with that on their own.

There has to be a richer collaboration and I think then of Cornwall, one of the integration care pioneers, where there’s a fantastic collaboration now going on between GPs and volunteers, working collaboratively, seeing them as part of a sort of coalition of support for individuals living in the community and GPs recognising that the involvement of these volunteers is easing their burden and making things better for those individual patients.

So those in my view are the four big shifts that have to happen and they are all demonstrated in one form or another. First of all in the 14 integrated care pioneers that now have been announced and are doing literally brilliant work in their communities but also they’re at the heart of this Better Care Fund and you, all of you, can be leaders in your communities of fundamental change to a better system and ultimately what all of this is about is providing better care for people and giving people the chance to lead better lives, happier lives, and I think that we have an enormous potential to make a real difference.

So in places in Greenwich, North Staffordshire and Cornwall, integrated care pioneers, they are leading the way. They are doing amazing work. I visited also Islington recently where this incredible collaboration within their community stopping people to start with getting diabetes. A whole team focused on that, to prevent that deterioration of health that leads to so many complications for the lives of those individual people and they’re in the process achieving savings for the system. Their work, encouraging local health services and local authorities to work better together, will revolutionise care and they will overcome problems, the barriers that often exist to integrated, joined-up care, and I want to just focus on one in particular.

I spoke at a conference last summer about the emerging vulnerable older people’s plan which is one of the Secretary of State’s priorities, and I asked the audience, what is your feeling about your own experience, about your ability to share information, to share data? And there was this overwhelming sense of frustration that came back at me with people feeling completely frustrated that there are all sorts of barriers in the way of sensible sharing of information to achieve good results for people.

So I went back and talked to the policy officials and we decided that this was something that we could do working with the pioneers to identify where the barriers are, what we can do about them, so that we can then share information across the whole system to inform your work in developing your plans for the Better Care Fund. And Southend in particular, one of the pioneers, came forward expressing their frustrations. So they found that there were problems with the NHS having access to local authority care data and vice versa. They couldn’t accurately put together a risk strategy which could guide them to build better, more integrated health and care in their community. So a national team of experts went to help them, including one of our leading academics on older people, an expert at information sharing in health care, and other NHS specialists. They worked with South End and what they learned will be shared across other pioneers in a national workshop which is happening very soon, and during the next few months we’ll be working with those other integration care pioneers to work through any of their particular problems.

This is a crucial foundation, it seems to me, for joined-up integrated care and emblematic of what we can achieve through professionals working together to solve the problem. I want to move from a situation where brilliant people across the country are doing the most amazing things despite the system, to a situation where we encourage and facilitate brilliant people across the whole system to get on and do great things, not held back by barriers to achieving those ambitions.

Now, a lot of you are already putting your plans together for the use of the fund and most of you would be doing this on a tight timescale as the guidance to how this fund should be used was only recently sent out. But for many of you this will be the latest step in long-running conversations about how to integrate joined-up care better in your area. But the Better Care Fund, it seems to me, provides an extraordinary catalyst for accelerated change and it’s the biggest promotion in my view of this shift from repair to prevention and shift from fragmented care to joined up care that we have ever seen.

And I am looking to all of you to be radical, to shape a better system, to be as ambitious as you can, to regard the better care fund as the start not the finish. This is ultimately quite a small percentage of the total health and care budget, but why do you have to stick to that? Why can’t you look beyond that to see what you can do in your areas to make your system more rational in order to achieve the objective that we must all focus on, achieving better care for your communities?

And this of course is challenging but I really look forward to hearing about what your plans are over the next few months and it’s crucial that we get these plans in place so that come next year, we are all in a good position to offer the best possible care and we should just remember that as long as we delay, we are short changing the people that rely on our services. Disjointed, fragmented, siloed services let down patients and carers, older people, disabled people, and many others.

The point is well illustrated when we look at recent statistics related to delayed discharges of care. The national average for total numbers of days delayed per thousand people aged 65 and above is 42 days. 42 days. But pioneer sites in Staffordshire, Worcestershire, Barnsley have been able to cut that average to, at times, just 4 days. An almost-tenfold reduction in delayed transfers of care for elderly people. And it’s a huge leap forward, improving those patients’ experiences and it’s all down to the different parts of the health and care system working better together. Older people are getting the care they need, when they need it, in the appropriate setting and freeing up hospital beds which, of course, we all know is of critical importance.

And it’s just one example of the type of improvement we can expect from the Better Care Fund. All health and care partners working together, through health and wellbeing boards will offer us all a chance to really scrutinise how we can deliver health and care services now. The changes you make through the better care plans will improve that service by focusing, as I’ve said, on preventative care, providing more seven day services offering care that fits around the person’s needs. These changes will lead to more people living independently, living better lives with a focus on supporting them to live and care for themselves at home.

My vision is that this is just the start. That if we look five, 10 years down the track, that we have a very, very different looking health and care system. One that is really joined up and one critically that empowers individual citizens and puts them at the very heart of what we are doing.

But I will end with the following thought. We have to protect health and care services. We have to do it. The need to change to deliver better joined up care and a more sustainable health and care system has never been more urgent. You are leading that change. Making integrated and more preventative care a reality. I look forward to hearing more about what your plans are in your local communities.

Thank you very much indeed.