ICSs need to include social care fully in planning and strategic decision-making. Local authorities are responsible for social care and have a clearly defined role within ICSs. The Health and Care Act 2022 includes local authorities in its minimum membership requirements for ICBs, giving local government a greater voice in NHS decision-making than ever before. In July 2022, we also published guidance on how ICPs and adult social care providers should work together.
I thank the Minister for his response but ICBs and ICSs have been fully operational only since last July—less than six months. The Minister is quite right that, when they were being set up, we argued strongly for the need for effective social care representation in both bodies to ensure that health and social care are integrated and fully embedded in both. However, this just is not happening. The ADASS spring survey found 73% of directors reporting that ICS management has had little impact on local investment in adult social care to date; some even said that ICSs were reducing investment. How does this help ICSs play a key role in their respective areas in, for example, tackling the staffing crisis in both services, prioritising adult social care and producing the urgently needed ICP integrated care strategies, which are due in June?
First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.
My Lords, I believe that six integrated care boards have been selected as national front-runners on innovations that will help move patients from hospital to their home. Can my noble friend the Minister confirm that these are going ahead, give examples and reassure us that they will be properly monitored, with data being collected? I have just realised that I called the Minister “my noble friend” but, due to my new role, all noble Lords are now my noble friends.
Replying on behalf of all noble friends, let me say that I am particularly pleased to see this scheme go ahead. Just yesterday, Members of the House were talking about whether we should have full-time contracted dom care people because they know their patients best. That is exactly what these front-runner pilots are designed to do: to try out these new ways of working and heavily invest in areas, which you probably cannot justify on a national level until you know that it really works. Leeds, for instance, is developing a transfer of care hub, while the Northern Care Alliance is focusing on dementia. This is all about seeing what works and then, when we know what works, scaling it up very quickly.
My Lords, I hope the Minister can assure the House that he has had an opportunity to read the Adult Social Care Committee’s report, which was published in December. The report makes it abundantly clear that the NHS will not achieve its objectives—some might even say its survival—unless social care is integrated at every level and includes the voice of unpaid carers. Can the Minister assure the House that these matters will be taken seriously?
Absolutely. It strikes me—again, I mentioned this yesterday—that less than 10% of the 13,000 so-called blocked beds contain people who will need to be in social care full-time in future. Most of them need short-term support and, once they have it, will be able to go back to living in their home, which is the best place for them to be.
My Lords, as the Minister has recognised, social care provision is largely in the domain of local authorities. The level of local authority representation on integrated care boards is therefore likely to have an impact on how powerful the social care voice is in integrated care system decision-making. Does the Minister have any information to share with the House about local authority representation across the 42 integrated care boards, including whether it goes beyond the statutory minimum, so that we can understand whether it is sufficient and likely to lead to the step change that I think we all want to see?
It is, as the noble Lord says, a statutory requirement that the local authorities are represented on the ICBs. In the last few months, I and other Ministers have met and had discussions with all the ICBs. Every ICB is asked to put up a few people. I have had the local authority representative there as one of only three or four people in the meeting—that is key to all of this. They have been critical participants. They are very involved, and it is vital that they remain so.
My Lords, the Government are to be congratulated on amending the Health and Care Act to ensure that responsibility for integrated care systems addresses the needs of children and young people under the age of 25. However, children with special educational needs or disabilities have lifelong problems. How will providers ensure that there will be integrated health and social care for disabled children and their families?
This is the whole point and the way that we are moving; the real decision-makers running their local areas should be the ICBs. They know their areas and the needs of the people—including people with special needs and learning disabilities—more than anyone. It is absolutely their responsibility to understand the needs in their areas and to ensure that they are provided for under the commissions.
My Lords, unpaid carers throughout the country are, more than often, working 24/7. The Care Act 2014 requires local authorities to deliver this high-quality care, including support for unpaid carers. How confident are my noble friend the Minister and his department that local authorities will undertake carers’ assessments for unpaid carers?
From my experience I understand that this is a very important part of their remit and role. As we are all aware, the unpaid carer role is vital and historically has probably not been recognised as much as it should have been.
My Lords, following on from the question asked by the noble Lord, Lord Laming, what plans has the Minister to encourage ICSs to embed co-production in the design and delivery of adult social care at the local level?