NHS and Social Care: Joint Working

Question

11:18:00

Asked by

To ask His Majesty’s Government what plans they have to promote joint training programmes and opportunities for joint working for staff who are separately employed by the NHS and social care agencies to encourage integration between the two services.

My Lords, the Government are committed to developing an integrated health and care workforce which is skilled and well supported and has opportunities for high-quality learning, to enable staff to develop and progress their careers across an integrated system. We are also implementing joint induction for all health and care staff, a mid-career management programme and, during 2025-26, the introduction of new management standards and unified core leadership and management standards for managers.

I thank my noble friend for that positive reply. Does she agree that one of the main barriers to integration between health and social care is the lack of knowledge of the skills and experience of other professionals? Should the importance of integration therefore be included in initial clinical training, and should clinicians of all kinds be encouraged to understand the work of others by job rotation, so that they can be helped to appreciate the role of other colleagues and the importance of all professionals to patient care, no matter which agency employs them?

I very much agree with my noble friend about the importance of integration. As she explained, it is not necessarily about training to be joint, but about the approach. I will feed back her particular suggestion about job rotation to Minister Karin Smyth, who is responsible for developing the workforce plan. I will also share her view—again, I am sure she will see this reflected in the workforce plan when it is published following on from the 10-year plan—on the importance of multidisciplinary teams in many areas. The one that we are talking about, health and social care, is a prime example.

My Lords, I thank the Minister for her previous very positive answers, but one of the biggest barriers to working together is different terms and conditions for care and health workers: in particular, the lack of pay for care workers who have to go between different visits in rural areas and have significant dead time. If we are really to move this forward, should we not put pressure on councils to ensure that the contracts they let allow for the time travelling between people who are being cared for?

The noble Baroness raises a practical and realistic point that many care workers speak about. She will know that we are implementing a new fair pay agreement that, for the first time ever, will reflect what people actually do. Also, for the first time, there will be a universal career structure for adult social care that supports care workers. The approach that the Government are now taking shows a line of movement that takes seriously the pay, terms and conditions of care workers. I should also add that the noble Baroness, Lady Casey, will have free range to decide how she wishes to conduct her review of social care. Perhaps the noble Baroness, Lady Watkins, will ensure that she speaks to the noble Baroness, Lady Casey, about that.

My Lords, does the Minister agree that sometimes the most effective integration of care is around the decisions and choices of the care recipient themselves? To that purpose, would she agree that the NHS should be pursuing personal health budgets that can be combined with direct payments from social care entitlements, so that recipients of care can design their care, which will sometimes include the appointment of staff who are able to meet both purposes?

I certainly agree with the noble Lord about the importance of the individual needs of the person at the centre. For too long—and part of this is a lack of integration—the needs of the person who receives, wants and needs that care and support have not been at the front. On his suggestion, I would just counsel waiting for the 10-year plan. It may not do exactly what the noble Lord says, but it will set out a way forward on how we will resolve such matters. I am sure that he will participate in further discussions about how we can get to the place that we all want.

My Lords, I was very pleased to hear the Minister’s words on the progress and planning for this NHS 10-year plan. I was looking through, well, everything that I could find, really, and I could not find that any progress had been made, so I wonder whether the Minister could update the House on what is happening now and when she thinks we might start implementing this programme.

I am not entirely sure, but I think that the noble Baroness is referring to my first Answer.

Yes, I am.

Good—thank you. This derives from the review by Sir Gordon Messenger. The first review was in 2022 and Sir Gordon came up with seven recommendations to strengthen leadership and management. To build on that, in November, Secretary of State Wes Streeting asked Sir Gordon to deliver further recommendations. That is why we now have a new national entry-level induction for new staff. As of 25 April this year, for example, it is being used by nearly 70% of trusts and ICBs to support staff enrolment. That shows how much it was needed and how much change it will make.

My Lords, the Archbishops’ Commission on Reimagining Care identified a number of solutions to tackle the workforce challenges in adult social care. These included better pay, improved career progression and role redesign. Could the Minister outline some of the steps that the Government are taking to address low pay, and to develop better training and development programmes and a more strategic approach to career progression in the sector?

I very much welcome that report and am pleased that the Government have been responsive to identifying what we need to do. I never tire of saying that, to support the workforce in the way that my noble friend said, we are introducing a new fair pay agreement for adult social care and implementing the first universal career structure for adult social care. That will—and I know noble Lords are concerned about this—lift the status and attraction of work in social care. I believe that, alongside, for example, the apprenticeships that we are now making available and many other measures, we will get to a place where those in the workforce are doing the job we would like them to do and are being properly recognised on all counts for it.

In the light of the 2023 Hewitt review into integrated care systems, how are the Government building greater awareness of adult social care in the NHS workforce in order to enable greater collaboration?

Well, it is absolutely part of training, and the movement towards that integration of understanding across both sectors has been continuing for some while. The right reverend Prelate gives me the chance to say that we also have a digital platform that allows skills to be recognised across. The more we can do in that way, both technically and with people, the more success we will have in being integrated and building care around the person who requires it.

My Lords, as I understand it, one of the principal issues about the integration of healthcare and community social care is the lack of data integration. Many hospitals still rely on manual processes to send discharge letters to GPs and social care providers. Would the Minister be good enough to tell us what the Government are doing to drive forward automation of discharge letters and similar clinical information?

The noble Baroness is quite right in her observations on the need to move to much better services here. First, on her point about discharge letters, appointment letters and so on, the Government have already committed funding and direct support to local areas that are not currently providing what we might call 2025-standard communication. Noble Lords will see a considerable change; some trusts are already doing that and doing it excellently, but we want to bring that up. On the noble Baroness’s specific point, I can tell her that we are continuing to encourage the use of digital social care records to make sure that the individual’s medical record is there. Over 85% of people who draw on registered care now have a digital social care record. I hope that I have gone a bit further than the noble Baroness was asking.