My Lords, it is a privilege to share this debate with my noble friend Lord Walton. I begin my contribution to the debate on the future of the NHS by addressing my remarks to the opportunities presented by social enterprise for the future of health and, in particular, primary care.
In recent months, many of us have listened with growing concern to the unfolding story of Baby Peter in Haringey—one of the tragedies that point to the lack of joined-
I was interested to hear my noble friend Lord Laming, in a Radio 4 interview, describing how difficult it was for Ministers to get the words about joining up health and social care off the pages of glossy reports and into reality on the streets of our towns and cities before yet another crisis erupts on to our television screens. I suggest that putting people before structures is the only practical way of joining up services and implementing a truly integrated approach to primary healthcare in this country. We need to use the innovative skills of social entrepreneurs and organisations that have a proven track record and to back such people by giving them the resources and freedoms that they need to transform the health and well-
Many of these people are doctors—I have worked with some of them. Many others are individuals working in third sector organisations and leading teams of dedicated people committed to improving health and social care services in their local communities. These people seldom appear on the NHS radar and, even when they do, are rarely valued for the contribution that they make. The tragedy is that despite the years of commitment to new commissioning structures—third sector compacts, social enterprise initiatives and the like—there is still little widespread procurement of local holistic services from social enterprises or the third sector. The true meaning of “third sector procurement” seems to be in the name itself. Successful third sector organisations and social enterprises often feel that they are the third choice—that the bits that the public sector might not want to deliver get passed down the line. Second in line is the private commercial sector and, finally, at the end of the queue, we have the third sector patiently waiting its turn for the crumbs from the table.
The poor souls in the third sector are no third-
This is my experience over 25 years in Bromley-
I am afraid that I see little room for optimism in the latest polyclinic initiatives. The noble Lord, Lord Darzi, and his team have produced a programme for primary care that will produce wonderful new buildings and a new level of integration that has never been seen before. However, I have a profound problem with the scheme. At its heart it is still a biomedical model of healthcare that focuses on delivering clinical interventions for patients. Important as this is, it is only one dimension of a multidimensional problem. We are building not polyclinics but monoclinics.
I am sure that the Department of Health recognises the multicausal nature of chronic ill health in our communities. However, after all these years of rhetoric, we still seem unable in this country to create commissioning structures that cut across the departmental silos of government and focus on the customer. Why should that be? In my view, there is a problem at the core of our understanding of integration. Many in the public sector still think that this is about only traditional bits of the public services working more closely together.
We need holistic approaches to public service delivery that use social enterprises to deliver better services and better value for money across a range of measures. Where better to start this approach than in primary care? These solutions are particularly relevant today when the financing of the medical intervention model has been put under severe strain as a result of the financial crisis. However, I fear that despite the rhetoric the Government—and perhaps a future Government—still do not understand how practically to use entrepreneurs in the delivery of health services. I know that it works because in the past few years I have had the privilege of seeing and working with such entrepreneurial health organisations across the country. These organisations put people first because they understand and are part of their communities. They bring together health and social programmes. They are trusted, not because they engage in elaborate consultations but because they have a track record of delivering services that local people need.
There is of course no shortage of action by the Government. A multiplicity of programmes for the provision of integrated health services by the public, private and social enterprise sectors has been initiated. My concern as I travel across the country is that these initiatives, while well intentioned, by and large do not rely on the ingenuity and talent of entrepreneurs and local people but continue to use the old bureaucratic and paper-
As I have listened to debates in your Lordships’ House in recent months, Ministers, including the noble Lord, Lord Mandelson, have highlighted in public conferences the virtues of social enterprise. Yet in the health sector basic conversations are still not taking place. I have spent the past five months since the publication of our report on social enterprise and health—here I must declare an interest—attempting to bring Ministers to the same table as colleagues from NHS LIFT and the Big Lottery Fund in order to bring new joined-
What the Government have done to date is commendable, but the NHS now needs to change its paradigm from the expensive clinical model to one based on networks and more modest-
If this Government—or a future Government—are serious about the future of the NHS and about social enterprise and community cohesion, I humbly suggest that a first step might be to do the following. First, they should ensure that their programmes are led by individuals with a strong track record of enterprise and appropriate risk-