Speech to the House of Lords 28th October 2010

My Lords, I want to make a few points about health and social care. How do we provide quality healthcare that meets the real needs of patients in today’s world? Will the popular biomedical model of health meet all those patient needs, or does its internal logic present us with a limited view of what a human being is and provide us with an expensive approach to healthcare? Is what we say that we believe about health believable?

My Lords, the GPs I work with in east London tell me that in poor communities such as Tower Hamlets, 50 per cent of the patients they see do not actually need a doctor; they need something else. What presents itself as illness may actually be more to do with a patient’s isolation, the need for a friend or a job, better housing or a more creative lifestyle. In such cases, attempts to find a magic pill or potion are inappropriate and a waste of resources; GPs and patients need our help.

In this new financial environment, there is an opportunity to begin to open up a more integrated and cost-effective approach to healthcare at a national level which builds partnerships between health and social care professionals and with the voluntary and social enterprise sectors, but it will require encouragement and leadership from within government if this more integrated and cost-effective approach is to work.

GP practices are anchors in local communities that could play an important role in the development of the big society. Four years ago, I was asked to intervene by the then CEO of the local authority in St Paul’s Way in Tower Hamlets, which is a single street in one of our most challenged housing estates. I am now leading the St Paul’s Way transformational project, so I declare an interest in this project, but I am pleased to say that it is fast becoming a pathfinder used to illustrate the benefits of joined-up working. We are now exploring the possibility of creating a community interest company, which in time may manage the facilities along the whole street. When I first arrived on the street, I was shocked to discover that there was the possibility of developing a new £40-million school under the BSF programme, a new health centre across the road and 500 new homes. So what was wrong? None of the key players in health, housing or education were talking to each other.

The new focus on patient-led healthcare could result in new relationships between doctors and health professionals and local members of the voluntary and social sectors. This more integrated approach is important because, at present, strategy is running on departmental lines. Education is introducing free schools, health is devolving budgets to GPs and social services are extending personalisation budgets. Society does not operate along departmental budgets. Go to any town or city district and ask the police for the top 100 families that they routinely deal with for anti-social behaviour. Ask the GPs who are their most demanding patients; ask the housing office and the courts. The same names will keep appearing. Despite decades of rhetoric, the same tragic newspaper headlines will keep appearing-baby Peter being one horrifying example.

Unlike the initiatives of the previous Government where the state was encouraged to be joined up, my colleagues and I would suggest that the state will never be joined up and that the answer is to let communities and local organisations, such as GP practices, join up on local streets to deliver joined-up services. I am encouraged that this is the direction that the Government seem to be taking us. We must take the opportunities that this presents. I suggest that in this financially strapped environment there is a new opportunity to turn this old health logic on its head. But the Minister will ask how we are going to do this and how we will we create the physical environments on the ground within which this can take place.

One answer is already there; namely, LIFT, the Local Improvement Finance Trust. We could do a great deal with this, but there is not time to go into the detail. I leave the Minister with one question: will he tell the House how he proposes to encourage GPs to take up the opportunities presented by the transfer of funding to GP practices? What is the Government’s plan for general practice to play in the creation of the big society?