Hansard

We all know that there are significant challenges to delivering healthcare, given the demographic trends that present us with an ever ageing and increasingly frail population. We celebrate our longer life expectancy, but we must show determination to boost poor statistics on healthy life expectancy, as members have mentioned.

We know that, as they grow older and frailer, the vast majority of older people wish to stay in their homes, with support as required, for as long as possible. It is true that, as part of the process, we want to see a shift from spend on the acute sector to spend on primary and community care.

Strangely, I commend what on first glance looks like an entrenchment of spending in the acute sector. I refer to the £200 million investment to enhance capacity at the Golden Jubilee hospital in Clydebank and the creation of six elective surgical hubs across the country. As we have an increasingly ageing and frail population, cataract surgery, knee replacements and hip replacements become increasingly important to sustain older people in their homes for longer. If we do not take the strategic decision now to increase capacity, whoever the Government is in five or 10 years’ time will be told that planning just was not in place five or 10 years ago. That spending decision has been taken now. Fundamentally, it is connected to ensuring that we can sustain people in community social care for longer. I wanted to put that on the record.

We need to do better on the interaction between health and social care integration and acute sector spend. I note that only two of the integration joint boards—Dumfries and Galloway, and Argyll and Bute—have acute sector spending as part of their combined budget. Other integration joint boards are missing a trick. After all, they will be looking at rehabilitation and enablement services for older people in communities. They will be looking at prevention of slips, trips and falls at home. In the acute sector, whether it is emergency treatment through the door of A and E or early intervention and preventative surgical interventions through the new acute hubs, there has to be a better integration of funding. I do not think that we have the balance right, although I accept that that is a decision for the integration joint boards.

I welcome the real progress that has been made in Glasgow in relation to the integration of health and social care. Sandra White gave us the specific example of care homes qualifying to provide free personal care for the elderly, and I recognise the issue that she raises. On delayed discharge, Glasgow has done well in recent months. David Williams, who gave evidence to the Health and Sport Committee this morning, talked about that. He is the chief officer designate for the shadow integration board in Glasgow and the head of social work at Glasgow City Council. That shows that, when there is a real focus, drive and determination on an integrated basis within the city, we can get it right. Indeed, the targets in Glasgow are being exceeded in some cases.

We need health and social care integration to similarly improve community health and social care, alleviate pressures on GPs and see the development of integrated health and social care teams that are attentive to the needs of the community and are shaped in a way that is meaningful to the integration joint boards via locality planning.

GPs are central to that process. I am delighted to see that QOF is going—that is a significant achievement—but what will replace it? The negotiations that are taking place in the vacuum that is left are just as important as the fact that QOF is going, and the new GP contract is a real opportunity to direct funding where it is most needed. Will it allow us to focus on tackling health inequalities, particularly in our most deprived communities? Will the integration joint boards be able—preferably in a co-production model with GPs at the most local level—to shape a more localised model of GP provision and how that interacts with the wider health and social care integration within communities?

Whether it is community pharmacists, physiotherapists, speech and language therapists, care-at-home staff, occupational therapists, nurse specialists or whoever, they will have to be part of a combined health and social care team, and GPs will have to have confidence in those teams irrespective of whether they are employed by GPs, health centres, the integration joint boards or whoever. If they do not have confidence in those teams, GPs will continue to refer directly to the acute sector, and that is part of the issue. We want GPs to have more tools in the box and to be able to refer to community disposals for health and social care needs.

People say that not enough is going on, but there is a huge amount going on, and there are a huge number of successes. I have not dwelt on the successes in my speech because the Opposition would have called that being complacent. Nevertheless, significant structural change is taking place and the benefits are starting to emerge. I am glad that there has been a significant degree of consensus in the debate, and I hope that that continues going forward.