Norman Lamb: 'I want real empowerment for people'
By David Brindle in The Guardian
Originally published by East Midlands Liberal Democrats
Liberal Democrat MP Norman Lamb has wasted no time getting down to work in his new role as care services minister. He talks to David Brindle about integration of health and social care, personalisation and funding reform
As someone who once remortgaged his home to fund the career of a rap singer, Norman Lamb is not averse to taking a gamble. So it should be no surprise that he's willing to bet he can deliver the progress on the integration of health and social care in England that has eluded so many of his predecessors.
Within seven days of his appointment last month as care services minister, Lamb was promising the "political oomph" necessary to take the concept of integration from the pages of academic journals and isolated examples of good practice, and apply it across the health and social care system. There was, he said, pretty much a consensus that it was the right way to go and no more time to lose.
By hitting the ground running, Lamb has provided a contrast to the low-profile start of his boss, new Tory health secretary Jeremy Hunt, who was also appointed in the government reshuffle. But whereas Hunt has a lot of reading to do to get up to speed, Lamb is an old hand at health, having been Lib Dem spokesman from 2006 to 2010 and played a pivotal role in the frenzied but ultimately fruitless attempts to broker a cross-party deal on social care funding reform just before the general election.
That his Lib Dem colleague Paul Burstow was then made care services minister in the coalition administration, while Lamb became parliamentary private secretary to deputy prime minister Nick Clegg, prompted raised eyebrows. Observers surmised those cross-party talks had left ill-feeling between Lamb and Andrew Lansley, the coalition's first health secretary. Now Lansley has moved on, so the story goes, Lamb is able to have the job he wanted two years ago.
He is determined to make up for lost time, fizzing with enthusiasm for integrated care models he has seen, from Torbay (which he cites repeatedly) to Oakland, California. He has already convened a roundtable of UK experts on integration, and is preaching a message that this age of funding constraint in public services is precisely the right climate to make an irreversible shift in the way health and social care are delivered.
"We can just take a very depressed view about the world in a time of austerity, with services cut back and dire warnings about the state of the system," Lamb says. "Or we can say: 'Right, we've got tough circumstances: how do we maximise use of the money we've got available; how we do shift the focus on to prevention; how do we ensure we're using the money optimally rather than making the perverse judgments that sometimes happen when you have this divide between health and social care?'"
Lamb argues that breaking down the divide is not only right for the individual, so that services are arranged flexibly around them, but is the only way the NHS will be able to meet the demands of an ageing population. "We have got to get it right in order to ensure we have a sustainable health service. If we don't get it right, we will bankrupt the system."
He believes new structures taking effect next spring, particularly local health and wellbeing boards hosted by councils with social care responsibilities, will bring the two worlds much closer together. The other two ingredients of change he identifies are political leadership, which he vows to give, and financial incentives. The Department of Health is experimenting with paying for a "year of care" for people with long-term conditions, rather than payment per episode of treatment, and he is deeply impressed by the way integrated care is driven by funding arrangements within the Oakland-based Kaiser Permanente health insurance scheme.
"For people with chronic conditions the idea of payment for an episode of care is ridiculous. It incentivises the wrong behaviour within the system: acute hospitals just benefit from doing more and more and yet we want to stop that patient with chronic conditions from going in constantly to that hospital."
There has been speculation the care and support bill will require the new NHS clinical commissioning groups, part of next spring's shakeup, to pool part of their budgets with councils.
Lamb says: "There is not a worked-out plan. I have not got to that point yet. There may be people thinking about it, for all I know, but I have not been part of that discussion."
While integration may be the key to changing the health and social care system, reform of social care funding remains top priority with the public and media. The government continues to duck a decision on implementation of the proposals of last year's Dilnot commission, which recommended a £35,000 cap on individual liability for care costs, although it says it supports the idea of a cap in principle. On returning to the backbenches, Burstow lost no time in publicly blaming the deadlock on Treasury resistance to the costs of £1.7bn a year and rising.
Speaking at the Conservative party conference a fortnight ago, Hunt described the costs as unaffordable and indicated the health department would need to make savings from "the huge amount of inefficiency in the system" to foot the bill at least in part. Lamb appears to disagree.
"I have got an open mind, but I find it difficult to imagine how we could fund Dilnot at a time when we are trying to get unprecedented efficiencies out of the system," he says. He is sceptical, too, about the idea of shaving the cost by making the cap an opt-in scheme rather than something that applied to all. "My problem with an opt-in is the evidence from around the world about whether voluntary insurance systems, which is what in effect it would be, ever deliver the scale of participation to make it really worthwhile.
"Again I have got an open mind if someone can produce evidence to me that contradicts this or [demonstrates] a new way of doing things that deliver the scale. But what I have seen indicates it would be likely to be a marginal activity which then wouldn't deliver the protection for the mass of people of modest means who would continue to lose everything until falling into the means-tested system."
Given his bruising experience of the talks held ahead of the election, it would be unsurprising if Lamb was wary of trying again to broker a cross-party deal on reform. But he insists that remains his preferred option. "I repeat my view that this transcends narrow party politics," he says. "If we can do it on a cross-party basis, a consensual basis, I am strongly in favour of that. But the bottom line is that we have to resolve this."
Another issue on which Burstow has spoken out since leaving government is the legacy of the scandal at Winterbourne View, the former private hospital near Bristol for people with learning disabilities, where a regime of abuse was exposed last year. Eleven workers at the unit have been convicted of offences and are being sentenced this week.
Burstow has said the health department needs to take a tougher line than hitherto in its final report on the case, due imminently, and initiate the closure of similar long-stay units by ordering local care commissioners to stop using them. Lamb is clearly sympathetic to this, but reluctant to comment in detail in advance of the report. "There needs to be a very firm line and a clear ambition to protect people in often very vulnerable situations from this risk of abuse," he says. "But also we need to be more ambitious not just to stop the abuse happening, but actually to dramatically improve their health and wellbeing."
He, like Burstow, is an advocate of personalisation of care and support to improve people's wellbeing. And he will be warning social care leaders at their conference in Eastbourne this week that he will be keeping a sharp eye out for "window-dressing" as the deadline of next April approaches for local councils to have offered personal budgets to all eligible users of social care services.
"I don't want to see any evidence of [care] plans being signed off by the service-user and described then as a personal budget if they haven't had any real involvement in it," he says. "I don't want a target achieved that turns out to be meaningless. I want real empowerment for people."
Progress on personal budgets is notoriously variable and the odds are long on all councils, or even most, meeting the deadline. But Lamb has shown he can pick a winner: that emerging rap singer, for whom he remortgaged, was a young man co-managed by Lamb's son, Archie, by the name of Tinchy Stryder. He's gone on to do rather well.
Family Married, two sons
Education Wymondham College, Norfolk; Leicester University (LLB law)
Career 2001-present: MP for North Norfolk; 1987-2001: partner and head of specialist employment unit, Steele & Co lawyers, Norwich; 1986-87: solicitor, Steele & Co; 1984-86: senior assistant solicitor, Norwich city council; 1982-84: trainee solicitor, Norwich city council; 1980-82: assistant, Greville Janner MP
Public life 1987-91: member, Norwich city council
Interests Football (Norwich City), walking, travel, art