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Mr. Wardell: I am grateful to my hon. Friend, and I am aware of those statistics.
The reluctance of many health authorities in Wales to pay for anyone to be in a private nursing home is shown up clearly in those statistics. I am glad that the Government have addressed that issue. In other words, they eventually--four years later--decided that the situation was not acceptable. They were content to leave that situation for that length of time. They were quick enough to rush legislation through the House yesterday, but they were not prepared to do the same for elderly and vulnerable people. However, I am glad that the Government eventually--slowly, but surely--saw the light.
I am pleased that the change has come about, but the report rests on an important circular, to which I have already referred. It was issued in 1995 by the Welsh Office and amended the circular of 1991. My personal view is that government by circular is not very satisfactory. I am uncomfortable with the way in which circulars are churned out by Government Departments. Nevertheless, the circular on which the report rests is about the discharge of people from hospitals. I hope that the Minister will be able to reassure me about the current practice in relation to paragraph 25 of that circular.
The report before us today assumes that money will be made available to enable implementation of that paragraph of the circular, which contains four pieces of information that hospitals should make available to patients before discharge. The Welsh Office relies on a manual on hospital discharge practice issued in December 1994, which is the latest in a series of hospital discharge workbooks.
What does the Minister intend to do about information that is clearly not being provided under the terms of the circular? It is the responsibility of the Secretary of State to ensure that the structure and operation of the health service is satisfactory. When it is not, what will be done? I shall not read all four of the relevant paragraphs, but perhaps the Minister can deal with them comprehensively. I am sure that he has the circular in front of him, or soon will have.
It states:
When I visited a hospital recently, I could have caused a major upheaval because I went from bed to bed asking patients who were about to be discharged whether they had received that information. I had the circular in my pocket. The hospital staff looked at me rather charily, wondering what I was doing.
What has the Minister been doing to check that patients who are being discharged are given the relevant information? My guess is that not many patients receive it. I make the same point as in relation to the discharge of means-tested patients between 1991 and 1995: what is the use of a finance order which changes the method of means testing patients who are being discharged if the circular on which the order is based does not do what it should?
The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards):
To save the hon. Gentleman time, if he will write to me about the particular hospital
Mr. Wardell:
I should be more interested if the Minister would write and tell me--or tell the House now--what powers he has to ensure adherence to the guidance. What can he do?
The order may extend and continue, rather than address, the anomaly that, if a person who is to be discharged from hospital to a private nursing home returns to his or her own home, the capital value of that individual's property would not be taken into account at £16,000 or any other level by the local authority in assessing the charges to be levied against that person. I am worried that the Government may seek to correct that anomaly by including the capital value in that calculation, which I would not want them to do.
My third point--I shall not continue the debate until 10 o'clock, although I do not often have the opportunity--
Madam Deputy Speaker:
Order. That will not be possible.
Mr. Morgan:
That was my fault.
Mr. Wardell:
I was informed by a Front-Bench Member that the debate could continue until 10 o'clock, Madam Deputy Speaker, so I am glad that you have made that point.
Mr. Jeremy Corbyn (Islington, North):
The debate can continue until 9.26 pm.
Mr. Wardell:
Yes, and I must remember that we have yet to hear the winding-up speeches.
We see in the current system a division of boundaries, whereby private nursing home patients fall into two categories--and those who are not subject to means testing, which the order continues, may be in the same room as those who are. A line is drawn according to whether an individual is to be a social care or a medical care case. I shall not debate the subject of incontinence pads because the Minister must be fed up with the problem of who pays for them.
The hospital doctor and the multi-disciplinary team considering the patient who is to be discharged will have to decide his or her future. Whatever their decision, if no long-term beds are available in the hospital service, the individual who is paid for by the health authority will be placed in a private nursing home. Some patients pay for themselves, whatever the capital limits, and some do not. The order builds on that divisive situation.
Although I am pleased in one sense that the Government have at last ended the anomaly introduced by the 1991 Welsh Office circular, even though it has taken them four years to learn the folly of their ways, I remain concerned that, despite the new capital limits, we are left with a means-tested system which does not make universal provision but is divisive and leads to some patients in the same institution being means-tested while others are not.
I thank you, Madam Deputy Speaker, for your indulgence.
Mr. Rhodri Morgan (Cardiff, West):
This is almost the last debate of this part of the current Session, and I suppose that Oscar Wilde might have said that nothing recedes like the recess for those of us who are left here this Wednesday night.
The change in the capital disregards that created the need for the order are part of the Government's two-pronged approach to ease the problem facing people with reasonable means who--because they scrimped and saved to purchase their homes, buy shares or acquire pension entitlements--fail the means test. The Prime Minister has made a big fuss in speeches over the past year or two, and as recently as last Friday, of using a phrase about wealth cascading down through the generations.
The problem is that wealth has not been cascading down the generations. This measure and others that we expect later this year are an attempt to make the Prime Minister's idealised version of the country which he is running appear to come true. I understand that about 40,000 people a year who have failed a means test for community care eventually have to sell their houses. One of the favourite phrases of the last Prime Minister was "a property-owning democracy". For many elderly people, this is a property-disowning democracy for those who require a long spell of care.
The Government have set about trying to remedy the problem created by their changes to the structure of the NHS and local authority social services provision. The problem for them is that their rhetoric has gone one way and their policy actions another, causing many people to sell their houses so as to stay in nursing homes and old people's homes. I hope that the Minister will shortly be able to confirm my figure of 40,000 houses a year having to be sold to enable people to have long-term care, and will tell us by how much he expects the figure to fall as a result of the change to the capital disregard.
My figures do not come from the Government--
Mr. Morgan:
The Government Whip need not get so excited. I make no apology for taking my figures from Laing and Buisson, commonly regarded as the bible on all matters relating to long-term care. The figure was given in recent evidence to the Health Select Committee, but if it is wrong I am happy to be corrected. The important thing is to find out how many fewer houses will have to be sold to allow for nursing home care as a result of this measure.
I wonder whether the Government will be able to put some more flesh on the speech made by the Prime Minister on Friday, to cover the other aspect of the Government's two-pronged approach. The Government want to introduce a partnership insurance scheme under which they will pay for long-term care after the first three years provided that people buy insurance for those first three years. Will that have a direct impact on the fear that old people have that they may not in the end be able to pass on their houses to relatives because they will have to trade their houses in for long-term care?
This debate also enables us to touch on other significant changes going on simultaneously. The change we are discussing tonight will take effect from Easter Monday, but on 1 April three other changes in related areas took effect. I hope that you will agree, Madam Deputy Speaker, that I would be in order if I mentioned them.
The first change concerns the new statutory right of a carer to have his or her needs assessed by local authorities. Thus local authorities will become instrumental in determining whether people need to go into old people's homes; if they decide that they do, the means-testing operation will be triggered. That in turn will depend on whether a carer at home can last out without becoming ill from strain and stress. That again depends on whether enough respite care is available--usually from a son, daughter or spouse. This change may also have a bearing on the number of people affected by the order.
The second change dating from 1 April concerns the new health authorities and local authorities in England and Wales. In Wales until 1 April, county council social service departments and health authorities had more or less identical boundaries, so there was a natural tendency to co-operate and work together. Pembrokeshire was the one exception, but that did not cause much difficulty, because it remained a subdivision of a social services authority.
During the coming year, the Minister will need to ensure that the former tendency towards co-operative working arrangements between health authorities and social service departments--in respect of hospital discharge, for instance--is not dissipated. Instead of eight or nine health authorities and social service authorities in Wales, there will now be five and 22 respectively. The Minister will need to monitor the situation over the next 12 months to be sure that the system does not start falling apart.
My hon. Friend the Member for Gower (Mr. Wardell) raised another important issue relating to the changes which were made recently, and which are still being digested. They are significant to the order. The orders for England and Wales refer to the fact that they are based on the provisions that have been around since 1948 under which one can means-test anyone who goes to a nursing home or old people's home.
"hospitals should provide simple written information about how hospital discharge procedures will operate and what will happen if patients need continuing care".
8.56 pm
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