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2.42 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I reassure my hon. Friends the Members for Hornchurch (John Cryer) and for Dagenham (Jon Cruddas) that there is almost nothing that I would rather be doing on a Friday afternoon than replying to this debate. The issues that they have raised are extremely important for hundreds of thousands of people throughout the country, and not just those in their constituencies. It is right that we should debate them.

My hon. Friends have highlighted the need to try to ensure that we have a seamless system so that we can effectively treat people—particularly elderly people—in the right place, at the right time and with the right kind of care. Therefore, making the connection between acute care, residential care, intermediate care and care at home is one of the biggest challenges facing us and everyone in the health service, social services, local government and the sector as a whole.

My hon. Friend the Member for Hornchurch pointed out that the issues relate to the whole system of health care. The problem of elderly people being kept in hospital for far too long is not only bad for them—instead of being in acute hospitals, they should be in residential care or supported at home—but it affects our ability to carry out elective care to ensure that people's operations are not cancelled and that they take place on time.

Furthermore, at the front end of the hospital system, the problem means that people who need care in accident and emergency or casualty departments are unable to be assessed and cannot find a bed because people at the other end of the hospital are kept in for far too long. Therefore, we should not view the issue in isolation. We need to put all the solutions in the right place.

Mr. Andrew Rosindell (Romford): Will the Minister give way?

Ms Blears: No, I want to finish my response.

We need to ensure that a proper system is in place.

My hon. Friend the Member for Hornchurch is also worried about the capacity of residential beds, especially in his community. The overall number of care homes in England is falling. There is concern about capacity across the country which is having an impact on hospital discharges. Providers of residential care places are worried about the level of fees that are paid to them. Some care homes have had to close, which is another problem that we face. I hope that I can reassure my hon. Friends and deal with the local matters that they raised.

The Government reached an agreement on 9 October with local social services departments. Building capacity and partnership in care is a concordat between the national health service and the social care system to discover whether we can put in place longer-term measures to increase the capacity of residential care in our communities. It is not good enough to have an on-the-spot purchasing policy. The system needs to be sustainable so that authorities can plan provision over years instead of facing the vagaries of the market.

The agreement sets out a range of principles and practices on how to build capacity and to make the fees that are paid to care home owners adequate so that they can continue to provide care. It will also consider how we

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can involve nurses, residential care workers, home care workers and people who work in sheltered housing in the system so that we provide the right care for people in the right place at the right time.

An important aspect of the agreement is its ability to be dynamic and flexible so that as circumstances change the contracting arrangements between local authorities and the residential care sector can change as well. My hon. Friend the Member for Hornchurch concentrated on the number of beds. That is a crucial issue, but we need to be innovative and creative in providing extra capacity. It is not simply a case of providing beds in residential care homes or hospitals. We need to put in place many more domiciliary care packages to provide hospital treatment at home. The vast majority of elderly people want to live independently in their homes if they can manage to do so. We have not been quick enough or creative enough in recent years to put in place extensive support packages that enable people to stay at home. Obviously there comes a time in people's lives when that is no longer possible and we have to ensure that good residential care is available, but we can find greater capacity by being more creative with our schemes.

Many authorities are thinking of setting up "fall" clinics that offer advice to elderly people on simple aids and adaptations to their homes, such as rails to ensure that they do not fall down the stairs. If an elderly person has a fall, they are far more likely to suffer a fracture and to be admitted to hospital where the institutional surroundings make them more dependent, which puts them on a vicious spiral that robs them of their ability to care for themselves. If we stop the fall occurring, we not only prevent the system from incurring huge costs, but improve dramatically that elderly person's quality of life. We need to do far more in terms of outreach teams and helping people to survive in their own homes.

We have provided £300 million over the next two years to tackle delayed discharges. It is a cash-for-change programme. The money comes with a commitment to change the way in which we have acted. Both my hon. Friends recognised that we have been in this situation for a number of years and the stop-gap mentality cannot continue. The systems that we put in place have to take us forward. The £300 million for delayed discharge is in addition to £900 million that has been earmarked for the rapid development of intermediate care, such as step-up, step-down facilities, so that people who do not need intense acute care have access in the community to more appropriate treatment. Sometimes people need nursing care rather than acute intervention. As my hon. Friend the Member for Hornchurch said, that sector is new, but it is growing at a tremendous rate.

Of the £100 million allocated this year, we have focused £47 million on the 55 councils that need most help. We recognise that some local authorities have a big problem, but we want to help every authority, so the remaining £43.5 million is being distributed to the other 100 councils on the basis of the standard spending assessment. A balance is being struck: we have allocated disproportionate amounts to the places with the greatest problems to try to bring them up to speed, but we are providing support for everybody because we know that there is a problem nationwide.

I agree entirely with my hon. Friend about the phrase "bed blocking". It is not one that I want to use, as the problem involves people being delayed in hospital. We

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must never forget that they are real people; they are not simply the occupants of beds. My hon. Friend is right that many hospitals are running at 97 or 98 per cent. capacity and the fact is that, once such a rate is reached, the knock-on effect on trolley waits and cancelled operations becomes all too apparent.

For the past 30 years or so, the received wisdom has been that we need fewer NHS beds. About 40,000 were lost in the last years of the previous Administration, but we are reversing the trend completely and this is the first year in which the number of general and acute beds has risen. The NHS plan sets a target to increase the number of general and acute beds by 2,100 by 2004. The latest figures, published this September, show that we are a third of the way there—an increase of more than 700 general and acute care beds in the past year.

We are beginning to turn things around, recognising that we need to increase capacity, and my hon. Friend generously acknowledged the increase of 60 beds at the new hospital that will be built at Oldchurch. I understand that there will also be an extra 19 beds at the King George hospital, which is exploring a new clinical model for organising its services and will be able to achieve extra capacity.

As both my hon. Friends are aware, a share of the extra £300 million to tackle delayed discharges has been received by Barking and Dagenham and by Havering. Barking and Dagenham got £480,000 and Havering received an additional £555,000, so almost £1 million is going into that community. It will have a significant impact on the ability of social services to purchase additional care and reorganise the way in which they support people through outreach teams, help at home, working with sheltered housing and working with all the other partners. I acknowledge that my hon. Friend the Member for Hornchurch thinks that even more resources are necessary, but we have an extra £200 million to spend next year from the £300 million in total and I hope that it makes a significant impact on the problems there.

Recognising that this is a whole-system problem, not simply one of delayed discharges, the Government are trying to tackle the difficulties at every stage in the hospital system. We have allocated extra funds to the NHS locally, so Barking, Havering and Redbridge Hospitals NHS trust received £254,000 in October to tackle longer waiting lists and ensure that, by next March, nobody has to wait more than 15 months for an operation.

That money is being used to fund extra theatre lists in the trust, and orthopaedic and ophthalmic patients have been transferred to the independent sector to create and free up capacity so that more people can come in for elective operations and there is no problem of cancelled operations, which devastate the patients concerned. Often they have been prepared for surgery, but suddenly the operation is cancelled. We are absolutely determined to try to ensure that that does not happen.

We also allocated £50 million at the beginning of November to reduce occupancy and trolley waits. Barking, Havering and Redbridge Hospitals NHS trust received £490,000. It has used £400,000 for patients

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requiring joint replacement and surgical work, so again capacity is increased and people get through the system more quickly. It has also commissioned 25 additional step-down intermediate care beds on the Harold Wood site. Patients waiting for discharge from the Oldchurch hospital site can be nursed in those beds, freeing up an extra 25 beds in the acute hospital to ensure that elective admissions get through as well.

I am sorry that I am citing rather a long list, but the Government have been extremely active recently in all the areas that I have mentioned. The most recent allocation of money from the centre was to reform emergency care. We issued a reform of emergency care strategy. That was a £50 million package to get additional nurses into A and E, and to provide a better assessment system to enable people to get through the system more quickly. The local trust will receive £154,000 this year to provide additional nurses for the two A and E departments. A further £632,000 will be provided next year, to try to ensure that patients in A and E receive the right care at the right time in the right place.

If we can get streaming systems into A and E departments that ensure that patients are dealt with by the appropriate level of staff—people with simple needs can be dealt with by nurses, and people with complex matters can be dealt with by consultants—we will be able to reduce waiting times. That will enable us to ensure that we increase capacity for elective operations, get people out of hospital more quickly once their need for acute care has been dealt with and then get them into residential care. We shall then see a flow of people through the system, with no one waiting any longer than is necessary at any stage of care.

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