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29 Oct 2002 : Column 847—continued
12.36 am
The Parliamentary Under-Secretary of State for Work and Pensions (Malcolm Wicks): The House of Commons has just voted for substantial parliamentary reform and modernisation to make the House fit for its purpose in the 21st century, so although I stand, and others sit, here at just past half-past midnight, we do so knowing that our nocturnal manoeuvrings will shortly be placed in the dustbin of our nation's parliamentary history, the lid shut tight.
I congratulate my hon. Friend the Member for Derby, North (Mr. Laxton) on bringing this important issue to the House's attention, and on the way in which he introduced a subject that is especially significant to those of our citizens who suffer mental illness, often over a long period. The contention that the level of benefit is insufficient to meet the needs of long-term hospital in-patients is not new—indeed, my hon. Friend and others have been pursuing a substantial increase in the rate of the allowance for some time, and I commend them for doing so. As he said, last May he brought representatives of Derbyshire patients council to meet me. I promised at that meeting that my officials would discuss these matters with officials from the Department of Health. Such discussions have now been undertaken, and I hope that they have resolved some of the issues of concern to him.
We are dealing with two distinct issues: first, the rules on benefits paid by my Department and, secondly, the maintenance support that long-term patients require. The personal allowance for long-term in-patients must be seen in the context of the overall benefit rules for people going into hospital. The principle behind the reduction in benefit is, as my hon. Friend acknowledges, not a new one—indeed, it has been a basic feature of the benefits system since the introduction of the national insurance scheme in 1949. The principle is a simple one: while the national health service provides free maintenance as well as free treatment, maintenance benefits, which are also paid out of state funds, should not be paid in full indefinitely. To do otherwise would be to provide twice for the same items. The rules have been applied, albeit with minor modifications, for more than 50 years.
Adjustments for periods spent in hospital are applied to most social security benefits. Currently, there is no reduction during the first six weeks in hospital, then an initial reduction is made—for example, a benefit such as the basic state pension would be reduced to #46.80 for a person without a dependant. After 52 weeks in hospital, benefit is further reduced to 20 per cent. of the prevailing rate of the basic state pension. As my hon. Friend says, that is currently #15.10 a week. In addition, the rules also protect a person's housing costs. It is important to acknowledge that.
Provided that the absence from home is expected to be less than a year, people in hospital who have low incomes and who retain a liability to pay rent for their homes can get housing benefit as long as they intend to return home and their home has not been let or sub-let.
We believe that these rules strike a fair balance between what the state should provide financially and the provision that individuals should make for themselves. However, we recognise that the rules are not immutable, and we have already committed ourselves to modernising them. To coincide with the introduction of the state pension credit next October, we plan to extend the period before the initial reduction in benefit from six weeks to 13 weeks. This change is a recognition of the fact that in today's society—my hon. Friend was urging us not to look back 50 years but to consider today's circumstances—people have more ongoing fixed commitments, such as housing costs and utility bills while they are in hospital. So people will be able to keep their full benefit for a full quarter before any downrating takes place. This will give them more time to plan their budget for when downrating does take place.
I shall put the matter in context numerically. More than 97 per cent of people are discharged from hospital within 13 weeks. The vast majority will not have their benefits, which are designed with the cost of everyday living in mind, touched during their stay in hospital. Those whose stay is longer than 13 weeks will also gain, I believe, from having a longer period where their benefits remain unchanged, as they too will have time to plan for their future circumstances. I hope that that shows our commitment to improve benefits for people who go into hospital, and perhaps puts the numbers in context. I hope that it shows also that we have been listening to my hon. Friend, his colleagues and his constituents.
Nevertheless, I recognise that my hon. Friend is predominantly concerned with a specific group of patients—those long-stay patients who are in hospital for longer than a year, and sometimes years, such as those suffering from long-term psychiatric conditions. As I have already explained, such people receive the lowest rate of benefit entitlement, which is #15.10 a week. That is because the national health service has assumed the responsibility for maintaining those patients who have spent more than 52 weeks in hospital.
This rate is, in effect, a personal allowance—it is just that. It is designed to meet a patient's personal day-to-day requirements such as newspapers, magazines and toiletry items, and other things of their choosing. The allowance has historically increased year on year in line with prices and so has maintained its relative value.
The Social Security Advisory Committee considered the level of the hospital personal allowance rate in 1987. To quote from the committee's conclusions,
- Xsome patients, particularly those who are more active, may find"
- Xis not sufficient for their needs, but we have no research to convince us the level . . . should be raised".
It is important to recognise that the allowance does not, and was never designed to, cover the purchase of more expensive items, such as clothing. These are the statutory responsibility of the local NHS trust to provide where necessary. Where there are abnormal needs because of a patient's condition or illness, and the patient or relatives are unable to afford the extra cost, the hospital also has discretion to top up the allowance to meet such needs.
I know that each individual's financial circumstances vary, particularly in cases where in-patients are more physically active. However, it has been broadly accepted that it is impracticable to require the benefit system to have regard to the detailed circumstances of each individual before the appropriate reduction of benefit can be assessed. That is why general rules have been adopted and common rates of benefit are payable.
I know that my hon. Friend, and other hon. Members and organisations such as MIND and his local organisations, have campaigned for the dignity of long-
term patients in hospital, particularly those suffering from mental health problems. His points about clothing and the dignity of having new clothes rather than second-hand ones would have a resonance in any century, as they certainly do in the 21st century. I listened very carefully to what he said in that regard.We consider that the current rates of benefit for people in hospital are fair and that the allowance is adequate to meet the day-to-day requirements of a person in hospital. Obviously, where there are local issues, they should be dealt with at a local level through contact with the chairman or chief executive of the national health service trust concerned. Nevertheless, we recognise that, for the system to work properly, we need to ensure that the highest standards of care, including the provision of items such as clothing, is maintained for patients requiring long-term care in hospital. That is why the Department of Health intends to ensure that best practice is shared throughout our national health service. Its officials will be happy to discuss the best way forward with relevant stakeholders at both national and local levels, including in my hon. Friend's constituency.
To sum up, the current arrangements for hospital downrating have been in place for many years and are designed to give the appropriate level of help, depending on the length of time spent in hospital. We are committed to improving those rules by allowing in-patients to keep their full benefit for 13 weeks rather than six weeks, as at present. For long-term patients, social security meets a limited range of needs in a personal allowance and the national health service has a statutory duty to meet other maintenance costs. As I said, the Department of Health will ensure that best practice in the care of long-term patients is shared throughout the national health service.
I trust that that deals at least in part with the proper concerns of my hon. Friend. We are considering the issue seriously and work is in progress to improve the arrangements for long-term patients, and not least those with often debilitating psychiatric conditions. I am grateful to him for bringing this vital matter to the attention of the House. It is an important matter to discuss at any hour of the day, although we will perhaps discuss it one day at a more civilised hour.
- Adjourned accordingly at thirteen minutes to One o'clock.
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