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14 Nov 2002 : Column 179continued
Mr. Milburn: Yes, in a word. As we said in the NHS plan, the more performance improves, resources bite and reform takes hold, the more autonomy will be earned throughout the health service. This is a big change, but I believe it is the right change.
That brings me to the final measure in the Queen's Speech, the delayed discharges Bill. I believe that we owe a duty to today's generation of older people, because it was they who built and sustained public health and social services in our country. They deserve dignity and respect in old age, but being trapped in hospital when they want to be cared for at home denies them both. Delayed discharge from hospital is a serious problem. Since we put in an extra #300 million last year to deal with it, rates have fallen by more than 20 per cent., but even today, 5,000 older people are needlessly in hospital when they are ready to leave.
The Community Care (Delayed Discharges etc.) Bill, which we have introduced today, brings fundamental reforms to deal with that problem once and for all. Under the current system, for as long as the elderly person remains in hospital, for good reasons or bad, they remain there at the cost of the national health service. Under the new system, when the patient is ready and able to leave hospital, the cost will pass to social services. Where social services fulfil their responsibilities, we will look to give them extra rewards. Where they do not do so, they will have to pay the hospital for the costs that it incurs in providing care for the patients.
The interests of older people are not served by a blurring of responsibility. The costs of care should fall where they belong. The Bill will help to ensure that the money that we have made available to social services is spent on them, so that capacity can be built up and not cut.
Mr. Stephen Pound (Ealing, North): I am very grateful to my right hon. Friend for giving way. A decent, well-performing social services authority such as the London borough of Ealing will find itself being charged #2.2 million a year, on its anticipated figures, through the #120-a-night charge, because of forces beyond its control. I am sure that he has considered the fact that, in many cases, the beds that are needed to move people away from hospitals providing acute care are simply no longer available in the community.
Mr. Milburn: I understand the capacity problem, but we will again have a problem if we think that the only way of caring for older people is placing them in residential care homes. Of course, the care homes sector is extremely important, but it is worth listening to what older people themselves say about where they would like to be cared for. Overwhelmingly, they would prefer to be cared for not in a care home, but in their own home.
The reform programme set out in the Queen's Speech draws on the traditions of social and community ownership that I believe inspired the founders of the national health service. It sticks firmly to the principles on which the NHS was founded, but places a new premium on local accountability for local services. Reform cannot be achieved by holding on to the structures of the last century; it has to be shaped by the expectations of this century. Reform means investing not only extra resources in front-line services, but power, trust, ownership and control.
As was obvious in the Secretary of State's remarks about foundation hospitals, the Government seem increasingly to make up policy as they go along in a series of knee-jerk reactions that occur when they are worried about their lack of delivery. Before we drug ourselves on yet more Government promises, let us take a rational view. We can see the clarity of thought and the intellectual cutting edge that Labour brought to health policy when it was elected in 1997 by looking at its manifesto. Indeed, it is very clear:
What about distorting clinical priorities? In the wake of the recent story that a senior surgeon at St. George's hospital in London had been told not to accept urgent surgical referrals from outside the London catchment area, the BMA warned that the performance targets had a distorting effect on clinical priorities. It said:
The problem for the Labour party is that, for far too long, it has believed its own propaganda. Essentially, its message in 1997 was, XThere is nothing basically wrong with the NHS; if only those wicked Tories would spend more money on it." For five and a half years, they have therefore thrown more moneybillions and billions of poundsinto the NHS, but what do we have in return? Despite a 10.8 per cent. funding increase between 199899 and 2001, hospital admissions have risen by only 0.9 per cent, as has been pointed out. Finished consultant episodes have risen by 2.3 per cent. The Secretary of State spoke about the maximum waiting time for a coronary bypass, but the average waiting time for a coronary artery bypass graft is now two weeks longer and there are still more than 1 million people on the waiting list. Some 80,000 fewer people are receiving domiciliary care. Emergency readmissions are increasing and have risen by 23,000 in the past two years. The Audit Commission, which is hardly an organ of the Conservative party, stated that in 1996, 73 per cent. of hospital patients in accident and emergency were seen by a doctor within an hour. That figure has now fallen to 53 per cent. Similarly, 90 per cent. of patients were admitted within four hours, but that has now fallen to 76 per cent. Some 60,000 fewer care home places exist than when Labour came to power in 1997.
How can it be that such a big funding increase is taking place while things are getting so much worse at the front end? That is the question that the Secretary of State has to ask. If the public could ask one question, it would be: XWhy is it that, with all this spending, our hospitals are so dirty?" It is this Government's sixth year in office, but 5,000 patients a year will die of the infections that they contract while they are in hospital. That is the equivalent of three Clapham rail disasters a week, which puts things into perspective.