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28 Nov 2002 : Column 503—continued
Mr. Milburn: The hon. Lady is absolutely right. This is interesting because, all too often, we hear from Conservative Front Benchers—I cannot speak for Conservative Back Benchers; I cannot speak for Front Benchers, come to that—that extra resources in public services do not produce results. But they do, and the hon. Lady is right: intermediate care is working. We have provided extra resources, and, as a consequence, capacity is being built up. We are also providing further extra resources for the next few years. If I know local government and social services at all, I know what they want to do—not least from my discussions with directors and members of local authorities. They want to spend more on social services provision. We have given them the opportunity to do that over the next few years, and we will do so further into the future, too.
Mr. Simon Burns (West Chelmsford): So as not to confuse the House, on the question of help for the elderly outside the residential care setting, will the Secretary of State confirm the answer given by the Minister of State, the hon. Member for Redditch (Jacqui Smith), on Monday that the number of households receiving domiciliary care has fallen since September 1997 by 97,900?
Mr. Milburn: What the hon. Gentleman is alluding to is simply the number of households receiving some form of home care. However, that is not the only category of people who receive help. Indeed, the number of older people helped, through the public purse, to live at home has increased, not decreased—I can give the hon. Gentleman the latest figures—from 638,000 to 661,000, so his allegation is simply not true.
Mr. Gerry Steinberg (City of Durham): Will my right hon. Friend clear up a tremendous confusion in my local authority in Durham? At Question Time recently, he promised to investigate whether the money given to deal with bed blocking in Durham has been used for that purpose. Durham county council's social services department tells me that it has not received the money from the primary care trust; the PCT says that it has. I am not sure how many beds were unblocked by the money that was supposedly given—£1.8 million. He said that he would come back to me, but he has not. Can he clear this up?
Mr. Milburn: I am amazed that confusion is reigning in Durham. That sounds a very unlikely state of affairs. The Minister of State, my hon. Friend the Member for Redditch (Jacqui Smith), who has responsibility for social services and community care, is looking into the matter. Two things are necessary. First, the local community bodies concerned—PCTs, social services and the acute hospitals—must come together and agree a course of action. That has not always happened. Secondly, if we can be helpful nationally, we will be. If our investigation or our involvement can help, we will be glad to provide such help.
The situation described by my hon. Friend the Member for City of Durham (Mr. Steinberg) is the nub of the problem. When partnership works, it is great; when it does not work, it is a disaster. The problem is that it relies purely on voluntary endeavour. If relationships are good, they are good; if they are bad, they are bad. We do not have an incentive in the system that allows each part of the partnership—health services on the one hand and social services on the other—to accept their responsibilities. That, fundamentally, is what the Bill is about.
Dr. Liam Fox (Woodspring): Will the Secretary of State please answer my question simply? If relationships are to improve under the Bill, why are three of the 10 clauses about dispute resolution?
Mr. Milburn: The hon. Gentleman knows fine well why that is so. If the world were a perfect place and if partnership were happening everywhere, there would be no need for my hon. Friend the Member for City of Durham to stand up and complain, no need for Opposition Members to stand up and complain about the same issue and no need for the Bill to be introduced. Partnership is a very cosy idea and, like every Member, I support it, but to make it work everybody has to accept their responsibilities. Sadly, sometimes they do not do so, which is why legislation is necessary.
Mr. David Hinchliffe (Wakefield): When I met consultants at Pinderfields hospital in my constituency over the summer, they told me that about a third of the
hospital's beds were occupied by people who did not need to be in them. Some were delayed discharges, but others had been admitted inappropriately by GPs. Does my right hon. Friend intend to extend the principles behind the Bill to fining others who are involved in health care? Is my hon. Friend the Member for Dartford (Dr. Stoate), who is a GP, likely to be fined for wrongly admitting his patients to the local hospital?
Mr. Milburn: No, I do not think that that is needed, partly because there are incentives in the system in respect of that. However, my hon. Friend makes a good point. It is perfectly self-evident that one problem that bedevils health and social services is the fact that people are all too often in the wrong part of the system at the wrong time. We are putting the incentives in place to correct the deficit in the NHS that he rightly describes so that in future—not before too long, I hope—I shall be in a position to give PCTs budgets for the longer term rather than just a year. They will have discretion over how to spend that money, whether on primary care, community care or hospital-based care.
One thing is absolutely certain, and my hon. Friend has argued this over many years: the problems for hospitals will not be resolved purely in hospitals. This country, and elderly people more than anyone else, require a broad spectrum of services—services in hospital, in the community and in primary care and, crucially, social care services.
Dr. Howard Stoate (Dartford): My right hon. Friend is very generous in giving way. May I clarify the comment of my hon. Friend the Member for Wakefield (Mr. Hinchliffe)? GPs sometimes admit patients inappropriately purely because they cannot get the care packages in the home that they would like and which would keep people in their home. Improving social services care would make that a thing of the past.
Mr. Milburn: I agree. I was coming to that. The Opposition, however, all too often seem fixated with the idea that the only form of care that counts is either hospital care or care in a care home. Care in homes is important, giving frail and disabled older people in particular the opportunities that they need; but there should be a broader spectrum of care choice, not just for those older people but for general practitioners and others working in the community who want to ensure that patients are placed appropriately.
Our extra investment in social services over the next few years will help to finance a 50 per cent. increase on the 1997 total in the number of extra care housing places, or very sheltered accommodation. A further 70,000 older people will receive rehabilitation services each year to prevent them from having to go to hospital unnecessarily in the first place, and to help them leave hospital speedily when it is safe for them to do so. The Bill, moreover, will make those and all intermediate care provision—whether provided by the health service or by social services—free to the user.
More older people will be able to choose to live at home. In the past, too many have faced a choice between going into a care home and struggling on in their own
homes. As a result of our investment, by 2005 twice as many older people will receive the intensive help they need in order to live at home as received it in 1995.
Mr. Hilton Dawson (Lancaster and Wyre): When he next visits Lancaster, would my right hon. Friend care to join me in visiting the Beck View extra sheltered housing project? He would see a tremendous example of partnership between Lancashire county council's social services department and Lancaster city council. Exactly the sort of work he has described is being done, enabling older people to remain in their homes for the rest of their lives.
Mr. Milburn: If I visit Lancaster—of which, as my hon. Friend knows, I am extremely fond—I will certainly do as he suggests. Recently, when I was in another great city—Leeds—I saw a superb example of extra care housing. If I remember rightly, it was supported by a local authority, a housing association and the national health service. As my hon. Friend suggests, such things can happen and are happening. What we need to do is build up the capacity, and Opposition Members must recognise that that can be done only if the necessary resources are committed to social services—which is precisely what we are going to do.
Mr. David Lepper (Brighton, Pavilion): I am sure that my right hon. Friend is aware of the support for carers that exists throughout the House. In view of what he said about ensuring the availability of a range of care options, will he, during the Bill's passage, return to the need to ensure that the current guidance on consulting and providing information for carers about hospital discharge is given the force of law? Will he also consider the provision of free care services for carers when they are needed as part of the care package relating to discharge?
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