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28 Nov 2002 : Column 506—continued

Mr. Milburn: I can give my hon. Friend an assurance on the second point. As for the first, we will want to issue guidance to those in all parts of the care system, but particularly to those in hospitals, about how discharge procedures should work. An important part of that is ensuring that not just patients but their families and carers are involved from the outset. Carers do a fantastic job, and the Government have no intention of trying to bypass their role. Indeed, we want to enhance it.

Ms Joan Walley (Stoke-on-Trent, North): May I refer my right hon. Friend to another great city, Stoke-on-Trent? How does he intend to secure the necessary accountability in the efforts to produce joint strategies for integrated care for elderly people?

The Edwards report on services in Stoke-on-Trent and North Staffordshire resulted in the transfer of £300,000 from the NHS to social services. However, the money was not actually spent on the services that it was originally provided for. What measures will he introduce in respect of accountability, because we need to ensure that money intended for a specific purpose is used just for that purpose?

Mr. Milburn: My hon. Friend makes an extremely important point. The Bill provides a partial answer, and

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in a moment I shall discuss the question of ensuring that responsibilities are also matched by resource responsibility. However, I can assure her that during this Session, we will introduce further legislation to ensure a better audit trail—in the health service and in social services—of where public money is being spent. We aim to strengthen the inspectorates on the health and the social care sides of the fence, and we intend to impose a legal obligation on both new inspectorates to work together. Otherwise, not only do elderly and vulnerable patients fall through the gap in the middle; sadly, public money sometimes does as well.

Several hon. Members rose—

Mr. Milburn: I shall give way to the hon. Member for Sutton and Cheam (Mr. Burstow), but then I must make some progress.

Mr. Paul Burstow (Sutton and Cheam): The Secretary of State has already acknowledged the concern of some of his hon. Friends that the additional resources that he has announced are not adequate. Given that the Government's inquiry into health service funding—the Wanless report—made a case for extra investment, and given that the report time and again flagged up the fact that no equivalent work was being done in social services, is it not time for a Wanless inquiry into social care, so that we can be certain that the additional resources are sufficient to deliver on this Government's commitments?

Mr. Milburn: We have made our decisions on social services for the foreseeable future—for the next three years—and as the hon. Gentleman knows full well, until very recently social services faced an annual cycle of budgets, because they had no real idea what they were getting. That is changing, and we must maintain that change and provide as much certainty and stability as possible in social services funding. I shall say something more on the matter in a moment, but we will continue to assess what social services actually need to fulfil their obligations. That is the right thing to do, and in particular we want to ensure that they have the resources to build up services in the community and at home.

As the hon. Gentleman will be aware, people are charged for community equipment such as handrails, walking frames or bath seats. This equipment can make the difference between an older person's becoming dependent, or remaining independent in their own home. The Bill's provisions will remove these charges altogether. Ring-fenced funding for up to 500,000 extra pieces of community equipment will be provided to an estimated 250,000 additional older people, and for the first time they will be provided free of charge.

The resources are therefore in place to establish capacity in the communities where it is needed by older people. Extra support in the community will, in turn, help to relieve pressure on hospitals. However, resources alone are insufficient to crack the problem of delayed discharge from hospital: reforms are needed alongside resources. Of course, some reforms are already beginning to bite. The first care trusts are now in place, and there are more to come. Under health legislation flexibilities, more than 180 local partnerships

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are now delivering services worth more than £2 billion a year. Finally, a single process for assessing older people's health and social care needs is being put in place.

Mr. Paul Truswell (Pudsey): Given the huge welcome for the long-overdue additional resources that have been spelt out, and given that further resources are planned, why has my right hon. Friend taken it upon himself to introduce this punitive legislation before thoroughly evaluating the use and impact of that money?

Mr. Milburn: I do not think that the legislation is at all punitive.

Mr. Henry Bellingham (North-West Norfolk): It is punitive.

Mr. Milburn: The hon. Gentleman will doubtless have an opportunity to make his speech in a moment or two, but it would be helpful if he would not shout at me during mine. The legislation is not punitive; it is about ensuring that the needs of the older person, rather than of any one part of the care system, always come first.

The Conservative party is in severe danger of becoming the party of the producer, and I know that it would not want to do that. It always used to pride itself on being the party of the consumer, but perhaps that has gone, too, along with its tradition of economic competence—or indeed being the party of the vulnerable.

Partnership is the key to delivery, but it works only when both health and social services are clear about their respective responsibilities. It is about giving as well as taking, and about being clear that what comes first is not the needs of any one service but those of every individual user of the service. When older people get trapped in hospital, that is a failure in partnership working.

Patients can be delayed for many reasons. In too many cases, they are delayed in hospital because social services departments are not fulfilling their responsibility to provide care in the community. Almost 1,000 older people are trapped in hospital simply because they are waiting for their needs to be assessed and their future care planned. Under the current system, for as long as elderly people remain in hospital, they do so at the cost of the national health service. There is no incentive for local government to tackle the problem. Indeed, there is every incentive to leave them stuck there. The Bill is not about imposing wholly new responsibilities on social services departments but about ensuring that they fulfil their existing ones.

Dr. Desmond Turner (Brighton, Kemptown): The Brighton and Hove authority has done exactly what my right hon. Friend is asking: it has entered into close partnership working with the local health bodies, and a care trust is emerging, but despite its best efforts there is still a serious problem of bed blocking, which is outside its control. Under the Bill, it is quite possible that the extra resources that the social services department has

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been given—thank you very much—could be used to pay punitive fines because of bed blocking that is outside its control.

Mr. Milburn rose—

Mr. Deputy Speaker: Order. Before the Secretary of State replies, let me say to the House that interventions are getting longer and longer, and hon. Members should really learn the art of the concise intervention, especially when they are taking time out of the time that they might hope to have later, if they catch my eye.

Mr. Milburn: Thank you, Mr. Deputy Speaker. I will take that as a hint to get on with it.

On my hon. Friend's question, that is precisely why we are making resources available to social services. Of course, there is a choice. We are giving £1 billion of extra cash, largely earmarked for elderly care services, and social services departments have a choice—although earmarking restricts their discretion to some extent, I suppose—about whether to use those extra resources to build up capacity, which is what they tell us they want to do, and is indeed the reason why we agreed to give them the extra money, or whether they want to transfer resources to the health service. Our understanding is that they want to build up services in the community, and they now have an opportunity to do just that. I perfectly understand that, in the days when budgets were rising by 0.1 per cent. a year in real terms, that was not possible, but we are now moving into an era in which resources will be rising by 6 per cent. a year in real terms, not only for one or two years but for three whole years.

It is not as though social services departments have not known that this measure was coming. Indeed, there are already extra resources in place. The day after the Budget in April, I stood here and announced precisely that this measure was coming. In October, we provided £300 million through the building capacity grant, so that social services could start the process of building up services in the community. However, I take my hon. Friend's point and I shall return to it later.

In all fairness, the costs of care should surely fall where they belong. Under the new system proposed in the Bill, when patients are ready and able to leave hospital but care is not provided for them in the community when it should be, the costs will indeed pass to social services, but there is also a requirement on the national health service to play its part in the discharge process by giving advance notice to social services that a patient may need community care on leaving hospital.

Under the Bill, where social services do not fulfil their responsibilities, they will have to meet the costs that the hospital incurs in providing care for patients whose discharge has been needlessly delayed. Where similar approaches have been used in other countries, they have worked. Opposition Members are always saying that we should learn from those experiences, and we are trying to do just that. The precise details of the scheme in Sweden are not the same as what we propose here—not least because the structure of health and social care is rather different—but the number of hospital beds occupied by delayed patients was halved in that country, and the average wait for discharge was reduced to just three days.

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Some have objected that the Bill will create a perverse incentive for hospitals to discharge patients too early, only for them to have to be readmitted. I understand those concerns, and that is why we have put in place the necessary safeguards to prevent that happening. In future, hospitals will be rated—and therefore rewarded—according to how well they do in reducing emergency readmission rates. What is more, under the new system that we are introducing to pay hospitals for what they do, they will not receive funding for patients who, within a certain period, are readmitted to hospital with the same complaint or a complication of it. Again, the incentive will be on the hospital to discharge appropriately, not inappropriately.

The fundamental objection to the Bill, however, has been that it is all stick and no carrot, as my hon. Friend the Member for Pudsey (Mr. Truswell) noted. The criticism is that social services are being given a new responsibility without adequate resources. Let me address that in two ways. First, this is not a new responsibility: it exists today. The system simply does not ensure that costs fall where responsibilities lie. Secondly, the Budget provides substantial extra resources for social services, and the means to increase capacity in community services. Incidentally, we took account of any likely costs to social services of this measure in making those resources available.

However, I have considered this point carefully and listened to the representations that have been made today, and on previous occasions, by some Labour Members and by local authorities and local government organisations. The maximum cost that social services would face in payments to hospitals under the Bill would be about £100 million in any one year. That estimate presumes three things.

The first is that councils make no progress whatever beyond the targets that they themselves have already set to reduce the level of delayed discharges from hospitals. Secondly, the £100 million estimate pre-supposes that social services do not use the 6 per cent. annual increase in resources to put in place new services to help reduce delayed discharges from hospitals still further. Finally, the estimate presumes that none of the £1 billion—most of which is earmarked for elderly care services, as I said earlier—gets spent on those very services. I do not believe for a moment that that is what local authorities will do—indeed, they will not be able to do that, as so much of the money is earmarked. Therefore, I do not believe either that social services will have to pay £100 million to the health service.

None the less, I have decided, for each of the next three years, to transfer an extra £100 million, on top of the resources already made available, from the NHS budget to social services for each full year in which the scheme operates. I am doing so in order to provide a positive incentive to ensure that the regime is not punitive and to make the system work. This extra £100 million will now enable individual councils to gain rather than lose from the system—provided, of course, that they make available the community services needed to reduce delayed discharges from hospitals. Hospitals can gain too. As social services reduce the pressures on hospitals, their costs will fall.

My intention is not, and never has been, to punish local government but to pursue a real and sustained reduction in delayed discharge from hospital. Frankly,

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there can now be no excuse for social services not to fulfil their responsibilities to older people. I have tried, therefore, to address the legitimate concerns that have been raised by my hon. Friends and others during the course of the debate.

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