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28 Nov 2002 : Column 511—continued

Mr. Edward O'Hara (Knowsley, South): I appreciate the purpose of the Bill, particularly the point about giving the social services extra funding to ensure that they are not punished. However, I have been listening carefully and there seems to be one omission from the Bill—the older people themselves. It seems that they are being treated rather instrumentally. Will my hon. Friend comment on what consultation might be available to older people or their families, or advocacy services if they are not capable?

Mr. Milburn: My hon. Friend makes an extremely important point. The philosophy at the heart of the Bill is straightforward. What counts is the user of the service, not health services or social services. They exist for a purpose—to serve the public and, in this case, to serve older people. For a variety of reasons—some to do with resources, some to do with historical capacity, some to do with the structural deficit in our health and social care system—too often older people are let down. That is simply not good enough.

The Bill is about doing what older people want. Older people always say that they want to be independent, not dependent. They want to live in their own home; they do not want to be in a care home, by and large, or in hospitals. Hospitals are not places where people choose to go—they want to get in as quickly as possible and to get out as quickly as possible. The philosophy of the Bill is about ensuring that the older person's needs are fully taken into account. As I said earlier, it is important that the views of individual older people and those of their carers and families are fully taken into account in the discharge process, and that is what we will do.

Mr. Andrew Lansley (South Cambridgeshire) rose—

Mr. Milburn: I will give way and then I really must wind up.

Mr. Lansley: If the Secretary of State were to act on what he said in response to the previous intervention, would the Bill reflect that patients exercising their choice under the choice directive would not lead to fines on social services? What guarantee will he give that the exercise of patient choice will not lead to costs and fines for social services?

Mr. Milburn: There are two issues about the exercise of choice. The hon. Gentleman talks about the direction on choice. There are two groups of people. Self-funders effectively pay for their own care and are not the responsibility of social services. However, social services have an obligation towards people who are their responsibility. There is a direction on choice, of course, and people should be able to exercise choice. However, the direction on choice has never, under the previous Conservative Administration or ours, been about older people being allowed needlessly to occupy hospital beds when they are ready, willing and able to go home. There are important issues surrounding the direction of

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choice, as the hon. Gentleman suggests, but what most people want is simple. They want to get in and out of hospital as quickly as possible.

I have today provided further resources to local government because we have been told that the problem is resources. I have provided the extra resources; we have assessed the cost of the fines. I have covered the cost of the so-called fines and frankly, there can now be no further excuses for social services not to fulfil their responsibilities.

Mr. Eric Martlew (Carlisle): My right hon. Friend is being very generous to local authorities, but he has not provided any extra money. He has actually taken £100 million out of the NHS, and that is a worry to me.

Mr. Milburn: That is true. [Interruption.] I hope that I am not intruding on private grief. I have transferred £100 million from the national health service to social services. It will help the national health service do its job because if we do not build up social services, NHS hospitals will not be able to do their job. I realise that the hon. Member for Woodspring (Dr. Fox) is hurriedly rewriting his speech as a consequence of my announcement, but it is no use for him to complain about transfer of resources—he is against resources. He is against resources going into the health service. He is against resources going into social services.

For the sake of people in hospital who need to come out and for the sake of people who need to be in hospital, we must address delayed discharges once and for all. The Bill is about making the system work for older people who are needlessly stuck in hospital. It is about putting older people first. It is about helping them to get the right care, in the right place, at the right time. For the first time, the Bill introduces a positive incentive to ensure that the resources of health and social services are directly linked to the responsibilities that they share. It will help to ensure that resources provided for social services are actually spent on social services. The Bill is fair to the national health service, it is fair to local government and, above all, it is fair to older people. I commend it to the House.

3.21 pm

Dr. Liam Fox (Woodspring): I beg to move, To leave out from 'That' to the end of the Question, and to add instead thereof:

As ever, whether it be the shambles of the fire dispute, the mishandling of the economy or the Government's increasing failure to deal with the woes of the national health service, their approach is exactly the same: to ignore criticism and to pass the buck. However, the problem with which the Bill deals is entirely of the making of the Secretary of State for Health and his Ministers.

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For the past few years, we have been warning of the inevitable consequences of Government policy, and our predictions, unlike those of the Chancellor, turned out to be right. In April 2002, there were an estimated 511,300 places in residential settings for the long-stay care of elderly and physically disabled people across all sectors in the United Kingdom. That is a drop of more than 60,000 places since Labour came to office.

By April 2002, capacity in all those sectors had decreased by 64,300 from the 1996 peak—a decrease of 11 per cent. If we correct those figures to take account of population change, the decrease is even greater: about 20 per cent. from the peak. Most frightening of all, despite all that Conservative Members and even some Labour Back-Benchers have said, 14,000 places were lost last year—the biggest single fall since Labour came to power.

Mr. Dawson: Will the hon. Gentleman tell us about the quality of those residential places? Why should elderly people have to opt for residential care rather than for the wide range of options that will keep them in their homes and support them in the community?

Dr. Fox: Indeed. The drop in the number of care home places would not be so worrying were it not for the drop in the provision of domiciliary care. As my hon. Friend the Member for West Chelmsford (Mr. Burns) has pointed out, almost 100,000 fewer households have been supplied with domiciliary care since the Government came to office.

What is the effect of all that on the NHS itself? First, as a result of delayed discharges the number of cancelled operations has risen by almost a third since 2000. The Government's own figures show that 77,800 operations were cancelled in 2001, compared with 50,000 in the year they came to power.

Secondly, the number of emergency readmissions has increased as patients are discharged early to try to meet the Government's targets. Over the past year, more than 500,000 patients had to be readmitted; in 10 health authorities the increase in readmissions was more than 10 per cent.

Some of the Government's answers and the Secretary of State's response to the problem are ludicrous. Hospitals will not be funded if patients are readmitted, so presumably if a patient with angina is discharged from hospital, suffers a myocardial infarction and has to go into coronary care, the hospital will not be funded for that. What a brilliant proposal—extremely helpful to NHS trusts, I am sure.

Kali Mountford (Colne Valley): I admire the hon. Gentleman's concern about delayed discharges. What resources would he commit to ensure that discharges were not delayed? How much money would he give?

Dr. Fox: It is a matter of priorities. If we were in office we would not be wasting hundreds of millions of pounds on the Government's pointless waiting list targets. We would not be employing the extra tens of thousands of bureaucrats that the Government require for an endless paperchase which today's proposals will make worse.

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We want to talk about whether the measure will make whatever funding is available work better or worse for patient care. The answer is clear: it will work worse because the situation is getting worse.

In the first quarter of this year, 8 per cent. of elderly patients who were discharged were readmitted within 28 days, and 3.2 per cent. were readmitted within seven. That is a massive increase even on just a year ago. What is the Government's response to this very complex situation? They have produced this pointless, ill-thought-out, punitive—a word used by the hon. Member for Knowsley, South (Mr. O'Hara)—contradictory and self-defeating Bill.

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