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28 Nov 2002 : Column 514—continued
Mrs. Joan Humble (Blackpool, North and Fleetwood) rose—
Dr. Phyllis Starkey (Milton Keynes, South-West) rose—
Dr. Fox: I shall give way to one of the revenge of the clones later. [Interruption.]
Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman. The House must quieten down; this is a debate, and we should have reasoned argument on both sides.
Dr. Fox: Thank you, Mr. Deputy Speaker.
Mr. Martlew: On a point of order, Mr. Deputy Speaker, is it right for an hon. Member to refer to another as a clone?
Mr. Deputy Speaker: I have heard quite a number of expressions which on the whole I would prefer not to be used, but I do not think that that word has been classified as non-parliamentary language.
Dr. Fox: You can always tell when hon. Members are getting desperate, Mr. Deputy Speaker.
The trouble with the Bill is that it tries to blame local authorities for something that is beyond their control. It will place new burdens and costs on them. It is based on false assumptions. It is will increase bureaucracy and red tape, damage health and social care relationships, produce perverse incentives and increase the likelihood of decisions on care being taken inappropriately. In other words, the Bill runs the risk of producing exactly the opposite of what the Government claim it will produce.
Mr. Hinchliffe : The central thrust of Conservative party policy on the care of the elderly appears to involve more and more institutional care. On the hon. Gentleman's travels around Europe—I met him on a plane a few weeks ago—has he dropped in on Denmark, which has a similar proportion of elderly and very elderly people to this country, but no old people's homes at all?
Dr. Fox: That is a very useful point. Perhaps the hon. Gentleman and I would agree on one thing: for elderly patients, as for all other patients, the most important phrase is Xappropriateness of care", which involves having a full range of provision. Some patients require and want long-term care in nursing or residential homes,
but that will not be available if the capacity decreases as quickly as it has in the past five years, and the Bill will do nothing to help.The Bill will add substantially to the burdens on already hard-pressed local authorities. At least the Government are being consistent. Let us consider the list of obligations imposed without proper funding in recent years, starting with flooding. Emergency grants from central Government are not even remotely covering all the costs of recent floods, as millions of council tax payers are about to find out. The Homelessness Act 2002, passed during the previous parliamentary Session, imposed new burdens on local authorities to draw up new homelessness strategies. Air targets have been devised by Brussels and announced by the Minister for the Environment but are being funded by no one. Waste recycling will cost at least £55 million, and there are asylum costs, travel concessions and the huge burden of children's services, the costs of which fall on local government and accounted for 64 per cent. of the total overspend last year.
Dr. Fox: I have given way already and will do so again later.
There is no point in Ministers saying that they are giving more money to local authorities, because the rate at which they are piling on responsibilities is greater than the rate at which funding is being applied to local authorities to cope with those responsibilities.
Most absurd of all, the Secretary of State said today that the Government have introduced the Bill because bed blocking is costing the NHS money and local government must play its part in sharing responsibility, but what are they proposing to do? They will fine the NHS £100 million and give the money to social services so that, when they fine them, they can give back the money. If that is not complete bureaucratic madness, I do not know what is. It can only help bureaucrats and produce paperchases; it will do nothing to help local government, hospitals or the patients themselves.
Rev. Martin Smyth (Belfast, South): I appreciate the hon. Gentleman's giving way on that point because I was lost earlier when I heard that health service costs would be reduced. Is it not a fact that the procedures in the health service put up the costs, so if beds are vacated—for which we would be thankful—there will be more operations, more procedures and increased costs and therefore health service costs will not be reduced?
Dr. Fox: The hon. Gentleman may be right. It is certainly true that despite the increased amount of money that the Government have undoubtedly put into the NHS in real terms, the level of activity coming out is very much less than predicted. Funding has increased by almost 11 per cent. in real terms, but the level of activity is up by less than 2 per cent. Clearly, therefore, there is a huge amount of wastage.
It seems that Ministers are not yet content with the amount of costs that they are imposing on local government. When one asks local authorities how much
they think the scheme will cost, one finds that their estimate is a lot higher than that of the Secretary of State. The Association of London Government estimates that the cost to it alone will be £25 million a year. Buckinghamshire estimates that it will cost £2 million; Essex that it will cost £3 million; Cambridgeshire, £1.4 million; Surrey, between £6 million and £7 million; and Kent, £5.5 million. What are Ministers trying to do? Do they have any understanding of the real problems of local government in the real world? I shall now give way to the hon. Member for Milton Keynes, South-West (Dr. Starkey).
Dr. Starkey: I am grateful to the hon. Gentleman for at least demonstrating, unlike the hon. Member for West Chelmsford (Mr. Burns), that he notices women and realises that they are individuals, not clones. Is he suggesting that councils should not fulfil their current obligations unless they get additional money from Government? Why does he think that some councils can fulfil their obligations but not others? Does he not think that the councils bear some responsibility for that?
Dr. Fox: Of course, they are supposed to work in a partnership wherever possible. But the whole point of the debate is to examine whether the Bill will improve the working relationships between health and social services, or whether it will make them more difficult. As I pointed out to the Secretary of State, if he thinks that the Bill will improve the relationship, why is 30 per cent. of the entire Bill devoted to new bodies being introduced to resolve disputes which, as the Bill admits, do not currently exist? That is not an improvement in the working of the current system, which is what everybody would like.
Much of the Government's case has been based on their interpretation of the system in Sweden. On 18 April 2002, the Secretary of State made a statement in the House of Commons, announcing the Command Paper, XDelivering the NHS Plan", in which he said that the Government were impressed by the success in getting delayed discharges from hospitals down of the system in countries like Sweden and Denmark. Had the Secretary of State made a visit to examine the project? No, he had not. According to the Health Service Journal, the Government's decision to bring in cross-charging was taken without even consulting Gert Alaby, the architect of the Swedish model on which Mr. Wanless had placed so much emphasis—although it was also reported that Mr. Wanless had not met Mr. Alaby either. Yet the Department of Health said recently that there had been conversations with a Xnumber of people" in Sweden.
If the Secretary of State or Mr. Wanless want to know about the problems in Sweden, they can ask the hon. Member for Ealing, North (Mr. Pound), who made a telling intervention in the Queen's Speech debate:
- XMay I point out some of the differences between that model and what we have been discussing today? In Sweden there was a two-year lead-in time before the proposals were implemented. In addition, local authorities had responsibility for a vast range of alternative provision, including direct commissioning of health care."—[Official Report, 14 November 2002; Vol. 394, c. 231.]
Several Labour Members, including the Secretary of State, have mentioned working relationships. The central proposal in the Bill risks undoing what has undoubtedly been a recent improvement in the NHS: the increased willingness of health and social care departments to work together. That still has a long way to go but, in the words of one Labour Member, Xthe direction of travel is positive when viewed as part of the complete patient journey," which in English means that things are getting a bit better on the ground. The real change that the Bill might introduce was well expressed by the British Medical Association, which fears that the plans will seriously damage working relationships:
- Xthe BMA supports co-operation and improving co-ordination between health and social services to provide seamless high quality services for vulnerable patients who may be adversely affected by the barriers that exist between social services and the NHS. The proposal for fines has the potential to damage some of the good relationships that have evolved with the greater opportunities for joint working. "
- XReal progress has been made in forging partnerships between health and local government, including the particularly successful joint work to alleviate winter pressures."
- XA recent Audit Commission report endorsed the successful partnerships already in place. We want to build on these to prevent unnecessary hospital admissions, reduce delayed discharges and provide integrated health and social care services. It would be a retrograde step if the current proposals undermined this trust and led to the development of adversarial relationships rather than cooperation between health and local government".
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