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28 Nov 2002 : Column 528—continued

Mr. Burstow: Under the Bill, such people will not have access to advocacy services to help them with their discharge and they will not even be asked, because the Bill does not address their right to give consent to be discharged. It does not even address whether the carer should be consulted. Such considerations are absent from the Bill. We have the vague promise that the discharge workbook, which the Government have been promising for two years to update, will be updated. The hon. Gentleman should address his question to Ministers, not to me.

Why does the Bill make no provision for patient consent or for consulting carers? I hope that we can persuade the Government to do that in Committee. As Carers UK has documented in its report, XYou can take him home now", 77 per cent. of carers said that they were not given a choice about taking on a caring responsibility. Carers UK also found that emergency readmissions had increased from 19 to 43 per cent. among the carers surveyed, and carers increasingly saw early discharge as the reason. Emergency readmissions have been increasing. The latest figures available show that 122,357 people experienced emergency readmissions, which is an 11 per cent. rise in two years. In its representations, the Royal College of Nursing points out that that is symptomatic of inappropriate discharges.

In the NHS plan, we were told that there would be an equivalent penalty system for emergency readmissions. What we have heard today is a watering-down of that, so there is no equivalence between emergency readmissions and delayed discharge. Instead, they are to be linked to star ratings and nothing else.

Dr. Murrison: Will the hon. Gentleman give way?

Mr. Burstow: I must make progress, so I will continue, if I may.

Standard 2 of the national service framework states that older people should receive care that meets their needs as individuals, and that the role of the NHS and social services departments is to enable people to make choices about their own care. The penalties will not facilitate that. Health care should be driven by the needs of patients, but the Bill puts tick-boxes and spreadsheets first. Ministerial obsession with delayed discharge is distorting priorities. Penalties to incentivise one part of the system will have knock-on effects.

What happens to the elderly person in their own home who is waiting for an assessment? What happens to their care? The Bill means that social services departments will be forced to prioritise the person in a hospital bed ahead of the person in their own home—a case of them being out of sight and out of mind, and certainly not being a priority when it comes to avoiding penalties.

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The message that the Bill sends to the House and the country is that the Government are setting up a system that creates perverse incentives where the only way in which some people can get appropriate care and ensure that they are fast-tracked is through hospital admission.

Mr. Burns: The hon. Gentleman estimated that the cost to local authorities of the provisions on fines would be approximately £50 million. What mathematical formula did he use to arrive at that figure?

Mr. Burstow: That is a very fair question. Indeed, we will be asking some questions about how the Secretary of State arrived at the £100 million figure that was mentioned today, which is very interesting and double the Liberal Democrats' estimate. We decided to adopt a conservative approach. The basis of the calculation was to use the most recently available delayed discharge figures and apply the rates differentially, based on £120 for London and the south-east and £100 everywhere else. We applied those levels to the figures that are provided on a regional basis, and that is how we produced our estimate. It is interesting that the Government's estimate is now twice as large. Perhaps that shows that they have figures that they have not yet made available that should be brought into the public domain.

Mr. Burns: Will the hon. Gentleman give way?

Mr. Burstow: The hon. Gentleman asked his question and had his answer, so he cannot really expect me to give way again.

The Bill is fatally flawed and will create a blame game between the national health service and social services. It will distort priorities, leave people waiting still longer in their homes to get the care that they need and result in patients and carers being left out of the equation. Delayed discharges are a symptom of chronic under-investment not only by this Government, but over decades, and of the rationing of care. The Bill does nothing to address those underlying problems; if anything, it will make them worse. That is why the Liberal Democrats will vote against it.

4.22 pm

Mr. David Hinchliffe (Wakefield): When we debate a Bill on Second Reading, we basically debate its principles. I fundamentally disagree with the principles of this Bill, which I think is flawed and will ultimately prove damaging to many positive policies that the Government have promoted.

My hon. Friends on the Front Bench deserve congratulation on many of the initiatives that they have developed, such as joint working, community care, the flexibilities in the Health Act 1999, limited pooling of budgets and care trusts. They have introduced a range of initiatives that have genuinely improved joint working locally, as the hon. Member for Woodspring (Dr. Fox) said. However, I fear that the Bill is taking us in the other direction. I welcome the Government's increase in funding for local authority social services, but it is a belated recognition of the serious difficulties that many local councillors face.

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The Select Committee on Health considered the figures for 2001–02 in its recent public expenditure inquiry. It is interesting to compare the real-terms growth of the national health service, at 9.4 per cent., with that of social services, which is 1.3 per cent. We are making assumptions about the Bill on the basis of the experience in that year and previous ones when that huge discrepancy existed in the funding of those two areas. An extra £100 million has been promised by the Secretary of State—it will be taken from health funding to go into social services—but the Health Committee estimated in its public expenditure inquiry, on the basis of the Government's figures, that local authorities are already spending £200 million more than their budget on social services in 2001–02. That puts his £100 million figure into context. Some 10 per cent. of English local authorities are spending more than their standard spending assessment levels.

It is fair to say that we have treated social services as a poor relation—a term that was used by the Secretary of State. We are now putting the boot into that poor relation and we need to think the matter through very carefully. As my right hon. Friend made his speech, one of my hon. Friends asked me, XWho thought this one up?" In trying to work out some of the measures in the Queen's Speech whose logic I cannot understand, having believed in Labour party health policy for my whole adult life, I have concluded that some adviser or civil servant has been rooting around in the cellars of Richmond house and found in a file some dusty papers that were prepared for a Tory Secretary of State 20-odd years ago. That is the only conclusion that I can draw on the logic of foundation hospitals.

The supposed logic behind the Bill is based on thinking that is completely outdated, because it is rooted in the social services environment of at least 20 years ago, when social services were direct providers of care and could offer care home places and accommodation under part III of the National Assistance Act 1948. I worked in social services for many years in the 1970s. I went to hospitals, saw patients who were deemed fit for discharge, assessed their suitability under part III, and could then arrange a direct placement under those provisions. That is no longer the case. The previous regime rapidly got rid of local authority direct care provision, and in answer to the Health Committee, the Government now describe the role of local authority social services as managing the private care market. The arena is now fundamentally different from the one in which I worked 20 years ago, when the thinking behind the Bill emerged.

I am concerned about being told that we are considering practice in Sweden. I have always had a great interest in Scandinavian social policy, as I think that Scandinavia is light years ahead of the UK, having been there a number of times. I also found out recently that the origins of the Hinchliffe family are Norse, so perhaps I am genetically programmed towards Scandinavian social policy. However, I know enough about Sweden—indeed, I shall be there on Sunday evening with one or two of my hon. Friends—to know that its health and social care system is fundamentally different. As other hon. Members have mentioned, the Swedish system is better resourced and Sweden has higher taxes and better services. There is also far less reliance on the private market, much greater direct

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provision and different charging regimes. We are making the same mistake that Tory Front Benchers have made on several occasions—that of going to Timbuktu, plucking out an obscure policy and trying to apply it to the UK. That is a ludicrous thing to do because the systems are fundamentally different.

Reference has been made to the Health Committee's recent inquiry into delayed discharges. I should like to quote from some of the evidence that we heard. Mike Leadbetter, the former president of the Association of Directors of Social Services, said that the measure was Xa perverse incentive" and added:

Dr. Gill Morgan, chief executive of the NHS Confederation, said:

Dr. Chris James of the NHS Alliance, speaking from a primary care viewpoint, said:

Those are the people who will be doing the jobs, and John Ransford from the Local Government Association agreed with all those points. We got a clear thumbs down. My recollection is that we did not hear any support for the Bill apart from that of the Department of Health. Indeed, the support expressed by some of the officials whom we interviewed was muted, as they could envisage some of the likely problems.

As I indicated in my intervention on the Secretary of State, my concern is that many factors outside the control of social services result in delayed discharges. For example, why do we not fine home nurses for failure to arrange home nursing packages because that sometimes results in delayed discharges? To my knowledge, that is a factor. What about ambulance service failures? I have come across cases in which people cannot get transport to enable them to leave hospital, especially if they have to travel some distance. What about the failure of housing authorities to arrange appropriate accommodation for people who can no longer go back to their homes because they need ground-floor accommodation or some form of specialised sheltered housing? What about resistance from relatives? I have encountered cases in which relatives have said, XNo, she's not coming out, because in our view she's not fit to do so." What should we do in such circumstances—fine the relatives? The Government do not seem to have considered that question.

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