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28 Nov 2002 : Column 540—continued

Madam Deputy Speaker: Order. The hon. Gentleman's time is up.

5 pm

Mr. Kevin Hughes (Doncaster, North): We heard from the Secretary of State that the Bill's basic aim is to prevent delayed discharges from acute hospital beds. As we know, that affects older people in particular. Other Members produced, in effect, a regurgitation of the professional whinges and excuses for not doing anything to tackle the problem—notably the hon. Member for Sutton and Cheam (Mr. Burstow), who for some reason managed to make a 25-minute speech although he is only a Back Bencher like me. I cannot remember when we decided that there were two Opposition Front Benches.

We are all worried about people being kept in hospital longer than necessary. No one wants to be trapped in hospital when they do not need to be there, and that applies especially to elderly people. It is well known that the vast majority of older people prefer to be in their own homes. That was demonstrated to me very clearly earlier this year, when my mother needed emergency surgery. After the operation all she wanted to do was go home, even when she was still in the intensive care unit. The care she received in hospital was first-rate, but she wanted to go home nevertheless. I am glad to say that as soon as she was able to leave she was discharged.

My family and I remain very grateful to all the staff involved in my mother's operation and after-care at the Doncaster and Bassetlaw hospital. Had she lived in a different area, things might well have been different, as we know from some of the stories we have heard today. In Doncaster, however, social services, the primary care trusts and the Doncaster and Bassetlaw trusts operate robust arrangements to ensure that they work together to reduce delays. It is an excellent example of collaboration and co-operation between health and social care services, providing support and care for patients who do not need to be in hospital for medical reasons. Patients who require time and care to recover from illness or surgery may need intermediate care, with intensive rehabilitation support, before going home or into sheltered or residential accommodation. Some may need round-the-clock nursing care in a nursing home.

Most people want to be able to stay in their own homes, as I have said. Health and social services have crisis intervention teams to prevent the need for admission to hospital, or to ease patients back into their homes. In many cases involving elective surgery, they start considering what needs to be done after patients come out of hospital before the patients have been admitted. That is where some authorities go wrong.

Joint agency panels allocate residential places for those who can no longer stay at home. The overall approach is to ensure that as many of my constituents as possible are given the right health and social care support, when they need it. The key is joint working and partnership throughout the caring organisations, and commitment to securing the best for local people. There is also a joint equipment store, and occupational

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therapists—of whom we have heard much today—employed by the NHS can assess and order equipment without the need for social services to agree to the ordering of each item, which means that delays are minimal. The provision in the Bill on liability for delayed discharge payments will certainly concentrate the minds of those who have not already started working together to reduce delays significantly.

For authorities such as Doncaster that have put considerable effort and resources into reducing delays, targets must not be seen to be unfair, and should take into account work already done. It would be perverse to set targets that are too high for those that have already started to act, while allowing those that have done nothing to benefit.

According to the House of Commons Library, the rate of delayed discharge in England as a whole is about 9.5 per cent. The rate in Northern and Yorkshire region is 6.5 per cent. Doncaster's average is only about 2.4 per cent. The worst rate this year peaked at 4 per cent. in September, probably owing to the actions of local private care homes, and fell to 1.9 per cent. in October.

All this demonstrates that where there is a will there is a way. Reducing delays have meant commitment across all services at the highest level, and proactive joint working has resulted in better outcomes for older people.

I do not agree with the British Medical Association and some Members that the plans for charging will seriously damage relations between the NHS and local authorities. Where we have the type of joint working that I have described, there should be no need for the charges. Of course, if some turn their faces against it, the BMA and Members may well have a point.

There are other ways of helping to reduce delayed discharge. In a recent report on the subject, the Health Committee rightly observed that telecare and telehealth systems had an increasing role to play in a modern health service, enabling people to stay in their own homes for longer. Tunstall, a locally based company seems to be at the cutting edge. For many years it has been providing telecare systems for a number of local authorities, giving a cover for 1.5 million older people throughout the country. Not only do such systems help older people to remain independent, but safe and secure in their own homes; the company is moving ahead, pioneering technology that can help to prevent hospital admission in the first place by monitoring vulnerable people at home. Following discharge the systems can monitor patients while they are at home, where they want to be. Blood pressure, blood oxygen levels, electrocardiograms, temperature and breathing rates can be monitored from centres, or even by a nurse on duty in the hospital ward. The benefits are obvious, and local authorities must start considering them.

The Bill's overriding intention is to get people out of hospital when they do not need to be there. It may well be, as the Select Committee said, a blunt instrument, but it tackles a problem that needs to be sorted out. Perhaps some need a blunt instrument to concentrate their minds—none more than the professional whingers Members have mentioned today.

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The victims of this situation are older people, who deserve better than being stuck—trapped—in hospital unnecessarily. The victims are also those in pain who wait for a hospital bed that is blocked because no one thought about after-care before they were admitted or while they were having treatment. The Bill should put an end to local empire protection and professional elitism, and finally kill the syndrome in which everyone thinks someone else is dealing with a problem when in fact no one is doing a thing. I look forward to joining my right hon. and hon. Friends in the Lobby to support the Bill.

Several hon. Members rose—

Madam Deputy Speaker: Order. Before I call the next speaker, I should explain that spokesmen for the second largest Opposition party are exempted from the time limit.

5.9 pm

Mr. Nigel Waterson (Eastbourne): You will doubtless forgive me, Madam Deputy Speaker, for not being drawn into any further comment on your ruling, which I know to be the case.

It is a pleasure, as always, to follow the hon. Member for Doncaster, North (Mr. Hughes). I hope that, at the end of my speech, he will let me know whether he considers me one of the Xprofessional whingers" to whom he referred at some length.

Mr. Kevin Hughes: It sounds as if the hon. Gentleman is one already.

Mr. Waterson: Well, there you go.

We all know when there is an intractable problem, because names and definitions keep changing. The phrase Xbed blocking" used to be used, but I am told that that is no longer very politically correct. Then Xbed blocking" became Xdelayed discharges," and now it is rather grandly called, Xdelayed transfers of care." Whatever it is called, it affects about 5,000 patients every day of each week of the year.

In my own constituency, as in many other parts of the country, there used to be great concern about so-called winter pressures and the associated problems. However, one of this Government's achievements—if that is the right word—is the creation of an all-year-round problem, at least in Eastbourne. They have created not only a list to get into my local hospital, but a list to get out, which reached an absolute peak of 149 blocked beds in June this year. So concerned am I about the issue that I have sought regular updates on that figure for a year or more. Although it has tended to fluctuate, until recently it has tended to fluctuate upwards.

What have this Government done? Typically, they have panicked, tabling a measure that will introduce the law of unintended consequences in spades. The proposal does not have a friend in the world, apart from the hon. Member for Doncaster, North, who seems to think that everybody else in the world is wrong and he is right. It would be difficult to point to any group, body or organisation involved in the consultation that considered the proposals a good idea—nor am I sure that the Swedes would accept fatherhood. Apart from the hon. Gentleman, nobody thinks it the right thing to

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do, and nobody thinks that it will work. We have heard from Labour Back-Bench Members, and we have heard other excellent contributions from Conservative Members. Basically, the Government are introducing a bed tax to get themselves out of this problem.

I turn to the likely effect in my own area of East Sussex, and in Eastbourne in particular. The irony is that the Government are introducing the proposals in a great rush at precisely the moment when places such as Eastbourne are beginning to see the fruits of a working partnership between the health service and social services authorities. In recent times, since Conservatives took control of the county council, there have been some major steps forward in social services. Conservatives took over a waiting list of 800 people who were assessed for social services care, but who under the previous regime were not getting it. That waiting list has gone—all those people have been dealt with.

The county council, in partnership with East Sussex Hospitals NHS trust, has actually over-achieved its bed-blocking targets. As the trust said to me in a letter of only yesterday:

The letter continues:

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