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28 Nov 2002 : Column 543—continued
Mr. Waterson: The hon. Gentleman says, XSay thank you," but no thanks are due to this legislation, which will actually set the two organisations at each other's throats instead of enabling them to continue to work in close partnership.
We have already heard how the number of delayed discharges, although still too high, has fallen as a result of partnership working. Mr. David Archibald, the director of social services, wrote to me saying that
- Xthe level of cross-charging could be as high as £2.5m."
- Xwould have to come from existing budgets to older people. This sum equates to 240 residential or nursing placements, or 800 home care packages."
We in East Sussex are told that the 6 per cent. increase over the next three years will be guaranteed, but that leaves aside the massive impact of the Government's proposal—already touched on by my right hon. Friend the Member for North-West Hampshire (Sir George Young)—to change the basis of local authority funding. In East Sussex, that could mean £44 million being taken straight out of the county council's budget in a worst-case scenario. Such a cut equates to the scrapping of nearly 2,500 elderly people's care. All this talk of a 6 per cent. increase is complete hokum, because of the massive effect—it is the financial equivalent of falling off a cliff—of such a cut in funding for authorities in the south-east such as mine.
There is also the question of the supply of suitable beds. For eight years, our county council was run—if that is not too ambitious a word—by the Liberal Democrats. Year after year, they paid the lowest rates per week to the private sector. No wonder so many homes have closed. As we have heard, some 66,000 care places nationally have gone since this Government came to power. To make matters worse, they insisted on keeping open wholly inadequate, county council run facilities that cost a great deal more than those in the private sector. My hon. Friend the Member for West Chelmsford (Mr. Burns) will remember responding to such debates when he was a Minister responsible for these issues. We have witnessed a run-down in basic provision. Where are these places to come from?
There is another, fundamental issue—the question of choice—that the Minister needs to deal with in her winding-up speech. Age Concern is extremely worried about this issue. It has drawn attention to standard 2 of the national service framework for older people, which states:
- XNHS and social care services [should] treat older people as individuals and enable them to make choices about their own care."
As Age Concern said in its letter to me, the Bill's penalties and provisions
- Xtake no account (and indeed make no mention) of the rights of older people".
In another letter, the director of social services said that, of the current cases, 59 per cent.
- Xresulted from difficulty in making nursing and residential placements due to capacity issues in the market place."
5.19 pm
Dr. Howard Stoate (Dartford): I welcome this debate and the Government's determination to tackle what is, after all, a very difficult problem. On any given day, 5,000 people are awaiting discharge that has been delayed for one reason or another—a problem which is
having a significant detrimental effect on acute sector NHS care, and which, like road congestion, has finally reached the point at which something must be done.Why are we in this situation, and what can be done about it? I have been in the health service for a long time. When I started out as a junior houseman, we worked in big Victorian hospitals with huge numbers of beds. Patients would be admitted through casualty, moved to a medical ward and then, if they were old enough, transferred to a geriatric ward or, if they showed any signs of mental instability, to a psychogeriatric ward, where they remained until the grim reaper decided that it was time to come and remove them, long after everyone else had forgotten where they were.
That unsatisfactory situation carried on for a long time. Now we have changed the regime completely, with modern hospitals providing high-tech treatment, and therefore much shorter stays. That works well, but it means a significant increase in throughput, with people who have received their high-tech care being quickly transferred elsewhere. It also means that many patients are discharged from hospital at an earlier stage of recovery, so it is essential that the facilities are there in the community or in their home for care to continue outside the hospital.
There is also now a much greater determination among patients to remain in their own homes as long as possible and to be transferred home after treatment as quickly as possible. Fortunately, there are now better facilities in the community to allow that to happen. When I was a junior doctor, it was difficult to set up care packages in people's homes.
The situation is strained in Dartford. According to a paper that I received just this morning from the Dartford and Gravesham NHS trust, there are currently 47 patients awaiting transfer, which constitutes about 12 per cent. of the hospital capacity, which is only just over 400. The trust says that there are enough care beds in the locality to deal with the local population, but because of the proximity of London a third of the beds are taken by patients from London whose authorities have much higher funding levels available for such care.
Recent changes in the inspection of care homes mean that older people with mental health problems are becoming more difficult to place. The ability of some patients to fund their care independently—they take up about a third of the available stock—also puts pressures on the beds available to social services. Six of the 14 nursing homes in the area are BUPA homes and charge more than the social service contract price, so top-ups are needed.
Patients with mental health care needs constitute a particular problem. Of the 47 patients awaiting transfer of care, 40 per cent. are waiting for EMI—elderly mentally infirm—places, which also puts great strain on the system.
Mr. Gale: As a Kent Member, I agree with much of what the hon. Gentleman is saying. He rightly highlighted the fact that inner-London boroughs are buying beds in Kent and blocking beds that are needed
by Kent social services to move people out of Kent hospitals. Will he ask the Minister to tell us how the Bill will even begin to address that problem?
Dr. Stoate: I thank the hon. Gentleman, but that is not quite the problem that I was talking about. I will come to that shortly when I refer to a constituency case.
The paper I received this morning points out that there are alternatives to nursing home care, and I am pleased to see that the acute trust is using much more sheltered accommodation with joint social services and health care team support. A community dementia team has been set up to allow people to receive care in their own homes, and that is certainly easing some of the pressure. The trust is working very hard indeed to make such alternatives available.
I want to talk about a constituent who was seen this morning by two of my constituency workers. He is quite a difficult case and his story highlights some of the problems. He has a rapidly evolving dementia and severe Parkinson's. I have a letter from his GP saying that he needs an EMI bed, but social services has said that it will not pay for EMI care but will pay only for nursing care and has put pressure on the GP to redesignate him accordingly. The GP has written to me in outrage, which is why I undertook to raise the case in the House.
Social services is prepared to pay £450 a week for my constituent's care, but not the £560 required for an EMI home—there is a place available—so he has now been languishing for many months in a bed in a community care NHS unit, quite inappropriately, as he does not want to be there, his family do not want him there and the NHS clearly does not want him there. For want of a top-up of £110 a week, he is occupying a bed in an NHS facility where his condition cannot be properly treated. As his condition deteriorates and his mental health care needs become ever greater, it is increasingly obvious to those caring for him that there is a problem.
The Bill will at least make discussions of such cases more realistic. They will take place more frequently, and we can hope for more appropriate care packages for different types of patients. However, if we introduce the reimbursement scheme by April 2003, it could cause problems and create pressure. What does the Minister think about that? Despite recent funding increases—£300 million earmarked for partnership in care last year—social services departments are still having problems with the effects of historical underfunding, so we need a period of pump priming to ensure that the capacity is in place before they face penalties. That will give them time to identify the services that they need to provide. For the proposals to work properly, we must have sufficient nursing home care beds, community facilities and home care packages in place.
We should not forget that early discharge is also a problem. If we ensure that hospitals are not put under pressure to send patients home or on to other facilities before they are fully ready, we will reduce the risk of the merry-go-round of patients being readmitted. We must ensure that step-down facilities are in place. I am pleased that a facility will be completed in Dartford and Gravesham by 2004 providing 60 step-down intermediate community beds, which will take enormous pressure off the social services and health departments. I would like to see such projects rolled out across the country.
We need a clear incentive for health care and social care services to work together to unblock delayed discharges, which are causing great misery for many of our constituents. At least the Government's proposals will get things moving, but they must recognise that procedures must be in place to allow the situation to improve before draconian penalties are imposed on already overstretched services.
The proposals will contribute greatly to improvements in care, provided that they are implemented in a way that allows social services to build up capacity in a measured way to unblock the problem.
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