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28 Nov 2002 : Column 547—continued
5.28 pm
Mrs. Patsy Calton (Cheadle): I do not believe that there is anyone in the House who does not think that elderly people should get the best possible care and a streamlined service so that they are not kept in inappropriate conditions. The issue is whether the Bill will help to achieve that. I am surprised that it has been introduced at all. On 2 July, the Minister and I served on a Standing Committee distributing grants to social services departments across the country, in order to allow them to implement measures to reduce bed blocking or delayed discharge. On the face of it, three-star local authorities were being given rather more leeway and were allowed to spend the money as they liked. Authorities with one, two or no stars had to provide detailed proposals and to spend the money on reducing delayed discharge caused by bed blocking.
As I said at the time, the problem is that one-star local authorities sometimes have very good delayed discharged figures. In Stockport, where I used to be chair of social services, the health authority and social services did excellent work to prevent bed blocking. A parliamentary answer to question 43988 made it clear that Stockport's delayed discharge figure was already good.
Stockport is a one-star authority with a good record in that area. I noted that the Kensington, Chelsea and Westminster health authority—which covers the three-star boroughs of Kensington and Chelsea, and Westminster—had a 9.8 per cent. delayed discharge rate in the same period. That is five and a half times the Stockport rate. I asked at the time how authorities with other problems could spend on anything that they liked apart from delayed discharge work, whereas the place that had prioritised the issue that the Government claim to want to support was made to go through the hoops.
I suspected that there were other anomalies to be found, but the Minister at the time did not answer the question. Less than five months ago, it was all right to allow social services departments with three stars to spend the money as they wished, even though their delayed discharge figures were comparatively high, but now the Secretary of State has apparently changed his mind. How come? Have not the extra grant payments worked? Does the Minister know? Has there been any monitoring? Why has the Secretary of State changed his mind since July?
The Secretary of State said that the needs of the older person always came first. They did not appear to do so in July. The Bill has aroused almost universal condemnation. It uses coercion just when local authorities and health authorities are beginning to adopt best practice. It is likely to worsen and not improve the situation for patients.
Various hon. Members have mentioned Age Concern's worries. The right hon. Member for North-West Hampshire (Sir George Young) quoted that organisation's view that the proposals were Xill conceived and impractical". Age Concern says that the Bill makes no reference to older people's rights, and it is especially worried about matters to do with consent and advocacy. It has stated that the proposals
- Xdo not treat older people as active participants in the provision of caring services, because they take no account (and indeed make no mention) of the rights of older people—for example, the Bill does not mention the need for consent of the patient at all stages of the process of discharge, or of the appeal rights of patients in relation to disputes between the NHS and the local authority."
- XConcentrating on delayed discharge and imposing penalties for this one aspect will not nurture the joint working (between health and social care providers) that is happening at the moment, and could lead to premature discharge and inappropriate placement decisions."
The Royal College of Nursing's observations have been mentioned by various hon. Members. The RCN made it clear that it was keen to support efforts to improve discharge planning, but that
- Xa system that penalises one part of the care sector could threaten or diminish partnership working."
Mention has also been made of Carers UK, which is concerned that core discharge procedures are likely to get worse. It stated that
- Xfrom 1999 to 2001, readmissions of the patient within two months of being discharged nearly doubled from 19 per cent. to 43 per cent."
- Xthe proportion of carers who felt early discharge was at fault rose correspondingly from 23 per cent. in 1999 to 45 per cent."
- X77 per cent. of carers said that they were not given a choice about taking on caring responsibilities."
- Xthe proportion of carers being consulted fell from 1998 to 2001 so that nearly four out of 10 carers were not consulted."
- Xthe proportion of carers who said their views and ideas were not taken into account rose from 36 per cent. in 1998 to 45 per cent. in 2001—nearly half of all carers providing substantial care . . . Only half of the carers were told about the sorts of care that would be needed upon discharge . . . 43 per cent. of carers said they were not given sufficient help on return home."
Mrs. Calton: Wait for it, I have a minute left. The NHS Confederation has also made it clear that positive incentives have an important role to play. It believes that fining could undermine existing local partnerships. It is also worried about administrative costs. Where is the money going to go? How will it be redistributed?
As many hon. Members have said, the start date of April 2003 is too early. The Government are going to wait until 2003 to find out the results achieved by the money that has been spent this year. They should wait at least until then, and then give notice of how they intend to act.
5.38 pm
Ms Joan Walley (Stoke-on-Trent, North): A great deal has been said already and I shall not go over it, save to note that the concern in my constituency about how we deal with community care and ensure that the resources are there when they are needed has not changed in the 15 years for which I have been a Member of this House.
One thing that has changed is that the underfunding that may exist now is nowhere near as great as in the years of the previous Conservative Government. However, we must make sure that the legislative time available to the House—and the additional funding made available by my right hon. Friend the Chancellor of the Exchequer—is used to the best effect. We must make sure that the provision is there when constituents need it.
In that respect, I question whether so much time and energy should be devoted to the Bill just now. I accept that sometimes one needs to wield a bit of a stick to make people do what is needed, but the carrot-and-stick approach is also needed.
Is my hon. Friend the Minister satisfied that the extra money that is provided for care in the community is enough? I would be a lot happier debating the Bill if we knew what the local government settlement would be and what extra money would be given to Staffordshire and Stoke-on-Trent social services. I accept that we have had an additional 6 per cent., which we would never have had under the Conservative Government, but we need to ensure that we are getting the extra money that will allow our social services to do what we expect them to do.
Dr. Murrison: Will the hon. Lady give way?
Ms Walley: I am sorry, I do not have time.
On bed blocking, as of this week, there are 48 people on delayed discharge in the North Staffordshire royal infirmary. If those people were not in those beds, that acute hospital would have beds for people who are desperate to get the NHS service that they need. So I have no doubt that the Government are right in making sure that we do not spend money on highly specialised services in our acute hospitals for people who no longer need that expert specialist medical treatment. We must put all our energies into finding a solution to get those people back from hospital into their home and the community, back into intermediate care or even into the long-stay beds provided by the Combined Healthcare NHS Trust, which, itself, has patients who cannot be discharged because of the lack of appropriate community facilities.
A constituent of mine has written to me consistently over 15 years imploring me to make sure that the Government do what is needed regarding dementia services. I have spent a great deal of time making the case to Staffordshire county council that it should give money or land to Claybourne, a specialist place for people with dementia, which is run admirably by Methodist Homes for the Aged. It is of great concern to me that hardly any of my constituents can be placed in Claybourne now that the land has been acquired and this wonderful facility has been built, open and even extended. Not as many as my constituents who should go there can go because the local social services cannot afford the cost of moving them. That means that although people in other parts of the country where social services have additional money can go to Claybourne, my constituents cannot. That is a source of genuine concern.
Let us by all means have a Bill that will penalise local authorities that do not comply with the standard required, but let us make sure that there are minimum standards of service. Wheelchairs should be provided to the community where they are needed. Let us make sure that we have occupational therapists. Let us make sure that people are not being kept in hospital for want of £20 for a handrail. I accept that we have to ensure that social services should be fulfilling those functions but in reality that is still not happening. I would rather look at ways of postponing the Bill until such time as we can do a proper audit and be certain that what should be happening is indeed happening.
We hear a lot about the need for modernisation, and I embrace that. The Edwards report on north Staffordshire has led to the award of extra money to oversee extra resources for care in the community and to deal with the need to transfer that funding from its traditional target of long-stay beds to care in the community. However, the implementation of the Edwards report is still not subject to full accountability. Until we have that, I feel that we cannot simply depend on a piece of legislation that will penalise and fine. If my hon. Friend can give me an assurance that the Bill will not only impose such disciplines, but ensure that the local social services are properly funded, able to respond to changes and accountable, perhaps we can look forward to making sure that our elderly people are not left at the mercy of a system in which they are sent from pillar to post and do not get the services that they need.
5.45 pm
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