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28 Nov 2002 : Column 555—continued

6.3 pm

Dr. Richard Taylor (Wyre Forest): I start from the same premise as most hon. Members who have spoken this afternoon: the Government are trying to tackle the problem of delayed discharges, which is exactly the right problem to tackle when we consider not only the financial implications but the quality of life of those elderly people towards the end of their days who are losing a few of their precious days in hospital. However, I am delighted to follow the right hon. Member for North-West Hampshire (Sir George Young) and the hon. Member for Wakefield (Mr. Hinchliffe), who did not mince their words. It gives me a great deal of pleasure also not to mince my words: this is the wrong Bill doing the wrong thing at the wrong time, and one cannot get away from that.

The regulatory impact assessment, which all hon. Members have probably seen, states that there are really only two options: do nothing, or introduce a

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reimbursement scheme. The most obvious solution of all—looking at the whole system—has been missed, but the Health Committee has done the work on that. I should like to make four points. I think that they all come from the Health Committee report; I do not think that I have included any of my own.

The first and most important point is to avoid inappropriate admissions. The latest figures show that about one in seven patients do not need to be admitted to hospital, and there are already ways to avoid that. Many places have multi-agency response teams—MARS teams—that GPs can call out to patients' homes to work out alternative methods of coping with them other than sending them to hospital.

One of my daughters is a nurse-consultant in intermediate care. Her job is to go into the casualty department and medical assessment unit of a very large hospital to sort out patients' care at home, if possible.

I must, of course, refer to hospital reconfigurations. I am delighted to hear that a Government paper is coming out, recognising that reconfigurations that take assessment centres away from the local population have to be reconsidered.

The second crucial point from the Health Committee report is that a named person should be responsible for co-ordination of all stages of the patient's journey right from the moment of admission—before then in the case of elective admissions—and up to and beyond discharge. My PCT has a discharge co-ordinator who goes round all the hospitals that the trust uses. In addition to such co-ordinators, named people who are responsible for each patient would make a huge difference.

The third point, which has been made already, is that it is absolutely crucial to consult patients and carers. They must be involved, not just as an afterthought, but right at the beginning. If discharge planning starts early, a logical conclusion can be reached. Is step-down care needed? If so, is it available? Can the patient get home? Are adaptations and other aids needed? Such planning has to start at the beginning.

In their response to the Health Committee report, the Government agreed with most of those points, but then seemed to put them all on the back burner. They said several times that they would introduce the system of reimbursement, but, as I have said, that focuses entirely on the wrong end of the process.

I congratulate the Government on revising the hospital discharge workbook, and I hope that the new one will come very soon and that it will produce a radical overhaul of the whole process of hospital discharge. I welcome the change agent team and the Modernisation Agency. A lot of good things are going on, but this approach is completely wrong.

In his introductory remarks, the Secretary of State said that partnerships were the key, and several speakers have said exactly the same. I cannot see how the Government can argue that the proposal improves partnerships. It sets one side of the equation against the other. One can blame the other, and thus avoid paying. The Secretary of State says that £100 million can go from the NHS back to social services to make up for the fine, which proves to me that he has suddenly realised that the proposal is mad.

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I will conclude my remarks, as I know that many other Members wish to speak. The Bill is wrong and should be thrown out. Like the right hon. Member for North-West Hampshire (Sir George Young), I have been counting speeches, and I think that the score is about 12-3. I wish that the Bill, which should be in the interest of patients throughout the country but not in the interest of political parties, could have been subjected to a free vote or decided on the number of speeches rather than a whipped vote, which, I fear, will automatically see it through.

6.10 pm

Andy Burnham (Leigh): It is a pleasure to follow the hon. Member for Wyre Forest (Dr. Taylor). I do not know whether the right hon. Member for North-West Hampshire (Sir George Young) is still keeping score, but I can tell both Members that I am about to pull a goal back. My speech will not be without observations of my own, having worked on the Health Committee report and taken a great interest in it.

The speech of the hon. Member for Woodspring (Dr. Fox) was high on conjecture and hypothetical situations but, other than what seems to be the Conservatives' policy of pumping money into care homes, contained no solutions to the issue of delayed discharges or bridging the divide between health and social services. If keeping care home places open is their overriding priority, they are sadly mistaken. That is no policy.

Conservative Front Benchers are not alone in not having answers on this subject. I worked briefly in the NHS, and I lost track of the number of seminars and workshops that I attended on bridging the divide between health and social services. Many good ideas and examples of good practice were discussed, but good practice only produces incremental change. There are huge problems in this area, however, which the system has failed to put right. My hon. Friend the Member for Doncaster, North (Mr. Hughes) referred to the need to concentrate minds, which is absolutely right. The system is not currently working for patients and families. I do not have all the answers, but the system needs to be made to work better and more quickly for those people than it does at present.

Opposition Members seem to be defending the current system. They seem to be saying that everything is fine as it is, but it is not good enough. We need to address that. Attacking these proposals should not be used as an excuse for saying that nothing should be done. The right hon. Member for North-West Hampshire referred to stress and tense situations in hospital, which are hallmarks of the current system. That is doing no good to patients or families.

In all the discussion about structures and processes, it is easy to lose sight of some of the purposes of the Bill. There are probably two clear objectives. One is to give elderly people in particular more appropriate treatment when they need it, to get them through the system and to get them back home, which is the important point. The second is to free up hospital beds so that more patients can be treated across the NHS. That problem has

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bedevilled the NHS, and we must get better at bearing down on blocked bed days, as they are called. Five thousand beds are currently blocked at any one time.

Laura Moffatt (Crawley): Is my hon. Friend aware that, despite all the good practice and all the hard work of many social services and acute trusts, when my acute trust began this work a year ago we had 70 delayed transfers of care and that this week we have 70 delayed transfers of care?

Andy Burnham: My hon. Friend is absolutely right. When minds are focused on this problem, and people start to bear down on the bureaucratic process that exists, it is amazing how the system can be made to work better. We should all bear that in mind.

As I said, the report found that there are 5,000 blocked bed days at any one time. It is important for hon. Members to consider the evidence that the Department gave as to why those beds are currently blocked: 22.2 per cent. are awaiting an assessment of care needs; 21.9 per cent. are awaiting a funding package to be agreed; 20.4 per cent. are awaiting a care home placement; 11.5 per cent. are awaiting further NHS care; and 6.7 per cent. are awaiting a domiciliary package of adaptations and equipment. Nobody can tell me, based on those figures, that there are not areas in which we can start to reduce delays in the system. Why are 22.2 per cent. waiting for an assessment of care needs? There must be things that can be done to bear down on that.

The report also mentioned our visit to the United States, to which, I think, my hon. Member for Wakefield (Mr. Hinchliffe) referred. On the United States system, the report clearly states:

of financial incentives

We visited a health maintenance organisation called Tufts Health Plan, which told us something extraordinary. The day its patients go into hospital for a planned admission, the builders move into their homes to adapt them so that they can leave hospital as soon as their care is complete. None of our constituents would recognise that experience. It is an example of good planning. There is no reason why it could not be done here, but our system does not place pressure on people to make them think that they have to do that good planning and deliver better services.

There are two reasons why the United States system works. The first is that the financial incentives are part of the process. They move people through the system and out of hospital quickly. The Bill tries to replicate part of that in our system. The second reason is that there is one budget and therefore only one person deciding how to get someone home as quickly as possible. On that matter, I bow to the experience of my hon. Friend the Member for Wakefield. In some ways, I am under his spell on the Committee. The Government should give careful consideration to a single budget as a way of getting people through the system more quickly. That is the ideal. It cuts away the possibility of squabbles about who is responsible or where the fault lies. We are more likely to get people through the system quickly with one budget and one objective than with a system of financial incentives or penalties.

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It will be a shame if the Bill halts the move towards single budgets in health and social services departments. I do not want that to happen.

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