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28 Nov 2002 : Column 559—continued
Mr. Dawson: I do not disagree entirely with my hon. Friend, but structural change is not the whole answer. Wherever there is a structure, there is a boundary, and other functions would be left out of a joint health and social care body. Surely it is our systems and values that are important. We must aim for the ultimate principle, which is to wrap services around the people.
Andy Burnham: My hon. Friend is right. People are the most important consideration. They do not mind whether the health department or the social services department provides their care. They do not care about the divides, which we have to break down. I favour a move to single pooled budgets. Having said that, the proposed system is the fall-back option. If people do not go down the collaborative route, another system has to be in place that will work for patients. It might be one or the other, but I hope that the Government will not rule out the good examples of joint working.
I echo what the hon. Member for Sutton and Cheam (Mr. Burstow) said about the readiness of the system to cope with the proposed changes. My local authority is a member of the special interest group of municipal authorities. We vehemently argue that we have been underfunded for years, especially in social services. One symptom of that is a severe lack of occupational therapists, which other hon. Members have mentioned. The health service and the local authority in Wigan employs occupational therapists, but the health service often takes them from the local authority, which struggles to keep them. I gather that there is a national shortage of occupational therapists and that there are 5,000 training places every year. The Government have to consider that problem if we are to achieve the ideal of getting people back home as quickly as possible.
The system is not able to adapt homes quickly enough. There is a 10 to 13 month wait in Wigan for an assessment for a stair lift. There are many former miners and people who suffer from industrial disease in my constituency. That is a hell of a wait for a home to be made adequate. That person could easily pitch up at hospital again before the changes are made.
Finally, will the Government consider the range of services and appropriate accommodation available in the community? Like my hon. Friend the Member for Wakefield, I believe that the choices available to people are not good enough, and my great hope is that the Bill will diminish the reliance on institutional care, in both residential and nursing settings. For people who are stuck in hospital for too long and who become institutionalised, hospital care becomes a pathway to residential care when, if they had been expedited through the system, that option may not have been the most suitable.
I should like to echo a point made by my hon. Friend the Member for Doncaster, North: why cannot we use social services resources to put better equipment in people's homes? When the Select Committee visited West Yorkshire, we saw people doing self-testing at home and sending their results to remote centres to identify any emerging health problems that may require
hospital admission. We should consider how we can concentrate resources on the point of entry to the system, rather than always thinking about how to cope with people when they need care. We should concentrate on getting to the point at which people do not need care, or, if they do, on ensuring that it is much later in life. If this system can keep people out of hospital in the first place, it can only be welcomed.6.21 pm
Mr. David Amess (Southend, West): I wholeheartedly agree with the speeches made by my right hon. Friend the Member for North-West Hampshire (Sir G. Young), my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and, yes, the hon. Member for Wakefield (Mr. Hinchliffe).
Thank goodness I do not have to stand up and make fawning speeches about the Government, so I can wholeheartedly say that this is a lousy Bill from an absolutely rotten Government. They should be ashamed that they are introducing it in the House. Some weeks ago, the Secretary of State gave evidence to the Health Committee, and I challenged him about consultants' contracts. I asked him whether he would take on the consultants and said that, if so, he must be mad. After a lot of waffle, which we also heard in his speech this afternoon, he said that he would not, and I judged him to be sane. I am now reconsidering.
These will be dark days for the Labour party and the Government. The economy is on the slide, and the Government will need all the friends that they can get. Having listened carefully to all the speeches today, I think that they are rapidly running out of friends among Back Benchers. The Bill is the ultimate case of buck passing, and, as we have heard, no one is in favour of it. There is a long list of people who have condemned the Bill.
What Member would say that it is terrific to have people stuck in hospital beds when they should be returned to their own home or admitted to a residential home? Of course Members of Parliament think that it is shocking. Who wants to stay in a hospital and catch MRSA? Every Member wants to do something about bed blocking, but the Government do not seem to understand that this ridiculous Bill, which they are trying to persuade the House to accept, will not solve the problem. In fact, it will make it much worse.
In part 2, the Secretary of State has had the cheek to take powers to allow him to remove, in circumstances set out in regulations, the power of local authorities to charge for certain community care services. That will do huge damage to local authority budgets, and authorities throughout the country are already struggling to meet the demands on them.
The Government should have listened to the Health Committee. We all know that, sadly, the House is not quite the force that it used to be, but Select Committees certainly provide a good means of challenging the Executive. Members of the Health Committee worked hard to prepare the report. We made 37 recommendations, and went to America and Canada. If the Government had listened to our recommendations, they would not be in a mess. For instance, we said:
- XThere are real risks that perverse incentives will be created that will undermine partnerships that have taken time to develop and foster an unproductive culture of buck-passing and mutual blame
- between health and social care. We agree that appropriate incentives have a role to play, but we would also urge the development of positive incentives that reward good practice, rather than any precipitate and over-zealous emphasis on penalties."
- XWe are concerned that the focus on tackling delayed discharges, entirely laudable in itself, could lead to an intensification of pressures to discharge patients too quickly, with inadequate preparation, and in situations that could intensify the demands on their carers. This has the potential to trigger a rise in readmission rates. Premature discharge leading to readmission is clearly stressful and in many cases harmful for the patient, and is also wasteful of resources. High levels of unplanned admission are likely to be a marker for poor practice."
In my constituency, there is a huge number of elderly people. If you want to live longer, come to Southend, West. In February, a local resident will celebrate her 109th birthday. She lives in a bungalow on her own, and recently I had the privilege of having a cup of tea with her. She is truly remarkable, but many other people are admitted to hospital with no relatives or loved ones to support them. It is thus not just a question of dereliction of duty by social services.
Will the Government look at the Warm Homes and Energy Conservation Act 2000 that I had the privilege of steering through the House? That measure would deal with bed blocking, as it tackles the important issue of fuel poverty. All hon. Members know that this winter a huge number of elderly people will be readmitted to hospital. Cold, damp homes are associated with premature mortality, physical and mental illness and impaired quality of life. They aggravate a wide range of medical conditions, increase suffering and make it harder to care for vulnerable people at home, thus adding to the burdens on the NHS. Those burdens are seen, as I have said, in growing waiting lists for admissions and bed blocking. No doubt, there will be another crisis this winter. National Energy Action believes that the Government should look carefully at recommendations that winter taskforces in primary care trusts should produce a local plan to deal with that problem, thus increasing awareness of the links between housing and health, identifying households at risk, and making referrals to fuel poverty programmes and good-quality energy advice.
Next week, members of the Health Committee will visit Sweden and the Netherlands. Although we are looking at sexual health, I have decided that I shall make it my business to find out how the Swedish model is working. According to one director of social services, the introduction of a programme of penalties in Sweden resulted in a two-year build-up, after which time all the accommodation was made available. It is crazy and disastrous that residential and nursing homes throughout the country are closing because of the onerous duties placed upon them by the Care Standards Act 2000.
This is a rotten Bill and I plead with the Government at the eleventh hour to drop it.
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