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28 Nov 2002 : Column 566—continued

The Minister of State, Department of Health (Jacqui Smith): We have had a good debate today. I certainly welcome the constructive suggestions made by some hon. Members about what more we can do to ensure that our older people get the right care at the right time and in the right place. Unfortunately, however, I cannot say the same about the contributions from the Opposition Front Bench. The hon. Members for Woodspring (Dr. Fox) and for West Chelmsford (Mr. Burns) failed noticeably to focus on the needs of older people, had no practical suggestions for improvement, and seemed to see their sole role as the champions of local government. I have to say that that is a bit rich, coming from the people who brought us the poll tax, rate-capping and a stream of central controls on local councils, but who now feign to believe in freedoms for local government.

Let us return to the real issue in the Bill. The existing system means that 5,000 people are currently stuck in hospital when they would be better served outside. This Government's investments in community alternatives and better working between social services and health have made all the difference. The hon. Member for Southend, West (Mr. Amess), in a strident contribution, said that all hon. Members wanted to tackle delayed discharge, but when his party left government, delayed discharges stood at around 6,985. By September 2002, that figure had been reduced by more than one third. That is because social services have been able to build up alternatives to hospital, more care homes have been commissioned, and there are higher fees, more home care provision, and more community equipment.

The way that we have achieved this, through ring-fenced funding and top-down central monitoring, is not sustainable. Extra money has gone to areas in which the problem is worst, rewarding failure with extra resources. As my hon. Friend the Member for Doncaster, North (Mr. Hughes) rightly said, we now need a system that rewards success. Throughout the NHS, we will build systems to ensure that money flows through ward activity to ensure faster, better-quality care. The Bill will enable us to do that across the health and social services divide.

I was a little disappointed by the suggestion that no one supported the Bill, and a bit surprised at the approach of the hon. Members for Westbury (Dr. Murrison) and for Wyre Forest (Dr. Taylor). The hon. Member for Westbury actually introduced a ten-minute Bill earlier this year which he said would facilitate a model based on the Swedish approach to delayed discharge, which he termed a Xhugely successful innovation". I do not know whether it is because he has ambitions that he has subsequently changed his mind, but it is very disappointing none the less.

My hon. Friends the Members for Hampstead and Highgate (Glenda Jackson) and for Blackpool, North and Fleetwood (Mrs. Humble) and the right hon. Member for North-West Hampshire (Sir George Young) expressed concerns about responsibility in relation to delayed discharge. There are two elements to

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this question. First, I want to reassure hon. Members that the Bill states clearly, in clause 4(4)(b), that a charge would be due only if

that is the assessment—

[Interruption.] For those hon. Members who clearly have not read the Bill, let me explain what that means. It means that if someone is a self-funder, or is waiting for an element of NHS care, and that is the reason for the discharge being delayed, the social services department will not be charged. That is fair and reasonable.

The second element, however, is that several people—and, I am afraid, some local authorities—are trying to argue themselves out of responsibilities that rightly lie with social services departments, such as assessing needs and commissioning or providing adequate alternatives. My hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) rightly challenged the hon. Member for Woodspring on whether his argument is that local authorities should not meet their responsibilities. That is what it appeared to be. The Bill will not impose extra responsibilities on local government, but we expect local government to shoulder those responsibilities for vulnerable older people that it already has.

Unlike the Conservatives, we have recognised our responsibility as a Government to fund the necessary developments. It has been claimed throughout the debate that there is not enough capacity in the care home sector for the Bill to work. There are clearly capacity issues in parts of the country, which is why our spending review made available resources for an increase in care home places. However, as my right hon. Friend the Secretary of State told the House on 14 November,

That is not how the majority of people want to be cared for. Most want to be able to return to their own homes, which is why we are providing the funding for local authorities to increase capacity across services for older people.

Once again today, we heard calls for more money from Opposition Members, including the right hon. Member for North-West Hampshire, and the hon. Members for South Cambridgeshire (Mr. Lansley) and for Eastbourne (Mr. Waterson), whose authorities received from the building care capacity grant £7.5 million, £3.2 million and £3.8 million respectively. Of course, they refused to vote for all that money when they were given the opportunity.

The Bill will provide the incentive for local authorities to use that funding to produce a range of services—not only care home packages, but interim and intermediate care involving the provision outlined by my hon. Friend the Member for Dartford (Dr. Stoate), such as step-down facilities, extra sheltered housing, home adaptation services and different home care packages. Only through the provision of such a range of services will older people get the choices they deserve in relation to the care that they receive.

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The important point is that there is a difference between how authorities, including those that face the same pressures, handle their responsibilities. As my hon. Friend the Member for Doncaster, North pointed out, using the approach that I have outlined, a difference is being made to the lives of people in Doncaster, North. For example, Croydon—part of the south-east that also faces pressures—has made a significant difference in respect of delayed discharges. The Bill will ensure that local authorities take responsibility, with the additional resources, for making the differences that will allow older people to get out of hospital when they need to.

My hon. Friend the Member for Leigh (Andy Burnham) outlined the particular constraint around staff and occupational therapists in particular, so I am sure he is pleased that, under this Government, there has been a 36 per cent. increase in occupational therapists in training. He is right: part of the capacity constraint is to ensure that we have the work force in place.

Several Members, including my hon. Friend the Member for Wakefield (Mr. Hinchliffe), concentrated on choice, among other things. Some have argued that the Bill will lead to patients having less choice regarding the services that they receive on discharge and that they will be pressured by local authorities to accept the first available placement. I believe that the opposite is true: the proposals will put the patient firmly at the centre of care and they should increase the choice available to older people. As we know from our experience with the building capacity grant, those councils that have achieved progress on delayed discharge have invested the money innovatively and in a range of services.

The Bill will increase choice in other ways, such as that of staying at home rather than going into hospital in the first place. Preventing people from going into hospital when they could be better cared for with support in their own homes is a key way to reduce delays, and sensible councils will invest in services that enable older people to exercise that choice.

Some Members raised the direction on choice, which exists to enable people to exercise choice when selecting a care home. The direction on choice does not mean that a patient has a right to occupy an acute bed indefinitely when others may be in much greater need. Even if someone is waiting for a place in the home of his or her choice to become available, that person should not be subjected to an inappropriate delay in an acute bed if he or she no longer requires acute hospital care, not least because that is not good for older people themselves. Councils need to invest in services such as step-down and interim care, or to provide intensive home care services so that patients can move to a more homely environment in the meantime.

Some Members expressed concern about consent and advocacy. Let me reassure them that nothing in the Bill removes the current practice or law on consent and advocacy. Many areas have very good advocacy services, and are involved in discharge planning. There is no reason for that to change. In fact, the Government are ensuring that advocacy is available for patients throughout the health service.

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Concerns have also been expressed about care, but I think my right hon. Friend the Secretary of State dealt with them. Several Members mentioned damage to partnership. Of course good working relationships exist in many areas, but partnership must be judged on the basis of what it produces. There must be more to the outcomes of partnership than simply a good set of minutes. If partnership is delivering, it will be the way in which to avoid reimbursement charges; but partnership depends on clarity about roles and responsibilities.

Whatever the good intentions locally, the current system rewards buck-passing. An older person stuck in hospital is paid for by the hospital, even if that person is the responsibility of social services. We propose that the social services budget should pay for the older person's care when it becomes the responsibility of social services. Essentially, this will be a payment for looking after the patient.

The Bill will clarify the roles and responsibilities of the various agencies. It will assist partnership. Most important, it will prevent older people from being caught in the middle of disputes.

The Bill will ensure that the needs of the patient are put first, not the needs of the NHS or local government. Delayed discharges are bad for older people, worrying for their families and carers, frustrating for patients waiting for treatment and wasteful of taxpayers' money. Each older person trapped in hospital is an argument for change, and each is a demonstration that the current system is not working. As my right hon. Friend made clear, the mark of any civilised society is the way in which it treats its senior citizens. The mark of an effective health and social care system is that it ensures choice, access, independence and quality of care for our older people.

The national service framework for older people is bringing health and social services together, and raising standards of care for older people. In July, my right hon. Friend announced a £1 billion package leading to faster assessment, more places in care homes and sheltered housing, more intermediate care services, and more support for older people wanting to live at home and their carers. Today we have responded to local government concerns about capacity by announcing that, in addition to the increases in social services funding, from next April we will transfer money from the NHS to enable social services departments to fulfil their responsibilities. This is a whole-system commitment to tackling delayed discharges.

Not only has the extra funding been opposed by the Conservative party; today Conservative Members have also opposed the reforms to make it work. We know that the extra money we are providing for our health and social services brings with it a responsibility for us all—a responsibility to ensure that it makes a difference. The Bill ensures that services needed to promote independence will be provided free. It places new duties on the NHS to work with local authorities. It rewards social services departments that live up to their responsibilities. Most important, it puts the needs of vulnerable people, not organisations, at the centre of the system. I commend it to the House.

Question put, That the amendment be made:—

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The House divided: Ayes 136, Noes 238.

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