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15 Jan 2003 : Column 724continued
Mr. Simon Burns (West Chelmsford): I will speak to amendments Nos. 41A, 5, 3, 4 and 2, which deal with empowering patients and particularly carers. In many ways, as has been said, the amendments complement and add to the new clauses moved by the hon. Member for Sutton and Cheam (Mr. Burstow).
It is right to say from the outset that it is extraordinary that throughout what the Opposition regard as a nasty and counterproductive measure there are no references to carers and patients or any powers and entitlements granted to them. Yet it is patients who are at the receiving end of the Bill, as are the carers, who are, as no one in the House would disagree, the unsung heroes of our society because of the tremendous work that they do in looking after loved ones and family members.
Mr. Hilton Dawson (Lancaster and Wyre): Does the hon. Gentleman accept that some of the amendments that he is speaking to are completely unnecessary, that some of what he has said is an insult to the social work profession, and that we cannot simply lay down in the House what social care professionals should do in every aspect of their work? Will he celebrate with me the fact that we can rely on the professionalism and ability of social workers in local authorities?
Mr. Burns: Unusually, I am inclined to agree with the Liberal Democrats. I think that I am right in saying that the hon. Member for Lancaster and Wyre (Mr. Dawson) was a social worker, so may I first say that, despite his cheap jibe, what I have said so far in no way criticises or attacks social workers, because they also have a very difficult job to do, and are often not given the credit for the work that they do? I think that carers' organisations and carers will be slightly surprised by the hon. Gentleman's comments, because they do feel aggrieved, and if he has bothered to take the time to read any of the briefings on the Bill from carers' organisations he will know that they do feel very aggrieved that the Bill makes no mention of carers or the role of carers.
Mr. Waterson: Does my hon. Friend agree that the point here is not the dedication of individual social workers but the pressures that social services departments will feel under? Indeed, the Bill is designed to make them feel those pressures, which will in turn distort the priorities that they might otherwise have in terms of care and packages for individual patients?
Mr. Burns: My hon. Friend has picked up an extremely relevant and important point. I wish the Government had better appreciated the implications of what the Bill seeks to do, because, as the Minister knows, it will be carers who bear the brunt of poor discharge procedures, and we believe that those will arise as a result of the Bill.
We tabled the amendments because between 1999 and 2001 readmissions of patients within two months of being discharged nearly doubled, from 19 per cent. to 43 per cent. The proportion of carers who felt that early discharge was at fault rose correspondingly from 23 per
I want to deal in order with the amendments that the official Opposition have tabled. Amendment No. 5 is intended to ensure that the patientand, where applicable, the careris aware of what will be provided on discharge, so that they know whether they would wish to accept that plan. The amendment also addresses issues where the patient lacks capacity. As clause 3(3) currently reads, there is no involvement with the patient, only agreement between the national health service and social services
The amendment would ensure that the patient and, just as important, their carer were fully aware of the cost of their continuing care and aware that they had consented to it. The importance of such knowledge and consent is emphasised by a case that my right hon. Friend the Member for Skipton and Ripon (Mr. Curry) drew to my attention. He has a constituent who has been confronted with what I think the House would rightly agree is a grave injustice with regard to free care under the Coughlan case. A Mrs. Airey, who is the mother of my right hon. Friend's constituent and holds power of attorney, was suddenly sent a bill for #7,000 by the care home to which her mother had been transferred from hospital by social services in Yorkshire. She had made no agreement, written or verbal, to pay anything. When she replied that the contract with the care home had been made by social services, and that her mother could not be asked to pay, she received a telephone call last Sunday week from the home manager, who said that he had consulted social services and that her mother would not be able to continue in the home if she did not pay. Social services wrote last week to say that my right hon. Friend's constituent must pay Xto protect her mother's place in the home", and that she had made the contract with the home. Mrs. Airey is adamant that she had done no such thing. As the House will appreciate, there is now a major dispute as to who placed the contract and who is financially responsible for paying the bill.
I believe that an amendment like amendment No. 5, with the plans in the new clause and the other supplementary amendments, would overcome that sort of confusion and argument, because there would be greater clarity at the point of discharge.
Ms Munn: I thank the hon. Gentleman for being so generous. He obviously has a different copy of the Bill from the one that I had. Perhaps he could point out where in the Bill it repeals legislation that already requires care plans to be in place and legislation that gives every carer the right to an individual assessment.
Mr. Burns: She is. If I could explain for a minute, perhaps the hon. Lady will understand. The trouble is that, regardless of the legislation that the hon. Lady is referring to, the Bill will, in effect, cause serious problems by putting pressure on local authorities to ensure that patients are often wrongly or inappropriately discharged from hospital and inappropriately placed in alternative forms of care, so as to avoid a fine under the Bill. That is why I, my hon. Friends and, I think, the Liberal Democrats believe that to protect against that occurrence and to minimise that possibility, the Bill, if it reaches the statute book, should have clearly defined rights and protections for carers and for patients, so as to seek to avoid an unpleasant and unfortunate by-product of a piece of legislation that is deeply flawed.
Amendment No. 3 ensures that national health bodies will consult patients as well as local authorities before it is decided what services, if any, will be made available following their discharge from hospital. The amendment ensures that the patient is informed and consents to whatever NHS services are to be provided. It also aims to deal with those people who are unable to give such consent in the absence of mental incapacity legislation.
Amendment No. 4 would place a further duty on NHS bodies simply to ensure that the views of the carer are considered when making arrangements for health services following the discharge of a patient. The wording is deliberate. The NHS body must simply take into account the views of the carer. It need not necessarily agree or act on those views, but it will have a duty to take them into account.
Amendment No. 2 would introduce a new subsection to ensure that patients and carers are also aware of when they are likely to be discharged and can ask for a review. It also aims to deal with people who are unable to give consent due to mental incapacity.
The amendments and new clauses are needed in the Bill. For that reason, and given that we discussed the subject at considerable length in Committee, I hope that the Minister has had time to reflect and is now minded to accept this strengthening of the legislation. I am sure that she will not doubt, as I certainly do not, that carers and patients need to be protected under this part of the Bill.