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15 Jan 2003 : Column 728—continued

Glenda Jackson (Hampstead and Highgate): If memory serves me correctly, the hon. Member for West Chelmsford (Mr. Burns) has surely come somewhat late to concerns about carers. I cannot remember one piece of Conservative health service legislation between 1992 and 1997 that enshrined the rights of carers on the face of a Bill. In that five-year period, they may have introduced the possibility of the carer's needs being assessed, but no statutory duty was placed on local authorities and they did not have to deliver.

I frankly acknowledge to the Minister that my reason for speaking to this group of amendments is anecdotal, but some of my constituents have expressed concern to me. They perceive that, as carers for someone who is frail or, in one instance, suffers from dementia, pressure could conceivably be placed upon them, as social services could be fined under the Bill if the NHS facility that is caring for their loved one says that he or she is ready to leave hospital but no alternative facilities can be provided. Even though Camden is an excellent authority in that respect, there are difficulties with finding available facilities locally. That is the overriding concern of my constituents.

In some instances, the carer is as frail as the individual who is in hospital, as I pointed out when we discussed the Bill in the House before. One such case involves a wife whose husband was in hospital. She became ill and, even though he had recovered, there was no one at home who could care for him. No interim placement was available in the locality and the couple had no relatives who could visit him in the place where he was to be temporarily cared for.

Those are the sorts of issues that are causing concern among carers and patients. They believe that undue pressure will be placed on their local authority to move their loved one from an NHS facility. In some instances, they know that the loved one will be returned not to their home, because no one there is capable of caring for them, but to a facility outside the local area.

My constituents are also concerned about what will happen when someone is to be cared for at home but the home requires a great deal of work to make it feasible for the carer to care for them, or for a carer with additional domiciliary care to do so. There again, some of my constituents believe that unnecessary pressure will be placed on local authorities as a result of the fines in the Bill and that the authority will in turn put additional pressure on them.

I hope that my hon. Friend the Minister will be able to say something to calm the fears of my constituents.

3.15 pm

Mr. Waterson: I speak in support of the majority of the amendments in the group, but in particular those tabled by my hon. Friends, especially my hon. Friend

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the Member for Woodspring (Dr. Fox)—amendments Nos. 41A, 5, 3 and 4 on the consent of patients and their carers.

Those of us who were members of the Committee and who tried to improve the Bill were disappointed not least at this important—indeed, central—flaw in the legislation. The Bill is a consent-free zone. Patients are treated as a sort of commodity, or as counters to be moved around the board to the best advantage of the agencies involved. It does not ensure that they or their families or carers will be consulted, let alone have their views taken into account when it comes to the timing of their discharge and the sort of care that they will be discharged into.

We will return to that issue, but as hon. Members on both sides of the House said on Second Reading and in Committee, it is extraordinary that the Government want to introduce this sledgehammer measure at a time when there are encouraging signs throughout the country and in east Sussex in particular—part of which I represent—of closer working between the different agencies. There have been problems. I do not think that any sensible observer of that aspect of the care scene would argue otherwise. However, there is now much greater evidence of better organisation within the different bodies and of greater co-operation. For example, although there continues to be a problem with bed blocking and delayed discharges in my area, the figure is much lower than it was a year ago. Indeed, my local hospital, Eastbourne District General, recently opened a discharge suite that is designed to ease the transition of patients out of beds that they no longer need to occupy earlier in the day and to the form of care to which they are to move.

Mr. Dawson: Does the hon. Gentleman regard those new levels of co-operation as a new Labour achievement? They were certainly not evident in any Tory legislation or policy during the 18 years for which the Tories were in power.

Mr. Waterson: The hon. Member for social workers, or whatever his constituency is, misses the point again. If the Government are going to try to take credit for solving the problem, they should certainly take the credit for creating it in the first place. In my part of east Sussex, the problem can solely be placed at the door of the Government.

There has been closer working between the agencies, in particular since control of the county council changed hands. The Tory administration has gone to great lengths to work more closely with the NHS and so forth. If blame is to be allocated locally—perhaps an element of consensus may spring up across the Chamber on this—the eight years during which the Liberal Democrats ran the county council contributed to the problem.

Ms Munn: Opposition Members have short memories. I was first introduced to the term Xbed blocking" during my social work training back in 1985–86, under a Government of the political persuasion of the current official Opposition. The problem has existed for many years. Why, after all this

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time, are the Conservatives so concerned about the fact that the Government have decided to do something about it, especially in areas where the progress made is not as it should be?

Mr. Waterson: I have not had the benefit of social work training—I am sure that that is a massive failing on my part. Two things need to be said. First, there has always been bed blocking, although the title attached to it has changed over the years. However, my constituency experience during the past 10 years is that whereas it used to be largely a winter phenomenon, it has become an all-year-round phenomenon of substantial proportions. At different times in the past couple of years, my local hospital has had the equivalent of two or three wards full of people who should not be in hospital. It is one of the lasting monuments to the Labour Government that they have created waiting lists not only to get into hospital but to get out.

Secondly, the Government appear to be convinced that the Bill is the solution, even though what they propose flies in the face of the conclusions reached by everyone else with any experience of the problems—not only Conservative Members of Parliament, but the Local Government Association, the Association of Directors of Social Services and the NHS. The Bill has not a friend in the world, apart from some Labour Members, and quite a few of them have expressed disquiet since the idea was stumbled across. It is another example of the Government's knee-jerk reaction to problems. All I can say to them is, XWelcome to Government." Normally, there are no simple solutions to complex problems.

If the hon. Lady is saying that the Bill is the answer—that some genius boffin at the Department of Health has produced a wonderful solution to the problem—why not pilot it? Why not follow the advice of bodies such as Age Concern and not implement the Bill across the board until 2004? Why not try it first in one or two areas? By all means choose those areas where the problem is perceived to be chronic. The Minister will concede, if she has not already done so in previous debates, that good progress is being made in east Sussex, but if there are pockets where the problem is extremely bad, why not pilot the provisions of the Bill in those areas and wait and see, rather than wasting the time, effort and resources of hard-pressed social services departments and NHS staff throughout the country?

Moving on to the practical details, I have already said that the Bill has no friends, but in an intervention on the hon. Member for Sutton and Cheam (Mr. Burstow) I mentioned what the Alzheimer's Society has to say. The society is extremely worried. It makes the point that

and that

In its briefing, the society rightly states:

and adds that

The concerns that were rightly expressed by my hon. Friend the Member for West Chelmsford (Mr. Burns) and the hon. Member for Sutton and Cheam about

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carers generally apply in spades to carers of people with Alzheimer's or other forms of dementia. The Alzheimer's Society briefing continues:

The briefing ends:

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