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15 Jan 2003 : Column 731—continued

Andy Burnham: The hon. Gentleman talks about what carers have to fear from the Bill. Surely carers in this country have far more to fear from a 20 per cent. cut in public spending, proposed by Opposition Front-Bench spokesmen just before Christmas? What would that do to social services budgets and what could carers expect as a result of such cuts?

Mr. Waterson: The hon. Gentleman is behind the game. Despite the assurances of the Prime Minister, it has been made clear that no Opposition Member is suggesting a 20 per cent. across-the-board cut, or anything like it. I am talking about the Labour Government's loony proposal to charge fines—the Minister was careful not to use the word Xfines" in Committee; she used various other, somewhat cuddlier, expressions—

Sir George Young (North-West Hampshire): Incentives.

Mr. Waterson: I am grateful to my right hon. Friend—I think that that was the word the Minister used. There would be charges to Xincentivise" people, although I doubt that any criminal who is fined regards himself as being incentivised. In any event, the game was blown when the Secretary of State used the old term Xfines" in the Chamber the other day. The Government are erecting a tremendous bureaucracy to fine social services departments—but may give back the fines because they are also setting up various appeal tribunals—to deal with a problem that in some places is visibly being tackled by the agencies themselves.

The next brief we received is from Help the Aged, which makes similar points. It says that the Bill

As I pointed out in Committee and on Second Reading, the Bill cuts right across the requirements of the NHS plan and the national service framework for older people. I do not know why Ministers publish all those worthy documents if they have no intention of paying any attention to them in legislation.

Age Concern provides a powerful voice for the sort of people who will be most adversely affected by the Bill and whom the Opposition parties are trying to help by amending the Bill. The organisation does not pull any punches, stating:

It refers to the finding of the Select Committee on Health inquiry into delayed discharges, that

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There is no talk of partnership in the Bill—patients will not necessarily be told what is to happen to them, and neither they nor their carers will be asked about it. Age Concern talks about the need for the consent of the patient and their carer, for the provision of adequate and proper information, for consultation and advocacy, for the patient to have the right to dispute the discharge decision, and for details of what will happen to the patient when there is a dispute—a subject that we will discuss later.

I return to what I have said throughout our consideration of the Bill. Consent of the patient, let alone the carer, is entirely absent from the Bill. We can only assume that it is a wholly Treasury-driven measure. It has nothing to do with the care of patients. It is designed to save money. As I have also said, in the area that I represent the problem is very much one that has been created by government.

Alan Simpson (Nottingham, South): We should all welcome the recognition of the problems that are faced by carers, however late it has come. We must also recognise that legitimate points are being raised by organisations representing older people as well as by organisations representing the interests of carers.

The specific concerns that I would like the Minister to address do not revolve around personnel issues in terms of a care package but relate to the circumstances in which people were admitted to hospital in the first instance and to the place to which they will be returned. Those points were made by my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson). I would welcome a reference from my hon. Friend the Minister to the way in which these matters fit in with our approach to a fuel poverty strategy that will tackle the root cause of many elderly people's admission to hospital. No matter how much personal care we build into a return package, fuel poverty will be the cause of further readmissions.

3.30 pm

For a long time, many of us have been concerned about the revolving-door syndrome in terms of hospital admissions for older people. Much of the blocking of discharges relates not to the specific illness but to home conditions that may make it almost certain that the illness will recur. Will the Minister clarify whether she will be issuing fresh guidance about home circumstances. I think that the issue is covered in amendment No. 27, which refers to the need to identify Xany services" that

We have been the first Government ever to introduce statutory targets for the elimination of fuel poverty in the home. Home warmth, home conditions and home safety are central to the health interests of older people and to safety when discharging older people from hospital to return to their homes. The amendments that were tabled in my name and in the names of other Members on a cross-party basis have not been selected, but perhaps the Minister will be kind enough to set out her proposals in the context of recognising that it is not only the human care package but the physical care package that needs to be considered in removing or addressing the bed-blocking problem?

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I would hate us to find that we had merely moved the problem from one location to another. I would not want us to replace the revolving-door problem with a pass-the-patient problem that surfaced in temporary locations to which a discharged patient was moved, not least because the people concerned may have been asking for a long time what help they can get from the Government or the responsible agency to make their life-long home a safe place in which to live.

Mrs. Calton : My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) and I support the remarks of the hon. Member for Nottingham, South (Alan Simpson). We added our names to the amendments to which the hon. Gentleman referred, which sadly have not been selected. We would have liked them to be debated as well. We hope that the Minister will take notice of the hon. Gentleman's comments and take them up when she replies.

We shall press amendment No. 37 to a Division, because it has the effect of ensuring that accommodation and personal care do not have to be free for more than six weeks. Effectively, that means that responsibility is thrown back to local authorities after six weeks. Liberal Democrats disagree with that approach. We believe that personal care should be free for as long as it is necessary. We have never pretended that it does not have to be paid for, but comments about charging that were made in Committee should be addressed.

In May 2000, the Audit Commission's document XCharging with Care" said that 94 per cent. of councils were charging for care compared with 72 per cent. in 1992–93. The charges were raising #225 million and funding 12 per cent. of the costs of care, compared with 8 per cent. in 1993–94. It is acknowledged that that income helps councils to maintain and improve services and target subsidies. It is also acknowledged that demand is increasing. Much is made also of the differences in the amount of care that people could expect to get for the same money throughout the country.

Councils have had the power to charge for social services care since the enactment of the National Assistance Act 1948. The current powers to charge were set out in the Health and Social Services and Social Security Adjudications Act 1983, which was introduced by a Conservative Government. It gave wide discretion to councils, but they had to be reasonable, and reasonably practicable, in what they brought in. In 1994, an advice note from the social services inspectorate provided further clarification, and a series of legal challenges established case law.

The Government's current funding formula assumes that a proportion of costs can be recovered through charges. A note from the Library makes it clear that, for the first time, in 1999–2000—under a Labour Government—the way in which the revenue support grant was distributed to local authorities took into account the fact that they have different capacities to cover costs by raising charges for domiciliary services. In other words, councils were expected to make charges if they could do so.

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Until 2000, only 6 per cent. of councils—

Jacqui Smith: Is the hon. Lady suggesting that distribution should not take into consideration councils' ability to raise charges, given that, as she said, that has been the legal position since 1948? Is she suggesting that we should not bear that in mind when we are distributing—in other words, that we should disadvantage those local authorities whose communities are poorer and less able to pay charges?

Mrs. Calton: I thank the Minister for her intervention, but I would have much more sympathy with her point of view if she acknowledged the level of unmet need throughout the country—in local authority areas considered affluent, and in those considered less affluent. The level of need is simply not being met because the indicators used are not sensitive enough to recognise it.

Against the background of grants allocated on the basis that charges would be made, and of reductions in grant to that end, 94 per cent. of councils were clearly not in a position to avoid charging.

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