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15 Jan 2003 : Column 754—continued

Mr. Kevin Hughes: Will the hon. Gentleman give way?

Mr. Burns: No.

We want to come up with positive and sensible ideas to seek to overcome the problem. We do not believe that the best way to achieve that is through fines. That is why to my mind amendment No. 8 is the most attractive alternative within the scope of the Bill. We believe that it will deal with the problem. Bringing down to a more or less nominal level the fines that the Minister is seeking to introduce and including that figure in the Bill would prevent the Chancellor from using the proposals as a new form of stealth tax. Without primary legislation, he could not seek to increase the level annually, or whenever the Government wanted to raise more money.

Mr. Kevin Hughes rose—

Andy Burnham: Will the hon. Gentleman give way?

Mr. Burns: I am sorry, but I cannot.

It is for those reasons that I hope that my right hon. and hon. Friends will join me in the Division Lobby. I further hope that any other hon. Members who care about coming up with positive solutions to the long-term care crisis, and who have said consistently on the Floor of the House and in Committee that they oppose the fining system, will join us in seeking to thwart the Government's intentions.

Mrs. Calton: I shall be very brief. The Liberal Democrats will support the amendment, but in spite of, rather than because of, the arguments advanced by the hon. Member for West Chelmsford (Mr. Burns). I should correct him on one point—I realise that I did not make myself clear: the figure of 25 per cent. referred to the opinion polls, rather than to whatever it was that he thought it referred to.

Jacqui Smith: I was glad to see some of the Opposition harmony return at the end of the debate. The hon. Member for West Chelmsford (Mr. Burns) was a little unfair. After talking about Liberal Democrat clipboards and anoraks—amusing though that was—he proceeded to talk about his own survey. I do not know

15 Jan 2003 : Column 755

whether he used a clipboard; it is more likely that he got someone else to carry out the survey, and perhaps they used a clipboard.

Mr. Burns: Perhaps I can help the Minister. No, I did not use a clipboard, because I try to distance myself from the Liberal Democrats as much as possible. Directors of social services were telephoned in their offices, and they provided the information. I put it on a piece of paper and added it up, and I got a total. [Interruption.]

Jacqui Smith: As has just been pointed out, I am sure that the hon. Gentleman would never be seen wearing an anorak, either.

The Bill seeks to provide an incentive for local authorities to supply prompt onward care for patients who are ready to leave hospital by introducing a charge that broadly reflects the cost to the hospital of providing a bed for a delayed patient. We had some lengthy discussions in Committee about the justifiable basis for expecting that, where the responsibility rests with social services departments to provide for a person's needs—usually, it is an older person—it is not unreasonable to expect them to take responsibility for payment as well, given that they will receive the necessary funding from the Government. The alternative is a system that is effectively a fine on the NHS, because the NHS is expected to pay the costs of people whose needs would be better served out of hospital, but who remain in hospital because alternatives are not available in the community. Anybody who opposes that principle must answer the question of whether it is justifiable for the NHS to bear costs for which it has neither legal nor practical responsibility. Nor, indeed, is it best suited to provide that particular form of care.

Sir George Young: Let us accept for one moment the principle that the Minister has just enunciated. Why does it not work the other way around? When the NHS imposes costs on social services, why does it not pay them?

5 pm

Jacqui Smith: I would be interested to know what examples the right hon. Gentleman has in mind. We explored in detail in Committee the principles of some of the financial incentives that are being introduced into the NHS. I made the point that it is possible to introduce financial incentives through the sort of financial flows work that we will be introducing into the NHS, some of which I spelt out earlier, without legislation. However, the interface between social services and health is such that we need to legislate in order to introduce financial incentives in that context.

I return to my original question, which has not been satisfactorily answered by anybody who opposes the legislation. The incentive is that the daily charge that we propose is higher than the daily costs that the local authority would otherwise incur in providing either residential or domiciliary care for the person in question. I hope that hon. Members will understand that there are very good reasons why the Bill makes no mention of the actual reimbursement charge.

We have chosen to set out the charge in regulations rather than in the Bill, as that will give us greater flexibility to amend the rates in line with inflation or

15 Jan 2003 : Column 756

other cost pressures. The hon. Member for West Chelmsford was either on a flight of fancy or lacks understanding about the nature of the charge, which is a transfer from one part of the public system to another reflecting the costs that have been borne. It is not raising money for the Government, but focusing the attention of social services departments on areas in which they already have responsibility and ensuring that they spend the extra investment that the Government are making available to them on the sort of alternatives that older people want to enable them to get out of hospital more quickly.

In the letter that I sent to members of the Standing Committee about the regulations, I spelt out that the charge will be based on the cost to the NHS of providing bed, board and personal care in an acute environment, but having removed indirect overheads and the cost of capital medical input and specialist nursing in order to reflect the lower costs of caring for a patient at the end of a hospital stay when medical needs have been reduced. In most cases, the figure will also represent a higher charge to the local authority than the daily costs of providing community care in a residential setting or in the person's home. Our intention is to remove what sometimes operates as perverse incentive in the system, enabling local authorities not to live up to their responsibilities, with the NHS bearing the costs of people's care because the necessary alternatives are not in place.

In our consultation, we asked whether a charge of #100 a day and #120 in London and the south-east would be appropriate. Responses suggested that that seemed about the right amount to create the incentive that we want. We will issue the regulations for consultation and consider any further responses about the amount of the charge and the boundary for the higher rate.

The hon. Member for West Chelmsford made clear what the amendments are about. They are not a serious attempt to consider the incentive effect or the appropriate level for the charges that will justifiably be put in place. They are simply wrecking amendments that continue for the Opposition the approach on which I commented during the debate on the previous group of amendments but one. Opposition Members are keen to oppose our proposals, but have no ideas about how we can cut delayed discharge. I am afraid that they are therefore letting down the older people who depend on all of us to provide a better system to ensure that they get the right care in the right place.

Mr. Burns: I listened carefully to the Minister, and it will come as no surprise to the House that I was not convinced by her arguments. Moreover, her comments towards the end of her speech were absolute and unadulterated rubbish. Therefore, I beg to ask leave to withdraw the amendment and I ask my right hon. and hon. Friends to join me in the Lobby in support of amendment No. 8.

Amendment, by leave, withdrawn.

15 Jan 2003 : Column 757

Amendment proposed: No. 8, in page 4, line 30, at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—
(a) #12, in the case of a social services authority in, or adjacent to, Greater London, or
(b) #10, in any other area.'.—[Mr. Burns.]

Question put, That the amendment be made:—

The House divided: Ayes 188, Noes 317.

Division No. 51
[5:05 pm


Ainsworth, Peter (E Surrey)
Allan, Richard
Amess, David
Arbuthnot, rh James
Atkinson, Peter (Hexham)
Bacon, Richard
Baker, Norman
Barker, Gregory
Baron, John (Billericay)
Barrett, John
Beggs, Roy (E Antrim)
Beith, rh A. J.
Bellingham, Henry
Bercow, John
Blunt, Crispin
Boswell, Tim
Brady, Graham
Brake, Tom (Carshalton)
Brazier, Julian
Brooke, Mrs Annette L.
Browning, Mrs Angela
Bruce, Malcolm
Burns, Simon
Burnside, David
Burstow, Paul
Burt, Alistair
Cable, Dr. Vincent
Calton, Mrs Patsy
Cameron, David
Campbell, Gregory (E Lond'y)
Carmichael, Alistair
Cash, William
Chapman, Sir Sydney (Chipping Barnet)
Chope, Christopher
Clarke, rh Kenneth (Rushcliffe)
Clifton-Brown, Geoffrey
Collins, Tim
Cormack, Sir Patrick
Cotter, Brian
Cran, James (Beverley)
Curry, rh David
Davey, Edward (Kingston)
Davies, Quentin (Grantham & Stamford)
Dodds, Nigel
Dorrell, rh Stephen
Doughty, Sue
Evans, Nigel
Fabricant, Michael
Fallon, Michael
Field, Mark (Cities of London & Westminster)
Flight, Howard
Flook, Adrian
Forth, rh Eric
Foster, Don (Bath)
Fox, Dr. Liam
Gale, Roger (N Thanet)
Garnier, Edward
George, Andrew (St. Ives)
Gibb, Nick (Bognor Regis)
Gidley, Sandra
Gillan, Mrs Cheryl
Gray, James (N Wilts)
Grayling, Chris
Green, Damian (Ashford)
Green, Matthew (Ludlow)
Grieve, Dominic
Gummer, rh John
Hammond, Philip
Hancock, Mike
Harris, Dr. Evan (Oxford W & Abingdon)
Harvey, Nick
Hawkins, Nick
Hayes, John (S Holland)
Heald, Oliver
Heath, David
Heathcoat-Amory, rh David
Hendry, Charles
Hoban, Mark (Fareham)
Hogg, rh Douglas
Horam, John (Orpington)
Howard, rh Michael
Howarth, Gerald (Aldershot)
Hunter, Andrew
Jack, rh Michael
Jackson, Robert (Wantage)
Jenkin, Bernard
Johnson, Boris (Henley)
Keetch, Paul
Key, Robert (Salisbury)
Kirkbride, Miss Julie
Kirkwood, Sir Archy
Knight, rh Greg (E Yorkshire)
Laing, Mrs Eleanor
Lait, Mrs Jacqui
Lamb, Norman
Lansley, Andrew
Laws, David (Yeovil)
Leigh, Edward
Lewis, Dr. Julian (New Forest E)
Lidington, David
Lilley, rh Peter
Llwyd, Elfyn
Loughton, Tim
Luff, Peter (M-Worcs)
McIntosh, Miss Anne
Mackay, rh Andrew
Maclean, rh David
McLoughlin, Patrick
Malins, Humfrey
Maples, John
Mates, Michael
Mawhinney, rh Sir Brian
May, Mrs Theresa
Mercer, Patrick
Moore, Michael
Moss, Malcolm
Murrison, Dr. Andrew
Norman, Archie
Oaten, Mark (Winchester)
O'Brien, Stephen (Eddisbury)
Öpik, Lembit
Osborne, George (Tatton)
Ottaway, Richard
Page, Richard
Paice, James
Paterson, Owen
Pickles, Eric
Price, Adam (E Carmarthen & Dinefwr)
Prisk, Mark (Hertford)
Pugh, Dr. John
Redwood, rh John
Reid, Alan (Argyll & Bute)
Rendel, David
Robathan, Andrew
Robertson, Hugh (Faversham & M-Kent)
Robertson, Laurence (Tewk'b'ry)
Robinson, Mrs Iris (Strangford)
Robinson, Peter (Belfast E)
Roe, Mrs Marion
Rosindell, Andrew
Ruffley, David
Russell, Bob (Colchester)
Sanders, Adrian
Sayeed, Jonathan
Selous, Andrew
Shephard, rh Mrs Gillian
Shepherd, Richard
Simmonds, Mark
Simpson, Keith (M-Norfolk)
Smyth, Rev. Martin (Belfast S)
Soames, Nicholas
Spelman, Mrs Caroline
Spicer, Sir Michael
Spink, Bob (Castle Point)
Spring, Richard
Steen, Anthony
Streeter, Gary
Stunell, Andrew
Swayne, Desmond
Swire, Hugo (E Devon)
Syms, Robert
Tapsell, Sir Peter
Taylor, Ian (Esher)
Taylor, John (Solihull)
Taylor, Matthew (Truro)
Thomas, Simon (Ceredigion)
Thurso, John
Tonge, Dr. Jenny
Tredinnick, David
Turner, Andrew (Isle of Wight)
Tyler, Paul (N Cornwall)
Tyrie, Andrew
Viggers, Peter
Walter, Robert
Waterson, Nigel
Watkinson, Angela
Webb, Steve (Northavon)
Whittingdale, John
Widdecombe, rh Miss Ann
Wiggin, Bill
Wilkinson, John
Willetts, David
Williams, Hywel (Caernarfon)
Williams, Roger (Brecon)
Winterton, Sir Nicholas (Macclesfield)
Yeo, Tim (S Suffolk)
Young, rh Sir George
Younger-Ross, Richard

Tellers for the Ayes:

Mr. David Wilshire and
Mr. Mark Francois


Adams, Irene (Paisley N)
Allen, Graham
Anderson, Janet (Rossendale & Darwen)
Armstrong, rh Ms Hilary
Atherton, Ms Candy
Atkins, Charlotte
Austin, John
Bailey, Adrian
Baird, Vera
Banks, Tony
Barnes, Harry
Barron, rh Kevin
Bayley, Hugh
Beard, Nigel
Beckett, rh Margaret
Begg, Miss Anne
Bell, Stuart
Benn, Hilary
Bennett, Andrew
Benton, Joe (Bootle)
Best, Harold
Blackman, Liz
Blears, Ms Hazel
Blizzard, Bob
Borrow, David
Bradley, rh Keith (Withington)
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brown, Russell (Dumfries)
Bryant, Chris
Buck, Ms Karen
Burgon, Colin
Burnham, Andy
Cairns, David
Campbell, Alan (Tynemouth)
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Casale, Roger
Caton, Martin
Cawsey, Ian (Brigg)
Challen, Colin
Clapham, Michael
Clark, Mrs Helen (Peterborough)
Clark, Paul (Gillingham)
Clarke, rh Tom (Coatbridge & Chryston)
Clelland, David
Clwyd, Ann (Cynon V)
Coaker, Vernon
Coffey, Ms Ann
Cohen, Harry
Coleman, Iain
Connarty, Michael
Cook, rh Robin (Livingston)
Cooper, Yvette
Corbyn, Jeremy
Corston, Jean
Cousins, Jim
Cox, Tom (Tooting)
Cranston, hon. Ross
Crausby, David
Cruddas, Jon
Cryer, Ann (Keighley)
Cummings, John
Cunningham, Jim (Coventry S)
Cunningham, Tony (Workington)
Darling, rh Alistair
Davey, Valerie (Bristol W)
David, Wayne
Davidson, Ian
Davies, rh Denzil (Llanelli)
Davies, Geraint (Croydon C)
Dawson, Hilton
Dean, Mrs Janet
Dhanda, Parmjit
Dismore, Andrew
Dobbin, Jim (Heywood)
Dobson, rh Frank
Donohoe, Brian H.
Doran, Frank
Dowd, Jim (Lewisham W)
Drew, David (Stroud)
Drown, Ms Julia
Dunwoody, Mrs Gwyneth
Eagle, Angela (Wallasey)
Eagle, Maria (L'pool Garston)
Edwards, Huw
Efford, Clive
Ellman, Mrs Louise
Ennis, Jeff (Barnsley E)
Etherington, Bill
Farrelly, Paul
Field, rh Frank (Birkenhead)
Fisher, Mark
Fitzpatrick, Jim
Fitzsimons, Mrs Lorna
Flint, Caroline
Flynn, Paul (Newport W)
Follett, Barbara
Foster, rh Derek
Foster, Michael (Worcester)
Foster, Michael Jabez (Hastings & Rye)
Foulkes, rh George
Francis, Dr. Hywel
Gapes, Mike (Ilford S)
Gardiner, Barry
Gerrard, Neil
Gibson, Dr. Ian
Gilroy, Linda
Godsiff, Roger
Goggins, Paul
Griffiths, Jane (Reading E)
Griffiths, Win (Bridgend)
Grogan, John
Hall, Mike (Weaver Vale)
Hall, Patrick (Bedford)
Hamilton, David (Midlothian)
Hanson, David
Harris, Tom (Glasgow Cathcart)
Healey, John
Henderson, Doug (Newcastle N)
Henderson, Ivan (Harwich)
Hendrick, Mark
Hepburn, Stephen
Heppell, John
Hesford, Stephen
Hill, Keith (Streatham)
Hodge, Margaret
Hoey, Kate (Vauxhall)
Hood, Jimmy (Clydesdale)
Hope, Phil (Corby)
Hopkins, Kelvin
Howarth, rh Alan (Newport E)
Howarth, George (Knowsley N & Sefton E)
Howells, Dr. Kim
Hughes, Kevin (Doncaster N)
Humble, Mrs Joan
Hutton, rh John
Iddon, Dr. Brian
Irranca-Davies, Huw
Jackson, Glenda (Hampstead & Highgate)
Jackson, Helen (Hillsborough)
Jamieson, David
Jenkins, Brian
Johnson, Miss Melanie (Welwyn Hatfield)
Jones, Helen (Warrington N)
Jones, Jon Owen (Cardiff C)
Jones, Kevan (N Durham)
Jones, Lynne (Selly Oak)
Jones, Martyn (Clwyd S)
Joyce, Eric (Falkirk W)
Kaufman, rh Gerald
Keeble, Ms Sally
Keen, Alan (Feltham)
Keen, Ann (Brentford)
Kemp, Fraser
Kidney, David
Kilfoyle, Peter
King, Andy (Rugby)
King, Ms Oona (Bethnal Green & Bow)
Knight, Jim (S Dorset)
Ladyman, Dr. Stephen
Lammy, David
Laxton, Bob (Derby N)
Lazarowicz, Mark
Lepper, David
Leslie, Christopher
Levitt, Tom (High Peak)
Lewis, Ivan (Bury S)
Lewis, Terry (Worsley)
Liddell, rh Mrs Helen
Linton, Martin
Lloyd, Tony (Manchester C)
Love, Andrew
Lucas, Ian (Wrexham)
Luke, Iain (Dundee E)
Lyons, John (Strathkelvin)
McAvoy, Thomas
McCabe, Stephen
McCafferty, Chris
McCartney, rh Ian
McDonagh, Siobhain
MacDonald, Calum
MacDougall, John
McFall, John
McGuire, Mrs Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McNamara, Kevin
McNulty, Tony
MacShane, Denis
Mactaggart, Fiona
McWalter, Tony
Mahmood, Khalid
Mahon, Mrs Alice
Mallaber, Judy
Mann, John (Bassetlaw)
Marris, Rob (Wolverh'ton SW)
Marsden, Gordon (Blackpool S)
Marshall, David (Glasgow Shettleston)
Marshall, Jim (Leicester S)
Martlew, Eric
Meacher, rh Michael
Meale, Alan (Mansfield)
Merron, Gillian
Milburn, rh Alan
Miliband, David
Miller, Andrew
Moffatt, Laura
Mole, Chris
Moonie, Dr. Lewis
Moran, Margaret
Morgan, Julie
Morley, Elliot
Morris, rh Estelle
Mountford, Kali
Mudie, George
Mullin, Chris
Munn, Ms Meg
Murphy, Denis (Wansbeck)
Murphy, Jim (Eastwood)
Naysmith, Dr. Doug
Norris, Dan (Wansdyke)
O'Brien, Bill (Normanton)
O'Brien, Mike (N Warks)
O'Hara, Edward
Organ, Diana
Osborne, Sandra (Ayr)
Owen, Albert
Palmer, Dr. Nick
Picking, Anne
Pickthall, Colin
Pike, Peter (Burnley)
Plaskitt, James
Pollard, Kerry
Pond, Chris (Gravesham)
Prentice, Ms Bridget (Lewisham E)
Prentice, Gordon (Pendle)
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Ken
Purnell, James
Quin, rh Joyce
Quinn, Lawrie
Rapson, Syd (Portsmouth N)
Raynsford, rh Nick
Reed, Andy (Loughborough)
Reid, rh Dr. John (Hamilton N & Bellshill)
Rooney, Terry
Ross, Ernie (Dundee W)
Roy, Frank (Motherwell)
Ruane, Chris
Ruddock, Joan
Russell, Ms Christine (City of Chester)
Ryan, Joan (Enfield N)
Salter, Martin
Sawford, Phil
Sedgemore, Brian
Shaw, Jonathan
Sheerman, Barry
Sheridan, Jim
Shipley, Ms Debra
Simon, Siôn (B'ham Erdington)
Singh, Marsha
Skinner, Dennis
Smith, Angela (Basildon)
Smith, rh Chris (Islington S & Finsbury)
Smith, Geraldine (Morecambe & Lunesdale)
Smith, Jacqui (Redditch)
Smith, John (Glamorgan)
Smith, Llew (Blaenau Gwent)
Soley, Clive
Southworth, Helen
Squire, Rachel
Starkey, Dr. Phyllis
Steinberg, Gerry
Stevenson, George
Stewart, David (Inverness E & Lochaber)
Stewart, Ian (Eccles)
Stinchcombe, Paul
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Stringer, Graham
Sutcliffe, Gerry
Tami, Mark (Alyn)
Taylor, rh Ann (Dewsbury)
Taylor, Dari (Stockton S)
Taylor, David (NW Leics)
Thomas, Gareth (Clwyd W)
Thomas, Gareth (Harrow W)
Timms, Stephen
Tipping, Paddy
Touhig, Don (Islwyn)
Trickett, Jon
Truswell, Paul
Turner, Dennis (Wolverh'ton SE)
Turner, Dr. Desmond (Brighton Kemptown)
Twigg, Derek (Halton)
Twigg, Stephen (Enfield)
Tynan, Bill (Hamilton S)
Vaz, Keith (Leicester E)
Vis, Dr. Rudi
Walley, Ms Joan
Ward, Claire
Wareing, Robert N.
Watts, David
White, Brian
Whitehead, Dr. Alan
Wicks, Malcolm
Williams, rh Alan (Swansea W)
Williams, Betty (Conwy)
Wood, Mike (Batley)
Woodward, Shaun
Wright, Anthony D. (Gt Yarmouth)
Wright, David (Telford)
Wright, Tony (Cannock)
Wyatt, Derek

Tellers for the Noes:

Mr. Nick Ainger and
Mr. Phil Woolas

Question accordingly negatived.

15 Jan 2003 : Column 760

Clause 6

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