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15 Jan 2003 : Column 775—continued

6.18 pm

Jacqui Smith: I beg to move, That the Bill be now read the Third time.

Throughout Second Reading, in Committee and during today's deliberations, we have given this Bill fair and measured consideration, and I want to thank all who were involved in Committee for that. Combined with a significant package of extra funding for older people's services, the Bill will bring an end to widespread delayed discharges, and ensure that older people get the services that they need when they need them. It is a Bill that is about the approximately 5,000 mainly elderly people who are delayed unnecessarily in an acute hospital bed. We know that an acute ward is very much the wrong place for someone to be when they are no longer in need of acute hospital care. To be delayed on an acute ward is demoralising for the individual; it can damage their confidence and their prospects for living independently or returning home in future. It is worrying for their families and carers, and bad for the taxpayer and the NHS, and that is why we are determined to tackle the problem.

We have made progress. Fewer people are delayed in hospital now than in 1997, but each person stuck in hospital when they want to be out is an argument for change. Throughout the passage of the Bill, Opposition Members have been quick to oppose but slow to suggest alternatives. As we have heard this afternoon, the Liberal Democrats propose lots of plans, but they have been short on solutions. We know that the Conservatives, who we have learned are the new-found friends of local government, oppose the extra investment that the Government propose—they voted against it—but they cannot even claim to be reformers. In their opposition to the Bill, they certainly cannot claim to be the friends of older people.

The Bill reflects our determination to match our extra investment with reform of the system to ensure that the needs of older people come first. It will do that, first, by creating a strong financial incentive for local authorities to comply with their existing duties to assist the needs of individuals who are likely to need community care services on discharge from hospital and to provide services to those individuals.

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Secondly, the Bill strengthens partnerships and brings about increased co-operation between the NHS and local authorities by introducing new duties for them to consult each other in assessing the patient's needs and deciding what services they will make available within set time scales.

Thirdly, by removing local authorities' power to charge for community equipment and intermediate care, the Bill simplifies the existing charging system, making it easier for users to understand and easier for local authorities and the NHS to provide those vital services jointly. Contrary to the concern that has been expressed today about partnership between health and local authorities, I believe that the Bill will lead to increased co-operation and joint working. For the first time, there will be a strong incentive for partners to get together to ensure that their discharge procedures work.

In certain ways, the Bill is already having a positive impact. Local authorities and their NHS partners are coming together in order to find common solutions to common problems and acknowledging the different parts that they have to play in achieving success. We know that planning for the implementation of reimbursement has led many partners to agree, for example, that they need to speed up their plans to implement fully a single assessment process. I feel confident that with so much good work and innovation already going on around the country, by the time reimbursement is implemented later this year, many local authorities and their NHS partners will have been able to find new and creative solutions to the problem of delayed discharge.

Opposition Members have worked hard during the Bill's passage to paint local authorities as victims. In fact, there is only one victim—the older people who are stuck in hospital when they should be out there getting the sort of services and support that we know they want and deserve. Let us be clear: the Bill does not place new responsibilities on local authorities. It simply seeks to add maximum time scales for the assessment and provision of services for which local authorities already have responsibility and places communications between a hospital and a local authority about a patient's case on a formal legal basis.

Of course, the Bill places new responsibilities on the NHS to inform local authorities when someone may need ongoing care in order to leave hospital and when people are fit to be discharged. We know that the NHS has not always taken its responsibilities to communicate with social services departments as seriously as it should. The Bill rectifies that and places the responsibility for payment where the responsibility for provision already lies.

As I have said already, these are not new responsibilities. Councils have had 18 months and #300 million in building care capacity grant, which has provided vital funding for councils to invest in the services and capacity needed to prevent delays. That investment has brought results. Almost 7,000 older people were trapped in hospital in March 1997, but by September last year that level had been reduced to 4,147. However, we have recognised that there are funding pressures for social services. That is why, in addition to the #1 billion package for older people announced on 23 July and the local government allocation announced on 5 December, on Second Reading my right hon. Friend

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the Secretary of State announced that an extra #100 million per full year of the scheme will be transferred from the NHS budget to local authorities in order to help them to build the capacity that will help them to avoid the costs of reimbursement and, most importantly, ensure that people will get the services that they need.

There has quite rightly been a focus during our debates here and in Committee on the needs of individual patients and their carers. That is right, because it is that focus that is at the centre of the Bill.

As I have explained this afternoon, the Bill does nothing to weaken a patient's right to consent or not to treatment. By creating a financial incentive for local authorities to carry out their duties, it will help to ensure that the needs of individual patients are met more quickly, and it will increase the choice that is available to them in terms of the services that they receive.

In the amendments that we have tabled today we have recognised the concerns about the needs and role of carers. We have also ensured that carers' services for discharge will need to be in place and that carers can benefit from free community equipment where they need it for their caring.

Reimbursement and other proposals in the Bill will lead to increased quality and choice for older people. If local authorities are to avoid delays, in the long term they will need to use the extra investment made available by the Government to invest in a wide range of services and capacity so that they can respond flexibly to an individual's needs, not just with residential care but also with intermediate and interim care, extra sheltered housing, equipment and adaptation services, and packages of intensive support at home, among other provisions.

The Bill presents an important opportunity to end widespread delayed discharge and to ensure that thousands of older people do not wait needlessly on an acute ward every day but are provided with a range of high quality community care services to meet their needs as soon as they are ready to leave. Ultimately, a safe transfer from an acute ward to a place where their needs can be more appropriately met is the minimum that older people should be entitled to and expect. That is what the Bill will ensure happens and I commend it to the House.

6.26 pm

Mr. Burns: To listen to the Minister, one might think that the Bill, which has almost completed its passage through this House, had emanated from a group of young Labour researchers meeting in some chi-chi wine bar in Islington, who, as the chardonnay got to them, thought they had come up with the most wonderful wheeze to deal at a stroke with the problem of delayed discharges. More worryingly, it seems that when they awoke the next morning they did not realise that the hazy wheeze of the night before was not such a good idea, and proceeded to pass the idea on to Ministers who, desperate for a quick fix, immediately embraced their ridiculous proposal and got the parliamentary

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draftsmen to produce a Bill which the Minister tells us is a series of incentives. We all know that the Bill is not a series of incentives: it is a straightforward system to fine local authorities.

On 11 December 2002, the Secretary of State gave the game away when, in answer to an hon. Member's question on a statement in the House, he referred quite blatantly to fines. The Minister, heroically—partly, I suspect, because she does not read Hansard on a daily basis—continued to maintain the myth that the Bill was an incentive measure. Even she finally slipped up today. She saw truth staring her in the face and the F-word passed her lips. She admitted that the Bill was a series of measures to fine local authorities.

What is so deeply disturbing about the Bill and the complacency of Ministers in the Department of Health is that the Bill in no shape or form recognises the crisis in long-term care in Britain—a crisis that has been gathering speed since 1997. Nowhere does the Bill address the problem of the loss of more than 60,000 care home beds, the closure of more than 2,000 care homes, or the fact that 100,000 households are no longer receiving domiciliary care compared with five years ago. That is what is so disgraceful about the Bill. It is a wasted opportunity.

By creating a system in part 1 that will effectively bamboozle local authorities into ensuring that patients are discharged from hospitals to avoid a fine, the Government think they have found a panacea, whereas in fact it is a short-term fix that will end in disaster. I predict now that in the next two years readmission rates for elderly people leaving hospital will increase at a higher level than the current rises. People will be taken from hospital and placed in what is not necessarily the most appropriate care for their needs because the local authority may be charged a fine.

The Government have got it wrong; that is not the right approach. As hon. Members have said, it will undo and damage partnerships between the health service and social services, which have taken a long time to achieve because of natural problems and jealousies in relation to who is responsible for funding. Under the previous Government—and, to their credit, this Government—the process of breaking down the barriers between the health service and social services has moved significantly forward, which is to be welcomed. This Bill will do great damage to that process, as it will create tensions between the two sides and reintroduce a blame culture that we all hoped was being banished as a thing of the past.

Although the Government have made money available for three years for local authorities to try to offset, in theory, the impact that the fines will have on social service funding and spending, there are also problems with that, as the fines are to be introduced on 1 April this year, as is the money. If we had had more time on Report we could have debated this matter, but if the money is to come in on 1 April 2003, and if the legislation is passed and the Government proceed with their cock-eyed scheme, the policy should have been to introduce the fines in April 2004 to give local authorities a 12-month breathing space to seek to resolve further the problems of delayed discharges. Bringing in those measures at the same time is a mistake. In addition, I believe that the money that the Government are making

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available will not match the level of fines that local authorities think they may incur, particularly in the early stages of the new policy.

For all of those reasons, I remain implacably opposed to part 1 of the Bill. I am disappointed that the Government have not been prepared to listen more carefully to those who oppose the Bill and who have highlighted its failings. I am a realist—I know my lot in life—and I understand that the Minister of State, charming as she is, will not necessarily listen to my helpful advice. But she does not have to listen to my advice: from her point of view, there are far more credible critics of this policy. There are Back-Bench Labour Members with great experience of social services and local government or the health service who are gravely concerned about this aspect of the Bill. There is the Local Government Association, whose leader, Sir Jeremy Beecham, unless I am wrong, is the Labour leader of Newcastle city council. There are most of the voluntary groups and charity groups in the long-term care sector. The care home owner associations and operators also believe that the Bill is a disaster. Many local authorities throughout the country genuinely believe that the Government are wrong and that the Bill will not solve the problems that they expect it to tackle.

I do not know whether the Minister has had an opportunity to phone social services departments in England and Wales. My office had a charming conversation with her social services department. We also contacted that of the Under-Secretary, the hon. Member for Salford (Ms Blears) and of the other Minister of State. We even spoke to the social services department in the Prime Minister's constituency. Not one had a smidgen of enthusiasm for fines, and they were worried about the amount that they might have to pay in fines in the next 12 months. Despite that, Ministers have not been prepared to reconsider.

We are now beginning the last 25 minutes of debate in the House on this nasty and flawed measure. Of course, it will leave the House with a majority in the next hour and go to another place. I assure the Minister that we shall continue to oppose it there, because we believe that there is a serious problem that needs tackling. I agree with her that the real losers are the patients who experience delayed discharge from hospital. However, the Bill is not the way in which to help them and minimise the problem. I therefore urge my hon. Friends to join me in vehemently opposing Third Reading.

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