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15 Jan 2003 : Column 779—continued
6.37 pm
Mr. David Hinchliffe (Wakefield): The Government deserve much credit for the steps that they have taken and the measures that they have introduced to improve collaborative working between health and social services departments. However, the Bill does not deserve credit and I agree with some of the points that the hon. Member for West Chelmsford (Mr. Burns) made and the anxieties that several hon. Members have expressed.
The Health Committee examined delayed discharges, and we did not receive evidence from any source—health departments, social services departments or voluntary organisations—in support of the principles at the heart of the Bill. Not even Department of Health officials appeared especially enthusiastic about it. I
made my anxieties known on Second Reading, but the Minister did not respond to them. She is a competent Minister, for whom I have a high regard, but I remain convinced that the Bill does not tackle those concerns.The model is based on the policies that were applied 10 years ago in Sweden. It was interesting to visit that country shortly before Christmas and discuss with political colleagues in the Swedish Parliament whether the measure could work. I admit that some improvements have occurred in Sweden, but colleagues were concerned about the number of people whose discharge from hospital was delayed. In Sweden, county councils run hospitals and municipalities run social services, and integration is being considered.
I humbly suggest that the Government may eventually want to consider that the lack of an integrated health and social care system is the genuine problem. An increasing number of Labour Members who have examined the matter are beginning to agree that integration is the way forward.
I cannot support the Bill. It is a bad measure that has not been thought through. It will damage the good, positive relationships between health and social services departments that the Government have created in some areas. I hope that, even at this late stage, they will see sense and take advantage of opportunities in another place to withdraw the measure.
6.40 pm
Sir George Young : I hope that the Government will take to heart the very measured comments that we have just heard from the Chairman of the Select Committee on Health.
I preface my brief remarks by saying that, given the terrible hand the Minister was dealt in being asked to take the Bill through, she did so with competence and patience, both in Standing Committee and on Report.
I said on Second Reading, which seems very recent, given the speed at which the Bill has gone through the House, that the Bill was one of the worst I had seen in some 30 years. Despite the heroic attempts by the Opposition parties and the welcome amendment that we have just passed on carers, I think that it is one of the worst Bills to go through the House in those 30 years. If there is one discharge that should be delayed, it is the discharge of this Bill from the other place.
I hope that the Government will find that their ambitions to get the Bill through quite quickly, by April this year, are dashed by the very serious consideration that those in another place give it. We have not had proper time to consider it. There were chunks that we did not debate in Standing Committee. We lost an amount of time on Report because of the statements that, understandably, were made.
Not only has the Bill been rushed through, but the timetable for implementation is very challenging. The Minister has ignored the many pleas from those who have to implement the Bill to delay it until April 2004. That was a concession that she might well have made.
Of course, the Bill is unwanted by local authorities, but it is also unwanted by the health service. We heard in Standing Committee of representatives of the NHS Confederation and of the medical profession saying that
they did not want it either, because it will damage the relationships that they value between them and social services.The Bill has been condemned by all the voluntary organisations. Just today, we heard from Help the Aged, Age Concern and the Alzheimer's Society. I cannot think of a single voluntary organisation that has welcomed the Bill. The point made by those to whom I have referred is that the Bill is misguided, because it focuses on one very narrow part of the problem—the discharge from hospital to care in the community, a care home—instead of standing back and taking a holistic look at the problem from start to finish.
The Bill is unfair and unilateral. It involves a unilateral fine by one part of the public sector on another, with no opportunity for that other sector to obtain reimbursement when it faces costs because of delays by the NHS. If there is a dispute, as we heard earlier today, the jury is not wholly unbiased.
The Bill ignores the role that the Government have played in reducing the capacity in the care home sector, which is one of the strategic reasons behind delayed discharges. It will distort local government priorities. Local authorities will spend less time and energy on prevention to avoid the fines. As we heard today, if one wants to get somebody into a care home, the best way to do it now is to get them into hospital first. The law of unintended consequences and perverse incentives will apply.
On Second Reading, the Bill was virtually friendless on the Government Benches. Indeed, the only contribution from Labour Members on Third Reading has been deeply hostile. At a time when the NHS needs less bureaucracy it will get more, with invoices flying backwards and forwards between social services and the NHS. I know of no right-wing economist in this country who ever proposed an internal market of this nature to deal with the problem.
I believe that the Bill is flawed in concept and will be divisive in its consequences. I shall walk through the No Lobby with a spring in my step to register in the only way still available to me my deep-rooted objection to this legislation.
6.44 pm
Mr. Kevin Hughes: I welcomed the Bill on Second Reading, and I assure my hon. Friend the Minister that I shall support her in the Lobby tonight.
The Bill is an instrument, albeit a blunt instrument, as described by the Select Committee of my hon. Friend the Member for Wakefield (Mr. Hinchliffe), to concentrate people's minds.
The hon. Member for West Chelmsford (Mr. Burns) and my hon. Friend the Member for Wakefield, for whom I have a great deal of time and respect, seem able to see only the negative points. They seem to think that the Bill will create a combat atmosphere between social services and the health services. I do not see it that way. The Bill will concentrate people's minds on better co-operation.
Sir George Young: Like the Whips Office.
Mr. Hughes: No, not like that.
We are talking about people, mostly old people, being trapped in hospital, and some social service departments and health authorities are doing very little to tackle that. Fortunately, in my constituency, they are doing something. Planning for discharge starts before patients are admitted for elective surgery, and that is how it should be. The team that works in Doncaster can call on a range of options. If necessary, it can use an intermediate care ward, which has been provided by joint funding, as well as aids, adaptations and all the rest of it. The proposals need not be combative at all; they can lead to more co-operation.
Let us not forget that the Bill is about getting people out of the hospital beds in which they are trapped even though they no longer need health care treatment. That is why I shall walk through the Lobby tonight in support of my hon. Friend the Minister and the Government.
6.46 pm
Mr. Burstow: I note that the hon. Member for Doncaster, North (Mr. Hughes) will not walk through the Lobby with a spring in his step, unlike the right hon. Member for North-West Hampshire (Sir George Young).
I thank the hon. Member for Wakefield (Mr. Hinchliffe) and his Select Committee for the report on delayed discharge that they published last year. It is an invaluable piece of research, which I found very useful in Committee, and many of the questions put to officials during the inquiry provided useful answers. As I read through the evidence given to the inquiry, it suggested to me that there was a great lack of enthusiasm among officials and, indeed, anyone who gave evidence about this approach. Indeed, officials said that delayed discharges are a symptom of a wider, whole system problem and that we are lacking in capacity, in planning and in preventing admissions in the first place. Four Committee sittings and consideration on Report later, nothing fundamental has changed in the Bill.
Rather than building on and continuing to encourage the partnership between the NHS and social services departments that hon. Members on both sides of the House would wish to develop, the Bill will create an adversarial approach of game playing and cost shunting between the two. Worse still, it will turn the patient into a commodity to be haggled over by social services departments and the NHS. There is no room in the Bill for informed consent.
As the Bill has progressed through the House, I have been drawn to the conclusion that it is about beds, not the needs or interests of patients. It is a strange sort of partnership that gives one partner a stick to beat the other. That sounds rather more like domestic violence than addressing the real needs of the health service.
The Bill, as it leaves the House, will put in place a system of fines, as the Minister has confirmed from the Dispatch Box today, that will distort the spending
priorities of local social services departments. Those departments will have to prioritise hospital patients for assessments and services, because a fine is attached, at the expense of those who are hidden, frail and isolated, in their own homes and who count only when they wind up in hospital because of a fall or some other mishap.In Committee, the Minister talked about the introduction of financial flows—she did so again today—that will lead to hospitals picking up a penalty if emergency admissions take place. She conveniently did not mention that that reform would not start until April 2004. She did not tell us that the single assessment process will not start until that date; nor did she tell us that, although some extra cash for some councils will arrive in April this year, councils did not know the details of those budgets until December and are only now beginning to find out what they mean for them and their communities in terms of council tax rises and investment in services. It is hardly surprising that the services to bridge the gap in capacity have not yet been put in place. The Minister has remained blind to the issues of capacity throughout this debate.
When the Bill makes its way to the House of Lords, I can assure the Government that my colleagues on the Liberal Democrat Benches will do all that they can to ensure that it does not have a safe passage through the other place. I thank my hon. Friend the Member for Cheadle (Mrs. Calton) and my staff for their hard work on the Bill. This is a bad Bill, and the Liberal Democrats reject it. It puts beds before patients and sets the NHS up against social services. It makes it much more likely that, in future, more people will get the wrong care in the wrong place at the wrong time.
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