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15 Jan 2003 : Column 783—continued
6.50 pm
Andy Burnham : I have sat here all afternoon listening to an unending stream of negativity and doom from the Opposition Benches. I feel compelled to rise to speak, because the Bill offers two major benefits to which the two Opposition parties have given no regard whatever. First, it will lead us, as a society, to support more people at home and lead to much less reliance on institutional care than at present. Secondly, it will bring down the average length of stay in acute beds, which will allow more patients to be treated on the NHS. All Opposition Members agreed that it would bring down the average length of stay, yet they seemed to suggest that that was purely negative. I put it to them that it might actually be positive.
Why will the Bill help more people to live at home for longer? My own family experience tells me that, once a patient has been deemed fit for discharge—that is, once a clinical decision has been made to discharge them, so there is no question of their being forced home too early—it is in the patient's direct interest that that discharge should happen as soon as possible. We have all seen examples of people who have languished in hospital for too long, then drifted into residential or nursing care and lost the opportunity to go back home and be supported there. The Bill will expedite the discharge process and, together with the provision of free aids and adaptations, get more people home once they are able to cope.
Unlike some on the Conservative Front Bench, I do not believe that nursing homes are a good place to be. I saw my grandmother deteriorate rapidly after she went
from a long stay in hospital to residential care and then to nursing care. Her personal possessions were stolen while she was in residential care, and her wedding ring was ripped off her finger in the last days before she died. Nursing homes are not a good place to be. We need to encourage more people to live independently at home, which is what I believe the Bill will allow us to do.The Bill will bring down the average length of stay in NHS beds, which will allow us to treat more NHS patients. Like the Health Committee Chairman, I, too, went to Sweden. We visited the Huddinge university hospital and heard from Dr. Lars Collste.
Mr. Burns: Will the hon. Gentleman give way?
Andy Burnham: The hon. Gentleman did not go to Sweden, so I will not let him intervene.
Dr. Collste told us that, before the cross-charging system was introduced in Sweden, the average length of stay for an in-patient episode was seven to eight days. After the system was introduced, it went down to 4.8 days. His view was that the system worked.
Mr. Burns: Will the hon. Gentleman give way?
Andy Burnham: I will not, because other Members want to speak.
We also heard, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, that the system was being reviewed by the Swedish Parliament. That is true. It is looking at ways in which the cross-charging system can be reconciled with more co-operation. It is not ditching the system; it is simply looking at how municipalities and counties can co-operate more when the system is introduced. I do not think that that is a bad thing, and the Department might like to look at the experience in Sweden before the measures in the Bill are finalised.
I congratulate the Minister on her skilful steering of the Bill through Parliament, and I look forward to it bringing the two major improvements that I have outlined to my constituents.
6.54 pm
Mrs. Joan Humble (Blackpool, North and Fleetwood): I welcome the opportunity to speak on this important issue. I shall preface my remarks by saying that I fully support the aims of the Bill. I have listened to my hon. Friend the Minister speak with some passion about the needs of elderly people trapped in hospital beds who ought not to be there and who need an appropriate form of care. It is absolutely vital that those people get the care appropriate to their condition or illness, whether that be a hospital bed, a nursing home bed, a place in a care home or intermediate care home, or support in their own home.
I rehearsed some of my concerns on Second Reading, and I still have concerns about the implications for local authorities, but one aspect of the Bill that I welcome is the introduction of new, robust joint assessment procedures. As I have said to my hon. Friend the Minister before, in my local area we have good working between health and social services, which I want to continue, but I am aware that the situation nationwide
is variable, so it is vital that we have a new and comprehensive assessment procedure to benefit patients in hospitals.Will my hon. Friend the Minister look carefully at the implementation timetable and listen to the concerns of local authorities, the health service and, especially, those elderly people who all need caring for? Will she carefully consider the comments that she is getting back to ensure that she is properly monitoring the implementation timetable so that local authorities, health services and, above all, the elderly people we represent are not disadvantaged?
6.56 pm
Dr. Desmond Turner (Brighton, Kemptown): I echo the plea of my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble) for clemency for local authorities such as mine, which have been doing their damnedest to do exactly what the Government have asked. They are producing the close working, but, none the less, they face problems and circumstances that are totally beyond their control, such as shortages of nurses and elderly mentally infirm beds as well as trained care workers to provide domiciliary care services. That means that punitive measures in clause 4 will cost them about #1 million a year if they are implemented this spring.
The authorities need more time, and it would be folly and very sad if the #100 million that the Government are giving to extend care capacity for this purpose were simply taken back in fines. That would achieve nothing. Therefore, sensitive timing of the implementation of the more difficult measures is essential.
6.57 pm
Glenda Jackson : On Second Reading, I paid tribute to the absolute commitment of Camden, my local authority, to creating a multi-faceted, properly integrated, high-quality service for elderly people. Indeed, my hon. Friend the Minister paid tribute to Camden and, I believe, Croydon on Second Reading and in Committee for their abilities in reducing delayed discharges, but I must tell her that my local authority's concerns are by no means stilled or quieted. I add my voice to those of my hon. Friends who have urged the Government to pay particular attention to the timetabling of the introduction of these measures.
On going into the fine detail, my local authority discovered that, far from getting a 6 per cent. increase, it is receiving only a 3 per cent. increase in social services funding. Certain authorities suffer from a shortage of available places, because the majority of elderly people undoubtedly want to remain in their locality, which can be a particular difficulty for an inner-London authority such as mine. There are also concerns in my local authority over the costs of implementing the examination of throughput on the issue. It urges the Government to allow it time properly to track how it can better integrate the more-than-one service required to ensure that elderly people are not left in hospital past the point required by their medical care.
I urge the Government to delay, if possible, the introduction of the measures until all local authorities have properly examined such questions. I accept that
not all local authorities are as effective or committed as Camden, but I do not believe that the effective and committed local authorities should be punished because others have still not got their act together.Question put, That the Bill be now read the Third time:—
The House divided: Ayes 323, Noes 188.
AYES
Abbott, Ms Diane
Adams, Irene (Paisley N)
Ainger, Nick
Allen, Graham
Anderson, Janet (Rossendale & Darwen)
Armstrong, rh Ms Hilary
Atherton, Ms Candy
Atkins, Charlotte
Austin, John
Bailey, Adrian
Baird, Vera
Banks, Tony
Barron, rh Kevin
Battle, John
Beard, Nigel
Beckett, rh Margaret
Begg, Miss Anne
Bell, Stuart
Benn, Hilary
Bennett, Andrew
Benton, Joe (Bootle)
Best, Harold
Betts, Clive
Blackman, Liz
Blears, Ms Hazel
Blizzard, Bob
Boateng, rh Paul
Borrow, David
Bradley, rh Keith (Withington)
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brennan, Kevin
Brown, rh Nicholas (Newcastle E Wallsend)
Brown, Russell (Dumfries)
Bryant, Chris
Burgon, Colin
Burnham, Andy
Caborn, rh Richard
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
Corston, Jean
Cousins, Jim
Cox, Tom (Tooting)
Cranston, hon. Ross
Crausby, David
Cruddas, Jon
Cryer, Ann (Keighley)
Cryer, John (Hornchurch)
Cummings, John
Cunningham, Jim (Coventry S)
Cunningham, Tony (Workington)
Davey, Valerie (Bristol W)
David, Wayne
Davidson, Ian
Davies, rh Denzil (Llanelli)
Davies, Geraint (Croydon C)
Dawson, Hilton
Dean, Mrs Janet
Denham, rh John
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
Eagle, Angela (Wallasey)
Eagle, Maria (L'pool Garston)
Edwards, Huw
Efford, Clive
Ellman, Mrs Louise
Ennis, Jeff (Barnsley E)
Etherington, Bill
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
George, rh Bruce (Walsall S)
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
Harman, rh Ms Harriet
Harris, Tom (Glasgow Cathcart)
Healey, John
Henderson, Doug (Newcastle N)
Henderson, Ivan (Harwich)
Hendrick, Mark
Hepburn, Stephen
Heppell, John
Hesford, Stephen
Hill, Keith (Streatham)
Hoey, Kate (Vauxhall)
Hood, Jimmy (Clydesdale)
Hoon, rh Geoffrey
Hope, Phil (Corby)
Hopkins, Kelvin
Howarth, rh Alan (Newport E)
Howarth, George (Knowsley N & Sefton E)
Hughes, Kevin (Doncaster N)
Humble, Mrs Joan
Hutton, rh John
Iddon, Dr. Brian
Ingram, rh Adam
Irranca-Davies, Huw
Jackson, Glenda (Hampstead & Highgate)
Jackson, Helen (Hillsborough)
Jamieson, David
Jenkins, Brian
Johnson, Miss Melanie (Welwyn Hatfield)
Jones, Helen (Warrington N)
Jones, Kevan (N Durham)
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
McDonagh, Siobhain
MacDonald, Calum
MacDougall, John
McFall, John
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)
Michael, rh Alun
Milburn, rh Alan
Miliband, David
Miller, Andrew
Moffatt, Laura
Mole, Chris
Moonie, Dr. Lewis
Moran, Margaret
Morgan, Julie
Morris, rh Estelle
Mountford, Kali
Mudie, George
Mullin, Chris
Munn, Ms Meg
Murphy, Denis (Wansbeck)
Murphy, Jim (Eastwood)
Murphy, rh Paul (Torfaen)
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)
Reed, Andy (Loughborough)
Reid, rh Dr. John (Hamilton N & Bellshill)
Robertson, John (Glasgow Anniesland)
Robinson, Geoffrey (Coventry NW)
Ross, Ernie (Dundee W)
Roy, Frank (Motherwell)
Ruane, Chris
Ruddock, Joan
Russell, Ms Christine (City of Chester)
Salter, Martin
Savidge, Malcolm
Sawford, Phil
Sedgemore, Brian
Shaw, Jonathan
Sheerman, Barry
Sheridan, Jim
Shipley, Ms Debra
Simon, Siôn (B'ham Erdington)
Singh, Marsha
Skinner, Dennis
Smith, rh Andrew (Oxford E)
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
Spellar, rh John
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
Todd, Mark (S Derbyshire)
Touhig, Don (Islwyn)
Trickett, Jon
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)
Wills, Michael
Wood, Mike (Batley)
Woodward, Shaun
Woolas, Phil
Worthington, Tony
Wright, Anthony D. (Gt Yarmouth)
Wright, David (Telford)
Wright, Tony (Cannock)
Wyatt, Derek
Tellers for the Ayes:
Joan Ryan and
Gillian Merron
NOES
Ainsworth, Peter (E Surrey)
Allan, Richard
Amess, David
Ancram, rh Michael
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
Bottomley, rh Virginia (SW Surrey)
Brady, Graham
Brake, Tom (Carshalton)
Brazier, Julian
Brooke, Mrs Annette L.
Browning, Mrs Angela
Bruce, Malcolm
Burnett, John
Burns, Simon
Burnside, David
Burstow, Paul
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
Curry, rh David
Davey, Edward (Kingston)
Davies, Quentin (Grantham & Stamford)
Davis, rh David (Haltemprice & Howden)
Dodds, Nigel
Dorrell, rh Stephen
Doughty, Sue
Duncan Smith, rh Iain
Evans, Nigel
Fabricant, Michael
Fallon, Michael
Flight, Howard
Flook, Adrian
Forth, rh Eric
Foster, Don (Bath)
Fox, Dr. Liam
Gale, Roger (N Thanet)
George, Andrew (St. Ives)
Gibb, Nick (Bognor Regis)
Gidley, Sandra
Gillan, Mrs Cheryl
Grayling, Chris
Green, Damian (Ashford)
Green, Matthew (Ludlow)
Gummer, rh John
Hammond, Philip
Hancock, Mike
Harris, Dr. Evan (Oxford W & Abingdon)
Harvey, Nick
Hawkins, Nick
Hayes, John (S Holland)
Heathcoat-Amory, rh David
Hendry, Charles
Hermon, Lady
Hinchliffe, David
Hoban, Mark (Fareham)
Hogg, rh Douglas
Holmes, Paul
Howard, rh Michael
Howarth, Gerald (Aldershot)
Hughes, Simon (Southwark N)
Hunter, Andrew
Jack, rh Michael
Jackson, Robert (Wantage)
Jenkin, Bernard
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
Letwin, rh Oliver
Lewis, Dr. Julian (New Forest E)
Liddell-Grainger, Ian
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
Marsden, Paul (Shrewsbury & Atcham)
Mates, Michael
Maude, rh Francis
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)
Page, Richard
Paice, James
Paterson, Owen
Pickles, Eric
Portillo, rh Michael
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
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
Taylor, Ian (Esher)
Taylor, John (Solihull)
Taylor, Matthew (Truro)
Taylor, Dr. Richard (Wyre F)
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
Webb, Steve (Northavon)
Whittingdale, John
Widdecombe, rh Miss Ann
Wiggin, Bill
Willetts, David
Williams, Hywel (Caernarfon)
Williams, Roger (Brecon)
Willis, Phil
Winterton, Sir Nicholas (Macclesfield)
Yeo, Tim (S Suffolk)
Young, rh Sir George
Younger-Ross, Richard
Tellers for the Noes:
Mr. David Wilshire and
Mr. Mark Francois
Question accordingly agreed to.
Bill read the Third time, and passed.
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