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19 Mar 2003 : Column 957—continued

Registration of Private Foster Carers and Child Protection

Tim Loughton accordingly presented a Bill to require the registration of private foster carers; to institute procedures for identifying and monitoring children arriving in the United Kingdom unaccompanied by adults with parental responsibility and make provision for their welfare; and to amend the law with regard to joint enterprise when prosecuting carers responsible for the death of children in their care; and for connected

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purposes: And the same was read the First time; and ordered to be read a Second time on Friday 4 July, and to be printed [Bill 80].


Motion made, and Question put forthwith, pursuant to Orders [28 June 2001 and 29 October 2002],

    Subsequent Stages

    3. Any further Message from the Lords may be considered forthwith without any Question put.

    4. Proceedings on any further Message shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—[Mr. Woolas.]

Question agreed to.

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Orders of the Day

Community Care (Delayed Discharges Etc.) Bill

Lords amendments considered.

Clause 1

Meaning of "NHS Body" and "Qualifying Hospital Patient"

Lords amendment: No. 1.

1.26 pm

The Minister of State, Department of Health (Jacqui Smith): I beg to move, That this House agrees with the Lords in the said amendment.

Mr. Speaker: With this we may discuss Lords amendment No. 2 and the Government motion to disagree thereto and Lords amendment No. 3.

Jacqui Smith: In welcoming the Bill back from the other place, I take this opportunity to express my appreciation of the work of my noble Friend Lord Hunt in taking the Bill through the Lords. He was a good and able colleague, who will be missed by me and by many people who are interested in this sector.

Lords amendments Nos. 1 and 3 are technical amendments, which are necessary to provide clarification that the Bill does not apply to any person who is ordinarily resident outside England and Wales. They do not affect the substance of the Bill in any way, but simply serve to avoid any misunderstanding in the future about the patients to whom the Bill is intended to apply. I therefore hope that hon. Members will join me in supporting them.

We disagree with the Lords in their amendment No. 2. The amendment would specifically exclude patients with a mental health condition from the Bill's provisions. The intention of the Bill is that payment responsibility should rest with the body that has responsibility for providing for the needs of a patient, to ensure that the patient receives the right care, in the right place and at the right time. It would establish a system of incentives to ensure the appropriate delivery of care.

The Government's intention is to use the regulations to exclude mental health care from the scope of the Bill, and later to extend the provisions of the Bill to other types of care where there are delays. We have chosen to take a pragmatic approach, as we do not want to overload local partnerships with preparing for implementation across the system.

It is not justified, however, to prevent the possibility of those provisions being extended to cover mental health. Indeed, the Joint Committee on Human Rights was concerned that the provisions of the Bill should not exclude patients with mental health problems, as that could be seen as discrimination because the nature of the patient's condition was mental rather than physical. However, we will make the decision to extend the scope

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of the Bill after a full and proper examination of the needs of mental health patients and of incentives in the mental health sector as a whole.

The Department has received representations from many mental health professionals who are concerned that their patients should be included in these provisions as soon as possible, to benefit from the more timely provision of services that should result. For example, an e-mail from a consultant psychiatrist for older people puts it clearly:

    "Many of my patients are waiting months for placement in appropriate long term care; waiting on an acute ward with acutely ill, depressed or confused patients is very detrimental to their health. They are just as disadvantaged as any other older patient which this Bill seeks to benefit".

I recognise that concern. Surely patients with mental health problems deserve the opportunity to ensure, as the Bill will for other patients, that they receive that care when they need it.

1.30 pm

If the Bill is successful—I am confident that it will be—in continuing to reduce patient waits for community care services so that patients can be safely discharged from hospital, I cannot understand how excluding mental health patients from the system can be justified. The right course of action is to monitor the effect of reimbursement on the acute sector and then, if appropriate, make a decision to include the mental health sector in the light of evidence. If we were to exclude that sector now, we would fail to recognise the very important benefits that the Bill could bring, and that could be discriminatory; so I hope that my colleagues and other hon. Members will disagree with the Lords in the said amendment.

Mr. Simon Burns (West Chelmsford): I wish to speak to Lords amendment No. 2. I hope that my right hon. and hon. Friends and others will not share the Government's view that they should disagree with the other place in that amendment, because its purpose is to exclude mental health patients from these provisions. Notwithstanding what the Minister has just said, we believe that there is a separate problem with mental health patients, as opposed to acute patients, partly because of the historic situation in the national health service until about a decade ago.

I believe that—this is becoming a bit of a cliché—mental health was a Cinderella service until about a decade ago, regardless of which Government were in power. If a Government—again, regardless of their political complexion—needed to make savings or had financial constraints on health spending for other reasons, it was too easy to sweep a range of services under the carpet, and mental health services suffered most. In addition, there was—sadly, there still is—a problem with the general attitude of this country's population.

Some people think that there is something odd or unacceptable about mental health problems, so people suffering from such problems do not receive the same consideration and concern from friends and even family as other patients. That prejudice has continued despite, to be fair, the efforts of this Government and those of John Major's Government to reduce the stigma

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attached to mental illness and to bolster the health service provision for those with mental illness with genuine increases in funding and focusing attention on improving and enhancing mental health care. There is still, however, a fundamental difference—whether it is right or wrong is another matter—between mental health patients and acute patients, and the Bill should reflect that fact of life, whether one likes it or not.

Of course, over-extended stays in psychiatric wards are a problem. For example, a recent survey in acute psychiatric wards, conducted by the Sainsbury Centre for Mental Health, concluded that hospital care was non-therapeutic, but there are times when hospital admissions cannot be avoided. For example, when patients are so ill that they are incapable of looking after themselves, hospitals provide the only appropriate care for them. However, mental health care is in many ways very different from acute care, so different approaches are needed.

Given those unique mental health considerations, if legal duties are imposed under the Bill to compel one part of the sector, in effect, to penalise the others, that could put at risk especially vulnerable patients suffering from mental health problems. In addition, there is a shortage of capacity in hospitals, other supported accommodation, rehabilitation services and 24-hour staffed beds in inner cities. As a result, to require local authorities to provide care quickly in those circumstances is unrealistic and unfair, and it could be dangerous in certain conditions.

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