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19 Mar 2003 : Column 973—continued

Notice of Patient's Possible Need for Community Care Services

Lords amendment: No. 5, in page 2, line 5, after "hospital" insert "after 1st April 2004".

Jacqui Smith: I beg to move, That this House disagrees with the Lords in the said amendment.

Madam Deputy Speaker (Sylvia Heal): With this it will be convenient to discuss Lords amendment No. 47 and the Government motion to disagree.

Jacqui Smith: Lords amendment No. 5 would delay for a year until April 2004 the implementation of the policy outlined in the Bill. When we announced the policy in April 2002, we were keen to implement it by April this year so that older people could benefit as quickly as possible from the improvements in services and procedures that we firmly believe the Bill will bring. They include: focus on the individual, and ensuring that people get the right care at the right time and in the right place; the introduction of incentives to invest in alternatives in the community so that older people are not trapped in hospital when they would be better treated outside; and a clear framework for partnership between health and social care locally.

2.30 pm

We know from the implementation team that we have established that many areas have made significant achievements since we announced the policies. The Bill has led to an unprecedented wave of activity around delayed discharge with local authority and NHS partners discussing shared problems and finding common solutions. Several areas have initiated reviews of whole systems to consider discharge processes and community service capacity so that they are well prepared for reimbursement.

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Other areas have planned staff increases or co-location to speed up assessment and improve discharge planning. The Bill can therefore be considered a success already because people know that if they do not make efforts to improve discharge procedures and put services in place, they cannot benefit from the extra funding that we are transferring from the NHS. They will have to reimburse the NHS.

Mr. Burns: Before the Minister embarks on a spinning fantasy, will she clarify the reason for her use in Committee and now of words such as "incentives", "bonuses" and "improvements", when the Secretary of State describes the penalties under the Bill as "fines"? Indeed, that is what they are.

Jacqui Smith: Despite having been involved with the Bill for a long time, the hon. Gentleman fails to understand the principle that payment follows responsibility. His failure to understand is not my fault. When responsibility for providing services based on the individual's needs shifts from the NHS to social care, so should responsibility for payment.

The Bill can already be considered a success and we are worried that amendment No. 5 in particular puts that at risk. One social services manager stated that in the past five years he had never witnessed so much commitment to reducing delays in the NHS and social care. That is not an isolated remark. People who attended a recent conference, which our change agents team ran, stated that, far from wrecking partnership—Conservative Members have sometimes alleged that—the pressure to improve discharge that the Bill generates led staff from the NHS and social services to discuss together, sometimes for the first time, plans to reduce delays in their local hospitals.

There is a genuine risk that the benefits of that concentrated effort will be lost.

Mr. John Bercow (Buckingham): I fear that the Minister risks creating a pervasive cynicism about the Bill—even more pervasive than that that has existed hitherto—unless she responds properly to the point of my hon. Friend the Member for West Chelmsford (Mr. Burns). If people incur a financial cost for doing something that they should not, or for failing to do something that they should, can the Minister think of a shorter or more accurate term for what they face than "fine"?

Jacqui Smith: A fine implies that someone is not supposed to be doing something. It is strange that the hon. Gentleman does not realise that we are considering putting right a position in which all the incentives in the system are for leaving people in hospital over a longer period because the NHS effectively pays for the needs of largely older people, responsibility for which should rest with social services departments.

If the hon. Gentleman wants to argue for cost-shunting and shifting responsibility, he should do so. The Bill aims to put matters right.

Mr. Bercow: If the Minister will allow me, I will exercise my discretion over the language that I deploy. I would not settle for the rather down-market lexicon that

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she has in mind for me. If she will not use the word "fine", why does the Secretary of State continue to do that regularly?

Jacqui Smith: Perhaps the hon. Gentleman should ask the Secretary of State. My right hon. Friend and I share an understanding that at present—[Laughter.] We can laugh and banter about words, but Conservative Members should be ashamed of the underlying reason for the measure. In 1997, 6,800 people were inappropriately delayed in hospital. Our investment and reforms have reduced that number.

Mr. Burns: It went up.

Jacqui Smith: I should be interested to know when that happened. There is a significant reduction in the number of delayed discharges that we inherited from the previous Government. Investment and some top-down management have brought that about. We have argued that such a system is not sustainable. We need to ensure that the system includes incentives for the considerable extra investment in local authorities to be spent on alternatives that provide that older people can get out of hospital when necessary. The Bill will achieve that. As I said earlier, to some extent it already ensures that that happens. It gives an impetus to the joint working that we need and the focus on the needs of individuals when they are ready to be discharged from hospital.

Accepting the amendments will convey the message that the work can be put on hold for a year. The impetus that has built up will be wasted and a continued and sustained reduction in waiting times for discharge will be delayed.

We have listened to the anxieties of the NHS, local government, the voluntary sector and responsible hon. Members about the speed of implementation and the need for time for new investment in services to bear fruit. The Government have therefore proposed delaying implementation for six months until October 2003. As Lord Morris said in another place:

Mr. Waterson: Will the Minister explain to a simple soul like me why it makes things better for the people who have to implement the measure in the real world to introduce it half way through a financial year? Is that sensible? What sort of chaos will that produce in the system?

Jacqui Smith: We would have preferred to introduce the measure in April but we listened to what people in the real world said about their worries. [Hon. Members: "Lords."] Whether hon. Members in another place are the people in the real world is questionable, but we listened to people who operate in the real world and we shall ensure, through the delay in implementation, that the considerable extra investment from April 2003–04 makes the necessary impact without delaying, to the detriment of largely older people, the incentives that the

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Bill establishes and the action that it has prompted. Those older people will benefit from the provisions and already benefit from the reduction in delayed discharge that the prospect of action has brought about. I do not understand what can be gained from delaying implementation for a year. There is something to lose from that.

Mr. Paul Burstow (Sutton and Cheam): The Minister has been telling us that the Government have been listening to real people outside this place. Will she comment on why the Government chose to ignore their own consultation results, which showed that primary care trusts, social services departments and voluntary organisations of all sorts told the Government that they wanted a delay of at least a year, and to see implementation no earlier than 1 April 2004?

Jacqui Smith: As I was explaining, we listen not only to those who provide the services, but to the people who need them. They are the older people who, in too large numbers, are being trapped in hospital when they would be better off being treated outside. We believe that the Bill will make a difference to those older people, and that is why we are keen to ensure that it is implemented as soon as possible. Of course we need to listen to the people who provide the services, but those—largely older people—who are being delayed in hospital when it would be more appropriate to treat them outside are at the heart of the Bill and of our concerns.

Sir George Young (North-West Hampshire): If it really is the view of elderly people that the Government should proceed as she has just outlined, why has Age Concern written to every Member of Parliament totally disagreeing with her?

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