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19 Mar 2003 : Column 979—continued
Jacqui Smith: Does the hon. Gentleman accept that the number of people aged 75 and over whose discharges have been delayed was 3,502 in December 2002? Is that figure not less than half the 6,985 that the Government inherited?
Mr. Burns: On the basis of parliamentary written answers I have received from the Minister, I accept that the figures have dropped. There is no secret about that. It is, however, bogus codswallop for the Minister to claim, as she did in her speech, that the result was achieved through the success of a Bill that has not even become law—although we are now used to new Labour, new spin.
The Lords amendments are at the nub of why my colleagues and I, along with many others, oppose this nasty piece of legislation. As I am sure you know, Madam Deputy Speaker, success has many fathers and failure is an orphan. One could list the examples, but as was pointed out by my hon. Friend the Member for Buckingham (Mr. Bercow) and my right hon. Friend the Member for North-West Hampshire (Sir George Young), in the real world in which people look after the elderly in hospital, care homes or their own homes on a daily basis there are no friends for the Bill: it is very much an orphan. Its only supporters are the Minister,
her boss and her Back Benchers—with notable exceptions. The wise Chairman of the Select Committee does not support it, along with many other Labour Members.Those Members do not support the Bill because it is wrong in its intent to introduce a system of fines that will do incalculable damage to the tremendous progress that has been made over the past decade or so in getting the NHS and local authorities to work together in the whole area of care for the elderly and discharge from hospital. As has been said by many local authorities and by the Local Government Association—led by Sir Jeremy Beecham, a Labour councillor I believe—it will damage, perhaps destroy, those working relationships. It will also set the NHS against social services departments. There are better ways of legislating. Moreover, the proposals are unfair. As we all know—except, of course, the Minister, who is in constant denial because this is not good news for the Government—more than 60,000 care home beds have been lost over the past six years.
Mr. Hinchliffe: The hon. Gentleman knows only too well that that figure, which he keeps parroting, is completely wrong. He knows that the Health Committee, of which he is a member, came up with a figure that, although it did not accord with the Government's figure, certainly did not accord with the Tories' 50,000 figure, which has now risen to 60,000. I respect the hon. Gentleman, who does a good job on the Committee, but he must accept that sometimes we come up with the facts rather than the fiction that he has just presented.
Mr. Burns: I respect the hon. Gentleman too. We have a mutual admiration society. If he returns to the relevant papers, however, he will be reminded that we asked the Select Committee to look into the matter and try to find a solution. The Committee said that both figures were right: my figure and the figure of about 19,000 that the Government gave about 18 months ago. The papers go on to say, though, that the Government's figure excludes the number of beds lost in the local authority sector. If the local authority figures are added to the private sector figures, we reach the figure that I have given.
Mr. Dawson: Will the hon. Gentleman give way?
Mr. Burns: No, because this is a timed debate and I want to make progress. Along with Lang and Buisson, an independent body, I believe that my figure is correct.
The fines will put pressure on social services departments to bring about inappropriate and premature discharge of patients from hospitals. Already—although, interestingly, the Minister did not mention this—the rate of readmission of over-75s has increased dramatically in the last few years. Let me give the Minister the figures. There were 12,165 readmissions within seven days of discharge in the second quarter of 2001–02; the number had risen to 13,813 by the third quarter of 2002–03. That is an increase from 2.9 to 3.3 per cent. Similarly, emergency readmission rates for up to 28 days have risen from 2.9 to 4.9 per cent. By putting unfair financial penalties on the system, patients will be discharged from hospital prematurely, and will
perhaps not receive the most appropriate care. As the figures suggest, the result will be unacceptable and unfair readmittance for those patients.3 pm
I believe that we must seek to bring down the level of delayed discharges. Everyone in this House accepts that having people in hospital who should not be there, and at a considerably greater expense than if they were out of hospital, is an utter waste of money; where we disagree is on the solution to the problem. To bring in a simplistic policy that sets local authority against the health service and vice versa, and which can lead to inappropriate and hasty discharges from hospital, and to readmissions, is the wrong way to proceed. I hope that many Members will join me in voting for amendment No. 5, which would postpone the introduction of this legislation by a year, to 1 April 2004.
As a sop to Back-Bench Labour MPs who were in revolt on Second Reading, the Secretary of State announced that health service money would be made available to social services to help them pay the fines that they will incur if they fail to comply with this law. However, postponing enactment of the legislation beyond the six months proposed by Lord Hunt following the introduction of this amendment would provide a year during which the money made available by the Department of Health could be invested to improve the situation, and to minimise the problems of delayed discharge. [Interruption.] The Minister nods in a negative way. Does that suggest—[Interruption.] Nodding in a negative way may be a contradiction in terms, but that is what she was doing. Is she suggesting that if this amendment were successful and the law's introduction were to be delayed by a year, the Government would not make that money available for the financial year 2003–04? If so, that differs from what the Government have been saying so far. If not—if the money will be paid out this April—it would be better to invest the money for a year in the health service, and in local authorities and social service departments, to seek to minimise the problem of delayed discharge. Then, if we have to, we could introduce the system of fines next year, after a year of investing the money to seek to minimise the problem.
If this legislation is as wonderful as the Minister claims, there should be a sunset clause—amendment No. 45—so that it is removed from law within five years of coming into force. The Minister asked what would happen if the problem were solved before then, but the answer is very easy for the Government. All that they would have to do is to repeal the law immediately; they need not wait for the sunset clause to take effect.
For those reasons, we should agree with the Lords. The Government may find it difficult to believe this now, but they will believe in time that the other place has in fact done them a favour by passing these amendments. In doing so, they have provided a semblance of improvement to what, in essence, is nasty legislation.
Glenda Jackson: As my hon. Friend the Minister knows, I share some of the disquiet evinced by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), who chairs the Select Committee that has dealt with this Bill. In this instance, it seems somewhat less than fair to
impute blame—essentially, that is what we are doing—in respect of an elderly or frail person who is kept in hospital for an unnecessarily long time because social services have not been able to create the proper care environment past their recovery.I shall not rehearse the arguments that I made on Second Reading, and I am grateful to the Government for listening to the concerns that have been expressed by my own local authority and by voluntary organisations throughout London. However, in a sense, a period of six months is neither fish nor fowl, nor good red herring. There are specific difficulties, of which my hon. Friend the Minister will be aware, that impact particularly on authorities such as mine, which represent inner-London boroughs. No one could argue that the borough of Camden has been lax on this issue, and I know that the Government would not attempt to do so. It is a beacon authority, and it has made extremely good use of the additional funding provided by the Government. It is assiduous in attempting to incorporate a properly constructed care package, with proper input from individuals or their carers. However, there are real difficulties in central London relating to the availability and cost of properties, and, on the most simplistic of levels, to the availability of a work force who are capable of adapting, say, an individual's private home for the necessary bathroom, shower and fitments, so that they can live within their own property. There are also grave difficulties in ensuring security of domiciliary care, when that is included in the package.
I raise these issues—I have no doubt that the Minister is aware of them—simply to ask the Government to consider, even at this late stage, delaying the Bill's introduction. As I said on Second Reading, I know that their heart is in the right place. No one wishes to see the elderly or frail kept in hospital if an alternative location would not only probably make them infinitely happier, but ensure their future health. There are real difficulties, but there is no difficulty as far as my local authority social services are concerned in attempting to create partnerships. Indeed, they have created extremely effective partnerships not only with the national health service and the voluntary sector, but with the private sector, which they deal with in many instances, to ensure the creation of a proper care package for individuals. However, there are difficulties in ensuring that internal office systems are the same—an issue that is not exclusively the responsibility of local authorities or of the NHS.
Solving such practical difficulties takes time, and I should point out to the Minister that it also takes money. I have my doubts about how beneficial it is to move £100 million from one aspect of the provision of care to another. However, it would be a shame if the money that the Government are investing were to be spent somewhat hastily not only because of the pressure resulting from the Bill's introduction, but because of the time pressure on the introduction of these requirements. As we know, more haste means less speed, but it also often means spending unnecessary amounts of money.
I ask the Government to consider the points that I have made and perhaps to delay the Bill's introduction. That would address many of the anxieties experienced not only by my local authority social services department and the NHS, but, most importantly—I stress this point to the Minister—by those who care for
the elderly. They are looking for a properly structured care package, and they are anxious about the time pressure resulting not only from the Bill itself, but from its introduction. If it were possible to extend the period before its introduction, many of my constituents would be very grateful.
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