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19 Mar 2003 : Column 1008—continued

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

Mr. Deputy Speaker: With this it will be convenient to take Lords amendment No. 15 and Government motion to disagree thereto, Lords amendment No. 16 and Government motion to disagree thereto and Lords amendment No. 18 and Government motion to disagree thereto.

Jacqui Smith: Although I am proposing that we disagree with the Lords in these amendments on the important issue of informing and involving patients and carers in the performance of the social services assessment and decisions about which services are to be provided, I hope that I can give hon. Members some reassurance that the Government have gone even further than the aspirations expressed in the Lords amendments in what we propose to do.

Amendments Nos. 14 and 15 propose that local authorities should consult patients and carers during the assessment of community care needs and obtain their consent to the care plan. Amendment No. 16 would further require the local authority to inform patients of the costs of this care.

It is clear in clause 3(11) that this assessment and care planning process is part of the section 47 assessment process and that it is therefore one stage, or part, of the single assessment process. By singling out this assessment and care planning process from all other section 47 assessments and care planning, we would differentiate the process under this Bill from all other processes of assessment and care planning. That would include processes outside the hospital and those applying to other patients in the hospital who do not happen to be "qualifying patients" according to the terms of the Bill.

We are very clear that there should be no difference in the type or standard of assessment to which a person is entitled, whether they are assessed in hospital or in their own home. I do not believe that that is what the amendments are designed to achieve. I would have thought that if it was necessary to reiterate these steps here—although they are set out already in statutory guidance for both section 47 assessments and the single assessment process—then it must be necessary for all assessments, not just for those in this Bill. We have always been clear that the Bill should not affect the underlying substantive law, and we would not want to agree an amendment that did just that.

Similarly, it has always been the case that care plans prepared as a result of a section 47 assessment should be agreed by the user. That point was made earlier by my hon. Friend the Member for Sheffield, Heeley (Ms Munn). Providing information about costs of care services is covered specifically in the section 7 guidance to local authorities on the single assessment process. Furthermore, it was covered in the statutory guidance on section 47 assessment that was issued to accompany the National Health Service and Community Care Act 1990.

With respect to assessments carried out under section 47, case law is already clear that the local authority must make reasonable efforts to provide patients with their

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chosen options, as long as there are no resource implications to prevent that. In reality, it would not be possible for the local authority to do that without having first consulted the patient to ascertain how he or she feels about the various choices available.

The Bill makes no difference to a patient's rights with respect to consent. Patients have an existing right not to consent to receiving the services that social services has assessed them as needing. Clearly, neither the NHS nor social services has a right to force services upon a patient who does not want to receive them.

Of course, good practice will dictate that patients should be kept informed and that they should be consulted at all stages of the discharge process. The revised hospital discharge workbook has a chapter specifically on patient and carer involvement. We will expect both NHS and social services staff to follow it. The statutory guidance for the Bill will also make it plain that patients and their carers and family are to be kept fully informed and consulted throughout the discharge process.

It is a slightly different case in terms of a carer's assessment, which is actually triggered by a request from the individual carer. There can therefore be no question of consent to the assessment, since it is implicit in the request for an assessment that the person involved has consented. In terms of agreeing the carer's plan, the statutory guidance is clear—the plan must focus on what the carer wants to happen, and agreement, or any differences between carer and assessor, are recorded and a copy provided to the carer. Moving away from this arrangement, as suggested in the amendment, would differentiate carers' plans from others. The amendment would make these plans less responsive to the carer's wishes than other carers' assessments carried out under section 2 of the Carers and Disabled Children Act 2000.

However, as I suggested earlier, I understand that the first three amendments in this group are trying to strengthen the arrangements around assessment and care planning. I hope that I made it clear that, if that is needed, it should be all section 47 assessments, regardless of where or when they take place.

Section 47(4) of the National Health Service and Community Care Act 1990 contains a power for the Secretary of State to issue directions as to the manner in which assessment is carried out. I can confirm, therefore, that we will issue a direction under this power to make it clear that the local authority, having assessed the needs of the patient, should consult the patient before deciding which services to provide. Where possible, it should gain agreement to the care plan, and provide information about the costs of that care plan.

That direction would apply to all section 47 assessments. It would not create the divergence that these amendments would create, but I hope that it offers some reassurance to the House that these important issues are being addressed.

Mr. Burstow : Some of the issues that we are debating under this group of amendments are a re-run of those that we debated a few moments ago, so many of my previous arguments also apply. We are now talking about the care planning process, as opposed to whether consent should be passed on social services in the first place.

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4.45 pm

I listened with interest to the Minister's comments to the effect that the amendments that were tabled by my noble Friends and other noble Lords cover only one particular stage of the assessment process, and I welcome her suggestion that the Government will issue section 7 guidance to apply these matters to all stages of the assessment process under section 47. However, if the Government are now minded to do that, would it not have been easier to table an amendment to the Bill to place it beyond doubt that it was part of the law of the land and a requirement on parties to assessment processes, whether they be NHS bodies, social services departments or any others? Although I find the measure a helpful step forward, it does not sufficiently answer my concern, or that of my noble Friends, that the provisions that we should like to be included in the Bill are not yet there. The amendments are intended to ensure that the issues of consent and mental incapacity are addressed fully and clearly in the Bill. For that reason, we particularly want to press amendments Nos. 14 and 18 to a vote so as to test the opinion of this House before the Lords considers the matter again.

My other question relates to the section 7 guidance that is to be issued. In the other place, Lord Hunt said that it was intended that a clear guidance or direction should be issued to the national health service in respect of continuing care assessments, that it would be put in writing as part of the process and that it would have to take place before a section 2 notice could be issued. Can the Minister confirm that that is the case, and can she explain why the provision is not included in the Bill, where it would be much clearer to all of us?

I shall certainly wish for votes on amendment Nos. 14 and 18, and I hope that the Minister can respond to my queries.

Glenda Jackson: The two issues that I should like to raise with my hon. Friend the Minister have essentially to do with consent. In my experience from my constituency, a carer will often find the health professional's definition to be simply incomprehensible. There is far too little movement in terms of the ability of health professionals to translate clinical assessments into the kind of English that most people would understand. That is particularly pertinent when the carer is also elderly.

The other issue concerns consent. It is not unusual for an elderly person who has been in hospital to be absolutely desperate to go home and absolutely to refuse any kind of alternative. That can often place an enormous burden on their carer, who, as I said, may be of an equal age. The individual concerned may be going back to a home that is completely inappropriate to their new needs. It is therefore not unusual for the idea of a temporary convalescent home—I still call them that, although I know that the situation has changed—to be presented so that the necessary adaptations to the family home can be undertaken. However, such homes can be a long way from where people live. Often, for the best of reasons to do with consent, the individual may place a terrible burden on their carer. Indeed, it is not unusual for the carer to end up in hospital.

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I am not being quite as precise as I would like to be, but I hope that my hon. Friend the Minister has picked up what I mean. There can be a fine line. Without wanting there to be a kind of prison state, I would like, when consent is given by the social services and the NHS to what the patient wants, better explanations to be given to the individual and their carer of the possible repercussions if the only proposal that is acceptable to the individual is to go immediately from hospital to home.

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