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19 Mar 2003 : Column 1029—continued
Lords amendment: No. 24.
Jacqui Smith: I beg to move, That this House disagrees with the Lords in the said amendment.
Mr. Deputy Speaker (Sir Alan Haselhurst): With this it will be convenient to discuss Lords amendment No. 25 and Government motion to disagree thereto.
Jacqui Smith: The amendments would impose a permanent statutory duty on inspection bodies to monitor the impact of the Bill on patients and carers, and a permanent statutory duty on the Secretary of State to report annually to Parliament. The implication seems to be that health and social care professionals will irresponsibly discharge patients with inappropriate care packages, but we do not believe that this will be the case. Of course, they will also duplicate safeguards and inspection mechanisms already in place, and will jeopardise the independence of those that are planned.
NHS and local authorities should, of course, already monitor the quality and effectiveness of their discharge arrangements, which are subject to the normal performance management, performance assessment and monitoring and inspection arrangements. Current inspection bodies already monitor the quality of discharge arrangements and the effect on patients and carers as part of their normal inspection and monitoring activities. For example, the social services inspectorate monitors the quality of services to older people. This will include the achievement of national priorities and targets—including the proportion of those helped to live at home, compared with residential care—as well as local improvement plans. As part of that, it will of course look at the quality of community support following discharge from hospital. It will also question the balance between investment in services and the amount spent on reimbursement charges.
In a similar way, when the Commission for Health Improvement reviews clinical governance arrangements within a hospital, it covers planning of patients' entire hospital stay and their discharge. That is an important part of its review methodology. Of course, where a combination of performance indicators and inspection points to particular problems in a given area, the inspection bodies and, ultimately, the Secretary of State have an escalating power to intervene, and to ensure that action is taken to improve outcomes and performance.
As hon. Members know, we have introduced legislation to establish two new health and social care inspectorates: the Commission for Health Care Audit
and Inspection and the Commission for Social Care Inspection. We have already stressed that those bodies will strengthen the accountability of those responsible for the commissioning and delivery of health and social services, and an important part of this role will be for both inspectorates to report annually to Parliament on the provision of NHS and social care. However, we have also stressed their independence from the Department, so although they will agree priorities with the Department, it would not be appropriate for detailed instructions such as those proposed in the amendments to pass from the Secretary of State to the inspectorate concerning the details and the frequency with which they need to inspect particular elements of older people's services.We do not believe, therefore, that it is necessary or appropriate to impose that permanent and specific statutory duty on the inspection bodies to monitor the effects of this Bill, or to impose a duty on the Secretary of State to report every year to Parliament specifically on the Bill's effect.
Mr. Burns: I should say at the outset that I am very disappointed with the Minister's assessment of, and views on, two very valuable and important amendments for the raising and maintaining of standards. This Government have rightly—I am not criticising them—always maintained that patients, the NHS itself and the professionals who work in it should attain the highest possible standards, and that the quality of care should be of the highest level. I can assure the Minister that I do not disagree with her one iota on that important issue. As constituency MPs, we owe that to those of our constituents who may use the national health service, and to the NHS itself because of the professionals who work within it. What surprises me is that the Minister, by rejecting the amendments, does not seem to share our enthusiasm for ensuring the highest quality and standards in all areas of the NHS.
For example, Lords amendment No. 24, notwithstanding the Minister's comments, seems eminently reasonable. It asks that
- "The Secretary of State shall specify to the bodies charged with inspection of health and social services that they should monitor, at regular intervals, the impact of this Act on patients and their carers."
The Government have been in power for six years now, during which time they have taken a perverse pleasure in examining every nook and cranny of our national life. They have not been averse to increasing bureaucracy, but when the other place makes an eminently sensible suggestion to ensure that standards are maintained, they—somewhat churlishly on this occasion—reject it. Under the Bill, the patient should be the most important part of the equation of the provision of health care, but the pressures that will be placed on social services by the fines system will mean that the
patient will be the piggy in the middle, caught between the NHS and local authority social services departments.
Mr. Greg Knight (East Yorkshire): My hon. Friend is making an effective case and demolishing the Minister's arguments. Is not the Minister wrong when she says that the amendments imply that some sort of wrongdoing is likely to take place? The words added by the other place refer to monitoring and to reporting back to Parliament and, in a democracy, that is eminently sensible and desirable.
Mr. Burns: I am indebted to my right hon. Friend. Perspicacious as ever, he has anticipated a point that I was about to make. In all candour, I was surprised and shocked by that comment from the Minister, because it was unfair. Nothing in any amendment to health legislation that I have supported has ever criticised or cast doubt on the huge professionalism of the staff at all levels of the NHS. It perplexed me, listening to the Minister, and I carefully read the words again in case the other place had—uncharacteristically—slipped up. I could not see that it had, and I am sure that the Minister will wish to rectify her comments later.
Mr. Waterson: I shall try to be charitable to the Minister and suggest that she and my hon. Friend are simply and genuinely at cross-purposes. When the Minister talks about the existing inspection and audit regime, that is fine, but we are talking about a Bill that may have all sorts of unintended consequences. If those consequences are undesirable—because, in the real world, it is just possible that the Minister could be wrong about the Bill—the sooner that we identify by specific audit any national trend that suggests that, the better for all of us.
Mr. Burns: My hon. Friend has made an important point, and he is right. We must ensure that we get the legislation right at this stage. I must say that I took umbrage at one point in my hon. Friend's intervention when he suggested—unless I misheard him—that the Minister was at cross-purposes with me because she wanted the best in this legislation. I find that difficult to reconcile in one respect. How can the Minister want the best for the Bill when she is bringing in a rather nasty system of fines on local authorities? That does not equal wanting the very best from the Bill. The Bill will do exactly the opposite of providing the very best.
Before those helpful interventions, I was saying that the Bill will mean that patients become caught, like piggy in the middle, between the NHS and local authorities. That will happen because the Bill will pressure authorities to discharge patients to avoid a fine. I am sure that the Minister does not want patients to suffer in any way. She is talking to her silent Whip at the moment; if she were listening to me, she would be able to hear what I want to tell her in all sincerity. However, she is clearly not listening and will therefore have to read Hansard.
Jacqui Smith: I have heard it all before.
Mr. Burns: The Minister says that she has heard it all before, which is odd, as I have not presented this
amendment before. It has come from another place, where common sense has prevailed and caused the Government to suffer a defeat. The Opposition in this House are trying to save the Government from making another mistake in overturning the amendment.Before that rather cruel intervention—the Minister cannot have heard my speech before—I was saying that it is important that patients do not suffer. I am sure that the Minister agrees with that. However, the Bill could cause them to suffer as a result of the possible early discharge from hospital to residential care or to domiciliary care in their own homes. That discharge could happen because local authorities want to avoid fines. The result could be emergency readmissions, or an unacceptable level of readmissions to hospital, within a seven to 28-day time scale.
In an earlier debate, I set out the rising incidence of emergency readmissions to hospital among people aged over 75. The statistics show that there is a problem, and I argued that it could be exacerbated by the Bill. Amendment No. 24 would help to minimise that potential problem.
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