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19 Mar 2003 : Column 1038—continued
Mr. Burns: My right hon. Friend touches on an extremely important point. He is as aware as I am that Westminster Hall is already used to debate Select Committee reports, so the precedent exists and the powerful suggestion that he is making would dovetail with what already happens in our proceedings.
6.30 pm
Mr. Knight: I agree wholeheartedly with my hon. Friend. An annual report does not have to be debated every year. If an annual report was good but was deemed to contain nothing exciting or worthy of criticism, then the usual channels could produce a system in which a debate did not have to occur every year. Clearly, cost is not an issue because the Minister did not mention it. I was apprehensive that she might argue that she did not want the amendments because of the cost to the Exchequer, but that does not seem to be a problem. I hope that she will think again. I say to her: be bold, be reckless and, in the light of the powerful arguments adduced in the debate, allow the amendments to stand.
Jacqui Smith: With the leave of the House, I shall respond to the debate.
Hon. Members suggested that a monitoring and reporting system is not in place to ensure that the good outcomes produced by the Bill will be clearly monitored. However, I outlined a variety of ways—I do not intend to repeat them—in which that will be ensured. I think that the amendments are otiose and that it can be argued that they will have a detrimental effect on the inspection bodies that will be established.
Having feigned indignation when I suggested that the amendments were proposed on the assumption that the health and social care services might not operate in the best interests of patients, the hon. Member for West Chelmsford (Mr. Burns) then gave a string of ways in which the system might indeed not operate in the best interests of patients. I reassure him that monitoring is in place to ensure that that does not happen. The NHS and social care performance indicators, introduced by the Government to ensure greater accountability of the performance of the NHS and social care services, already include delayed discharges, emergency readmissions and home care to help people live at home. We are also introducing indicators on the speed of service provision. Those will show when substantial problems arise.
Hon. Members also asked about debating annual reports that are made to Parliament. Under the previous system—with the exception of the Commission for Health Improvement, largely inherited from the Conservative Government—annual reports were published, but not to Parliament. Under the new system, the Commission for Social Care Inspection and the Commission for Health Care Audit and Inspection will make annual reports to Parliament. We amply cover the concerns of hon. Members that both the successes and the challenges are reported to Parliament on an annual basis.
When we debate the legislation to establish the new inspection bodies, I shall be interested to hear whether Opposition Members raise concerns about the need to ensure that they are able to make an independent determination of quality in the health service and social care service. That would be different from the approach
taken by the hon. Member for West Chelmsford, who believes that we should instruct the bodies in the minutiae of their considerations.
Mr. Burns: I did not say that.
Jacqui Smith: That is the implication of the Lords amendment. The other place claims to believe in the independence of the inspection bodies, but that claim lies rather uncomfortably with the proposals in the amendment.
I want to spend some time responding to the points raised by the hon. Member for Sutton and Cheam (Mr. Burstow) about, among other things, his specialist subject of continuing care. On the points made by the National Audit Office about the definition of good practice, one of the important features of the Bill is that it will put in place a clear process and decision points for determining a delayed discharge and, therefore, the point at which reimbursement should kick in. I heard what the hon. Gentleman said about his colleagues on the metropolitan authority in the west midlands, but perhaps that authority would welcome a visit from the Department's implementation team to ensure that some of the concerns can be ironed out before the Bill comes into force.
The hon. Gentleman asked about the broader definition of delayed discharge. Sir Nigel Crisp, the chief executive of the NHS, has written to those trusts that told the National Audit Office that they were not using the definition. All of them have confirmed that they are now using the correct definition.
The hon. Gentleman also asked about continuing care and its relationship with free nursing care. When nurses undertake a determination of NHS-funded nursing care, we have made it clear that all nurses should consider eligibility under continuing NHS health care criteria as the first step in assessing people's needs for care in a care home providing nursing. Furthermore, in the guidance on NHS-funded nursing care, we have consistently maintained the distinction between NHS-funded nursing care and continuing NHS health care, making it clear that NHS-funded nursing care is part of a spectrum of care that falls short of what one would expect to see when the primary need is for health care. As I have suggested, we have made it clear that, regardless of the eventual setting in which someone is likely to be cared for, we expect the first consideration in a joint assessment of someone's need to be always the extent to which that person meets or does not meet the criteria for NHS continuing health care.
Mr. Burstow: The Minister is making some helpful clarifications. However, will she also undertake to take away the workbook that is currently used for guiding nurses in applying the tool for assessing the entitlement to free nursing care contributions? The workbook contains a case that is exactly the same as a real case considered by the ombudsman, and that must provide incorrect information and the incorrect basis for making decisions.
Jacqui Smith: I was just coming to that point. I have pointed out that the first task is to assess whether someone has a need for NHS continuing care and emphasised that we must consider that on a case-by-case basis. The fictitious case that the hon. Gentleman
mentioned would be considered in the assessment of nursing care only if the continuing care criteria were not met. A consideration of that would previously have been carried out. The hon. Gentleman's points about the workbook are not justified.We are considering inspection and monitoring, and the hon. Gentleman asked whether we could consider the monitoring of the continuing care criteria. Although not solely in response to his concerns, we have asked CHI to consider local policies and criteria as part of a review of the older people's national service framework.
In conclusion, I believe I have provided the reassurance that right hon. and hon. Members wanted. The amendments are unnecessary and challenge the current arrangements and the independence of the inspectorates that we want to develop. For that reason, I hope the House will disagree with the Lords.
Question put, That this House disagrees with the Lords in the said amendment:—
The House divided: Ayes 308, Noes 198.
AYES
Abbott, Ms Diane
Adams, Irene (Paisley N)
Ainger, Nick
Ainsworth, Bob (Cov'try NE)
Allen, Graham
Anderson, rh Donald (Swansea E)
Anderson, Janet (Rossendale & Darwen)
Armstrong, rh Ms Hilary
Atherton, Ms Candy
Atkins, Charlotte
Bailey, Adrian
Baird, Vera
Banks, Tony
Barnes, Harry
Barron, rh Kevin
Begg, Miss Anne
Benn, Hilary
Bennett, Andrew
Benton, Joe (Bootle)
Berry, Roger
Betts, Clive
Blackman, Liz
Blears, Ms Hazel
Blizzard, Bob
Borrow, David
Bradley, rh Keith (Withington)
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brennan, Kevin
Brown, rh Nicholas (Newcastle E Wallsend)
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burgon, Colin
Burnham, Andy
Byers, rh Stephen
Cairns, David
Campbell, Alan (Tynemouth)
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Caplin, Ivor
Casale, Roger
Cawsey, Ian (Brigg)
Chapman, Ben (Wirral S)
Chaytor, David
Clapham, Michael
Clark, Mrs Helen (Peterborough)
Clark, Dr. Lynda (Edinburgh Pentlands)
Clark, Paul (Gillingham)
Clarke, rh Charles (Norwich S)
Clarke, Tony (Northampton S)
Clelland, David
Clwyd, Ann (Cynon V)
Coaker, Vernon
Coffey, Ms Ann
Cohen, Harry
Coleman, Iain
Cook, Frank (Stockton N)
Corbyn, Jeremy
Corston, Jean
Cousins, Jim
Cox, Tom (Tooting)
Crausby, David
Cruddas, Jon
Cryer, Ann (Keighley)
Cryer, John (Hornchurch)
Cummings, John
Cunningham, Jim (Coventry S)
Cunningham, Tony (Workington)
Dalyell, Tam
Davey, Valerie (Bristol W)
Davidson, Ian
Davies, rh Denzil (Llanelli)
Davies, Geraint (Croydon C)
Davis, rh Terry (B'ham Hodge H)
Dawson, Hilton
Dean, Mrs Janet
Dhanda, Parmjit
Dobbin, Jim (Heywood)
Dobson, rh Frank
Donohoe, Brian H.
Doran, Frank
Dowd, Jim (Lewisham W)
Drew, David (Stroud)
Drown, Ms Julia
Eagle, Angela (Wallasey)
Eagle, Maria (L'pool Garston)
Edwards, Huw
Efford, Clive
Ellman, Mrs Louise
Ennis, Jeff (Barnsley E)
Etherington, Bill
Field, rh Frank (Birkenhead)
Fitzpatrick, Jim
Fitzsimons, Mrs Lorna
Flint, Caroline
Flynn, Paul (Newport W)
Follett, Barbara
Foster, rh Derek
Foster, Michael (Worcester)
Foster, Michael Jabez (Hastings & Rye)
Foulkes, rh George
Gapes, Mike (Ilford S)
Gardiner, Barry
George, rh Bruce (Walsall S)
Gerrard, Neil
Gibson, Dr. Ian
Gilroy, Linda
Godsiff, Roger
Griffiths, Jane (Reading E)
Griffiths, Win (Bridgend)
Hain, rh Peter
Hall, Mike (Weaver Vale)
Hall, Patrick (Bedford)
Hamilton, Fabian (Leeds NE)
Hanson, David
Harris, Tom (Glasgow Cathcart)
Havard, Dai (Merthyr Tydfil & Rhymney)
Healey, John
Henderson, Ivan (Harwich)
Hepburn, Stephen
Hewitt, rh Ms Patricia
Heyes, David
Hill, Keith (Streatham)
Hoey, Kate (Vauxhall)
Hood, Jimmy (Clydesdale)
Hope, Phil (Corby)
Hopkins, Kelvin
Howarth, George (Knowsley N & Sefton E)
Hughes, Beverley (Stretford & Urmston)
Hughes, Kevin (Doncaster N)
Humble, Mrs Joan
Hurst, Alan (Braintree)
Iddon, Dr. Brian
Illsley, Eric
Jackson, Glenda (Hampstead & Highgate)
Jackson, Helen (Hillsborough)
Jamieson, David
Jenkins, Brian
Johnson, Alan (Hull W)
Jones, Jon Owen (Cardiff C)
Jones, Kevan (N Durham)
Jones, Martyn (Clwyd S)
Joyce, Eric (Falkirk W)
Kaufman, rh Gerald
Keeble, Ms Sally
Keen, Alan (Feltham)
Kidney, David
Kilfoyle, Peter
King, Andy (Rugby)
King, Ms Oona (Bethnal Green & Bow)
Knight, Jim (S Dorset)
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Lammy, David
Lawrence, Mrs Jackie
Laxton, Bob (Derby N)
Lazarowicz, Mark
Lepper, David
Levitt, Tom (High Peak)
Lewis, Ivan (Bury S)
Lewis, Terry (Worsley)
Liddell, rh Mrs Helen
Linton, Martin
Lloyd, Tony (Manchester C)
Love, Andrew
Lucas, Ian (Wrexham)
Luke, Iain (Dundee E)
Lyons, John (Strathkelvin)
McAvoy, Thomas
McCabe, Stephen
McCafferty, Chris
McCartney, rh Ian
McDonagh, Siobhain
MacDonald, Calum
MacDougall, John
McFall, John
McGuire, Mrs Anne
McIsaac, Shona
McKechin, Ann
McWalter, Tony
Mahmood, Khalid
Mahon, Mrs Alice
Mallaber, Judy
Mandelson, rh Peter
Mann, John (Bassetlaw)
Marris, Rob (Wolverh'ton SW)
Marsden, Gordon (Blackpool S)
Marshall, Jim (Leicester S)
Marshall-Andrews, Robert
Martlew, Eric
Merron, Gillian
Milburn, rh Alan
Miliband, David
Miller, Andrew
Mitchell, Austin (Gt Grimsby)
Mole, Chris
Moran, Margaret
Morgan, Julie
Morris, rh Estelle
Mountford, Kali
Mudie, George
Mullin, Chris
Munn, Ms Meg
Murphy, Denis (Wansbeck)
Murphy, Jim (Eastwood)
Murphy, rh Paul (Torfaen)
Naysmith, Dr. Doug
Norris, Dan (Wansdyke)
O'Brien, Bill (Normanton)
O'Brien, Mike (N Warks)
O'Hara, Edward
Olner, Bill
O'Neill, Martin
Organ, Diana
Osborne, Sandra (Ayr)
Owen, Albert
Palmer, Dr. Nick
Perham, Linda
Picking, Anne
Pickthall, Colin
Pike, Peter (Burnley)
Plaskitt, James
Pollard, Kerry
Pope, Greg (Hyndburn)
Pound, Stephen
Prentice, Ms Bridget (Lewisham E)
Prentice, Gordon (Pendle)
Prosser, Gwyn
Purchase, Ken
Purnell, James
Quin, rh Joyce
Quinn, Lawrie
Rapson, Syd (Portsmouth N)
Reed, Andy (Loughborough)
Reid, rh Dr. John (Hamilton N & Bellshill)
Robinson, Geoffrey (Coventry NW)
Roche, Mrs Barbara
Rooney, Terry
Ross, Ernie (Dundee W)
Roy, Frank (Motherwell)
Ruddock, Joan
Russell, Ms Christine (City of Chester)
Ryan, Joan (Enfield N)
Salter, Martin
Sarwar, Mohammad
Savidge, Malcolm
Sawford, Phil
Sedgemore, Brian
Sheridan, Jim
Shipley, Ms Debra
Simon, Siôn (B'ham Erdington)
Simpson, Alan (Nottingham S)
Singh, Marsha
Smith, rh Andrew (Oxford E)
Smith, Geraldine (Morecambe & Lunesdale)
Smith, Jacqui (Redditch)
Smith, John (Glamorgan)
Smith, Llew (Blaenau Gwent)
Soley, Clive
Spellar, rh John
Squire, Rachel
Starkey, Dr. Phyllis
Steinberg, Gerry
Stevenson, George
Stewart, David (Inverness E & Lochaber)
Stewart, Ian (Eccles)
Stinchcombe, Paul
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Stringer, Graham
Stuart, Ms Gisela
Tami, Mark (Alyn)
Taylor, rh Ann (Dewsbury)
Taylor, Dari (Stockton S)
Taylor, David (NW Leics)
Thomas, Gareth (Harrow W)
Timms, Stephen
Tipping, Paddy
Todd, Mark (S Derbyshire)
Trickett, Jon
Truswell, Paul
Turner, Dr. Desmond (Brighton Kemptown)
Turner, Neil (Wigan)
Twigg, Derek (Halton)
Twigg, Stephen (Enfield)
Tynan, Bill (Hamilton S)
Vaz, Keith (Leicester E)
Vis, Dr. Rudi
Walley, Ms Joan
Wareing, Robert N.
Watson, Tom (W Bromwich E)
Watts, David
White, Brian
Whitehead, Dr. Alan
Wicks, Malcolm
Williams, rh Alan (Swansea W)
Williams, Betty (Conwy)
Wills, Michael
Wilson, Brian
Winnick, David
Winterton, Ms Rosie (Doncaster C)
Wood, Mike (Batley)
Woodward, Shaun
Woolas, Phil
Wright, Anthony D. (Gt Yarmouth)
Wright, David (Telford)
Wright, Tony (Cannock)
Tellers for the Ayes:
Mr. John Heppell and
Mr. Fraser Kemp
NOES
Ainsworth, Peter (E Surrey)
Allan, Richard
Amess, David
Ancram, rh Michael
Arbuthnot, rh James
Atkinson, David (Bour'mth E)
Atkinson, Peter (Hexham)
Bacon, Richard
Baker, Norman
Barker, Gregory
Baron, John (Billericay)
Beggs, Roy (E Antrim)
Beith, rh A. J.
Bellingham, Henry
Bercow, John
Beresford, Sir Paul
Blunt, Crispin
Boswell, Tim
Bottomley, Peter (Worthing W)
Bottomley, rh Virginia (SW Surrey)
Brady, Graham
Brake, Tom (Carshalton)
Brazier, Julian
Breed, Colin
Browning, Mrs Angela
Bruce, Malcolm
Burnett, John
Burns, Simon
Burnside, David
Burstow, Paul
Calton, Mrs Patsy
Cameron, David
Carmichael, Alistair
Cash, William
Chapman, Sir Sydney (Chipping Barnet)
Chidgey, David
Chope, Christopher
Clappison, James
Clarke, rh Kenneth (Rushcliffe)
Clifton-Brown, Geoffrey
Collins, Tim
Cormack, Sir Patrick
Cran, James (Beverley)
Curry, rh David
Davey, Edward (Kingston)
Davies, Quentin (Grantham & Stamford)
Davis, rh David (Haltemprice & Howden)
Djanogly, Jonathan
Dorrell, rh Stephen
Doughty, Sue
Duncan, Alan (Rutland)
Duncan Smith, rh Iain
Evans, Nigel
Fabricant, Michael
Fallon, Michael
Field, Mark (Cities of London & Westminster)
Flight, Howard
Flook, Adrian
Forth, rh Eric
Foster, Don (Bath)
Fox, Dr. Liam
Gale, Roger (N Thanet)
Garnier, Edward
George, Andrew (St. Ives)
Gibb, Nick (Bognor Regis)
Gidley, Sandra
Gillan, Mrs Cheryl
Goodman, Paul
Grayling, Chris
Green, Damian (Ashford)
Green, Matthew (Ludlow)
Greenway, John
Grieve, Dominic
Gummer, rh John
Hague, rh William
Hammond, Philip
Hancock, Mike
Harris, Dr. Evan (Oxford W & Abingdon)
Harvey, Nick
Hawkins, Nick
Hayes, John (S Holland)
Heald, Oliver
Heath, David
Hermon, Lady
Hoban, Mark (Fareham)
Holmes, Paul
Horam, John (Orpington)
Howard, rh Michael
Hughes, Simon (Southwark N)
Hunter, Andrew
Jack, rh Michael
Jackson, Robert (Wantage)
Jenkin, Bernard
Jones, Nigel (Cheltenham)
Keetch, Paul
Kennedy, rh Charles (Ross Skye & Inverness)
Key, Robert (Salisbury)
Kirkbride, Miss Julie
Kirkwood, Sir Archy
Knight, rh Greg (E Yorkshire)
Laing, Mrs Eleanor
Lait, Mrs Jacqui
Lamb, Norman
Lansley, Andrew
Laws, David (Yeovil)
Leigh, Edward
Lewis, Dr. Julian (New Forest E)
Liddell-Grainger, Ian
Lidington, David
Lilley, rh Peter
Llwyd, Elfyn
Loughton, Tim
Luff, Peter (M-Worcs)
McIntosh, Miss Anne
Mackay, rh Andrew
Maclean, rh David
McLoughlin, Patrick
Malins, Humfrey
Maples, John
Marsden, Paul (Shrewsbury & Atcham)
Mates, Michael
Maude, rh Francis
May, Mrs Theresa
Mercer, Patrick
Mitchell, Andrew (Sutton Coldfield)
Moore, Michael
Moss, Malcolm
Murrison, Dr. Andrew
Norman, Archie
Oaten, Mark (Winchester)
O'Brien, Stephen (Eddisbury)
Öpik, Lembit
Osborne, George (Tatton)
Ottaway, Richard
Page, Richard
Paice, James
Paterson, Owen
Pickles, Eric
Price, Adam (E Carmarthen & Dinefwr)
Prisk, Mark (Hertford)
Pugh, Dr. John
Randall, John
Redwood, rh John
Reid, Alan (Argyll & Bute)
Rendel, David
Robathan, Andrew
Robertson, Hugh (Faversham & M-Kent)
Robertson, Laurence (Tewk'b'ry)
Robinson, Mrs Iris (Strangford)
Robinson, Peter (Belfast E)
Rosindell, Andrew
Ruffley, David
Russell, Bob (Colchester)
Sanders, Adrian
Sayeed, Jonathan
Selous, Andrew
Shephard, rh Mrs Gillian
Simmonds, Mark
Smith, Sir Robert (W Ab'd'ns & Kincardine)
Smyth, Rev. Martin (Belfast S)
Spelman, Mrs Caroline
Spicer, Sir Michael
Spink, Bob (Castle Point)
Spring, Richard
Stanley, rh Sir John
Steen, Anthony
Streeter, Gary
Stunell, Andrew
Swayne, Desmond
Swire, Hugo (E Devon)
Syms, Robert
Taylor, John (Solihull)
Taylor, Matthew (Truro)
Taylor, Dr. Richard (Wyre F)
Taylor, Sir Teddy
Thomas, Simon (Ceredigion)
Thurso, John
Tonge, Dr. Jenny
Tredinnick, David
Turner, Andrew (Isle of Wight)
Tyler, Paul (N Cornwall)
Tyrie, Andrew
Viggers, Peter
Waterson, Nigel
Watkinson, Angela
Webb, Steve (Northavon)
Whittingdale, John
Wiggin, Bill
Wilkinson, John
Willetts, David
Williams, Hywel (Caernarfon)
Williams, Roger (Brecon)
Willis, Phil
Winterton, Ann (Congleton)
Winterton, Sir Nicholas (Macclesfield)
Yeo, Tim (S Suffolk)
Young, rh Sir George
Younger-Ross, Richard
Tellers for the Noes:
Mr. David Wilshire and
Mr. Mark Francois
Question accordingly agreed to.
Motion made, and Question put, That this House disagrees with the Lords in the said amendment.—[Jacqui Smith.]
The House divided: Ayes 318, Noes 198.
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