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Mr. Paul Burstow (Sutton and Cheam): This is the last gasp for consideration of this Bill and today's consideration of Lords amendments is all about banking the concessions, reassurances and undertakings that have been given by Ministers at the Dispatch Box here and in the other place. We should thank the Minister for making those concessions and I place on record my appreciation of the hard and diligent work undertaken by my noble Friends Baroness Barker and Lord Tim Clement-Jones, who pursued several of the concerns that I and my hon. Friend the Member for Cheadle (Mrs. Calton) raised in Committee—not least the question of how the Bill will operate. We certainly welcome the concessions, not least the fact that the amendments will allow both Houses to consider the matter through the affirmative procedure. Conservative Front-Bench Members and I raised that issue in Committee, and we are pleased that, in this last stage of consideration, it will be built into the Bill.

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I should like to ask the Minister about the operation of amendment No. 2C, which states that regulations

"may not prescribe a description of care which is, or includes, mental health care unless a draft of the regulations has been laid before, and approved by a resolution of, each House of Parliament."

By dint of the drafting, could a person living in a care home as part of a period of intermediate care be excluded if he also had dementia? If Ministers were minded to include care home settings in future regulations on discharge arrangements—I believe that that was intended in other clauses—and if a person receiving intermediate care in a care home setting also had dementia, thus receiving mental health care services as part of the overall package, would any such regulations have to be subject to the affirmative procedure if the Bill's powers were extended beyond the acute sector into the care home sector? Will the Minister clarify whether that is the Government's intention? On a quick reading, it would be possible to interpret the amendment that way, so it would help if the Minister clarified the position.

As I said, we shall not oppose the amendment and we shall bank the other concessions gained from the Minister, and in the other place, over the past few weeks.

Jacqui Smith: I do not intend to respond to much of the contribution of the hon. Member for West Chelmsford (Mr. Burns). I simply reiterate the constructive approach that I have adopted throughout the legislation by saying that the principle is right. Although we will probably—though not necessarily—start with predominantly older people whose discharge from acute hospital care is delayed, it has always been our intention to consider the extension of the provisions if they prove, as I believe that they will, successful in providing incentives to ensure that people get the right care at the right time in the right place. We have always recognised that different people in different circumstances may need a slightly different approach—for example, in respect of the period of time necessary for an assessment, or the level of charge appropriate to particular circumstances.

The amendments that we are debating today are our attempt to assure hon. Members that we recognise such differences. In the context of the specific issues or concerns pertaining to mental health, it is appropriate that, when and if we get to that particular stage, we examine proposals in detail and allow Parliament to do so as well.

The hon. Member for Sutton and Cheam (Mr. Burstow) raised a specific matter. The Bill will already allow the provisions in part 1 to be extended to people in care homes. He is right to say that we discussed in Committee the circumstances in which that might happen. People delayed in intermediate care could well be in a position where it would be appropriate to extend the part 1 provisions to them.

As I made clear in my introduction, the extent to which that would be subject to the affirmative procedure would depend on the primary reason for the care. The regulations would be extended to mental health patients in circumstances where the qualifying patient was under

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the care of a consultant psychiatrist. That is our definition, and it would be the determining factor as to whether subsequent regulations would be subject to affirmative resolution.

The hon. Gentleman also wondered whether we would need to consider the specific circumstances involved in extending the provisions in part 1 to intermediate care, and whether I accepted that such care often had an impact on people with dementia. I assure him that the answer to both questions is yes. Whether the affirmative resolution procedure and these particular amendments will be involved depends specifically on whether a person is under the care of a psychiatric consultant.

Mr. Burstow: The Minister has spoken about the involvement of consultant psychiatrists, but the mental health of older people is often dealt with by psychogeriatricians. They deal with dementia particularly, but with other conditions as well. Is the Minister specifically excluding reference to psychogeriatricians, or are we talking only about psychiatrists in this respect?

Jacqui Smith: The amendments deal only with the circumstances in which the affirmative resolution procedure would be necessary. All the way along, our argument has been that there might be a variety of people—including those older people under the care of psychogeriatricians—for whom it would be appropriate to use the provisions in the Bill. When we come to extend the provisions of part 1 to those suffering from mental health problems, we will need to define what we mean by the phrase "qualifying patient". It is in that context that I said that it seemed appropriate to define them as being those people who are under the care of a psychiatrist. That does not mean that other patients would not be able to benefit from the provisions of the Bill—either now, if they fit the definition of "qualifying patient", or in the future.

I hope that the House will feel able to agree with the Lords in the amendment.

Lords amendment agreed to.

Lords amendments Nos. 2C to 2E agreed to.

Jacqui Smith: I beg to move, That this House agrees with the Lords in amendment No. 26B, an amendment to Lords amendment No. 26, as amended: in line 26, at end insert—

"(7A) Until 31st March 2005 the period of two days referred to in subsection (7) is exclusive of Sundays and public holidays in England and Wales."

In Committee, we discussed the inclusion or exclusion of weekends and public holidays from the minimum interval—the time following notification in which social services must assess and arrange services for a patient. I said that I did not believe that we should state on the face of the Bill that it was acceptable for local authorities to take five days as a minimum period to assess patients and make services available for them. It is worth reminding ourselves that we are talking about a minimum period, and the Bill makes it clear that a discharge would begin only from the end of the minimum period or from the point at which somebody was ready to be discharged.

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5.30 pm

As I pointed out in Committee, the Bill already ensures, owing to better communication between the NHS—particularly hospitals—and social services, that it is likely that somebody going into hospital for an elective operation would already have had their potential need for social services notified to the local authority beforehand, providing a longer period than in many cases exists at the moment. If they went in as an emergency patient, current figures suggest that only 30 per cent. of such patients come out within three days. We are talking about setting a minimum period that would probably not affect most patients, who will have a longer period.

Opposition Members have asked us to enshrine in the Bill the possibility that it could take much longer to assess a patient and to make services available so that they can safely leave hospital. A delay does not become any more acceptable to a patient and their family just because it takes place at the weekend or on a bank holiday. A person in an acute hospital bed who no longer needs to be there is not at less risk of the consequences or less vulnerable because social services do not work at weekends. It has been argued that although many social services departments are improving, and are sometimes able to operate for seven days a week, they cannot immediately be expected to perform those functions outside the normal working week. Although I firmly believe that social services should be moving towards a more flexible approach to working hours that means that the needs of individuals for community care services can be more effectively met, I accept that that will take time.

The amendment requires the regulations on the minimum assessment period to exclude Sundays and public holidays from that period until 31 March 2005.

Mr. Burns: Let me seek clarification so that there is no misunderstanding. The Minister says that the amendment excludes Sundays and bank holidays, but if she looks at subsection (7), she will see that it refers to

"at least two days excluding Saturdays, Sundays and public holidays."

Did she erroneously forget to mention Saturdays?

Jacqui Smith: I think, dare I say it, that the hon. Gentleman is looking at the wrong amendment. Our amendment, instead of excluding Saturdays, Sundays and public holidays, inserts new subsection (7A), which says:

"Until 31st March 2005 the period of two days referred to in subsection (7) is exclusive of Sundays and public holidays in England and Wales."

We have replaced the provision on Saturdays, Sundays and public holidays that was previously in the clause with the provision that until 31 March 2005 the regulations will exclude Sundays and public holidays.

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