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1 Apr 2003 : Column 867—continued
Mr. Burns: I am grateful to the Minister, and I am happy to confirm that she is absolutely right. However, given that she has conceded two thirds of the loaf, why did she not include Saturdays?
Jacqui Smith: I was explaining how I had been somewhat reluctant even to concede two thirds of the
loaf. We are talking about the minimum period of time within which we expect social services departments and health providers, working together, to determine an appropriate package of care that ensures that somebody can leave hospital safely. My argument throughout has been that modern social services departments should work over weekends. I do not think it appropriate to say to an older person, "I'm afraid you're going to have to stay in hospital because we're not in a position to sort out your package of care this weekend."The amendment seeks to acknowledge the fact that we are in a period of transition and that, given the considerable extra investment that the Government are putting into social services departments, it is likely that the departments will build up their ability to assess people, build up the flexibility of their assessments, and build up their ability to offer services over weekends. It is therefore reasonable of us to say that we will extend the minimum period up to 31 March 2005 so that it does not include Sundays and public holidays. That will mean that local authorities have from now until January 2004—given the other changes that were made in the other place on the point at which charging will start—to plan and prepare for Saturday working before charging kicks in. They will have at least another 15 months after that to move to a seven-day service. We will mirror that in the regulations to do with notices. Although Sundays and public holidays are not part of the planning period, they will not count in the time scale of any notices that are given by the NHS to local authorities. That is a compromise. I do not believe that anyone would want the Bill to contain the message that it is acceptable for older people routinely to wait five or more days in hospital for an assessment of the services required. However, by excluding Sundays and public holidays until 2005, we are giving local authorities time to change their working practices and minimise delays for individual patients.
I think—dare I say it—that what I have said reflects the constructive approach that we have taken throughout the process while at the same time maintaining our commitment to put in place a system that ensures that people are not trapped in hospital when they are ready to leave as a result of a failure to put in place community care alternatives. As the Bill has gone through both Houses, we have responded in a variety of areas where improvements to the legislation were possible. The principle has been maintained all the way through, but I hope that hon. Members will feel able to support this compromise and agree with the Lords amendments.
Mr. Burstow: The issue of bank holidays and weekends was first pursued first in Committee in this House and then quite vigorously by my noble Friend Lord Clement-Jones in the other place. The proposal had all-party and Cross-Bench support in the other place. That was important, as it allowed us to reach the point that we are at today—with two thirds of the loaf ready to be considered. On the basis of the consideration in the other place and the points that have been raised by the Minister today, I feel that a further delay in implementing this change in respect of Sundays and bank holidays is very welcome. However, it gives rise to some questions that I would like to put to the Minister.
The Minister is right to say that none of us wants a situation in which a person is unnecessarily left languishing in a hospital bed. We want all efforts to be made to ensure that a person who is ready to be discharged does not stay in hospital unnecessarily. For the benefit of those hon. Members who are able to listen to me, I want to ask the Minister about the cost of moving from a five-day-a-week service to a seven-day-a-week service. From reading the Lords deliberations on the clause it is not entirely clear whether the Government have any idea of the cost of moving to a seven-day-a-week service. It cannot be cost free. Can the Minister tell us whether the cost will be contained in the additional
- "resources that are being allocated through the comprehensive spending review"?
We do not entirely reject the argument for moving to a seven-day-a-week service, not least because of some of the points about children's services made recently by Lord Laming in his report. In some cases, people need services that are available 24 hours a day and, in respect of discharge, seven days a week. The amendment would allow us to move towards that situation in an orderly fashion, which is certainly welcome.
The delay is welcome, not least because it affords us the opportunity further to understand how the assessment process will work out. During consideration of these and other amendments in the other place, there was some discussion about the planning of the discharge process and the production of care packages. For example, after a person was discharged to their own home, there would be further assessment after two weeks to see whether everything was working as intended. However, it was not made clear during those deliberations whether that would apply to someone who was discharged to a care home. It would be helpful if the Minister could confirm that it will not apply only to someone who is discharged to their own home. People discharged to care homes would also benefit from such an assessment. Sometimes placing someone in a care home is the wrong decision and the person could recover more effectively and lead a more independent life in their own home with an appropriate care package.
Finally, I draw the attention of the House to the fact that the amendment will have the useful effect of delaying for several years the introduction and implementation of the Bill's provisions in respect of Sundays and public holidays. It is rather amusing that the whole Bill was meant to come into effect today—April fool's day. The legislation should have been implemented this year and it behoves the Minister to acknowledge that that timetable was never realistic if there was to be adequate parliamentary scrutiny of the measure. Parliamentary scrutiny has resulted in the improvement of the Bill, which means that most of its provisions will not be implemented until next January. That is welcome progress from the point at which we began our proceedings on the Bill many months ago.
We are willing to accept the amendment. Two thirds of the loaf is certainly better than nothing.
Mr. Burns: I echo the words of the hon. Gentleman, who rightly reminded the House that April fool's day 2003 was the day on which the Government intended the Bill to come into force—the day on which the fines were to start. In her heart, if not through her mouth, the Minister will agree that we have saved the Government from being the ultimate April fools. If it were not for my noble Friends who tabled the amendment that postponed the legislation, we should not have seen the Government climb-down that has led to its coming into force on 1 January 2004. I am sure that the hon. Lady will accept that we have done her and her Government a great favour by imposing common sense on them.
The Minister rightly said today that she had tried to take a constructive approach throughout all the proceedings on the Bill, as well as on this amendment. It is wonderful how constructive one's approach can be if the Opposition parties have been even more constructive in showing the Government the error of their ways, and when common sense prevails in another place. As any student or follower of the saga of this legislation knows, in Committee, on Report and in another place we have explained time and again to the Minister that not to exclude Saturdays, Sundays and Mondays would be a mistake, because there is essentially a five-day service at present, and to extend that service to seven days would, certainly in the short term, cause considerable problems—not least in funding, as the hon. Member for Sutton and Cheam (Mr. Burstow) said.
5.45 pm
Although I urge the Minister to resist her usual rant on the subject, it would be interesting if she would address the points made concerning the funding of the service when it in effect changes from a five to a seven day service, because in the real world, as the Minister is aware, services tend to slow down over the weekend and over bank holidays. That is rightly or wrongly a fact of life, and that is why we have pushed so hard and so long with this amendment, to try to save the Government from not facing the reality of the current situation.
As I told the Minister in an intervention, we have two thirds of a loaf rather than the whole loaf, but then, as the Minister could with some justification say because she will have heard it numerous times before, when one is in opposition and the Government have an overall majority of about 165 seats, any crumb that falls from the Minister's table is more than welcome. In fact, it could be seen as a considerable victory.
I do not want to dwell on the narrow party political point, because this is not so much a party political victory as a victory for common sense. It is a victory for patients, a victory for social service departments and probably a victory for the NHS, so I too welcome what the Minister has said and agreed to with this two thirds of a loaf.
In conclusion, I have one final question for the Minister, which I dearly hope she will be prepared to answer so that we may end on a satisfactory note. The amendment seeks to give leeway for Sundays and public holidays over the assessment process to help social
service departments to avoid incurring fines through no fault of their own. The Minister—except once or twice when she had serious lapses—has refused to use the f-word. She has used her thesaurus and the Labour spin machine and she has come up with every word under the sun to describe what the Bill does and what the amendment seeks to minimise. She has used the euphemism "incentives". She has used the word "charging". She has used other words, but except when she has had a lapse she has never used the word fines. But to the Minister's embarrassment, her own Secretary of State, in his statement to the House the day after the Budget, used the f-word. He was quite blatant. He said that the fines imposed under the legislation would, "x, y, zee." Why does the Secretary of State use the word fines when the Minister has steadfastly refused to do so? Will the Minister now face the reality of the situation and accept that the Bill is just a cackhanded way in which to penalise one public service—social services departments—at the expense of the NHS by imposing fines?As my hon. Friends and I have two thirds of a loaf and are not greedy, we will not press any amendment in this group to a Division because, once again, we are grateful to the Minister for taking our advice in a very constructive a way—we gave the advice—and tabling the amendment.
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