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House of Commons

Tuesday 16 September 2003

The House met at half-past Eleven o'clock


[Mr. Speaker in the Chair]


London Local Authorities and Transport for London Bill [Lords]

Considered; amendments agreed to.

Mersey Tunnels Bill (By Order)

Order for consideration, as amended, read.

To be considered on Tuesday 14 October.

Oral Answers to Questions


The Secretary of State was asked—

Foundation Hospitals

1. Mr. David Cameron (Witney): What recent representations he has received from NHS trusts about the Government's plan for foundation hospitals; and if he will make a statement. [129948]

The Secretary of State for Health (Dr. John Reid): My ministerial colleagues and I have had a number of discussions with the chairs and chief executives of NHS trusts, and this dialogue will continue.

Mr. Cameron : I thank the Secretary of State for that answer. If foundation status is really about giving hospitals greater freedom, will he look again at the strict rule under which no hospital can increase its income from private patients? Is he aware that Nuffield Orthopaedic hospital in Oxford, where NHS patients will always come first, has used private income to subsidise the NHS and help to pay for investment? It wants to continue to do so, but the base year is very restrictive. Will the Secretary of State ensure that foundation status will not make things worse in that regard?

Dr. Reid: I know that the hon. Gentleman takes a deep interest in health care and the health service. He will understand that we are trying to achieve a balance between the power that we decentralise and the maintenance of a balanced benefit for all the people of this country through the national health service. The cap that has been put on the proportion of patients who

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can be treated privately in the new foundation hospitals is intentionally set to be fair to the vast majority who rely on the NHS. It will be fixed as a percentage of the income derived from private patient activity that applied to each NHS foundation trust in the financial year ending April 2003. That will ensure that the cap applies fairly to all trusts, irrespective of when they make the transition to NHS foundation trust status.

Mr. Gordon Prentice (Pendle): What representations has the Secretary of State received about the Government's proposals, which I think are very opaque? Will people be able to vote if they have paid £1, or if they have pledged to pay £1? What estimates have NHS trusts made about the likely turn-out in the elections?

Dr. Reid: Discussions are under way in this House and in another place about the exact details, but let me make it clear that it is a good thing that we should reduce the amount of diktats from the centre and pass more control to people in local areas. If we are truly going to have a national health service capable of meeting the differentiated needs, ambitions and expectations of 60 million of our fellow citizens today, we shall have to decentralise. I commend to my hon. Friend the authority on these matters who said that he was deeply conscious that one of the great dangers of a Government health service was over-centralisation, and that the wider the decentralisation that could be achieved, the better it would be for everyone. That authority was, of course, the founder of the national health service, Nye Bevan, speaking in 1946.

Mrs. Patsy Calton (Cheadle): Does the Secretary of State intend to ensure that the regulator gives precise instructions about the cap? Clause 15 of the Health and Social Care (Community Health and Standards) Bill, which is currently going through the other place, has confused people with regard to the capping of private health care. As it stands, the clause does not insist that the regulator should cap private health care.

Dr. Reid: I think that this issue is pretty clear to everyone, whatever opinion they may hold, except the Liberal Democrats. If the hon. Lady can show me anyone outside the Liberal Democrats who is confused about it, I will certainly consider their case. This is, however, a refreshing change for me. Having listened all week to objections from the trade unions, the producers organised, it is nice to hear the comments of the Lib Dems—the producers disorganised.

Elderly Care

2. Jeff Ennis (Barnsley, East and Mexborough): What steps he is taking to increase support available for older people to stay in their own homes. [129949]

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): Our published priorities set attainable but challenging targets for health and social care bodies to increase the support available for older people living in their own homes. We are

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supporting that with an average 6 per cent. annual increase in real terms in resources for personal social services between 2003 and 2006.

Jeff Ennis : What steps could the Government take for people suffering from dementia and other long-term illnesses who are occupying hospital beds to help them to move back into their own homes rather than into a nursing home, if that is what they wish? There is definitely a demand from elderly people to stay in their own homes for as long as possible.

Dr. Ladyman: I entirely agree with my hon. Friend. We are getting the message loud and clear from older people that they want to have the choice of staying in their own homes. When people are awaiting discharge, a package of care should be put together that is based on their choices and their needs. The delayed discharge grants that we have made available are for improving services in a person's home. Discharge into their home should be every bit as real a choice as discharge into a nursing home.

Mr. Richard Bacon (South Norfolk): Sir Nigel Crisp recently acknowledged before the Public Accounts Committee that planning for the discharge of older patients from NHS acute hospitals, which is related to the support available for older people in their own homes, is now worse than it was four years ago. Why is that?

Dr. Ladyman: If Sir Nigel Crisp said that, he is wrong. Delayed discharge grants have given resources to local councils and local health authorities to put in place a mechanism by which delayed discharges can be eradicated from our hospital system. Any local council that has been doing a reasonable job of planning for this eventuality will make a profit from the delayed discharge grants, because it will receive more in grant than it is having to pay in fines.

Andy King (Rugby and Kenilworth): I welcome what my hon. Friend has said about extra resources for this purpose. In the past, people's perception has all too often been that they have been forced to remain in their own homes. Will he assure us that people will have real choice, and that it will be based on sound assessments of their needs?

Dr. Ladyman: I can give my hon. Friend that assurance. He is right that in the past it was assumed that people would go into nursing homes or residential care. We are getting away from that. It is sad that the Liberal Democrats and the Conservatives are devising policies to return to a system whereby people are forced into nursing homes instead of being given the choice of care in their own homes.

Mr. Simon Burns (West Chelmsford): Why will domiciliary care workers in this sector from 1 October face an increase since July of 142 per cent. in the fees they have to pay for their Criminal Records Bureau check?

Dr. Ladyman: They will have to pay an increase because we intend to ensure that those who care for old and vulnerable people are of suitable character and

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reputation. Surely that is something with which the Conservative party would agree. We intend the CRB checks on care workers to be self-funding, but the employers will pay the bills for them.

Mr. Bill O'Brien (Normanton): I noted the reply that the Minister gave my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) on support for people in their own homes. Will he comment on the divide between medical and social care? Strategic regional health authorities have set up a matrix to guide people, because that division causes problems and has an impact on the care of people in their own homes and in nursing homes.

Dr. Ladyman: I think that the issue to which my hon. Friend refers—if I am wrong I would welcome a meeting with him afterwards—is the dispute that arose because the ombudsman discovered that certain people were not being properly assessed for NHS continuing care. The Government have acknowledged that there were some failures in some areas. Different criteria were being used and were not being properly applied. We have instructed all the strategic health authorities to come up with consistent criteria, and to review the cases of those who may not have been properly assessed for continuing care. Those people will be fully compensated for any financial losses that they incurred as a result of any decision.

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