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Standing Committee Debates
Community Care (Delayed Discharges etc.) Bill

Community Care (Delayed Discharges etc.) Bill

Standing Committee D

Tuesday 10 December 2002


[Mr. John McWilliam in the Chair]

Community Care
(Delayed Discharges etc.) Bill

10.32 am

The Chairman: I apologise to the Committee for being late. My street is being dug up and there is a five-minute detour to get here, but no one warned us.

The Minister of State, Department of Health (Jacqui Smith): I beg to move,


    (1) During proceedings on the Community Care (Delayed Discharges etc.) Bill the Standing Committee shall meet four times, namely on Tuesday 10th December at 10.30 am and 4.30 pm, and on Thursday 12th December at 8.55 am and 2.30 pm

    (2) Proceedings on the Bill in Standing Committee shall, so far as not previously concluded, be brought to a conclusion in accordance with the following table—



    Conclusion of proceedings

    Clauses 1 to 3

    1.00 pm on 10th December

    Clauses 4 and 5

    7.00 pm on 10th December

    Clauses 6 to 11

    11.25 am on 12th December

    Clauses 12 to 16, new Clauses, new Schedules and any remaining proceedings

    5.00 pm on 12th December

I welcome you to the Chair, Mr. McWilliam, and to this Committee; I also welcome all other hon. Members. At the moment, that is all I wish to say.

Mr. Simon Burns (West Chelmsford): I join the Minister in welcoming you, Mr. McWilliam, and your co-Chairman Mr. Conway, to the Chair, to preside over our proceedings for the two sitting days of this Committee. I place on record the fact that, on principle, the Opposition have always opposed the idea of guillotine motions, as they stifle the opportunity for debate not only in Committee but in the House.

Question put and agreed to.

The Chairman: Starred amendments will not be accepted, so any amendments should be tabled in good time. There is a money resolution, copies of which are available. I do not intend to call any manuscript amendments either.

Clause 1

Meaning of ''NHS body'' and ''qualifying hospital patient''

Mr. Paul Burstow (Sutton and Cheam): I beg to move amendment No. 58, in

    clause 1, page 1, line 9, leave out 'and' and insert 'or

    (c) a Care Trust within the meaning of section 45 of the Health and Social Care Act 2001; and'.

I too welcome you to the Chair, Mr. McWilliam, and look forward to serving under your chairmanship during the four sittings on the Bill.

Column Number: 4

This is intended as a probing amendment. It is designed to explore the Government's thinking about the relationship between the penalty system proposed by the Bill and by the health flexibilities set out in the Health Act 1999, and the joint management arrangements such as care trusts that were set out in the Health and Social Care Act 2001. According to a written answer that I received a couple of weeks ago, 16 pooled budgets in operation around the country have been explicitly set up to deal with delayed discharge issues.

I hope that in response to the amendment the Minister will tell us how she sees those arrangements working in a system in which penalties apply. During the inquiry into delayed discharges by the Select Committee on Health, she said that four care trusts were in place to deal with services for older people, as well as those 16 budgets. Will she make it clear which bodies will be liable for the penalty? Will responsibility lie with social services departments, with the pooled budgets or, when service responsibilities have been merged into them, with the care trusts? The Bill does not make that clear. It is not obvious that the regulation-making powers elsewhere in it are sufficient to enable the fine to be directed to the agency that, within the terms of the Bill, is responsible.

For example, how will an area that operates a pooled budget or care trust share in the £100 million announced by the Secretary of State for Health on Second Reading? How will that be paid? Will it be paid to the social services department and then passported to the pooled budget? Will that be dealt with in regulations?

Will the Minister also spell out how the Department of Health arrived at the figure of £100 million? In recent written answers, she did not say clearly how it was worked out. She implied that it was in some way a capped or maximum figure, and that local authorities could not be subject to penalties that exceeded £100 million. She should give some answers on that subject, not least because it is the time of year when local authorities struggle to balance their books and make their budgets add up in time to set new budgets for the early part of the next year. It would help local authorities if they knew earlier rather than later the basis on which the money would be distributed. If they have pooled arrangements or are thinking about having them, will the money be passed to those pooled budgets? If so, on what basis?

What role will care trusts have in the system? The Bill does not deal with them at all.

Mr. Burns: The hon. Member for Sutton and Cheam (Mr. Burstow) rightly said that this part of the Bill—it will become apparent during our proceedings that the same is true of many others—contains several issues on which there is confusion about what the Government intend. That is partly because so much of the Bill will take effect through regulations, rather than through its provisions themselves.

I will not try your patience by elaborating on that, Mr. McWilliam, as there will be far better opportunities to do so later. However, I will say now

Column Number: 5

that the Bill contains a fundamental flaw; I shall leave aside its content as a whole for now, as we believe that the Bill is deeply flawed. In many ways, it is a mere skeleton that will be fleshed out by regulations that no member of the Committee has seen in advance, so we are somewhat in the dark about exactly what the Government intend to do about the fine detail, through the regulations.

That brings me back to the hon. Gentleman's point about flexibility in the health service. The Bill goes counter to the trend established in previous legislation towards giving greater powers to health trusts, primary care trusts and social services departments. I have welcomed the increasing reduction, in the past decade or so, of barriers between social services departments and the health service in the provision of community care and social care. However, the Bill is centralising, over-prescriptive and controlling, and introduces the concept of fines. The Minister owes it to the Committee to tell us in greater detail what she is expecting—

The Chairman: Order. The amendment is narrow, and the hon. Gentleman is making a clause stand part point.

Mr. Burns: I am grateful for your guidance, Mr. McWilliam. I shall abide strictly by it. Can the Minister explain, with regard to a care trust such as that mentioned in the amendment, how the sum of £100 million announced by the Secretary of State will be distributed? Will it be distributed to a PCT or shared between a PCT, a care trust and an acute trust in a local area? How, as the hon. Member for Sutton and Cheam has already asked, was the figure of £100 million arrived at? Is it a blanket £100 million per annum for three years, or is it up to a maximum of £100 million?

Given that the Government have assessed that the cost of delayed discharge to care trusts, PCTs and acute trusts runs at about £180 million per year—a figure that has been reinforced by our research with social services departments—and that the level of fines anticipated by social services departments at current levels will be a similar figure, why £100 million? What will happen after three years, if there are still problems with delayed discharge and the money is not made available? I hope that the Minister will deal with all those points. They are an important factor in our consideration of how effective this part of the legislation will be.

Jacqui Smith: It is important to outline the role that we see for incentives in the Bill. Incentives must be put in the right place to ensure that patients do not have to wait for services, and are not trapped in hospital—because the system is slow, or because the NHS and social services are arguing about which services are needed—when they would be most appropriately served out of hospital. In some cases, the poor funding experienced by many social services departments in the years preceding 1997 meant that social services had an incentive to slow down the system to protect their budgets. As I outlined on Second Reading, we have made progress on tackling delayed discharge not only through investment but through top-down performance management.

Column Number: 6

However, performance is still patchy, and the Bill will enable us to put in place a new approach, which will work at a local level.

10.45 am

The hon. Member for West Chelmsford (Mr. Burns) accuses the Bill of centralising arrangements, but it does precisely the opposite: it puts in place the necessary incentives at local level to ensure that the significant extra investment that the Government are putting into social services is spent on the community alternatives necessary to ensure that older people are given the choices that they need and the opportunity to leave hospital at the appropriate time.

Mr. Nigel Waterson (Eastbourne): Does the Minister accept that partnership working in areas such as mine has proved its worth, and targets for reducing delayed discharges have been over-achieved? The problem is that the Bill simply sets everyone at each other's throats again. It does not discriminate between areas where partnership is being implemented constructively and those where it is not. Surely the Minister can see that.

Jacqui Smith: I shall go on to talk in a little more detail about how the Bill promotes partnership—but I fundamentally disagree with the hon. Gentleman. First, of course, partnership is about results. In combination with the £100 million transfer, about which I shall talk in a little more detail, the Bill will provide rewards and incentives for areas that have good partnerships at local level and already achieve good results. It will do that by focusing on individuals and on the way in which they are processed through the system.

Secondly, partnership depends on a clear understanding of the roles and responsibilities of the different sections of the system. If there is a criticism of the system, it is, I am afraid, that there has sometimes not been clarity about social services departments' responsibility towards people—particularly older people—who are leaving hospital. The Bill will ensure that there is clarity. That will promote partnership, not undermine it.

The hon. Members for Sutton and Cheam and for West Chelmsford mentioned the £100 million. It is worth remembering that the Bill is being introduced in the financial context of a significant increase in resources for social services departments over the next three years. Indeed, the annual real-terms rate of growth of investment in social services will be doubled. In addition, we have recognised the need for a reward element in the Bill, which is about incentives. That will ensure that we put in place the resources necessary for social services departments to build capacity so that older people get the right care in the right place at the right time. The important point about the Bill is not that there will be charges but that it will give incentives for the sort of behaviour that ensures that social services departments will not have to pay charges. It is about providing the right services in the right place at the right time.


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