Community Care (Delayed Discharges etc.) Bill

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Mr. Burstow: On the subject of building capacity, will the Minister tell us whether the Department has examined how long it will take to commission the

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additional services that will be available as a result of the new investment?

The Chairman: Order. I have given hon. Members considerable latitude, but the clause is very narrow and deals mainly with definitions. The hon. Gentleman is making a Second Reading point.

Jacqui Smith: In that case I shall not be tempted down that route, Mr. McWilliam—much as I would like have liked to respond.

The hon. Members for Sutton and Cheam and for West Chelmsford referred to the £100 million, and it would be helpful if I worked through the process by which we arrived at that figure.

Social services departments have already benefited from the £300 million building care capacity grant that has been available since last October. They have also have set a target for delayed discharge, which they expect to reach by next March. It reflects their ability to build capacity as a result of that £300 million. The figure is 4,200. Let us assume—I think it is a fair assumption, if not somewhat generous to social services—that 60 per cent. would be the responsibility of social services, and let us also assume a certain breakdown of the 4,200 between the areas outside London and the south-east, where the daily charge will be £100 a day, and the areas in London and the south-east, where the daily charge will be £120 a day. On that basis, we can calculate for each of those areas what the figure, multiplied by the proportion that is the responsibility of social services, multiplied by the total, would be. It equals approximately £100 million.

It is understandable that Opposition Members want some reassurance about the basis of that calculation, not least because our estimates range from £49 million—

Mr. Burns: Off the back of an envelope.

Jacqui Smith: Something even smaller.

Mr. Burns: A postage stamp?

Jacqui Smith: Yes, a postage stamp—which nevertheless formed the basis of a Liberal Democrat press release. The hon. Member for West Chelmsford seems to have plucked another figure out of the air—£180 million.

Mr. Burstow: Will the Minister give way?

Mr. Burns: Will the Minister give way?

Jacqui Smith: I give way to the hon. Member for West Chelmsford.

Mr. Burns: I am sure that the Minister would not want to do me down, and I must point out that my figures were not calculated on the basis that she suggests. If she had read my speech on Second Reading properly, she would realise that my figures were calculated after telephoning social services departments and asking them what they estimated the fines would be.

Jacqui Smith: I think that I have spelled out the process by which we calculated that £100 million per

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full year of the scheme's operation is a reasonable estimate of the likely fines. I have not seen the details of the questions that the hon. Gentleman asked social services departments, and in view of some of his behaviour on Second Reading, I am unsure whether he made it completely clear to social services departments who was telephoning and what he was asking them. However, it is for the hon. Gentleman to explain the basis of his calculation. I have explained the basis on which we made ours.

Mr. Burstow rose—

Jacqui Smith: Now the hon. Gentleman will tell us the details of what was on his postage stamp.

Mr. Burstow: I think that you would rule me out of order if I did that now, Mr. McWilliam, but I shall gladly do so during the clause stand part debate.

The Minister has spelled out the assumptions that she and her Department made in arriving at the £100 million figure, but what was the split between the £120 a day area and the £100 a day area? What proportions were assumed?

Jacqui Smith: We assumed that of the 4,200, 1,900 would be in the £100 a day area and 2,300 would be in the £120 a day area. I hope that answers the hon. Gentleman's question.

On the issue of reward, we made the calculation of £100 million on the assumption that after March 2003 no local authority will make any further progress in reducing the levels of delayed discharge—but that is unlikely to be the case. We have therefore ensured that there will be an element of positive reward for local authorities. As they make progress, they will be covered for what we believe the fines might cost them and they will be able to benefit from the progress that they are making. In that way, the areas that tackle delayed discharge effectively will be able to benefit from the system that we set in place.

Hon. Members have raised issues relating to flexibilities under the Health Act 1999 and care trusts, and I now turn to the detail of those issues. The amendment seeks to add care trusts to the list of NHS bodies in clause 1. Technically, that is unnecessary, as a care trust is either an NHS trust or a PCT. Clause 1 details the definitions of both the trusts and patients in question that qualify under the Bill.

The hon. Gentleman's probing amendment is about how particular partnership arrangements would work under the Bill. It is worth pointing out, as I did to the hon. Member for Eastbourne (Mr. Waterson), that we cannot assume that partnership automatically brings results, although it is an extremely important contributor to results. Therefore, it is important that those incentives are in place.

As we said in the original consultation on the Bill, pooled projects can now be set up as a result of the Health Act 1999. They have been set up between health and social services partners for health and social services in the community. In the case of a pooled budget, the partners need to consider the intended use of the budget very carefully. They need to consider

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which services are to be provided from the budget, and explicitly include that in the partnership agreement.

The hon. Member for Sutton and Cheam—referring to a written answer that I suspect I gave—rightly pointed out that 16 pooled budget areas currently cover delayed discharge. They may not, of course, cover the social services responsibility for providing alternatives to hospital. For example, some, I believe, cover the joint employment of occupational therapists, or the joint employment of teams that will enable people to be discharged more quickly. In those cases, the partnership may ensure that the local partners are better able to reach their targets on delayed discharge, although the pooled budget will not necessarily bear the responsibility for ensuring that alternatives are in place. In those cases, the responsibility for payment of any charges that arose would remain with the local authority.

As they make the partnership agreement, the partners will need to consider whether the services are key to dealing with hospital discharge, and whether the social services' contribution to the pooled budget reflects an intention to make any reimbursement to the acute trust from that pooled budget. That would then be dealt with in the budgetary part of the partnership agreement. The legal position remains that the local authority is responsible for the reimbursement, although the payments may be made from the pooled budget, with the PCT's agreement.

Mr. Burstow: I am trying to follow the Minister's explanation. Am I right to understand that, on the basis she mentioned, the 16 pooled budgets that have been established to deal with reducing delayed discharges to hit targets are unlikely to be subject to fines, because the financial agreements that have already been arrived at do not include them, so there would have to be renegotiation?

The Chairman: Order. We are now way off the clause. The point that the hon. Gentleman raised arises under clause 4, not the present clause or amendment. In view of the latitude that I gave other Members, I have allowed the Minister considerable latitude—but the Committee should discuss the financial aspects under clause 4, which is where they lie.

Jacqui Smith: Thank you, Mr. McWilliam. I will respond briefly to the point about care trusts over and above partnership agreements.

The services provided by the care trusts that carry out all social services functions, or services for older people and adults, do not yet include NHS acute services. Our proposals provide that the payment should be made to the acute trust, although I am sure that that will be discussed later. The principle of reimbursement for the care in the acute sector is to ask the local authority—or, in the instance that we are considering, the care trust—to reimburse the acute trust for the cost of looking after someone if the responsibility for looking after that person has been transferred. In those cases, the principle of reimbursement for the actual care given in the acute sector once the patient is supposed to be the care trust's responsibility still holds. The care trust will be

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responsible for any necessary reimbursement to the acute trust, and that should be borne in mind when the care trust's budget and objectives are set.

You are right, Mr. McWilliam, to say that we have had a relatively wide-ranging debate on the amendment. I hope that the hon. Member for Sutton and Cheam feels that his probing has drawn some results and that he can therefore withdraw the amendment.

Mr. Burstow: The Minister has given some information about which I shall want to ask more questions when we reach a later clause. However, in the light of what we have been told, and although I may want to return to the matter later, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

11 am

Mr. Burns: I beg to move amendment No. 8, in

    clause 1, in page 1, line 14, leave out 'or is expected to receive'.

The Chairman: With this it may be convenient to take amendment No. 9, in

    clause 2, page 2, line 4, leave out 'or is expected to become'.

I remind the Committee that the amendments are very narrow in scope: they deal only with the question whether people who are expected to receive care should be included in the Bill.

 
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