Community Care (Delayed Discharges etc.) Bill

[back to previous text]

Mr. Burns: The amendments are probing in nature and concern those people who are ''expected to receive'' care. I should be grateful for further information from the Minister. The clause defines an ''NHS body'' and a ''qualifying hospital patient'', and, with reference to the latter, states that it is someone

    ''who is receiving (or who has received or is expected to receive) care''.

I fully understand, and find unambiguous, the references to someone who ''is receiving'' or who ''has received'' care. However, I experience a degree of confusion about someone who ''is expected'' to receive it. The expression has a logical meaning in English, but what is meant in the context of the Bill? How do you know whether you are expected to receive care? Does that expectation arise because you have a medical complaint that may develop?

The Chairman: Order. The word ''you'' refers to me, in Committee, and as will be obvious to hon. Members, I do have a medical complaint—a rotten cold. However, the hon. Gentleman should use the third person.

Mr. Burns: Thank you, Mr. McWilliam. I am sorry to hear of your complaint.

Sir George Young (North-West Hampshire): You fall within clause 1, Mr. McWilliam.

Mr. Burns: Indeed, as my right hon. Friend says, the clause may be more relevant to you, Mr. McWilliam, than was first apparent, in view of what you have told the Committee.

Patients with a medical complaint that in the normal run of things can develop into something more serious might be expected to receive care at some point. Is that what the clause refers to? Alternatively,

Column Number: 11

is it intended solely to denote someone who is elderly, who might on that account be expected to require care at some point? The explanatory notes also suggest a need for clarification. They state:

    ''To be a qualifying hospital patient, a patient must be receiving care of a type prescribed in regulations.''

There is no mention of patients who are expected to receive such care. I understand that explanatory notes are not binding. They are intended as guidance and illumination rather than a hard and fast catch-all explanation of every element of the legislation. However, they miss out that definition.

I wonder whether the Minister would give a greater explanation, because we do not want to pass a skeleton Bill—it will be fleshed out by regulation, so in some ways we are very much in the dark—that could cause confusion or misunderstanding over exactly what the Government mean by the qualifications and elaborations. If the Minister were to explain exactly what she intends by that part of the definition of a patient requiring care, it would go a great way to reassuring us.

The Chairman: Order. Before the question is put, I remind the Committee that the reading of newspapers and periodicals, or even photocopies of them, is not allowed in Committee—the hon. Member for Edmonton (Mr. Love) should put it away.

Mr. Burstow: I want to ask a question of the Minister. We are exploring who might be expected to be in need of care. One category is those patients who it is expected will be admitted to hospital as elective admissions. Will the Minister explain why the Department does not seem to know the split between those who are admitted to hospital on an elective basis, and how many of them experience delayed discharge, and those who are admitted as emergency cases who experience delayed discharge? Given that the Department does not have that information and has not sought it, it is difficult to understand how the clause will work. At the moment, the Department does not know how many of those people there are, and therefore the financial or practical implications of putting such a provision in the Bill. Will the Minister explain why the Department does not seem to know that information and what is being done to get it?

Jacqui Smith: The hon. Gentleman is getting the hang of the Bill—I am sure that the hon. Member for West Chelmsford will get the hang of it before long—because he recognises that the provision is about how to cope with elective admissions. It is acknowledged to be good practice to begin planning for discharge before admission if the admission is for elective treatment. Generally, the best time to start thinking about what such patients are going to need for discharge is when they go to hospital for their pre-admission assessments. That can be a key step for avoiding delays following an operation or treatment; delays may mean patients losing confidence and perhaps never attaining the full benefits of their treatment.

Column Number: 12

When we come to clause 2, we shall be discussing one of the important features of the Bill: the requirement for trusts to notify social services departments about the needs of those who are likely to require community care services when discharged from hospital. Clause 1 defines those who will be covered by the Bill. It is important that councils should be notified about those who expect to receive that care—in other words, before their elective admission—because councils will want as much time as possible to make assessments and provide the right conditions. The majority of elective admissions lead to short stays in hospital, and for much of that they will be receiving treatment and recovering from it. It will help if aftercare can be planned as far as possible.

On the point made by the hon. Member for Sutton and Cheam, the Department has information about the likely duration of hospital stays for those aged over 65, depending on whether there is an elective or an emergency admission. I shall pursue his question about whether our hospital episode statistics are broken down between those two types of admission. The problem—I think that this is his point—is whether the type of admission has a bearing on whether discharge is delayed. It is important to note that the Bill does not rely on high-flown statistical analysis of whether one category or another is more likely to involve delayed discharge—that depends on the individual needs of patients and whether they enter hospital electively or in an emergency. The Bill ensures that all the incentives are in place for individuals to be assessed as quickly as possible and that suitable community care alternatives are provided equally quickly.

I hope that hon. Members' concerns have been met and that the hon. Member for West Chelmsford will withdraw the amendment.

Mr. Burns: I am grateful to the Minister. She has allayed my fears by giving a fuller explanation, particularly as regards elective patients. That raises an important point. It is crucial in the case of elective admissions that there is a turn-key operation, whereby social services departments, and possibly other charitable organisations, can assess the needs of an individual after treatment in order for adaptations to be made inside the home on discharge.

That leads to another matter, which I shall float in little detail so as not to be out of order—I hope that we can return to it later. One can do as much assessment and analysis as is required of what is needed to adapt a home for a patient to return to it, but that costs money. Social services departments have faced a serious problem for some years in that they do not always have the financial resources to make the adaptations that will allow the seamless return home that the Bill, idealistically, seeks to facilitate. I shall not pursue that now, because I do not wish to fall foul of your strictures, Mr. McWilliam. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Burns: I beg to move amendment No. 1, in

    clause 1, page 1, line 14, leave out from 'receive)' to end of line 15 and insert 'geriatric, acute care'.

Column Number: 13

The Chairman: With this it will be convenient to take amendment No. 59, in

    clause 1, page 1, line 15, at end add 'except where the patient is accommodated in an independent hospice, an NHS palliative care unit, or a care home within the meaning of the Care Standards Act 2000'.

Mr. Burns: This, too, is a probing amendment, leading on from amendments Nos. 8 and 9. The Bill defines ''qualifying hospital patients'' as those who are receiving, who have received or who are expecting to receive

    ''care of a description prescribed in regulations.''

I think that it is in order, because of the amendment and the wording of the clause, to discuss the regulations. The Bill does not describe what will be prescribed in the regulations. The explanatory notes give us an idea of what the regulations will include:

    ''In the first instance it is intended that the prescribed type will be acute or geriatric care provided in a general and acute hospital.''

They continue with what is presumably a hope list, saying:

    ''The types of care may later be extended to other sectors, such as mental health or intermediate care, as appropriate.''

Such hopes are very much up in the air. The Government may want to realise them at some point, but they are not as hard and fast as, for example, a manifesto commitment.

11.15 am

I am slightly disappointed that it is not clear from the Bill exactly what the Government want it to deal with in the first instance. It is rather unsatisfactory that we must rely on regulations that we have not seen, and on the very broad guidance in the explanatory notes. I say that especially because regulations throughout the Bill will be subject to negative rather than affirmative resolution. I will not argue the case for negative versus affirmative resolutions for statutory instruments, because we will debate that on another amendment. However, it is still valid to make the narrow point that it is a mistake to rely so heavily on unseen regulations to flesh out the Bill.

As I said, our probing amendment is intended to tease out from the Minister more information than is in the explanatory notes about what the Bill will deal with in the first instance. Can the Minister share with the Committee more of her understanding of what will be in the regulations, which will give detailed descriptions? I assume that her Department has been working on the general contents of the regulations for a considerable time, and I hope that she will tell us that it more or less knows what will be in them. If so, I make a further plea. Given that the Government pay lip service to the idea of open government and sharing information, will she release to the Committee the details of her thinking on the regulations, which she and her Department will no doubt issue as soon as they can after the Bill becomes law? That would enable us to complete our work over our two days of sittings in a better and more informed way.

On the advice of her parliamentary draftsmen, the Minister may argue—probably with some justification—that it would be wrong to accept the amendment. She may argue that it would put the Bill

Column Number: 14

in too much of a straitjacket and require the Government to introduce further legislation if they wanted to extend the descriptions in the Bill to intermediate and mental health care. I have considerable sympathy with that argument, but before the Minister is too cruel to the Opposition, who cannot rely on the professional services of parliamentary lawyers and draftsmen, I remind her that we tabled our probing amendment solely to tease out more of her thinking. If draft regulations on this and other parts of the Bill are available to her, will she make them available to the Committee to help and enhance our scrutiny?

 
Previous Contents Continue

House of Commons home page Parliament home page House of Lords home page search page enquiries ordering index


©Parliamentary copyright 2002
Prepared 10 December 2002