Community Care (Delayed Discharges etc.) Bill

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Mr. Burstow: Although I shall be speaking to amendment No. 59, I support the line of questioning pursued by the hon. Member for West Chelmsford. It would be useful to have some illumination of what the Government intend to achieve through the clause and the Bill's regulation-making powers, in connection with extending the provisions over time.

Amendment No. 59 is almost the opposite of amendment No. 1. It would exclude from the Bill several aspects of health care services, which, it could be argued, should not be included in the regime in question: hospices, palliative care units and care homes. Because the Bill does not specifically exclude them, there is reason to be concerned that they might be included. Will the Minister provide an outline of the Government's intentions, and confirm that they do not ever intend to use the Bill and its regulation-making powers to include such institutions in the provisions?

Like amendment No. 1, our amendment is meant to probe the Government's intentions. It is difficult fully to map out and understand the policy intentions behind the Bill when so much is to be dealt with in regulations. If the Committee could see some of the regulations this week, that would undoubtedly help to make our discussions speedier and more timely. It would also help local authorities and the health care bodies that will have to implement the regulations to get on with things. They face the prospect of those regulations being published within weeks of the Bill coming into force, leaving them to rush arrangements through at a rate of knots. They will probably then become objects of opprobrium for not getting it right. It would help them if the Department could provide the material early, thus creating at least a chance of making a flawed system work a little better.

Jacqui Smith: The Bill is intended, as I suggested earlier, to set up a framework of incentives that could operate in a range of areas where patients cannot obtain the community care services that they need and are delayed in in-patient settings. Amendment No. 1 would narrow the scope of the Bill to affect only patients receiving acute and geriatric care. I understand that, as the hon. Member for West Chelmsford made clear, it is a probing amendment. Nevertheless, I must emphasise that it would be detrimental. If, as we believe, the Bill will work for older people in acute care, there will be potential for the incentives to work for other services.

We have already made it clear that we intend the Bill initially to apply to the acute sector only. We have taken a pragmatic approach, focusing on the most

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significant areas where there is an acute problem—I hope hon. Members will excuse the pun—and where it is most obvious that too many people, mainly older people, are not receiving the right care at the right time in the right place.

However, there are other sectors that suffer delays too; the hon. Member for West Chelmsford mentioned mental health. People may remain in intermediate care when other, longer-term care would be more appropriate. Perhaps that even applies to people in community care beds, for whom alternatives might be appropriate. That is why we have included the regulation-making power in the Bill, so that we can extend its scope as and when appropriate. We do not want to remove that power, as the amendment would. Doing so would mean that non-acute patients such as mental health patients, those in intermediate care and those in community hospitals could not benefit eventually from the improved assessment processes and faster provision of services that the Bill will deliver.

The amendment would prove unworkable in its current form, as no definition of acute or geriatric care is set out in the Bill. Those terms could therefore be open to interpretation and lead to disputes. That is why we need to draft regulations carefully. We need to consult widely, consulting not only hon. Members but the people who will implement such legislation. I cannot promise that regulations will be available for the Committee's scrutiny in the next two days, but I assure its members that the regulations will be open for consultation. An important task needs to be undertaken: to ensure that those whom we intend to be the first priority for incentives—those who receive acute or geriatric care—are properly defined.

Mr. Burns: The Minister just said that regulations would be put out to consultation so that everyone—not only hon. Members, but interested parties from outside the House—had an opportunity to consider them and comment on them. As we study the legislation, it is important that we understand the provisions that are hidden from us because they will be implemented through regulation. Will she give us a commitment that they will be out to consultation so that we can examine them before Report?

Jacqui Smith: I would not like to make a commitment that I was not sure that I could stick to, and I am not completely clear about the parliamentary timetable. However, I assure the hon. Gentleman that it is important that we get the regulations right. That is why they will be open for consultation.

We have made it clear that the key point of the legislation, and the first priority of the regulations, is to set up the framework of incentives to benefit the people most affected by delayed discharges. They are mostly older people; the provisions could benefit others as well, but those are the people who are most often inappropriately delayed in acute hospital care when they would much rather be elsewhere.

The hon. Member for Sutton and Cheam makes a fair point about seeking clarification about who could,

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who would and who would not be included in future. Amendment No. 59 seeks specifically to exclude patients accommodated in independent hospices or NHS palliative care. I assure him that we would not consider it appropriate for the new arrangements to apply to the types of care that the amendment would exclude.

I understand the concern that people near the end of their lives should not be discharged from hospices or palliative care and sent home if that is not what they want. I assure the hon. Gentleman that there is no prospect of such a thing happening under the Bill. In fact, patients in independent hospices would technically be excluded from the Bill in any case, as they are accommodated in neither a health service hospital nor an independent hospital in pursuance of arrangements made by an NHS body. They will not be covered by the clause.

Mr. Burstow: I am grateful for those assurances, but will the Minister confirm that when a person nearing death is in an acute care setting, and the prospects of transfer to a palliative care unit or hospice are negligible, that person will not be discharged?

Jacqui Smith: I think that I can give the hon. Gentleman that reassurance. We are going to consider the details of cases in which the Bill's provisions might not apply to particular discharges, or to patients still in acute beds. I believe that it would be appropriate to ensure, both by guidance and, if necessary, by regulations, that the situation that the hon. Gentleman mentioned does not arise.

I hope that I have reassured the hon. Gentleman that the Government have no intention of including NHS palliative care in the regulations. The intention is to prescribe acute and geriatric care in the first instance, and later to extend the Bill's provisions to other forms of care in which problems of delay occur, and for which we feel that the framework of incentives would be effective. I hope that after those reassurances, the hon. Gentleman will feel able to withdraw his amendment.

11.30 am

Mr. Burns: I thank the Minister for that explanation. My probing amendment has achieved what I hoped it would, which was to get a greater understanding of the narrow point of what the Government intended to do. There is still a problem with the regulations. However, I hope that the time scale will allow consultation on those, so there will be an opportunity to see the small print of what the Government intend. From experience across the political field, we have found that it is important to study the small print of the Government's intentions, because things sometimes crawl out of the woodwork that one would not expect. I hope that the time scale will make it possible for the regulations to be in the public domain for us to peruse and study before Report. In the light of the Minister's comments, and that proviso, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 1 ordered to stand part of the Bill.

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Clause 2

Notice of patient's possible need

for community care services

Mr. John Baron (Billericay): I beg to move amendment No. 2, in

    clause 2, page 2, line 6, after 'body', insert 'and the responsible authority'.

The Chairman: With this we may take the following amendments: No. 104, in

    clause 3, page 3, line 1, after 'body', insert 'and the responsible authority'.

No. 24, in

    clause 3, page 3, line 1, after 'body', insert 'or responsible authority'.

No. 25, in

    clause 3, page 3, line 5, after 'consult', insert 'and agree with'.

Mr. Baron: I, too, welcome you to the chair, Mr. McWilliam, and look forward to serving under your chairmanship.

One of the Conservative party's main concerns is that the Bill threatens the co-operation and partnership that exists between NHS bodies and social services in many parts of the country. The stated aim of clauses 2 and 3 is to secure better communication between the NHS and local authorities with social services responsibilities, but I fear that that will not be the result.

Recently there has been good progress in forging co-operation and partnerships between the NHS and local government. That was clearly seen in the successful teamwork in alleviating winter pressures. As presently worded, the Bill threatens that co-operation. That is not simply due to the fines—although that is the major bone of contention—but because the Bill appears to be one-sided, in that the NHS bodies alone are in the driving seat on many of the major decisions, particularly those relating to patients being moved on from hospitals.

 
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Prepared 10 December 2002