| Community Care (Delayed Discharges etc.) Bill
|
|
Dr. Phyllis Starkey (Milton Keynes, South-West): Will the hon. Gentleman explain which alternative bodies, apart from the NHS, he thinks are in a position to assess the clinical needs of patients, and whether those needs should be met in hospital? Mr. Baron: If patients are being moved from hospitals to social services, social services should have a say in determining their clinical requirements, because they will be meeting those requirements once those patients leave hospital. It is an error simply to rely on the hospitals. There must at least be a period of consultation and co-operation, and I hope that the amendments would move us in that direction. Ms Meg Munn (Sheffield, Heeley): Does the hon. Gentleman not accept that the Bill will move the relationship between the health service and social services on by requiring the health service to notify social services? That requirement does not currently exist in legislation, although it is good practice. Mr. Baron: Point taken—but, at the same time, all parties must co-operate on transferring patients. It cannot be left solely to NHS bodies to decide the criteria for transferring patients who become the Column Number: 18 responsibility of social services. There must be closer co-operation. Obviously, NHS bodies must have a say, but social services must also be consulted because many patients are transferred to them.Andy Burnham (Leigh): Will the hon. Gentleman give way? Mr. Baron: I must make some progress, but I shall give way one more time. Andy Burnham: I am following the hon. Gentleman's arguments fairly closely. Is he really suggesting that social services should be able to oppose a clinician's decision to discharge a patient? Mr. Baron: If the hon. Gentleman reads the amendments, he will see that I am suggesting closer co-operation and consultation. Every effort must be made to reach decisions jointly. If social services do not agree with the criteria set by hospitals, there will be no basis on which to forge partnerships and co-operation. That is the key point. We are trying to encourage co-operation, partnership and teamwork. There could be many difficulties if only one body makes the decisions, or if, as happens in some cases, a body does not consult. We are trying to avoid such difficulties through the amendments. Andy Burnham rose—
Mr. Baron: If the hon. Gentleman will allow me to make some progress, I will try to develop my arguments. I would welcome his intervention—but perhaps after I have made my point. It appears from subsection (1)(b) that the NHS body alone decides whether a patient who is about to be discharged requires community care services. That is hardly co-operation or partnership. Amendment No. 2 would put that right by adding the words ''and the responsible authority'' after ''NHS body''. We hope that that would establish a partnership of care between the NHS and social services. That would give both parties joint responsibility for deciding whether a patient was fit to be discharged and for setting up an appropriate care package. In short, it would ensure that NHS bodies and social services worked together to assess a patient's condition. That would place a duty on both parties and further encourage joint working. I should add that the Local Government Association and the NHS Confederation support those proposals. In the same vein, amendments Nos. 24 and 25 would forge close co-operation in the implementation of the provisions of clause 3. It appears from clause 3(5) that the NHS body is solely responsible for initiating changes to plans, where the patient's circumstances have changed. Again, that is hardly co-operation or partnership. Amendment No. 24 would remedy the problem by making the NHS body and the responsible social services authority jointly responsible for making the decision. It would encourage co-operation and partnership. We propose a similar amendment to clause 3(6), which states:
Column Number: 19
Again, that is hardly co-operation or partnership. In amendment No. 25 we suggest that the NHS body should not only consult but agree with the responsible authority. It is surely in the patient's best interests that both parties to the arrangement agree the level of care required for safe discharge. In conclusion, we fear that the Bill threatens the increasingly close co-operation and partnership between the NHS and local government that has existed in recent years. The Berlin wall— Ms Munn: Will the hon. Gentleman give way? Mr. Baron indicated assent.
Ms Munn: I apologise for stopping the hon. Gentleman in mid flow. He is talking as though there is not already legislation concerning the way in which social services and the NHS work in terms of putting together care plans and assessment. My understanding is that the Bill will add to the process, and will deal with situations in which NHS hospitals fail to identify early the fact that safe discharge will be an issue. It places the responsibility where it needs to be, so that the existing joint operations and partnerships between local authorities and NHS bodies can come into effect. Mr. Baron: On the contrary, I am saying that co-operation exists and that it has been getting better. Hence the good teamwork that has been exhibited in alleviating winter pressures, for example. We fear that the Bill will create a Berlin wall between NHS bodies and local government, whereas barriers have, until now, been coming down. Not only does the Bill recreate the wall, but a number of the clauses give those on one side of the wall—the NHS bodies—all the ammunition to fire at those on the other side. Examples include clause 2(1)(b), clause 3(5) and clause 3(6)— Mr. Waterson: I appreciate the effect of partnership working, which happens in my area, but does my hon. Friend share my concern that there might be a systemic problem in that there is an irreducible minimum of beds likely to be blocked at a given time in a particular area, which is a function of the underfunding of social services across the board? That is likely to get worse rather than better. Hon. Members: What did you do about that when you were in power? The Chairman: Order. Sedentary interventions are to be deplored. Mr. Baron: I have great sympathy with my hon. Friend the Member for Eastbourne. One of our concerns is that the £100 million charge is a way of diverting resources from social services and ensuring that the money travels to NHS bodies. Our amendments Nos. 2, 24 and 25 at least try to provide ladders over the Berlin wall so that people can discuss and co-operate, and the patient can benefit. Their aim is to improve co-operation and partnership Column Number: 20 in an otherwise difficult world, and I commend them to the Committee.Mr. Burstow: I shall speak to amendment No. 104. It deals with co-decision in partnership working, which ought to be the norm in managing an appropriate discharge or transfer of care. The hon. Member for Billericay (Mr. Baron) is right to express a concern about the potential effect of the Bill. I liken it more to the driving of a wedge between agencies that currently, in some parts of the country, do not work effectively as partners. Introducing the financial mechanism will encourage the NHS and social services departments to shunt responsibilities instead of confronting the need to work together to deal with the responsibilities to the person in the hospital bed. The Government published the conclusions of their consultation about the implementation of the Bill on 29 July. The results from 268 respondents were received on 18 September. It is interesting to note that 35 per cent. of respondents came from local councils; 21 per cent. came from primary care trusts; and 16 per cent. came from NHS trusts. There were also various joint responses.
11.45 amSeveral aspects raised in the responses go to the heart of the debate on this group of amendments. When asked for their views on whether the reimbursement proposals would have a deleterious impact on partnership working, 77 per cent. of respondents said that they believed that the proposals could damage partnerships. Whether that relates to long-established partnerships or to those that are just developing, I would have hoped that the Government would have reflected on the fact that 77 per cent. of respondents, including acute trusts and PCTs, responded in that way, and would have made some adjustments to the Bill before it saw the light of day. Mr. Burns: Does the hon. Gentleman agree that it is highly significant that the 77 per cent. of organisations that feared that the proposals would have a harmful effect on partnerships included bodies from the NHS? Contrary to what Ministers keep saying, those organisations share the view that the proposals will have an adverse impact on the relationship between social services departments and NHS bodies. Mr. Burstow: I entirely confirm that view, which certainly seems to be the view of those who responded to the consultation. Some 14 per cent. of responses were joint responses from those who operate NHS Health Act 1999 flexibilities. It beggars belief that we are debating a Bill that does not appear to have been amended in any way to reflect those concerns, not least the fact that 100 per cent. of respondents said that they felt that the date set for implementation—April 2003—was too soon. The results of the consultation make interesting and disappointing reading, in so far as they do not seem to have influenced the legislation. I want to pick up on one or two issues relevant to the amendment that were mentioned during the Health Committee inquiry into delayed transfers. The Committee spent some time exploring the definition of delayed discharge. Indeed, during the Committee Column Number: 21 inquiry, the Minister made it clear that she expected the NHS to use the definition laid down by the Department. The definition is key to the amendment because it establishes where responsibility lies for deciding when a person is fit or safe to be discharged.During the Health Committee inquiry, Department officials set out a definition. Mr. David Gilroy, deputy chief inspector, social services inspectorate (performance), told the Committee:
He went on amplify what that meant:
Will the Minister confirm whether that definition will be used in the guidance and regulations? Will whether a person is ready for discharge still be a matter for co-decision, through multi-disciplinary assessment? From my reading of the Bill, it appears that that definition, to which the Government were so clearly committed only a matter of months ago, has been changed, although it is fundamental to the proposals. Amendment No. 104 would include in the Bill the idea that underlies that definition. From reading the Select Committee inquiry, it seems that definitions have been shifting around. For example, the Health Committee spent some time asking the Minister about ''frictional discharge''. That definition is important if we are to understand where responsibility lies. She replied:
She was interrupted at that point and so did not conclude. When I read that, I asked whether the Department could define what it meant by frictional discharge. It would seem useful to know how that was fed into the targets set, and what it meant for the division of responsibilities between health and social services. I was told in a written answer that
Does that mean that the definition of frictional discharge will vary from one part of the country to another? It would help if the Minister could clarify the definition. If we are to understand whether we are still to have co-decisions between health and social care about discharges, it is essential that we know whether the Minister and her officials are wedded to the definition that they used during the Select Committee inquiry. Does that still stand? It is not used in the Bill, but it is key to amendment No. 104. Column Number: 22
|
| |
| ©Parliamentary copyright 2002 | Prepared 10 December 2002 |
