Community Care (Delayed Discharges etc.) Bill

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Jacqui Smith: As my hon. Friend the Member for Sheffield, Heeley (Ms Munn) identified, the clause is about ensuring that everyone who needs information must have it as quickly and efficiently as possible, so that they can assist in the development of better assessments and processes to get people from hospital care to alternatives in the community. Good practice tells us that the earlier we start planning a patient's discharge, the more successful and efficient that discharge will be. That applies to emergency admissions, starting when people are admitted for an emergency, and before admission for elective admissions.

I am pleased that Opposition Members have such a rosy and positive view of the good work in local partnerships. I have a positive view of partnerships, but I believe that they must ensure that we do not have 5,000 people, mostly older people, stuck in hospital when they should not be.

Mr. Baron: Although the Minister agrees that partnerships have done plenty of good work, does she accept that the situation on delayed discharges was improving? Does she agree that we should build on the trends of the partnership and teamwork exhibited in recent times, especially when alleviating winter pressures? Does she think that we should encourage closer relationships and partnerships rather than implementing a Bill that will create a Berlin wall?

Jacqui Smith: The hon. Gentleman and I can certainly agree that the Government have successfully reduced the level of delayed discharges. It is significantly lower than it was under the Conservative Government. There has been some success, but it has been dependent on Government investment. Opposition Members have opposed that investment. They think that partnership is a good thing, but are not willing to pay for results.

Mr. Waterson: I am sure that the Minister has the national statistics at her fingertips to form the basis of that claim; after all, that is one of the things for which she is paid. Although my area is regularly under pressure in winter, as my hon. Friend the Member for Billericay pointed out, the concept of all-round bed blocking is relatively novel, certainly in Eastbourne district general hospital, and it has been created under the present Government. I wish that the Minister would stop trying to score party political points and address the serious problem. What I say may be untrue in other parts of the country—it is the Minister's job to know—but I am telling her the position in my authority area.

Jacqui Smith: I am glad that that is the position in the hon. Gentleman's authority. I would not want to challenge his figures, but I hope that he looks carefully at the basis for his assertion that there is no issue with delayed discharge in his area.

Mr. Burns: As the Minister has made an allegation about what happened under the previous Government and what has happened under the present one, will she say now how many delayed discharge patients there were in March 1997?

Jacqui Smith: I cannot tell the hon. Gentleman at this precise moment, but I will ensure that I back up

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my assertion, which is correct, that figures have fallen under the present Government.

Mr. Burns rose—

Jacqui Smith: The hon. Gentleman is pursuing his leader's approach, so I shall let him provide the answer.

Mr. Burns: I am slightly confused, but grateful for the Minister giving way. For her benefit, I must mention the Government's record on delayed discharges. She gives the impression, although she talks of improving matters further, that it was downhill all the way from 1 May 1997. I remind her that in the first quarter of 2001–02, there were 6,361 delayed discharge patients, but by the second quarter, the figure had risen to 7,065. That, I suggest, is not an improvement.

Jacqui Smith: I am glad that the hon. Gentleman allowed me to sit for a moment, because it has given me the opportunity to answer his question. In March 1997, there were 6,985 delayed discharges of patients of 75 years of age and over—a rate of 13 per cent. By September 2002, those figures had fallen to 8.9 per cent. and 4,147.

The Chairman: Order. Can we return to the amendments? We seem to be having a Second Reading debate. I shall take a severe view of it, if it continues, when considering whether we should have a clause stand part debate.

Jacqui Smith: Before I was interrupted, I was talking about the importance of clause 2. It will ensure that planning discharges can be started early. Local authorities need to be told in advance that an individual may need services upon discharge. Only then can they start planning to ensure that those services will be available. The hon. Gentlemen suggested that there is excellent partnership and communication. I agree that those do exist in some areas, but, sadly, not in others.

The Bill will ensure that the NHS and social services communicate about hospital discharges; it will place a new duty on the NHS formally to notify the responsible social services authorities about patients who are likely to need services in order to ensure their safe discharge. Social services authorities will thus be able to start that planning earlier. The purpose is to ensure that patients receive prompt, efficient and appropriate discharge.

The amendments seek to make the NHS and social services come to joint decisions about matters that I suggest are not appropriate for joint decision; indeed, the effect could be not only that they do not to serve to assist in that process but that they hold it up. Of course joint working is important. It is essential that the NHS and social services work together in consultation and in partnership throughout the discharge process in order to ensure that patients' needs are fully met; and they should do it in relation to each patient.

Opposition Members like to talk about statistics, as do I when they show that our policies are successful. However, what is important about the Bill is that it

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focuses on individuals and on the joint working necessary to ensure that they get the care they need when they need it.

Mr. Burstow: The Minister is making the important point that we are talking about joint working, and I hope that she can now answer the question that I put to her. Does the definition given by the deputy director of the social services inspectorate still stand? Are decisions still being taken by both social services—through multidisciplinary assessment—and clinicians?

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Jacqui Smith: The hon. Gentleman asks whether the Bill will change that definition; it will not. After consultation with the team, hospitals have always had to make the final decision on whether it is safe to discharge someone. As my hon. Friend the Member for Leigh (Andy Burnham) said, surely we would not expect anyone else to determine whether it was clinically safe to discharge someone.

Clause 2 is about notifying social services that it might be necessary to arrange community care to ensure that someone can be safely discharged from hospital. Some of the amendments imply that social services and the NHS would need to agree on whether social services should be notified about a patient's case. It is unclear quite how the NHS could come to such an agreement with social services, not least because social services might not even be aware of a patient's existence before the NHS notified them. It is a bit nonsensical for social services to have to agree to be notified by the hospital that a patient exists.

Mr. Burstow: Amendment No. 104 to clause 3 is very relevant to the matter the Minister is discussing. Does the Minister accept the definition that Mr. Gilroy gave the Select Committee? Must both a clinical and a multidisciplinary decision be taken before the clock starts ticking on the final penalty that the Bill will introduce? Must both those conditions be satisfied before the Bill's fine mechanism is put in place?

Jacqui Smith: I think that I answered that question. Indeed, I was very clear. Obviously, we will continue to discuss what starts the clock ticking when we come to clause 4 later this afternoon.

Clause 2 is about notification. The hon. Member for Sutton and Cheam rightly said that some of the amendments relate to clause 3, and I shall refer to them later. The logic behind clause 2 is that the NHS must be solely responsible for deciding to notify the local authority of a patient's case. Only the NHS will have knowledge of the case. Notification is necessary to start the whole important assessment and discharge process dealt with by the Bill.

Opposition Members suggested that the amendments would give social services more control over which patients were referred to them, and particularly over how an assessment was carried out. There may be concerns that the NHS would refer people to social services just in case they need services, or that it will take a scattergun approach to referrals. However, the Bill makes it clear that we are talking about people who are likely to need community

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services if they are to be safely discharged. The decision whether a patient is likely to need services on discharge should, and can, be taken only by the NHS. The next stage is for social services to assess the patient, and it will be for social services alone to decide whether they actually need services on discharge. The Bill therefore clearly sets out where responsibility for parts of the pathway lies.

As set out in clause 2, notification is necessary to start the process. If social services are already aware of the patient and already provide services for them, they will quickly be able to form a view of what is needed. On the other hand, if they carry out a preliminary assessment of the patient, and decide that the patient does not need their services, they should inform the NHS. That would be one circumstance in which a notification would cease. The NHS would then need to plan the services that it would provide, with that knowledge. It would also be for the NHS and social services to give patients information and advice if they needed to make their own arrangements.

Amendment No. 24 is completely unnecessary and would achieve nothing new. There may be cases in which social services consider that a patient's circumstances have changed since the original determination of what services would be needed on discharge; for example, the person's carer or spouse might be ill, or it might be impossible to make adaptations to the home to allow them to return there. That would mean that the services that social services had decided to provide would no longer be suitable, and that the NHS would no longer consider it safe to discharge the patient home.

If social services became aware of the change in circumstances, they would want to inform the NHS that they believed it should withdraw the notice; the discharge plan would need to be remade. They could do that without any explicit provision in the Bill. We shall make that clear in regulations. Clause 3(5) is intended to deal with a change in the patient's circumstances that leads the NHS to entertain concern that that the services decided upon by the local authority will no longer be sufficient to make it safe to discharge the patient. It is therefore for the NHS, rather than social services, to determine whether the circumstances have changed sufficiently to warrant withdrawing the notice given under clause 2.

Amendment No. 25 suggests that the NHS should be under a duty to agree with social services what services it would make available. Of course it is crucial for the NHS and social services to work together in the assessment and in their determination of what someone would need so that they could safely be discharged from hospital. We shall come to the detail about the form that the assessment might take when we reach clause 3, but that is precisely why the Government made clear, in the single assessment process, the outcome that we would expect from the assessment. However, that is not quite the same as saying that when the assessment is carried out, a legal agreement is necessary—a veto for either partner over the contents of the package.

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It is for the NHS to determine the NHS services that a patient needs, and for social services to determine the community care services a patient needs. Although, as I have suggested, they must consult and they can and should enter into a discussion about the services that are needed, there can be no legal requirement for them to reach agreement about what each should provide. That would create a veto, which in turn would not help to achieve what we want—to ensure that no older person waits inappropriately in an acute bed.

I have explained what we intend clause 2 to achieve with respect to notification, and how clause 3, without undermining the need for joint working, provides recognition of the legal position with respect to the assessment. I hope that in view of that, the hon. Gentleman will withdraw the amendment.

 

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Prepared 10 December 2002