Community Care (Delayed Discharges etc.) Bill

---

[back to previous text]

Mr. Baron: Having listened to the Minister, I am not convinced. Recently the number of delayed discharges, although still too high, has fallen as a result of closer partnerships between NHS bodies and local government. The Bill now threatens those closer partnerships. If the Minister wants to persist with the ludicrous system of fining, she should at least allow local authorities a real say in the major decisions that affect the transfer of patients. Local authorities should have a say about whether a patient is fit for discharge and what is the appropriate care package. Local authorities should have some say in changes to plans because the patient's circumstances have altered, rather than simply being consulted when it is being decided which services, if any, will be made available following discharge so that the patient can be safely discharged. The amendments would allow local authorities to be party to such decisions and would therefore go some way towards resolving the issues. Because these are key decisions affecting the welfare of the patient, it is right for both the NHS body and local government to agree about the best course of action; otherwise there will be little co-operation and partnership.

The fear that such provisions will increase the likelihood that partnership and co-operation will suffer is felt not only on the Opposition Benches, but has been expressed by such bodies as the Association of Directors of Social Services, the NHS Confederation and the Local Government Association. While recognising the good progress in teamwork and partnership in recent years, those bodies have stated that it would be a retrograde step if the current proposals undermined trust and led to the development of adversarial relationships rather than co-operation between the NHS and local government. Our amendments would go some way towards redressing the imbalance that the Bill creates. They would give local authorities a real say in some of the key decisions that affect the transfer of patients. Without the amendments, the NHS body would call all the shots, and that is unreasonable. Having heard from the Minister, I do not believe that the amendments have been adequately addressed, so I shall press the amendment to a Division.

Column Number: 27

Question put, That the amendment be made:—

The Committee divided: Ayes 7, Noes 9.

Division No. 1]

AYES
Baron, Mr. John Burns, Mr. SImon Burstow, Mr. Paul Calton, Mrs. Patsy
Gillan, Mrs. Cheryl Waterson, Mr. Nigel Young, Sir George

NOES
Burnham, Andy Dawson, Mr. Hilton Fitzpatrick, Jim Keen, Alan Love, Mr. Andrew
Moffatt, Laura Munn, Ms Meg Smith, Jacqui Starkey, Dr. Phyllis

Question accordingly negatived.

The Chairman: Before I call the next group of amendments, and with the notable and welcome exception of the winding-up speech of the hon. Member for Sutton and Cheam, I have to tell the Committee that we cannot continue to have Second Reading debates or clause stand part debates on narrow amendments. The next group of amendments is extremely narrow; I hope that hon. Members will stick to them.

Mr. Burstow: I beg to move amendment No. 63, in

clause 2, page 2, line 10, after second 'the', insert 'Primary Care Trust, housing and'.

The Chairman: With this it will be convenient to discuss the following:

Amendment No. 31, in

clause 2, page 2, line 10, after 'services', insert 'or housing'.

Amendment No. 33, in

clause 2, page 2, line 30, after 'services', insert 'or housing'.

Mr. Burstow: Amendment No. 63 addresses the questions of who is responsible for delayed discharge and who else should be in the loop during the process. Other amendments deal in part with that, but amendment No. 63 deals with whether housing departments and primary care trusts should be bracketed with social services departments as responsible authorities in the Bill. Our intention is to probe the Government's thinking, so that we understand why those bodies have been excluded from the Bill.

We seek information on how the Bill's provisions will interact with the scheme for supporting people, which is to be implemented from 1 April next year. Funded and channelled through housing departments, that scheme will establish a distinction between people who receive services to support them in their accommodation—whether it be sheltered housing or other settings—and those who receive care. Some aspects of, for example, domiciliary care could be defined as supporting people under the guidance issued by the Office of the Deputy Prime Minister, whereas other aspects could be defined as care under the care standards legislation. Can the Minister help the Committee and those who will struggle to understand where liability will fall?

What will happen when a discharge is delayed in a county district area where the responsibilities for housing and social services are split between the two

Column Number: 28

tiers—when a package of care and support is delayed because, although the social services department arranges the care element promptly, the support element provided through supporting people by the housing department at district level is not put in place on time? Will the social services authority still pick up the tab, or will the regulations, which we have not seen, deal with that matter and exclude it as one of the categories that would not result in a penalty? It would be useful if the Minister could provide a degree of clarity.

12.15 pm

Similar considerations apply in relation to primary care trusts. The issue relates to the transfer of the concept of penalties and incentives within the system, the birthplace of which is Sweden, I think. It is interesting that there are many differences between the system set up in Sweden and the one in Britain. One of the lessons learned in Sweden after 10 years was that the original system excluded a role for the general practitioner. The amendment is an attempt to find out what role in delayed discharges the Minister envisages for, for example, community nursing services and GP services. They seem to be completely outside the system. There appears to be no equivalent system of incentives or penalties either in the Bill or in any of the consultation documents published so far.

I hope that the Minister can address those issues—on supporting people interfaces, how GPs and primary care trusts should discharge their responsibilities, and how the Government assume they are to be incentivised.

Sir George Young: Amendments Nos. 31 and 33 refer to point that I raised on Second Reading about the involvement of housing authorities and the regime that is being established.

[Laura Moffatt in the Chair]

I say in passing that, although the Committee is making good progress, there is a risk that we will not touch upon any of the important issues in clause 3, namely, what the services to be provided will be and what the involvement of the patient and carer will be. I am concerned that the regime of penalties—or incentives, as the Minister calls them—will be badly targeted, because the housing authorities are not, in the words of the hon. Member for Sutton and Cheam, in the loop.

In many parts of the country, there is unitary local government—the same body provides social services and housing. In those parts of the country, therefore, the distinction is not important. In many areas, however, the county council provides social services and the district or borough council provides housing. There is a further refinement in that housing in many parts of the country has been transferred from the district council to a housing association under large-scale voluntary transfer.

Perhaps I can best describe the problems that I believe will arise by referring to a constituent of mine, Mr. G, who suffers from cerebral palsy and is in a wheelchair. Following a fall earlier this year, he was discharged from hospital to his home, which is owned

Column Number: 29

by Testway Housing. His needs have been assessed by an occupational therapist from Hampshire county council's social services, whose recommendations include the installation of a Closomat toilet and a level access shower. Those are the services that he needs in order to live with dignity and independence in his home.

Those services are provided not by social services but by the housing authority. I therefore approached the landlord, Testway Housing, to see if it would pay for those essential adaptations so that Mr. G could live in his home. I was told that Testway has an annual budget for carrying out adaptations for the disabled, which has been set at £103,000 for this year. That money is used for adaptations costing up to £1,000; for anything that costs more than £1,000, in common with owners and other private tenants, Testway tenants must apply for a disabled facilities grant. DFGs are administered and funded by the housing authority, Test Valley borough council, not by Hampshire social services. Testway said that it did not have the funds, and suggested that I ask Test Valley borough council if it would pay for the adaptations.

Test Valley borough council did not have the resources to do that. Not only that, but it wrote to say:

''I regret that I can't give the assurance that . . . adaptations will be funded on April 1st 2003.''

In other words, Mr. G will not get those services for at least three months. The letter continued:

''I am afraid that the best advice I can offer at this time is for''—

Mr. G—

''to progress his enquiry to the full application stage as quickly as possible so that it can be lodged as an application, when it will join the 6 month waiting list''.

Test Valley has made a bid for increased funding and hopes that the Government Office will give it a greater allocation next year. The letter continued:

''I am sorry not to be able to help . . . at the moment but the number of inquiries for disabled adaptations is outstripping the amount of money we have available.''

There we have a classic case of someone needing services that are not the responsibility of social services.

Turning to the regime under the Bill, as it stands, without my amendment, it will be social services that carry the can. In a case such as the one that I have outlined, the authority will have to pay the fine if the housing authority does not provide the necessary adaptations. That is not defensible.

 

---

Prepared 10 December 2002