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[Mr. John McWilliam in the Chair]
I hope that the Minister will either accept my enlightened amendments or give an assurance that in the scenario I outlined, social services will not be fined. I hope that the Minister can resolve the debate speedily by saying that in that scenario, there will be no fine; otherwise, we will have a serious problem.
Mr. Baron: I wholeheartedly support my right hon. Friend's amendment. It seems strange that such fines should be so badly targeted. Housing authorities are not in the loop, and if social services are not responsible for the delay, why should they be fined? It seems grossly unfair. We seem to have only half the
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picture. As my right hon. Friend said, the housing associations should be brought within the loop.
Jacqui Smith: Quite rightly, the amendments open up a discussion about the important role that housing often plays in ensuring that people can leave hospital when needed. We agree that housing and, as the hon. Member for Sutton and Cheam said, community health services are important when considering discharge, and that the NHS and social services must work closely in planning those services. That is made explicit in clause 3. However, the notification stage in clause 2 is about the likely need for social services, and the PCT does not provide those.
As the PCT is responsible for the provision and commissioning of all health services for all patients, and because it will have other patients awaiting admission, it will already be working closely with the acute trust—not only through its commissioning—to ensure that its patients are not delayed at any point. As a result, close communication already exists between the PCT and hospitals and the notification suggested in the amendment will already be occurring.
Amendments Nos. 31 and 33 make the point that housing, too, is an important factor in ensuring that older people can be safely discharged from hospital to suitable accommodation, where they can keep their independence. I agree with that, as does the Secretary of State, which is why he said in July that part of the package financed through additional funding for social services would be
''a 50 per cent. increase over the 1997 total in the number of extra-care housing places—very sheltered accommodation—available for older people, and we will work with local authorities, housing associations and others to bring that about.''—[Official Report, 23 July 2002; Vol. 389, c. 871.]
The hon. Member for Sutton and Cheam asked how the Bill related to the supporting people legislation, especially in relation to the classification of support under the supporting people programme. We have issued, or will soon issue, guidance on the distinction between different forms of housing support that will meet many of his concerns. The introduction of the supporting people programme in general terms as part of Government policy is important in bringing together, in a more appropriate and joined-up way than has previously been the case, the support necessary to ensure that people receive the care that they need.
Another important contributor is the role that home improvement agencies play. The hon. Member for West Chelmsford commented on the need to invest in such improvements to help to tackle delayed discharge, and I agree. That is why in October we announced funding of £9.5 million over the next three years for home improvement agencies. It will be ring-fenced within the new access special grant to expand community-based social care services, and to reduce delayed hospital discharge. That will be the first specific Department of Health investment in home improvement agencies, and will contribute to reductions in delayed discharges through the prompt supply of basic housing repairs.
Mr. Burstow: The Minister moved swiftly on from the pending issue of guidance. Such guidance has been
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issued and I have looked at it, which is one reason why I posed the question. What happens when difficulties with the provision of the supporting people package result in a delay in discharge? Will social services still pick up the penalty for that?
Jacqui Smith: I am coming to the point—it relates to something that the right hon. Member for North-West Hampshire (Sir George Young) said—about how to ensure consultation between social services and housing, and where responsibility lies. I hope that that will answer the hon. Gentleman's question.
One of our technical concerns about the amendment is that it would not bring about closer working between health, social care and housing. In fact, it would be divisive. We are talking about notification. The amendment's drafting would mean that the NHS body had a choice of giving either the social services authority or the housing authority in whose area the patient was ordinarily resident notice of the patient's potential need for community care services on discharge, so that that authority became the responsible authority.
In practical terms, it would clearly be nonsensical for the NHS to have to make such a choice. If it chose the housing authority, that, too, would be a nonsense. As hon. Members have pointed out, an authority cannot assess for community care services unless it is a unitary authority—unless it has both housing and social services responsibilities. Such an assessment would clearly be led by social services as an assessment of community care needs.
Few discharges are delayed for reasons entirely connected with housing. Social care is nearly always the main need. However, it may not be possible to care for the person in the place where they were living before they entered hospital, so although we agree that housing is important in the context of the Bill, it will be for social services to involve the housing authority where it is obvious that there is a housing need. That is the first stage in responding to the concerns that have been raised.
Under section 47(3)(b) of the 1990 Act, relating to assessment responsibilities, social services are already under a duty to notify the housing authority if, during their assessment, it appears to them that people may need services from the housing authority. Through guidance on the Bill and through our other work to stimulate the provision of innovative care and housing packages, we will continue to emphasise the importance of housing solutions in giving older people what they want—independence and their own home, as well as confidence that they will receive any care that they need in their own home.
12.30 pm
Responsibility in the event of failure to provide a housing adaptation, as in the case mentioned by the right hon. Member for North-West Hampshire, will depend on the definition of housing adaptations—he rightly identified different legislative bases for different sorts of housing adaptations—and on the definition of minor adaptations. We intend clearly to outline those
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definitions in regulations, which we will discuss under clause 12. We will define both community equipment and minor adaptations, which it will be the responsibility of social services to provide, and for which, as a result of the Bill, they will no longer be able to charge.
Obviously, if such adaptations have not been provided, social services will have to pay the charge. For example, failure to provide a rail to help someone get in and out of the bath or another sort of assistance that clearly falls in the same category would result in a charge to social services. However, if such a major housing adaptation is required that it must be provided by the housing department, such as a stair lift or a walk-in shower—that might be the sort of housing adaptation to which the right hon. Gentleman was referring—but has not been provided by the time when the NHS anticipates that the person will be ready for discharge, that would count as a change of circumstances in the context of the original discharge plan compiled by the NHS and social services. If the NHS thinks that without the adaptation it would be unsafe to discharge the person to their home, it must renotify social services so that a discharge plan that takes account of the lack of adaptation can be produced. Then, because they were renotifed, social services would not be charged for the delay.
Of course, interim care in a residential setting might be possible—I am not referring to the case mentioned by the right hon. Gentleman—if the adaptation required is to make the home, bathroom or bedroom accessible. Alternatively, when social services and the NHS reassess what is necessary for that person to be safely discharged from hospital, it could be appropriate to provide additional personal care to help with bathing, for example, if major adaptations to the bathroom are necessary. Clearly, where there is a failure to provide a housing adaptation that was determined in the original discharge plan, it would be inappropriate to charge social services, but it would be appropriate for the hospital to renotify social services so that an assessment could be carried out to determine the best way of providing the package that will enable the patient to leave hospital.
Sir George Young: The Minister has gone into some detail and I note what she says about the NHS being able to decide that there has been a change of circumstances. However, under clause 3(5), all that it needs to do is withdraw the original notice and, if it considers it appropriate, issue a further notice under clause 2. Another notice would appear, saying, ''These adaptations are needed—and by the way, they must still be provided by the housing authority.'' As I have said, it might take six months for the housing authority to find the necessary resources. Will the Minister assure me that in such a case the social services department would in no circumstances be fined for a failing that had nothing to do with it?
Jacqui Smith: It would be social services' responsibility to make any alternative arrangement that proved possible—such as, for example, providing an interim placement. To take the discussion back to the needs of the person, it is unsatisfactory if someone is stuck in hospital because of an argument between
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the housing authority, the social services authority and perhaps even the NHS—as hon. Members may know, that happens. Following the renotification it would be within the remit of the social services authority to find an alternative way of ensuring that the person in question could leave the acute bed and enter a more appropriate setting.
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