| Community Care (Delayed Discharges etc.) Bill
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Mr. Baron: In paragraph (h) of the new subsection (2A) that amendment No. 67 would insert, it strikes me that the phrase
could be rather vaguely construed. What form would that consideration would take? Also, what means would be available to secure an amicable solution and the due consideration of the older person's views, with a view to ensuring that they would be discharged and moved on in a suitable way? Mr. Burstow: I am grateful to the hon. Gentleman for drawing attention to paragraph (h), which gives me the opportunity to discuss the issue of carers, too. Both matters are absent from the Bill. Certainly, in my view, at each stage of hospital care, informed consent is necessary. To deal with occasions on which informed consent cannot be given, other amendments have been tabled, tackling issues of Column Number: 38 mental incapacity. The hon. Gentleman or his hon. Friend the Member for West Chelmsford may move those later.It seems to us that, either in the terms of the amendment or in another manner devised by the Government, the Bill should stipulate that persons about to be discharged from hospital—whether after a delay or not—should be consulted about such matters as where they are to be transferred to, if that is a health care setting, or whether any long-term permanent care is to be provided in a care home or as home care. The amendment is intended to secure that result. However, it is important that we should include in the single assessment framework an assessment of the carer's need. It is clear from research done by Carers UK that as many as 70 per cent. of carers who have been involved in the discharge process say that they felt as if they had been dumped on. They were put in a position in which they had no choice. They were not assessed to ascertain whether they had the capability or means to provide the care, and they were not offered an assessment of their needs as a carer. All such matters are covered by the amendment. I hope that the Minister will assure the Committee that they will be dealt with not just in regulations but in the Bill. If discharge planning issues that have been in need of attention for a long time, and which carers' and other organisations have brought to the Government's attention, are dealt with in the Bill, it may be possible to avoid some of the unsatisfactory situations that have arisen in the past, in which patients became involved in a game of pass the parcel between agencies, with the carer as an innocent bystander who had to pick up the pieces. Mr. Waterson: In the brief time available I want to make a couple of points in support of amendment 67, which I think has some excellent ingredients. I want to focus particularly on the issue of patient choice, which is patently missing from the Bill. I am familiar with the issues to do with bed blocking, delayed discharges, or whatever the current expression is, not only in my area, where it has been an ongoing problem in recent years, but as vice-chair of the all-party group on ageing and older people. I want to focus on proposed new paragraphs (f) and (h). Paragraph (f) deals with the
Perhaps more importantly, paragraph (h) refers to the
Column Number: 39 I touched on standard 2 of the national service framework for older people. The Bill makes complete nonsense of that. I am sure that all hon. Members have a copy of the briefing from Age Concern, which has a number of worries. It says:
There is nothing in the Bill that will improve that; some local authorities are apparently cavalier about the choice or preference of the older person in question. Age Concern continues:
If the Bill becomes law in its present form, the sad fact is that the older people will be treated like embarrassing parcels, to be shunted from one part of the care system to another, in the hope of avoiding a fine or similar penalty. As part of the unanimous voice of criticism, Help the Aged raises its
It writes:
I do not want to repeat any of the good points made by the hon. Member for Sutton and Cheam, but I wonder what contingency plans the Minister and her officials are making for the almost inevitable legal challenge by a representative patient once the Bill becomes law. I would very surprised if either some pro bono human rights lawyers—possibly the Prime Minister's wife, if she is not too busy—or others, possibly supported by Age Concern or Help the Aged, do not make an issue of this. The way that things are written, they would be right to do so, because the Bill flies wholly in the face of patient choice. It is ironic that the Bill not only denies patient choice—I do not think that patient choice is mentioned anywhere, and I will be interested to discover whether the regulations do so—but flies in the face of the choice directive and human rights legislation. It is also ironic that the Government have consistently eroded the choice available to patients or potential patients. I refer to the case of my constituents, Mr. and Mrs. Ryder. Ms Munn: Surely the issue of choice relates not only to residential or nursing care but to staying at home, which most people want. The Government have Column Number: 40 provided much more money and many more options so that people may choose what they want.Mr. Waterson: I would be persuaded of that argument if the hon. Lady could point to the word ''choice'' anywhere in the Bill. Perhaps I have missed it, but I cannot see it anywhere. Not only does the Bill deny patient choice by not making it a priority, but the Government have eroded the choice of, for example, care and residential homes available. I mentioned the Ryders, who in the face of the new regulations sold their residential care home. They had barely shut their home when the Government did a U-turn on the requirements for lifts and so on of homes such as theirs. I wrote to the Secretary of State for Health on 6 August, asking what he was going to do to compensate Mr. and Mrs. Ryder for that grotesque unfairness, and have yet to receive a reply. It being One o'clock, The Chairman proceeded, pursuant to Sessional Order C relating to Programming (29 October 2002) and the Order of the Committee [this day], to put forthwith the Question already proposed from the Chair. Amendment negatived. The Chairman then proceeded to put forthwith the Questions necessary to dispose of the business to be concluded at that time. Clause 2 ordered to stand part of the Bill.
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| Prepared 10 December 2002 | |
