Standing Committee D
Tuesday 10 December 2002
[Derek Conway in the Chair]
The Chairman: I am delighted to see the Committee this afternoon; no doubt hon. Members are pleased to see a Chairman here, so that we can make some steady progress.
Liability to make delayed discharge payments
Mr. Simon Burns (West Chelmsford): I beg to move amendment No. 26, in
clause 4, page 3, line 34, leave out 'two days' and insert 'three working days, excluding Saturdays, Sundays, Bank Holidays and Public Holidays.'.
May I say what a pleasure it is, Mr. Conway, to have you chairing our proceedings. You said that we would be able to make steady progress this afternoon, but I am not altogether sure that I fully share your optimism. As you know, many of us, especially Opposition Members, regard the Bill as particularly pernicious, and clause 4 contains the mechanisms that drive the system of imposing fines on local authorities.
Clause 4 deals with what the Government rather euphemistically call a
''liability to make delayed discharge payments'',
but it is nothing short of a straightforward fining system. Whatever spin Ministers may put on it by using the words ''incentives'' or ''payments'', the bald fact is that it is a system to fine local government. The amendment would ameliorate the mechanisms of that procedure. As we said in earlier debates, we are against the system root and branch; we believe that it will not work, that it is unfair and that it will undo the steadily improving relationships between local authority social services departments and NHS bodies in patient care and the discharge of patients from hospital.
What the Government suggest in the Bill will undo all that good work by giving social services departments a liability in certain circumstances; in effect, they will carry the can. The system envisaged under clause 4 would mean social services departments having to pay a fine to NHS bodies in connection with delayed discharges. The procedure envisages that after a local authority has received notification that a patient is likely to need community care services, it will have two days in which to find a placement and make arrangements for that patient's care on discharge from hospital. That placement could be in domiciliary care, residential care, nursing care or through a home care package, whichever is most appropriate for the patient.
We have grave concerns about the time scale for that operation. What is often called a crisis in long-term care suggests that, in some parts of the country,
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there may be problems in fixing deadlines. For example, as we heard in earlier debates, there is the choice directive; but what will happen under the time scale for discharge, once the notification has been issued, if patients do not choose or do not wish to go to the residential care home that the social services department may have identified?
What if the patient is incapable of taking a decision or voicing an opinion, but their family is unhappy? All too often the closure of beds in certain parts of the country—particularly the south-east and the south-west—means that appropriate beds are not available in appropriate homes. What will such things mean to the time scale? What happens if someone of the Jewish faith particularly wants to go to a Jewish residential home, but no bed is available? Such problems will put social services departments at an unfair disadvantage.
We have another problem with the arbitrary period of two days. What happens if it falls on a weekend? More often than not, there are particular problems finding places on Saturdays and Sundays, but subsection (3) takes no account of that. Nor does it take account of bank holidays, which will mostly fall on Mondays, although sometimes on Fridays. There might also be a public holiday. Such circumstances will place too much strain on the system and place social services departments in an unfair and exposed position.
There is also the danger that local authorities discharge patients too quickly to meet the time scale following notification and to ensure that they do not incur a fine. Again, that is a dangerous situation to put patients in. Over the past two years or so, several written answers from Ministers in the Department of Health have shown that readmission rates in the health provision system are escalating, and I am sure that hon. Members on both sides of the Committee agree that that is unacceptable. One does not want the clause, and subsection (4) in particular, to sanctify in law a system that seeks to avoid the problem of delayed discharge, only to increase premature discharge, such that the recovery of patients suffers a setback and they are readmitted to hospital.
The amendment would remove the two-day period, and include the three working days, excluding Saturdays, Sundays, bank holidays and public holidays. That would avoid the difficulties that I mentioned with providing services. It would also remove from local authorities the strain of having to fall in with the terms of the notification and the time scale in subsection (3) on weekends, public holidays and bank holidays.
I hope that the Minister will give sympathetic consideration to what is genuinely meant as a helpful amendment and an attempt to avoid problems. I assure her that the official Opposition—and, I suspect, the Liberal Democrats—will do all we can during the Bill's passage through Parliament to ensure that this muddled and wrongly aimed Bill fails to get on the statute book. If it does, however, and problems arise because the Government failed to budge on this issue, I do not want to be in the position of saying, ''I told you so.'' That would give me no pleasure. As we study and seek to improve the Bill, our priority must be to
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anticipate and avoid pitfalls, and I hope that the Government recognise that. All too often, they reach a decision, and take the view that it is right, come hell or high water—they will not listen to anyone who tries to help improve a piece of legislation and avoid problems that many people fear will occur. In this case, problems may arise because of the narrowness of the time scale.
Mrs. Patsy Calton (Cheadle): I, too, welcome you to the Chair, Mr. Conway.
In supporting the amendment, the Liberal Democrats are very concerned indeed about the effect that a minimum prescribed period of two days would have on joint working. Two days is perhaps a further indication that the Government do not understand the efforts that must be made in the discharge of some patients, given their complex circumstances. Consultation with carers, with the patient, with housing authorities, and with care homes were discussed earlier today. However, it is quite ridiculous for all those necessary consultations to take place in a two-day period.
The Liberal Democrats want to know if the Government are suggesting that a team consisting of social services, housing, and so on, should be standing by all the time in case they are needed. How big should that team be, and who should be in it? Are the Government suggesting that only one social services person could make the decisions for housing and the multitude of other matters, or will there be others?
The Minister of State, Department of Health (Jacqui Smith): I start by welcoming you to the Chair, Mr. Conway. I am sure that we will continue to make good progress this afternoon, as we did this morning.
As the hon. Member for West Chelmsford (Mr. Burns) rightly emphasised, we are moving on to the provisions that implement the framework of incentives on which the legislation is based. I think that it is worth reiterating some of the points that we briefly touched on this morning, but which are pertinent to the way that the clause works, and to the overall framework.
As Opposition Members have emphasised, there has been success in reducing the levels of delayed discharges from our hospitals. That has been due to significant improvements in both the way that agencies work together, and in the amount of investment that the Government have made to ensure that such things happen. However, we are not satisfied. When 5,000 people are still trapped in hospital when they would most appropriately be cared for elsewhere, the system is not yet working properly. A certain complacency was demonstrated this morning, and I hope that we will not see it this afternoon.
Mr. Burns: I assure the Minister that there is no complacency among Opposition Members about what is going on.
The Minister talks about a reduction in the number of delayed discharge patients. As she will remember
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from earlier debates, the figure increased to over 7,000 in 2000–01. She also fails to mention the equally important increase of the large number of emergency readmissions of patients aged over 75. For the first quarter of 2001–02, the figure was 29,878 patients. By the fourth quarter of that year, it had risen to almost 31,500. There is a danger that that will increase as a result of fines.
Jacqui Smith: Opposition Members have often referred to readmissions. In building a whole-systems approach, it is important to ensure that people leave hospital when it is safe for them to do so and that they will not need to be readmitted in an emergency. Readmission figures have been consistent since the beginning of 1999. Opposition Members often emphasise the number of readmissions. Part of the reason for the increase in readmissions even when the rate remains the same is that more people are admitted.
In the first quarter of 2002–03, 7.5 per cent. of elderly patients who had been discharged were readmitted as emergencies within 28 days. That compares with 7.3 per cent. in the same period last year. That is a small increase, and we are determined to ensure throughout the system that it does not worsen. Our target is to maintain a steady rate of emergency readmissions, while bearing down on delayed discharges.