Community Care (Delayed Discharges etc.) Bill

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Mr. Burstow: I am sure that the Minister would not want to gloss over the fact that when the joint Labour and Liberal Democrat Administration north of the border, in Scotland, had to make choices about prioritising their expenditure, they resolved to introduce free personal care. Not only Liberal Democrats but Labour Members of the Scottish Parliament are taking the credit for that.

Jacqui Smith: Part of devolution is that people make different decisions in different parts of the country.

Mr. Burns: We are on a devolved subject, and the Minister may not be aware that the system in Scotland has not been as successful as expected, although I would hope that the hon. Member for Sutton and Cheam is aware of that. Highland council and several other local authorities have notified the Scottish Executive that they do not have the money to meet the statutory requirements on free personal care.

Jacqui Smith: I accept what the hon. Gentleman says. He highlights the fact that difficult decisions must be made about limited resources, and different parts of the United Kingdom may make different decisions. I reiterate, however, that even where Liberal Democrat councils have the opportunity to make certain choices, they do not always do so. Unlike us, they have not made the choice between spending £1 billion on personal care or—as we will—on providing 130,000 additional carers services, 500,000 extra pieces of community equipment, 70,000 more intermediate care places, 30,000 more home care places, 6,000 more council-supported residential care places and 6,900 extra care housing places. The Government are committed to doing all that in the next three years, supported by ring-fenced money. That will ensure that social services can provide more

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community-based social care services and give more people the care that they need to continue living independently and, ideally, at home.

We could not have done that if we had made the decision to make personal care free. The final choice is between whether we use the new power responsibly, focusing on the two services in which integration can reduce delayed discharge but in which charging gets in the way of integration, or whether we use it in such a way that the expansion in services for older people is jeopardised. Funding personal care is the wrong choice. I strongly urge the Committee to reject the amendment.

3 pm

Mrs. Calton: I thank the Minister for her response; I am not at all surprised by its level and quality. Those who are not simply playing with words in this Room but are listening outside have a different view of such matters. Although it is okay for a Minister to rattle off a long list of how many of this and how many of that, after five years people in the community know that promises do not always come to fruition. They will believe the long list at the end of three years when it has been delivered. Delivery is not always the Government's high point.

The Minister made the point that the intermediate care for six weeks and community equipment had been fully costed at £18.5 million. On what estimate of demand was that sum based? It seems singularly low for the quality of care that I would expect.

Jacqui Smith: The £18.5 million was based on returns in relation to the spending currently undertaken by local authorities on community equipment services. The extra community equipment services that I mentioned would be covered by the additional £640 million that will be made available through the access grant. The costing for the free intermediate care was made on the basis of research into that portion of intermediate care provided by social care, multiplied by the portion provided by the authorities that currently charge. The additional money is also aimed at providing the additional intermediate care places outlined.

Mrs. Calton: I thank the Minister for that intervention. The Audit Commission's updated report, ''Fully Equipped 2002—Assisting Independence'', makes the subject clear. Under the heading,

    ''Understanding the underlying level of demand'',

it states:

    ''A critical first problem is that service commissioners and providers generally have no idea of the underlying level of demand for equipment services. Unmet need is a serious problem as without equipment, people can face social exclusion. Data on the numbers of people who need help are not readily available. This hinders service planning and the ability to monitor changes in patterns of need and demand over time. By no stretch of the imagination can equipment services be described as 'needs-led'. And, of course, the failure to assemble such vital information could be said to be discriminatory—no such dearth of information exists in services for people with coronary heart disease or cancer.''

Jacqui Smith: Will the hon. Lady give way?

Mrs. Calton: I should like to finish my point. To use current levels as a base is simply to miss the point, as

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those levels do not meet the needs. I made the point earlier that if something that is needed is to be charged for, it is likely that not all the need will be met.

Jacqui Smith: The hon. Lady is right. However, does she accept that I explained to her that we were funding both the current estimated levels of provision of community equipment services, and an increase of 500,000 pieces in the next three years? We could not make that expansion had we made the choice that she suggests that we have made.

Mrs. Calton: Obviously I recognise that there has been an expansion. I am querying whether £18.5 million reflects the need. My view is that the expansion will not meet the undoubted need. The charges effectively prevent much of the need coming to light. Until they are removed for these necessary services, we shall not know the full extent of the need. Although I accept what the hon. Member for West Chelmsford (Mr. Burns) said earlier, decisions have to be made in government, and those decisions have been made in Scotland.

Mr. Burns: If the hon. Lady accepts what I said, how can she draw the conclusion that she has?

Mrs. Calton: I thank the hon. Gentleman for his intervention. We must remember that this is not a debating society issue—it does not require a button pressed here or there. Complex needs have to be taken into account. If insufficient funding is made available, that must be considered and decisions must be made about further funding. To say that because there is insufficient funding one cannot afford something without testing or piloting is a nonsense. I cannot agree with the hon. Gentleman.

We have been told that the proposals do nothing to improve the situation. I do not see how we can provide choice if we accept that charging discourages the use of necessary services. That is what the Audit Commission said. The necessary services are still there—it does not matter what we say in this Room. If services are needed in the community, they are needed. It is not good enough to say that we cannot do something because we cannot afford it. We afford a great many things in this place, and looking after the intimate care needs of older people should be given a very high priority.

Question put, That the amendment be made:—

The Committee divided: Ayes 2, Noes 9.

Division No. 14]

Burstow, Mr. Paul
Calton, Mrs. Patsy

Blackman, Mrs. Liz Fitzpatrick, Jim Keen, Alan Linton, Martin Love, Mr. Andrew
Moffatt, Laura Munn, Ms Meg Smith, Jacqui Starkey, Dr. Phyllis

Question accordingly negatived.

Mr. John Baron (Billericay): I beg to move amendment No. 50, in

    clause 12, page 7, line 22, after 'provided', insert 'following the patient being informed of the costs of services following this free

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    period and an assessment made for continuing NHS health care and for community care services of that patient'.

I also welcome you back to the chair, Mr. Conway.

The amendment aims to ensure that patients are not discharged to free intermediate services without some knowledge of what the costs will be once that has ended and it has also been established that they do not qualify for fully funded NHS care. We on the Conservative Benches are concerned that older people, perhaps not in the best state of mind because of a recent operation, will accept intermediate care without realising either that, according to the Department of Health's circular HSC 2001/001, that is normally limited to six weeks or that they might qualify for fully funded NHS care on a longer-term basis.

Although it has caused confusion in some quarters, most patients will not be aware of the ruling in the Coughlan case, which found that if a person's need for care home accommodation was primarily driven by health requirements, and that it was beyond what a social care package could provide, then that person was entitled to free, fully funded NHS care. We are concerned that the system might inadvertently funnel patients down the intermediate care route, after which they might be left to their own devices. Alternatively, those same patients could be entitled to fully funded NHS care which—although more expensive for the NHS—would be better for the patient, and possibly more cost-effective for the NHS, in the long term.

At that point in their treatment, perhaps because they have just had operations, patients could feel particularly isolated and vulnerable. There is no guarantee that they will have relatives or carers close to hand. Meanwhile, there is no guarantee that home care staff will be fully aware of the rights of the patients, particularly their NHS entitlements. The amendment aims to ensure that patients are fully aware of the implications of the options available to them and of whether, if a full assessment had been made, they were entitled in the first place to fully funded NHS care. The amendment is important, not just because of the state of health of the patients but because they might be feeling vulnerable and isolated. We should do all that we can to ensure that they are fully aware of their options.

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Prepared 12 December 2002