Community Care (Delayed Discharges etc.) Bill

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Laura Moffatt (Crawley): Does the hon. Gentleman understand that an elderly person who no longer requires—in clinical terms—acute care is in a vulnerable position in that setting? Moving the care pathway into a much more settled situation, such as intermediate care, is underlining that acute care is not good for older people. It should not be continued, and to allow it to continue increases the risk of problems with mobility and of getting infections. It is very bad for them and it would not be advisable to ensure that the situation continued. Moving on to intermediate care is the best option.

Mr. Baron: I do not necessarily disagree. I am just saying that patients should be made fully aware of their options. I doubt that the hon. Lady would disagree with me in the sense that, after an operation,

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patients have—broadly—a choice of two routes and should be aware of that. It seems only fair and logical that they should be aware that costs may be involved after intermediate care ends and that they may qualify for fully funded NHS care. On that basis, I commend the amendment to the Committee.

3.15 pm

Ms Munn: I want to flesh out some of the issues. Although I have some sympathy with what the hon. Gentleman is trying to achieve, there is a real difficulty with how the processes work. As my hon. Friend the Member for Crawley (Laura Moffatt) has just said, there is a need to move on elderly people as soon as possible. An assessment of their need for intermediate care services can be carried out, but it would be premature when they leave acute services to determine the outcome of their stay in intermediate care. It is impossible to give a person a realistic assessment of the services that they may need and their likely cost at that time. I have some sympathy with the view that people should know the range of services that will be available. After all, that is part of the usual assessment and care management process, but it does not seem sensible to consider delaying a move until it is possible to be more definite about that.

From my experience gained working in the area for several years, I am aware that, when people first leave hospital, they often feel vulnerable and believe that they will need more care and support than they actually subsequently need.

Mr. Burstow: The hon. Lady is making an entirely fair point. Of course, we all share the common objective of wishing to see people who are fit and well, or on the way to being fit and well, in the most appropriate care setting, which, as the national service framework says, is often intermediate care. Does she agree that it is important that the NHS should continue to cover the costs of a person's care, pending the outcome of a review of their continuing needs?

Ms Munn: We need to return to what actually happens, rather than dealing with a theoretical description. It is not a matter of carrying out a review. An initial assessment is carried out and, if it is determined that a safe discharge to their home—the first preference for most people—is not possible, and that a person would benefit from some intermediate care support, a reassessment is necessary to consider the different options available. What the hon. Gentleman says may be right, but the process of assessment is ongoing.

The benefits of intermediate care are such that some things that cannot be assessed while the person is in hospital can be assessed in other settings. Therefore, the process of moving a person on to intermediate care is, in itself, part of the ongoing assessment. Hopefully, through that process, people will become more confident and more able to look after themselves and, perhaps, manage with less support than they would have thought was possible when they were in hospital, in an unusual situation, and feeling vulnerable. We need to have a care for the reality of the situation and understand that too much

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information about a range of possibilities early on in the process may not be helpful to the person and their family in determining what care they need.

Mr. Baron rose—

Ms Munn: I was about to sit down, but I am more than happy to give way to the hon. Gentleman.

Mr. Baron: The hon. Lady is very kind.

We are not suggesting that continual assessment should suddenly cease. We are suggesting that, wherever possible, patients should be given the necessary information so that they are informed about the choices available to them, because intermediate care usually, although not always, ends after six weeks. Patients can sometimes be left a little in the lurch, not knowing what will happen thereafter. In other cases, patients are offered intermediate care when they are entitled to fully funded NHS care. We are arguing under the amendment that patients should be more fully informed of the options that are available.

Ms Munn: The hon. Gentleman makes a fair point, but I am not sure that that is what the amendment would achieve. I refer Opposition Members to legislation that has been enacted for nearly 10 years. The whole process of assessment and care management and the exploration of options for care is part of the expectations of current practice.

Jacqui Smith: I have some sympathy with the points made by the hon. Member for Billericay (Mr. Baron). However, the amendment is unnecessary and potentially detrimental to the assessment process. I shall explain why.

I agree with the hon. Gentleman that it is important, subject to people's ability to understand them—and therefore subject to the information being provided in a suitable way—that people should be fully aware of the options and implications. That is why, when someone is going for elective admission—we are talking about intermediate care following a period in hospital—the earlier that social services are notified to carry out an assessment the better. That links to what we were discussing earlier. However, I disagree with the hon. Gentleman's suggestion that, whether or not someone has continuing NHS care or intermediate care, it is primarily a choice for them. Those types of care are for different functions. If someone needs continuing NHS care, someone should get it. Intermediate care, as my hon. Friend the Member for Crawley pointed out, is for a completely different purpose—for rehabilitation, or for getting people back to independence.

Good practice is drawing up a care plan for intermediate care that is based on an appropriate assessment, and that assessment should determine at the outset whether someone needs continuing care—and if they do, they should get it. If they need long-term care following intermediate care, they will get that as well. That assessment should include anticipated outcomes and a clear idea of the services that will follow. As my hon. Friend suggested, it should include a mid-point review to check progress and to adjust the services if necessary. We made that point last year in the intermediate care guidance that the hon. Gentleman

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cited. The guidance on single assessment and on fair access to care emphasised the importance of reviews and of reassessing people's needs.

Mrs. Calton: Is not the central point about the amendment—forgive me for asking—that patients should be able to express what they believe should happen and that they should be made fully aware of possible unexpected costs? I accept that one should not worry a patient with the idea of costs immediately after an operation. Some sensitivity must be shown when discussing those issues. However, to regard the matter as something that patients have done to them, instead of something in which they should be actively engaged, is concerning. Have I missed the point?

Jacqui Smith: On this occasion, the hon. Lady has not missed the point. I do not disagree with her. Indeed, I had already said that it was important that patients and their carers should be aware of the different options and the costs that might result. We have gone further than that. Guidance on assessment requires that care options and the associated charges and contributions that individuals might have to make should be discussed with patients and their families. I do not disagree with her about that. The definition of intermediate care in the guidance issued by the Department refers to provision

    ''on the basis of comprehensive assessment''


    ''cross professional working within a single assessment framework''.

I question, however, whether the mandatory approach taken by the amendment is appropriate. We already have in place the single assessment process, which covers assessment of continuing care, long-term care services and intermediate care.

Mr. Burstow: As I understand it, the single assessment will be in place from April 2004, so it is not in place everywhere yet. We shall come to the partial assessment process in the Bill. Will the Minister confirm that continuing care needs will be assessed at that point as well? Alternatively, will they be assessed post-discharge?

Jacqui Smith: As we discussed on Tuesday, the hospital part of the process in clause 3 will be part but not all of the single assessment process. Things will depend on the situation. It may be obvious that someone needs continuing NHS care as soon as they are assessed, in which case it should be made available to them. It may be obvious that what they need is a package of community care services, and in that case the social services department would clearly have responsibility for providing those services under part 1. There may be disagreement, and the patient may believe that they should be entitled to NHS continuing care. Nothing in the Bill changes the current rights of a patient who believes that they should have such care. That might deal with the intervention that the hon. Member for Billericay made earlier.

Let us go back to what is already in place in the assessment process. Local authorities already have a specific duty, under section 47 of the National Health Service and Community Care Act 1990, to assess a person's needs for community care services when it

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appears that a person may need services. When social services think that a person might also need NHS or housing services, they are required to notify the relevant body and ask for its involvement in the assessment process.

The purpose of single assessment is to ensure that the scale and depth of assessment is proportionate to older people's needs, that agencies do not duplicate one another's assessments, and that professionals' time is not wasted on duplicate assessments. That is important when considering the amendment. When we talk to older people, I suspect that we all hear their frustration at a troop of different professionals coming to assess them, asking the same questions and duplicating their own and the professionals' effort.

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