|Community Care (Delayed Discharges etc.) Bill
Mr. Baron: Does the hon. Gentleman acknowledge that, using the Department of Health's definition of intermediate care, some cases extend beyond six weeks?
Mr. Burstow: That is the point, and I am grateful for the hon. Gentleman's intervention. By using the amendment to probe the Government's intentions, we are making the point that the guidance provides a basis for intermediate care that does not presuppose
Column Number: 20that, in every circumstance, people will have six weeks and no more. Indeed, some may require less than that. The hon. Gentleman is right to make that point.
We need to hear from the Minister that the flexibility in the guidance will be in place when it comes to the free element of intermediate care, and that people in their seventh week will not find themselves suddenly having to pay for services that were free for the first six weeks.
Jacqui Smith: The hon. Member for Sutton and Cheam is right that the purpose of clause 12 is to enable community equipment services and the intermediate care services to be provided free of charge. I assure him in response to the question whether community equipment would be free only if it were a matter of getting out of hospital that the answer is no. The costing assumptions and the Bill ensure that it would be free for whoever and in whatever circumstances it was needed. The same is the case, subject to the definition, for intermediate care. In other words, social care intermediate care would be free not only to allow people to come out of hospital. The same would apply if it was given to avoid admission to hospital; that would also be free.
The hon. Gentleman also asked about residential care. If someone is entitled to free community equipment in the community, that free equipment should also be available in residential care. As for those things that would be the responsibility of the NHS, interestingly enough, one important benefit of the contribution towards nursing care has been a much better relationship between the NHS and nursing homes in many places. We are beginning to see some of the equipment that the hon. Gentleman spoke of, such as pressure mattresses, being provided; the NHS is taking into consideration its responsibilities to provide that equipment, even with privately funded nursing care.
Mr. Burstow: I am grateful for the Minister's answers to some of my questions. Can I be clear that, in the circumstances that she describes, she would expect hoists and the other items of equipment provided in residential nursing homes to be free in every part of England—and that it would be provided by the NHS, not as part of a package by the care home owner or by the individual?
Jacqui Smith: I did not go quite as far as the hon. Gentleman wants to push me, but I did say that guidance—for example, on NHS-funded nursing care—provides that access to equipment for individuals is given on the same basis as for the community. When we come to our debate on the definitions of community equipment services, that may answer some of the hon. Gentleman's questions.
I recognise that the hon. Gentleman proposed the amendments to gain clarity about our intentions. However, not only are they unnecessary, but it would be potentially detrimental to define either of those services in primary legislation. The Bill does not refer to intermediate care or to community equipment. Instead, it imposes powers and duties on local authorities to make arrangements for different types of people who might need social care.
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For example, section 29 of the National Assistance Act 1948 requires local authorities to make arrangements for the welfare of certain disabled people. Section 45 of the Health Services and Public Health Act 1968 requires local authorities to make arrangements to promote the welfare of the elderly. I am sure that all hon. Members will know from their avid reading of the legislation that schedule 8 to the National Health Service Act 1977 deals with services designed to prevent illness, for the care of persons suffering from illness and for those who have been suffering from illness who need aftercare. The reference in the clause to paragraphs (a) to (c) of section 17(2) of the Health and Social Services and Social Security Adjudications Act 1983 refers to the responsibility to provide services under those parts of the Acts that I have just mentioned. That is the most appropriate basis on which to set down in the Bill the policy intention of providing free community equipment services and intermediate care.
Amendment No. 92 and new schedule 2 are loosely based on the list in my Department's community equipment guidance, which was published last March. [Interruption.] I am glad that the hon. Member for Sutton and Cheam thinks that the list is reliable, but there is a problem with the way in which he has used it, and included only a small part in the amendment. For example, his list excludes communication aids, which are included in the guidance, but includes pressure relief mattresses, which are treated differently in the guidance. I use that example to illustrate the difficulties of including lists in legislation as the hon. Gentleman does. I take it from the fact that he is nodding that he accepts that.
Mr. Burstow: The amendment is probing.
Jacqui Smith: Right. The hon. Gentleman is probing our intentions, and the important thing is that we set up a legislative system that lets local social services decide what community equipment is suitable, while ensuring that no charge is made. We intend to use regulations to provide a broad definition of aids and minor adaptations, and to leave social services the discretion that they now enjoy to provide the most appropriate services. We have consulted on the details of the regulations, and we will want to consult further.
Mr. Burstow: I am sure that many organisations will actively engage in that consultation. That is true not least of Age Concern, which is particularly anxious to have as much clarity as possible at the earliest stage to avoid variations across the country. In drafting the guidance, will the Minister also consult on the eligibility criteria, which will have an impact on these provisions, to avoid variations across the country?
Jacqui Smith: Clearly, if we say that community equipment services, as defined in the regulations, are free, we will not need eligibility criteria in quite the form that the hon. Gentleman suggests—unless I have misunderstood him.
Mr. Burstow: The point that I am trying to make is that even where a service is free, different authorities may draw up different eligibility criteria to determine whether it is to be provided, and the Minister could still see variations occurring. I hope that she will at
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Jacqui Smith: I accept the hon. Gentleman's point, but the issue is being covered in the free access to care services guidance, which provides a framework in which local authorities can determine their eligibility criteria.
In drafting the Bill, we consulted the Department's user group on community equipment services on the definition of those services. The group includes a range of user organisations and the voluntary sector. Interestingly, they did not want a list of eligible equipment. The community equipment services team, which the Department set up, also consulted people involved in providing community equipment services, and they did not want a list of free equipment. Furthermore, Age Concern's response to the Queen's Speech said that there should not be a limited list of services, so our proposals are in good company. We are taking a pragmatic approach that reflects what people want, and that is mirrored in the new power.
Mr. Burstow: I am ever so grateful to the Minister for giving way again. Could she make available—if not today, then perhaps by Report—the broad definition of community services to which she referred? We could then consider and debate it.
Jacqui Smith: That comes under the same category as issues that I was talking about this morning, in that I can undertake to make available a summary of what would be included in the regulations. That may provide some reassurance. For example, when we consider community equipment, we shall think about the appropriate definition; when we consider minor adaptations we shall think about the value—probably £1,000—that would distinguish a minor adaptation from one that would, as we said on Tuesday, more properly be distributed through a disabled facilities grant process.
Our approach reflects the purpose of the new power to remove the charging barrier to gaining access to services, and to make joint equipment stores, with pooled budgets, much more common—but not to dictate or change the services that are currently provided by local authority social services departments. The arguments are similar with new schedule 3, on intermediate care services. It is mainly based on guidance that my Department issued last year. However, we have some concerns about its implications for what would be included or excluded. I do not think that such inconsistency is desirable in the Bill. That is why we intend to provide a broad definition of intermediate care services in regulations, which could, in time, be amended to reflect emerging best practice—backed up, of course, by statutory guidance, possibly enabling us to go into more detail.
As the hon. Gentleman pointed out, we have included the limit of six weeks in the Bill. Quite an important part of the definition of intermediate care is the fact that it is time-limited, because it is concerned with creating independence rather than reinforcing dependence. Its focus is on rehabilitation. For that reason it is justifiable that the time limit should form part of the definition.
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Mr. Burstow: I know that professionals such as physiotherapists are concerned about the way in which a cut-off point would reduce their professional discretion to make a judgment about a person's ability to benefit and, ultimately, to recover and live independently as a result of intermediate care. Will that cut-off really always bite at six weeks, resulting in charges from the seventh week onwards, or is there still a possibility of some flexibility?
|©Parliamentary copyright 2002||Prepared 12 December 2002|