Community Care (Delayed Discharges etc.) Bill

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Jacqui Smith: I undertake to consider the hon. Gentleman's point—and of course, an amendment has been tabled concerning the six-week limit—but it is important that legislation should be clear about the confines of, or focus implied in, intermediate care. Of course, care provided by the NHS would be free anyway. As for social care intermediate services, our research suggests that in the vast majority of cases the appropriate period is usually about four weeks—even for residential social care intermediate services. Six weeks will not chop off the services for large numbers of people. Discretion might, I suspect, be possible in relation to decisions made by social services departments. Although the Bill provides for there to be no charging for six weeks, there could nevertheless be discretion for care managers or social services managers after the end of that period.

The hon. Member for Sutton and Cheam also mentioned the shortage of occupational therapists to make assessments. I believe that I mentioned on Second Reading some of the figures for the increases in occupational therapist numbers—those already working and those in training. The NHS plan also includes plans for further increases. Furthermore, occupational therapists and our team considering the implementation of community equipment services are interested in whether it is possible to alter the way in which assessments are carried out, and perhaps to distinguish between those that are relatively simple, and which might entail an element of self-assessment, those requiring the specialist skills of occupational therapists, and those requiring technicians working with occupational therapists. The need for work on that matter is important.

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I am confident that the Bill will contribute to ensuring that, for services provided locally, charging does not, as we sometimes fear it does now, get in the way of providing the sort of integrated service that people need. The amendments would not allow that flexibility. I hope that the hon. Gentleman has been reassured by the extra information that I have provided and feels able to withdraw the amendment.

I shall comment on amendment No. 91—although I do not think that the hon. Gentleman spoke to it—about carers, and whether services provided directly to them are to be charged for. We said in the guidance that we issued last year on intermediate care that its implications for carers should be thought through carefully. Clearly it would not be in keeping with the Bill if, say, a heavy bloke—[Interruption]—not that there are any in this Room. Let us say that if a heavy person were to be discharged to his home from hospital, on the assumption that his wife or carer would assist him in moving, and if his wife was short

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or had a bad back, and needed a hoist or other assistance to enable her to care for him, it would be unacceptable to charge for the equipment, because it would be designated community equipment for a carer's service. The effect would be the same as if the man who had been discharged from hospital had been given the equipment.

We have, therefore, some sympathy with the hon. Gentleman on this issue, which I know has also been raised by Carers UK, among others. We intend to return to it on Report with an appropriate amendment.

Mr. Burstow: I am grateful to the Minister for her response to my inquiries about the clause and how it will work. The amendments were intended as probing amendments. I am well aware of the Government's concerns about long lists in Bills. However, I found the Minister's comments about the broad definition useful, and I hope that we shall be given as much detail as possible on that before Report. Similarly, I take the Minister's points about carers and I look forward to an amendment being tabled on Report. Whether it will pertain to heavy blokes I do not know, but I certainly hope that it will help carers to deal with their burdens. Although I might want to return to these matters at a later date, I now beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Burstow: I beg to move amendment No. 93, in

    clause 12, page 7, line 32, leave out subsection (4).

The Chairman: With this it will be convenient to take the following amendments: No. 122, in

    clause 12, page 7, line 32, leave out subsection (4) and insert—

    '(4) The regulations may not require that the costs of accommodation and living costs (excluding the care costs of the kind referred to in subsection (1) and Schedule (Social Care not ordinarily charged for (No. 2)) referred to in subsection 3(a) are to be free of charge for a period exceeding six weeks.'.

No. 51, in

    clause 12, page 7, line 33, leave out 'exceeding six weeks' and insert 'outside of the time when the patient is assessed as within the criteria for receiving services free of charge'.

Mr. Burstow: I shall speak briefly, because we have already been able to explore some of the relevant issues when we debated the previous group of amendments. The amendment is focused on the cut-off point of six weeks specified in the Bill. The argument is that it should be possible for discretion to be exercised locally, based on an assessment of individual needs and the likelihood of people being able to respond to a further period of intermediate care in a way that will enable them to return home and live independently. Including the cut-off point in the Bill seems to get in the way of that aim. It also seems to be contrary to the guidance, which implied some flexibility. The amendment would give the Government the chance to think again. We hope that they will do so.

Mr. Baron: The Opposition have a slight problem with subsection (4), which appears to limit the scope of the regulation-making powers under subsection (1) in respect of what may be prescribed as a qualifying service under subsection (2)(a). Accommodation

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provided under part III of the National Assistance Act 1948 may not be required to be free for more than six weeks. The explanatory notes say:

    ''This reflects the recommended time that intermediate care is provided in both the NHS and social services, based on current practice and existing guidance.''

The amendment aims to ensure that intermediate care in a care home is not limited to six weeks, in line with Department of Health guidance on intermediate care, which states in circular HSC 2001/001, paragraph 8:

    ''Exceptionally, for example following a stroke, patients may require intermediate care for slightly longer than six weeks.''

That may be exceptional, but we can all think of times when intermediate care is required for longer than six weeks, and we want to ensure that there remains enough flexibility in the Bill to ensure that such cases can be catered for. We all know that older people who require care in a care home may need longer than six weeks to recuperate, and the Department of Health circular cites stroke victims as an example.

Amendment No. 51 would enable patients who have been assessed as still requiring intermediate care after six weeks to continue to receive free services and accommodation. After all, the current guidance allows for extension beyond six weeks subject to a full reassessment and authorisation by a senior clinician. The amendment would likewise ensure that there would be an assessment to establish that free services were no longer required, rather than insisting, as the Bill does, on a rigid cut-off date for all cases. It attempts to marry the provision of free services with free accommodation, which seems logical and fair. The Bill contracts the Department of Health's definition of intermediate care by appearing to restrict free accommodation to six weeks. I hope that the Minister accepts that that provision appears illogical, and that she will respond positively.

Jacqui Smith: The hon. Member for Sutton and Cheam is right; we discussed the six-week limit on the previous amendment, and some of what I said then remains important. We believe that there are sound reasons for maintaining that limit; it is specifically linked to the fact that we are dealing with the provision of intermediate care services. The provision is based on accepted good practice and reflects existing guidance.

The hon. Member for Billericay quoted the intermediate care guidance, which said that exceptional extensions beyond six weeks should be subject to a full reassessment and should be authorised by a senior clinician. I have sympathy with what he said about care that might be provided for stroke patients. I repeat what I said to the hon. Member for Sutton and Cheam: notwithstanding the fact that the definition suggests that in the vast majority of cases free care would be limited to six weeks, intermediate care provided by the NHS is not charged for. That case is slightly different. We need to ensure that people do not see intermediate care as an alternative to long-term care or other long-term provision; the NHS and social services must carefully assess a person's need for intermediate care services in order to provide rehabilitation and the active therapy that promotes

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independence, not as an alternative to long-term care or community care.

Mr. Burstow: In clause 11, a procedure is available to Government to extend the scope of the measure to include residential rehabilitation schemes and intermediate care schemes. That would enable them to address the concern that the Minister is voicing. Is it necessary for the Bill to include belt and braces at a specific cut-off date when a power exists to deal with the matter through regulations?

Jacqui Smith: The function of clause 11 is, as the hon. Gentleman says, to ensure that if we thought it appropriate and the services were provided in care homes, we could extend the framework of incentives that the Bill sets out to other services such as intermediate care. Social care intermediate care services will not necessarily always be provided in a residential setting.

As I said earlier, we have good evidence of average stays for intermediate care services. The survey that I referred to showed that most services operate seven days a week and the average stay lasts for between 12 and 26 days. Even where the primary purpose is social care, the average stay is 29 days. For residential intermediate care it is 31 days—that is, four and a half weeks, well within the six week period. There is solid evidence from an independent survey, commissioned before this legislation was proposed, that social care-based intermediate care is typically provided for less than six weeks.

 
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Prepared 12 December 2002