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Mr. Burns: I have been extremely generous in giving way and I want to make progress.
The Government have missed a golden opportunity. If they were to legislate, they should have come up with a positive system of reducing the number of delayed discharges in our hospitals rather than the negative approach of introducing a fines system. These measures will also undo the excellent work that has been established over the last 15 years in fostering good working relationships and partnerships between the NHS and social services departments. That work was long overdue and it has led to a more seamless provision of service. It will—[Interruption.] The Secretary of State says that we were in power, but if he had been listening carefully he would know that I said "over the last 15 years". If he looks through his history books, he will notice that a Conservative Government as well as a Labour Government were involved in that work.
The Secretary of State for Health (Dr. John Reid): That is precisely the point that I was making. The hon. Gentleman talks of the lack of money provided by Governments over the last decade—[Interruption.] He mentioned money about four minutes ago. Earlier, he also mentioned the lack of Government support during the past 15 years, so will he at least accept that a significant proportion of the alleged deficiencies must have come from the Government whom he supported? Indeed, as far as I can recall he was a member of that Government for a prolonged period.
Mr. Burns: I do not think that the Secretary of State was listening carefully so I shall repeat what I said so that he can fully understand me—[Interruption.] The right hon. Gentleman obviously did not hear me because his intervention bore no relation to what I said. I said that the measures would undo the excellent work that has been established over the last 15 years in fostering good working relationships and partnerships between the NHS and social services departments. I still
believe that. Tremendous work was done in the 1990s and also, to be fair, under the Labour Government who have taken it to a logical conclusion, to ensure that the barriers—the them-and-us culture—between the NHS and social services were broken down and that the organisations worked seamlessly to provide a better service.I applaud the Government for doing that, just as I applaud the last Conservative Government for laying the foundations and starting the work. It is a good step forward and it must be continued. My concern, however, is that the Act that came into force last week will set back that good work, because it could reintroduce a blame culture when decisions are taken about when and how to discharge patients.
Another consequence of the enforcement of the Act is that the number of emergency readmissions will rise further as patients are discharged prematurely from hospital so that local authorities can avoid hefty fines for delayed discharges. There will be a costly, time-consuming, bureaucratic shambles, which could result in the opposite of what the Government intended.
Dr. Ladyman: How could that possibly be the case when the delayed discharge reimbursement system will not apply until a clinician has said that the patient is ready for discharge?
Mr. Burns: The clinician may say that, but it may not be physically possible for the local authority to find a place for the patient in a home or to provide a domiciliary care package. We shall see arguments between the NHS and social services about whether a patient should be discharged, although I accept that the whip hand in the decision-making process rests with the NHS.
Have Ministers considered how the burden of the fines could affect their constituencies? Of course, the Secretary of State must be delighted. This health policy, like all the Government's other health policies for England, will not impact on his constituency one iota. He is in a unique position in the ministerial team in that he is the only member of it whose local social services department will not face the possibility of paying out tens of thousands of pounds in delayed discharge fines every month, as his constituency is in Scotland and thus immune from this rather nasty measure.
How will the measure affect other health Ministers? Let us consider the social services department in the county of the Under-Secretary of State for Health, the hon. Member for South Thanet. My hon. Friends may not remember that Kent is implacably opposed to the Minister's policy. Anyway, it originally estimated the cost of fines as potentially some £5.2 million a year.
Mr. Julian Brazier (Canterbury) (Con): Will my hon. Friend give way?
Mr. Burns: I would like to make a little progress.
As the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) will undoubtedly know, her local social services department will receive £315,000 for the remainder of the current financial year and £600,000 for next year. Although the department hopes that that will be enough
to cope with the fines, it is not yet sure how much it will have left to invest in mechanisms to reduce the number of delayed discharges in the future.In any event, this is a case of robbing Peter to pay Paul. Rather than being spent actively and positively in toto on mechanisms to reduce the number of delayed discharges, central Government money is being given to social services departments with one hand and taken away with the other, in fines. That is a cockeyed system. The net result is that the money, often a significant amount, is not being used constructively.
The Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson)—who, unfortunately, is not present—will find that her local social services department expects fines in the region of £25,000 a week. We have to ask whether that considerable sum could not be spent more positively and productively. As for the department in the constituency of the other Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), it originally estimated that its fines would cost about £2.74 million in the first year of implementation. Again, exorbitant amounts are being used in fines rather than being spent positively and meaningfully to tackle a problem.
I believe it is time the Government acknowledged the urgent need to give more security and confidence both to our vulnerable elderly people and to those who care for them. That is why I urge my right hon. and hon. Friends to support the motion.
4.47 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
- "welcomes the real terms increase in social services funding of 20 per cent. between 1997 and 2003, and the commitment to continue these increases by an annual 6 per cent. in real terms from this financial year to 2005–06; notes that councils are able to use these resources to increase fees they pay to care homes where they think necessary, with 2002–03 figures showing 56 per cent. of local councils in England and Wales increasing the fees they pay by at least 5 per cent; notes that the Laing & Buisson Care of Elderly People Market Survey published in July 2003 puts bed capacity in care homes from all sectors at 470,000 with demand estimated to be around 460,000; further notes that over 80 per cent. of older people say they want to live independently in their own homes for as long as possible; supports the Government's policy of improving choice by providing alternatives to residential care with 20,900 more households since 1998 receiving intensive home care packages, 143,200 additional people receiving intermediate care services since 1999, and a cash injection of £87 million to be spent on creating 1,500 new extra care housing places by 2006; and further supports the Government's policy of driving up care standards where the care is delivered and ensuring that older people are not held unnecessarily in acute hospital beds when their care needs can be better met elsewhere.'."
Chris Grayling (Epsom and Ewell) (Con): Will the Minister give way?
Dr. Ladyman: I will establish my thesis first.
The Conservatives seem wedded to a model of care for older people that could have been plucked from the 1980s. To them it seems that dependency and a care home place are the inevitable result of old age. We take a different approach. We want to put the individual at the centre of care. We want to offer a spectrum of care choices, and we will go the extra mile to help people maintain their independence and stay in their own homes for as long as possible.
Our vision is a million miles from the service that we inherited in 1997. Although we are much closer to it today than we were then, we are not there yet. We inherited a low-quality, dependency-based care system that was imposed on people because it was all that was on offer to them. In its place, we are building a high-quality, well-regulated system that makes independence a real option and gives individuals control of their care.
As we make that transition, however, the care industry and the market in which it operates will have to adapt. It will be a challenge for the industry and for care users, but it is not a challenge that we can duck. It saddens me, therefore, that rather than helping the industry to adapt the Conservatives have decided to set their face against change and to swallow every myth that the care home sector wants to throw out.
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