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Delayed Discharges

9. Mrs. Annette L. Brooke (Mid-Dorset and North Poole) (LD): What assessment he has made of progress in reducing delayed discharges from hospital. [195007]

The Secretary of State for Health (Dr. John Reid): The report "Better Health in Old Age", published today by Professor Ian Philp, highlights the progress already made on delayed discharge, which has fallen from 6,419 adults delayed in acute hospital beds in December 2001 to 2,619 in June 2004. That is a fall of almost 60 per cent. in less than two years, which has released capacity of 1 million bed days a year. That is equivalent to building eight district general hospitals.

Mrs. Brooke: The Commission for Social Care Inspection has found that pressure to free up beds is forcing staff to transfer people into nursing homes when a home care package might be preferred. Is the Secretary of State content that the needs and wishes of vulnerable older patients are fully taken into account when targets are pursued? Should we consider whether the target or the needs and wishes of the people should take precedence?

Dr. Reid: I beg to differ with the hon. Lady: the report found no such thing. It contrasted bad practice with good practice, and we want all local authorities and everyone involved to follow the good practice that it highlighted.

Mr. Jim Cousins (Newcastle upon Tyne, Central) (Lab): I congratulate my right hon. Friend on his efforts. In the city of Newcastle, the problem of bed blocking has largely been resolved over a period of 12 months.

That said, at a meeting in about four hours' time, the new Liberal administration in Newcastle will declare the position of director of social services redundant. That gives me some concern about whether our developments and progress will be maintained. Will my right hon. Friend keep a close eye on that?

Dr. Reid: I am surprised and disappointed to hear that. As my hon. Friend pointed out, we have made fantastic progress on delayed discharges and have put in very high real-terms increases for social care funding. The national delayed discharge grant of £100 million has assisted with that. I am pleased to reassure my hon. Friend that there is still a statutory obligation that means that someone will have to be appointed to be in charge of adult social services.
 
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Rev. Martin Smyth (Belfast, South) (UUP): While I congratulate the Minister on the decline in the number of those requiring to be discharged from hospital, what total and what percentage of those discharges are now being dealt with by intermediate carers?

Dr. Reid: There has indeed been a very welcome increase in intermediate care, and I hope that that will continue. I do not have the exact figures, but we have put great effort into making sure that the transition from hospital to home in the community is one that has been facilitated by resources and capacity. If I may, I shall write to the hon. Gentleman with the exact figures.

Mr. Bill Olner (Nuneaton) (Lab): I congratulate the Secretary of State on the improving figures on people being held in hospital instead of going home or to other places. It is the case, though, particularly around this time of year, that a lot of elderly people suffer accidents, and there are other winter problems. What capital or other resources are being put into local hospitals so that they are better able to provide for the elderly at this time?

Dr. Reid: My hon. Friend is right to say that we are putting tremendous effort into making sure that hospitals are prepared for the winter. Although we have coped extremely well over the past three winters—some of the terrible sights that we previously saw did not appear, which is to the credit of NHS staff—we should never take that for granted. One bad viral infection or the spread of something like a variant of flu can always make things very difficult, which is why I am glad that, despite the problems with Chiron, we are now on stream with flu vaccines so that anyone who wants one should certainly be sure to get one.

Other very simple things could be done, such as our efforts to protect old people from falls. Some 400,000 old people a year seriously damage themselves through falls. We have a simple programme, laughed at by some aesthetes, called the sloppy slipper programme. Those 400,000 often injure themselves because of faulty footwear, which can be simply remedied, with a great deal of relief for everyone. There are also intermediary care facilities in which 330,000 people, many of them old folk, are assisted between hospital and home.

Royal United Hospital, Bath

10. Mr. David Heath (Somerton and Frome) (LD): If he will make a statement on the financial situation of the Royal United hospital, Bath. [195008]

The Minister of State, Department of Health (Mr. John Hutton): The trust is working with the Avon, Gloucestershire and Wiltshire strategic health authority to achieve a recurrent balanced financial position. In order to assist in this process, the Department has deferred the repayment of deficits and provided significant and sustained direct financial support through the SHA in each of the past three years.

Mr. Heath: Anyone who knows the RUH gives credit for the standard of surgical and medical nursing care there and pays tribute to the efforts of the management team, in combination with the Government, in putting
 
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things right. The fact remains, however, that patients at the RUH still pay a penalty for the management mistakes of years ago. In a context of increasing resources for the NHS, surely it makes sense for the RUH to start with a level playing field from which it can build, rather than a deficit from which that is more difficult.

Mr. Hutton: I think we all agree in principle with the hon. Gentleman. The truth is, however, that the money has to come from somewhere. If he is going to wipe out a deficit, it has to be paid for by other parts of the NHS. To imagine that anything else is possible is the fantasy-land politics that large sections of the Opposition inhabit.

Health Trust Funding

11. Matthew Taylor (Truro and St. Austell) (LD): What account is taken of local wage rates in allocating funds to health trusts; and if he will make a statement. [195009]

The Minister of State, Department of Health (Mr. John Hutton): NHS allocations policy has taken account of differences in local wage rates since 1976. The market forces factor, within the funding formula, addresses variations in costs in delivering care, such as higher recruitment and retention costs. The formula is reviewed by an independent body, the Advisory Committee on Resource Allocation. Decisions on the 2006 to 2008 allocations have still to be made.

Matthew Taylor: What the Minister does not say is that historically the impact of different wage rates in the private sector in the wider community have been mitigated both by a balancing factor, so that neither the highest nor the lowest is fully factored in, and by counting the poorest 46 of the 177 wage areas as one group, effectively raising the poorest areas—Cornwall has the lowest wages of any—up 46 places in the rankings. Why is the Minister determined to implement, through the tariffs, a system that will tie the amounts paid to local hospitals one to one to local wage rates, when national pay scales apply in the NHS, leaving the poorest areas to get the least NHS funding—with, I understand, no academic research to back that up? Will he at least place the detailed research to justify that in the House of Commons Library?

Mr. Hutton: Ministers act on the advice of the independent experts who have historically provided that sort of information to us. We are trying to be fair to everyone across the NHS. My hon. Friend the Member for Falmouth and Camborne (Ms Atherton) recently discussed that with my right hon. Friend the Secretary of State.

I am surprised by the hon. Gentleman's impression that something is fundamentally flawed with the market forces factor and that it should not be taken into account. He might want to read paragraph 4.63 on page 25 of Liberal Democrat policy paper No. 68, which says:

"Funding will be"—

Mr. Speaker: Order. I instruct the Minister not to waste the time of the House.
 
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Ms Candy Atherton (Falmouth and Camborne) (Lab): There have been real improvements in Cornish health care in recent years, and I am grateful to the Government for that. However, there is concern in the county about the issue. Will my right hon. Friend reassure me and my constituents that the vital investment in Cornish health services will continue?

Mr. Hutton: I am certainly prepared to have a serious discussion with my hon. Friend about that, but I can tell her that the Liberal Democrats have no answer to the problem.

Mr. Owen Paterson (North Shropshire) (Con): In my constituency, there are two enterprising sets of GPs— in Ellesmere and in Oswestry—who want to take advantage of competitive local wage rates and expand the service and the number of people they employ, but they also depend on allocations of funds from central Government to the primary care trust. The Minister's colleague, an Under-Secretary of State for Health, wrote to me on 15 June saying that those allocations to PCTs would be made "in the autumn". Today is 2 November. When in NHS terms does autumn end and winter begin? When will we know about those figures?

Mr. Hutton: We hope to make allocations to primary care trusts very soon, but we are waiting for figures from the Office for National Statistics on population growth. Given the representations that Ministers have received, it is important that we base the allocations on the most up-to-date information about population growth, because they are capitation payments. We hope to be able to do that in January.

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): I thank my right hon. Friend for the £233 million increase in strategic health authority funding since 1997, which has allowed us to have nearly 2,000 extra nurses and about 84 general practitioners. On the market forces factor, I thank him for the discussions that he has held with me since I raised that matter in March. It is my understanding that there has been some progress over the summer and I hope that he will continue to discuss it with us, as he has just indicated. Does he agree—

Mr. Speaker: Order. That is about the third supplementary question that the hon. Lady has asked. There should be only one supplementary question.

Mr. Hutton: We shall certainly continue those discussions with both my hon. Friends. In fact, the NHS in the south-west peninsula has received additional funding of nearly £400 million and I doubt very much whether that would have come from any of the Opposition parties.

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