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Baroness Hollis of Heigham: My Lords, there is still a Labour Government!
Lord Higgins: My Lords, the Minister says that there is "still a Labour Government"—well, it is all their fault just the same. It is bad enough that the Minister refers to the previous Conservative government.
I am not going to blame the Labour government of 1945. My point is that their errors should be dealt with now. We need an up-to-date assessment. I strongly suspect that the amounts that are being downrated are in no sense up to date and may be inappropriate. I hope that the Minister agrees that further research in that regard is important.
The third issue involves problems on discharge. That issue divides into two parts. The first arises when people fail to notify their hospital that their benefits are overpaid and when the department tries to claw back that overpayment. That may cause considerable concern because the person may have spent the money in the mean time and, if he is on low benefits, he may have the greatest trouble repaying the sum. In many cases, the department may rightly decide that that is not a practical approach.
The other issue involves the question of whether such people are capable of resuming payments once they have been discharged, the amount being paid having previously been reduced while they were in hospital. An amendment moved in Committee sought to deal with that matter.
We need to take into account the state in which many people are discharged. The noble Baroness, Lady Greengross, rightly pointed out that we no longer have the kind of geriatric beds in hospitals that used to be available. I remember when, as a new Member of Parliament, I first went round the hospital in my constituency—a perfectly good hospital—in, I believe, 1965. The condition of its wards was absolutely appalling, quite apart from the stench. People are now discharged much more rapidly but perhaps in a state in which they may not be able to say, "I must be sure to get my benefits restored". A number of representations that we have received involve particular cases in which benefits were not restored. In one case, I gather, that had not been done after seven months.
I came across a case only the other day involving someone who had been discharged from hospital. If we need to judge whether that former patient could deal with this kind of complex problem, we must consider the fact that when he got home his family asked him, "What is that in your arm?" It was the needle that had been used for injections, and so on. The person was so unaware of what was going on that he had not noticed the needle until his family pointed it out to him. It is important to do all that we can to ensure that benefits are resumed at the earliest possible moment.
The amendments that I have tabled are simple and clear-cut. We need to consider clearly between now and Third Reading the extent to which that problem, which is a growing concern to many, can be improved, if not solved totally.
Baroness Barker: My Lords, after two such excellent expositions on this issue, I do not intend to speak for long. Along with other noble Lords, I have recently been asking a number of questions in an attempt to do what the noble Lord, Lord Higgins, suggested; namely, to try to find out what actually happens. That is extraordinarily difficult to do. I have a particular interest in that matter. Another brief that I hold is for social care. As intermediate care increasingly becomes a reality for older people, there is an even greater need for clarity about the position of people receiving NHS care in different circumstances and settings.
I have two main questions for the Minister. The first is about the operation of the 28-day rule. If someone is readmitted to hospital within 28 days, his previous time in hospital is counted in the calculation of the six-week period. How many people on average per year are caught by the 28-day rule? That is extremely important, in view of the Government's new policy on rehabilitation and on moving people out quickly into the community; sadly, they sometimes have to return.
When we discussed this matter in Committee, several of us pressed the Minister on the cost of administering changes. She gave us some helpful figures at that time and in writing about the cost of the arrangement to the Department for Work and Pensions. In view of joined-up government, what is the cost to the NHS of administering the system? That is important because the Government are adopting this approach and, at the same time, talking about increased emphasis on having discharge plans for patients that are successful, that enable them to return home and that enable older people to resume their life.
The noble Baroness, Lady Greengross, and the noble Lord, Lord Higgins, gave examples provided by a range of voluntary organisations, including Age Concern—an organisation for which I work, as noble Lords know—of the distress that the arrangement can cause older people. Such distress has a severe impact on their physical health.
Those are the technical points to which I hope the Minister will respond. I add my strong support to those who say that it is time that the system was
renewed. It was designed for the 1940s, when there was a Labour government, but they were of a very different type.
Lord Rix: My Lords, I speak as president of the Royal Mencap Society. I hope that noble Lords notice our new name. I support Amendments Nos. 2, 13 and 14, which were spoken to by my noble friend Lady Greengross and the noble Lord, Lord Higgins.
Although the Bill concerns those in receipt of the state pension, it embraces others, too, inasmuch as the hospital downrating rules, about which we have heard a great deal, apply to all who are in receipt of state benefits, including those with a learning disability. Therefore, I should be grateful if the Minister would clarify which disability benefits will be excluded from the hospital downrating rules and which will be included. How my daughter, who has Down's Syndrome and is blind and virtually immobile through hip dysplasia, is expected to understand all the administrative niceties when she is admitted to hospital beats me, while her carers would find the whole operation both complex and burdensome.
Therefore, as has already been stressed, I hope that the Government will review the hospital downrating rules which are now outdated—after all, does one now receive a discount for the nights that one spends on a trolley?—and bear no relationship to the current state of the NHS and the costs of old age and disability.
4 p.m.
Earl Russell: My Lords, perhaps I may add a few words, first, in support of Amendment No. 2. While there is discussion about the future of this House's powers in relation to statutory instruments, I believe that it is necessary that we probe with some care the creation of a power to make regulations. This is our last chance. If we create a power to do something of which we later disapprove, we discover it too late.
Therefore, perhaps I may look at the words in Clause 2(6) to which Amendment No. 2 refers:
- "Regulations may provide that, in prescribed cases, subsection (3) shall have effect with the substitution . . . of . . . a prescribed amount".
With regard to the body of the main amendment, I remember spending a term working at Berkeley. As one went up the hill, house prices rose as they used to do in central Hampstead by approximately 1,000 dollars a foot. Academics tended to be somewhere between a third and half way up the hill. I once asked who owned the houses at the top and received the answer from a senior colleague: "Plumbers".
I am not sure whether or not that was fair on plumbers, but plumbers expect to be paid. People who are away in hospital and who do not keep their heating
running at a level at which they might otherwise do tend to suffer from frozen pipes. Plumbers expect to be paid. Many expenses continue unabated and are perhaps increased because of a stay in hospital. Where a family is involved, one notices that, as the patient's costs may decrease, so the relatives' costs, especially in relation to transport and meals out, are liable to increase.It has been brought home to me forcefully on my travels when speaking to meetings of the party in rural areas that that is particularly true because of the centralisation resulting from the closure of small local hospitals. In one area of Lincolnshire I remember it being represented to me that previously one could take an hour off work and visit a relative in the local hospital. Now one had to drive 60 miles, take a whole day off work and lose a whole day's wages. I wonder whether account has been taken of that in the calculations.
I also wonder whether account has been taken of the amount of work that downrating creates for the NHS. In that regard, following the Starred Question asked by the noble Baroness, Lady Greengross, I asked the Minister what cost was borne by the DWP. The Minister replied that there was none because the work was done by the NHS anyway. But I had not noticed that the NHS was short of work to do. Are we perhaps placing on it a burden which we have no call to do? And is this one case where we could reduce the costs of running the NHS without any injury to patients? Having listened to the Minister throughout debate on the Bill, I understand how difficult it is to simplify the social security system. But is there here, just once, the opportunity to do so? If we were able to do so, is there a case for saying that we should?
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