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Lord Goodhart: My Lords, does the Minister agree that there is little point in deciding whether the European Union is technically a federation, a confederation or something in between? Does she further agree that it needs a governing instrument and that it makes very little difference whether or not that is called a "constitution"?
Baroness Symons of Vernham Dean: My Lords, that is the point I was endeavouring to make. The question of a statement of principles lies at the heart of what we are trying to pursue. I applaud the setting up of the European convention. We had a lengthy and exciting debate in your Lordships' House on this issue when we discussed the Nice treaty. We need to address the questions of how we can make the European Union better understood; how we can make it more democratically accountable—a point to which your Lordships often return during our discussions on this matter—and how we can make the European Union more effective. That is what we are trying to pursue through the convention.
Lord Monson: My Lords, does the Minister agree that because of excessive harmonisation and the absence of genuine subsidiarity, the individual nation states of Europe have less autonomy in certain matters than do South Dakota and Rhode Island?
Baroness Symons of Vernham Dean: My Lords, we will have the opportunity to discuss how we pursue subsidiarity through the convention. There has been a great deal of concern and interest about this matter in the House. I stress that the question of subsidiarity is a two-way street. That is implied by the very word. It is the principle whereby the European Union acts only where it can add value at an EU level to the legislation under discussion. We have a genuine opportunity in the upcoming convention, on which discussions began on 28th February, to discuss the very issues which the noble Lord, Lord Monson, and many other noble Lords wish to take further.
Emergency Hospital Re-admissions
11.30 a.m.
Lord Clement-Jones asked Her Majesty's Government:
- What action they propose to take in response to the rise in the number of patients needing emergency re-admission to National Health Service hospitals.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, reducing the number of emergency re-admissions is an important priority for the NHS. NHS trusts are expected to target this area as part of their performance, improvement and clinical governance programme. The National Service Framework for Older People—with specific standards, targets and milestones to improve general hospital care, stroke services, and falls prevention and rehabilitation—will improve the quality of services and care that older people receive, including the tackling of emergency re-admissions.
Lord Clement-Jones: My Lords, I thank the Minister for that reply. However, would it not be as well to try to establish the causes of the emergency re-admissions? Does the Minister agree that there are only two reasons: an over-zealous attempt to meet government waiting list targets on the one hand, or inadequate care in the community on the other, due to lack of government resources for social services?
Lord Hunt of Kings Heath: My Lords, I certainly agree that we need to look at the main reasons for emergency re-admissions, but I have failed to detect any evidence to support the claims that the noble Lord subsequently made.
We know from research that an emergency re-admission to a hospital may be a consequence of the natural course of a patient's disease, or that he or she may not have received appropriate care after the first admission; or it may be entirely unconnected with the original patient care. A literature search by the National Centre for Health Outcomes Development, examining evidence throughout the world based on studies of older patients, suggests that between 15 and 60 per cent of re-admissions are unavoidable; but in two studies of medical patients, between 9 per cent and 18 per cent of re-admissions were considered preventable. That is why every NHS trust should be looking through its clinical governance programmes at the specific reasons for re-admissions—and that is what we expect the trusts to do.
Lord Walton of Detchant: My Lords, does the Minister agree that, as suggested by the noble Lord, Lord Clement-Jones, one of the major factors responsible for this situation is—I do not like the unfortunate term—bed-blocking in acute hospitals by elderly patients who have nowhere to go? Is it not the case that, progressively across the country, more and more care homes in the community have closed down
within the last two years? Is it not also the case that certain misguided health authorities, such as that in Oxford, have closed down valuable community hospitals such as those in Burford and Watlington?
Lord Hunt of Kings Heath: My Lords, I agree with the noble Lord that community hospitals have an important role to play in ensuring that rehabilitation and intermediate care facilities are available. He will know that, as a result of the Government's policy, we are seeing a great deal of investment in additional places for intermediate care.
So far as concerns care home capacity, the noble Lord is right to point out that there has been a reduction in the number of care home places throughout the country. The position is patchy, with some parts of the country still having an excess of places over the number of people wishing to go there. We have put in extra resources to local authorities to enable them to buy additional care home places. As regards bed-blocking, I am glad to report that we have seen a reduction in the number of beds blocked between the third quarter of the current financial year as opposed to the third quarter of the last financial year.
Lord Morris of Manchester: My Lords, can my noble friend say how seriously the present shortcomings in providing community care are impacting on the incidence of hospital re-admissions? What figures are available? Moreover, ought the pejorative term "bed-blockers" to be applied, not to vulnerable people for whom only hospital care is available, but to those failing in their legal duty to provide adequate and appropriate community care for them?
Lord Hunt of Kings Heath: My Lords, my noble friend is right to suggest that, if appropriate community care and community facilities are not available, that can have an impact, particularly on older people who have been discharged from hospital and who may have cause to be re-admitted. That is why, in dealing with the issue of beds that are being blocked, we have made additional resources available to local authorities which can be used to purchase extra care places. More importantly, those resources can also be used to provide additional packages of community care.
Part of the work of an NHS trust in reviewing re-admission rates is to ensure that discharge procedures are as effective as possible, and that there is a strong partnership between the health service and local government, to make sure that there is a seamless transition of care.
Baroness Blatch: My Lords, does the Minister agree that there is a flaw in the collection of data as regards waiting lists and re-admissions? It was brought to my notice that a patient on the point of going into theatre for an operation was in fact sent home pending further tests and the operation taking place at a later time. She
is now not deemed to be on the waiting list, although, by anyone's understanding, she is still waiting for her operation.
Lord Hunt of Kings Heath: My Lords, I am always happy to examine individual cases to see whether the trust has recorded a patient properly. It is very important to the Government to ensure that data collection is treated with all due seriousness by the NHS. It is why we commissioned the Audit Commission to examine the quality of NHS data, and why we have agreed with it that it will undertake spot-check reviews of NHS trusts to make sure that they are recording data properly.
Business of the House: Debate this Day
11.36 a.m.
The Lord Privy Seal (Lord Williams of Mostyn): My Lords, I beg to move the Motion standing in my name on the Order Paper.
I am advised by the House authorities that this Motion is necessary to ensure that none of the three Motions standing in the name of my noble friend Lord Whitty is subject to pre-emption. Today's procedures and this business Motion have been agreed by the usual channels. Without this business Motion, we should find ourselves in difficulty; namely, that if either of the first two of the Motions standing in the name of my noble friend were agreed to, the remaining Motion or Motions would fail.
Your Lordships, quite reasonably on all sides, want to have a guarantee of three votes. If the House agrees to this business Motion, I can give that guarantee. No matter what happens in any of the votes, there will be no question of pre-emption and three votes would be assured.
Assuming that your Lordships agree to this business Motion, the procedure is intended to be as follows. My noble friend Lord Whitty will move the first Motion standing in his name. The whole debate will take place on that Motion. When we reach the end of the speakers' list, some time later today, my noble friend will wind up the debate and the first vote will then occur. After the first vote, my noble friend Lord Whitty will formally move the second Motion. We shall vote on that Motion straightaway, without any further debate. When the second vote is complete, my noble friend will move his third Motion. We shall vote again without further debate. That third vote will conclude our proceedings.
As your Lordships have seen, there are 45 names on the speakers' list. There is no time limit, but perhaps, if Front-Bench speakers voluntarily limited themselves to 15 minutes and all Back-Bench speakers voluntarily restricted themselves to, say, eight minutes, we could conclude our proceedings at a reasonable time this evening.
Moved, That, notwithstanding the practice of the House that matters already decided may not be brought forward again during the same Session, the House may if it thinks fit consider and vote on all the Motions standing in the name of the Lord Whitty this day.—(Lord Williams of Mostyn.)
On Question, Motion agreed to.
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