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Lord Hunt of Kings Heath: My Lords, I agree with my noble friend that the announcement in yesterday's Budget and our intent today will bring great joy in the National Health Service. Not only are extra resources being provided, but stability over a five-year period, which is important.
I also agree that the term "delayed discharge" is probably a better one to use, although I detect from the Liberal Democrat Benches that even that term does
not appeal to all Members of your Lordships' House. We all know why we need to tackle the issues with gusto. We know of the problems that there have been despite the generally good work undertaken by health and local authorities. There have been capacity problems in terms of getting people out of hospital, but intermediate care is one way in which that is being tackled.At the end of the day, an incentive system, which is based on schemes in Denmark and Sweden, is the right way to go. I believe that the 6 per cent extra resources per year in real terms for social service authorities over a three-year period, plus "incentivisation", is the best way forward. I agree with the noble Baroness that it is better to use a carrot than a stick. Some sticks are needed and the financial incentives will work in the sense that the more enthusiastic local authorities are and the greater their ability to hasten the appropriate discharge of patients from hospitals, the more resources they will have for other services. The less local authorities are able to do that, the fewer resources they will have. I believe that that is the right kind of incentive.
In relation to care homes, we have all looked with concern at the viability of some of them. I believe, and it is our expectation, that the resources that we are now making available to the social service authorities will enable, where appropriate, an increase in fees to care homes to take place.
Lord Roberts of Conwy: My Lords, perhaps I may press the Minister a little harder on the issue of where the present National Health Service Reform and Health Care Professions Bill stands. In light of the White Paper, to what extent will that Bill and its provisions become redundant? The Minister sounded somewhat complacent about the timing of the legislation to come. Nevertheless, I am sure that he will be aware, as I am, that promises have been made to improve the NHS by the time of the next election. Four years is not a great deal of time when primary legislation is required.
The Minister referred to the training of doctors and consultants. Will he say a little more about the Government's plans? Perhaps I should declare an interest as president of the University of Wales College of Medicine. We are anxious to know the Government's plans. Did I understand the Minister to mean that some of the money allocated to the health service could be put directly into social care?
Lord Hunt of Kings Heath: My Lords, on the final point about social care, the funding of social service arrangements to help the discharge of patients will go down the normal route of allocation to local authorities. On the other hand, we have arrangements for the pooling of resources. There is a partnership between the health service, local authorities and care trusts. We are keen to see integrated services. There will be different pools of money, but the specific "incentivisation" of local authorities to improve arrangements for patients when they are discharged will come through the normal local authority allocation route.
In that respect, under the arrangements that are agreed between health authorities and local authorities at a local level, if health services were actually responsible for the problems in terms of discharge, they would face the financial penalty. I want to make it clear that there is no suggestion of simply targeting local authorities and saying that they are the ones to blame and no one else. We want a partnership approach.
On the Bill, I am not complacent, but I was given due warning by the Chief Whip, who reminded me that at this stage I cannot say at what point legislation could be introduced to take forward some of the proposals. What is clear from the Statement is that further primary legislation will be required. I regard the current NHS Bill as a stepping-stone. It contains important measures in relation to patient and public involvement in the health services in Wales, as the noble Lord knows, primary care trusts, strategic health authorities and regulation of the professions. We are anxious to see that enacted.
On the training of doctors, the noble Lord will know that we have seen a considerable increase in the intake of medical schools in the past few years. By the autumn of this year, for example, we estimate that that intake will be 1,250 a year more than in 1997 and that it will increase to 1,950 by 2003. Clearly, as the Statement mentioned, it takes a long time to train a doctor, and even longer for a doctor to become a consultant. That is one of the great inhibitions in expanding the capacity and it is one of the reasons why we look to nurses and to other professions to take on more responsibility. We are making progress and the new contracts that we are negotiating with the leaders of the doctors' profession will also enable us to meet some of the current shortfalls.
Baroness Howarth of Breckland: My Lords, as someone who has worked in a local authority and a health authority area for many years, I welcome the announcement. I have a question about the timescale. The Minister said that it was not possible to give the House the timescale, which I understand. However, can he tell the House how we are to keep the morale of staff in those services at top notch with the degree of uncertainty that they experience?
I declare an interest as a member of the board and vice-chair of the National Care Standards Commission. That commission has been operating for three weeks and we have just re-organised hundreds of staff into 70 offices. The Minister will know that we do not yet have all the standards in place. While I believe that there is a need for further re-organisation and inspection, timing is crucially important. It is also important for the staff to understand where they stand in relation to their jobs. Managing that is critically important.
The management of change requires sensitivity as it is a delicate task. As the noble Lord, Lord Clement-Jones, said, we have had huge change. It will affect the delivery of service and the productivity that people can
deliver. Often their efforts are redirected into the issues of change rather than into primary care. The National Care Standards Commission inspects the institutions that care for the most vulnerable people in our community. Can the Minister tell the House whether the Government are considering issuing messages, in some detail, to staff about what this change will mean to them? It is no use having general reassurances about how wonderful they are—we all think they are absolutely wonderful. They need to know what will happen to them tomorrow.A second point is whether the Minister will consider other IT programmes before developing the health service's new IT programme. I say that from my experience of at least three government IT programmes, which frankly, when they were accepted by the people for whom they were commissioned, were near disasters. We should at least get that right in the next round.
Lord Hunt of Kings Heath: My Lords, in relation to IT we need to learn the lessons of past efforts in central government. Looking back over quite a long time, the NHS has had a number of IT initiatives that have ended in failure. One reason why the NHS moved away from central direction was because of the failure of some central IT projects in years gone by. We need to get the balance right and to have greater central direction. We need to give a good deal of help to local people to work within a system that enables the NHS as a whole to work together and to work across organisational boundaries. Certainly we are seeking advice from across government and the private sector on IT matters. I very much take on board the points raised by the noble Baroness. While we are disappointed with progress in some areas of IT, there have been some significant achievements on which we need to build.
I pay tribute to the staff of the National Care Standards Commission, the Commission for Health Improvement, and indeed, the Audit Commission, as it is important to place on record my gratitude for the outstanding work that has been undertaken. In the case of the Audit Commission, it is universally agreed that the value-for-money studies have been outstanding. We are anxious to ensure that the quality in the new inspectorate is kept to the same high order. I pay particular tribute to the Commission for Health Improvement because, from a standing start, it has undertaken a huge number of reviews. The staff of the National Care Standards Commission have also had to start from a blank sheet of paper in double-quick time.
We want to meet the current organisations very soon to discuss the practicalities of where we are going. In the meantime, we wish to encourage them to carry on the good work, and to work together because many of the changes that we are making can start by organisations collaborating. I know that they already do so very effectively. It is worth remembering that the staff of the current organisations will form the broad bulk of those who will go into the new organisation.
We need to talk through the details, but I am anxious to ensure that the people currently in those organisations feel supported and valued.
There has been a clear recommendation from Kennedy. Noble Lords in our debates on the National Health Service Reform and Health Care Professions Bill asked for an integrated approach, which is welcome as a general principle.
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