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Lord Astor of Hever: My Lords, despite the Minister's response, all the statistics show the percentage of emergency readmissions rising, and rising fast. The Government have already announced the incentive of hefty fines for local authorities as regards the delayed discharge of patients. When will that be introduced for NHS trusts?

Lord Hunt of Kings Heath: My Lords, I do not agree with the noble Lord's assessment of the figures. The truth is that they bib and bob around. For instance, in quarter four of 1997–98, the figure for readmissions for over-75s was 7.1 per cent. In the same quarter of 2001–02, the figure was 7.2 per cent. There are variations over that four to five-year period.

The delayed discharge Bill, which the House is debating at the moment, has been brought forward to provide the right incentives for local authorities and the NHS to get their act together, so that quick assessments take place with ample notice to local authorities. That should enable proper planning, proper discharge procedures and more support available for people to go back into the community.

Baroness Barker: My Lords, is the Minister aware that in evidence given to the Select Committee on Health last year it became apparent that older people discharged from hospital on a Friday were three times more likely than those discharged between Mondays and Thursdays to undergo emergency readmission? In view of that can he explain why, under the delayed discharge Bill, the Government will compel older people to be discharged at weekends?

Lord Hunt of Kings Heath: My Lords, the point about the delayed discharge Bill is that older people stuck unnecessarily in hospital can become institutionalised. The outcome for them can be very negative. That is why we have brought the Bill

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forward. The intention is that local authorities will be informed far quicker than often they are now that an older person will require assessment. That will enable proper assessments to take place. As a result of those proper assessments, more facilities and support can be made available in the community. The noble Baroness will know that we have also intimated that we will transfer 100 million in a full year to help local authorities to put those services into place.

Baroness Noakes: My Lords, is it not true that the delayed discharges fines Bill will provide a massive incentive for NHS trusts to discharge elderly patients early, because it is in their financial interests to start collecting fines from local authorities?

Lord Hunt of Kings Heath: No, my Lords, it is not a fines Bill. It is an incentives Bill.

Noble Lords: Oh!

Lord Hunt of Kings Heath: Oh yes, my Lords. The incentives will be there to encourage both the NHS and local government to do better than they do now. We are transferring 100 million in a full year. That is the estimated cost to local authorities of dealing with the average figure of 5,000 older people whose discharges are delayed at the moment because local authorities have not got their act together.

So far as perverse incentives are concerned, I do not agree with the noble Baroness. It cannot be in the interests of the NHS to discharge people before they should be discharged.

Baroness Pitkeathley: My Lords, will my noble friend confirm that the readmission of elderly people to hospital is often a result of the breakdown of the carers—of the families who look after them? Will he therefore confirm that he will continue to encourage local authorities and social services departments to provide extra services to help those carers?

Lord Hunt of Kings Heath: My Lords, I certainly agree that it is very important that we continue the progress in providing greater support to carers. We will do that. The noble Baroness will know that amendments made in another place to the delayed discharges Bill have reassured the carers' association as to its position under the legislation.

Baroness O'Cathain: My Lords, in support of the comments made by the noble Baroness, Lady Pitkeathley, I want to ask the Minister whether any study has been done about the effect on elderly patients brought back into their own homes from the security of hospital. From feeling that no matter what happens to them they will be looked after, they suddenly have an emotional response and do not feel secure at home any longer. Therefore, is any counselling service available to those elderly people to make them feel better once they are reintegrated in their own homes?

Lord Hunt of Kings Heath: My Lords, the noble Baroness has raised an important point. Clearly, if as

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a result of the assessment it is considered better for an older person to go back into their own home, it is important that the right services are available. In the first few days when it is particularly difficult, it is also important that all due support is given. As regards research, we have the National Centre for Health Outcomes Development, which is looking into the issue of readmissions at the moment. I hope that that will provide more information. We have also made available 2 million for further research into older people's services. We are inviting bids at the moment in that area.

Lord Campbell of Alloway: My Lords—

Baroness Warnock: My Lords—

Noble Lords: Cross Bench!

Baroness Warnock: My Lords, in the light of the Minister's last answer, which was very sympathetic towards older people returning home, is he aware that it is in the last degree unlikely that older people returning from hospital on a Friday—that has been mentioned as a problem—will be able to get any help at all on a Saturday or Sunday? Perhaps the Minister could assure us that that will be looked into.

Lord Hunt of Kings Heath: My Lords, I certainly understand that point. The criticisms that are often made of current discharge procedures are: first, that the NHS is very late in notifying local authorities that a particular patient is ready for discharge; secondly, that discharge then takes place very rapidly; and thirdly, that the proper community support services are not available. The delayed discharge Bill, in which there is clearly a great deal of interest, ensures: first, that the local authority gets due notification; secondly, that an assessment and care package has to be made and put in place within three days; and thirdly, that 24-hour notice is given of discharge. The point that the noble Baroness raises about Saturdays and Sundays and the preparedness of agencies to give support is very well taken.

The Lord Bishop of Hereford: My Lords, will the Minister say whether many readmissions are due to clinical misjudgment that has led to premature discharge from hospital? If that is the case, what can be done to improve the quality of clinical judgment?

Lord Hunt of Kings Heath: My Lords, the simple answer is that we do not know that. That is why the research by the National Centre for Health Outcomes Development to which I referred will be helpful in trying to pinpoint some of the causes. There is no doubt that part of dealing with the issue is to improve the quality and standards of care for older people in hospital. It is with that that the National Service Framework for Older People is concerned. If at the same time as improving care for older people in hospital we can improve the whole process of

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discharge procedures and after-care support, I believe that we shall be able to make an appreciable improvement in the current problem.


3.9 p.m.

Lord Blaker asked Her Majesty's Government:

    Whether they expect to make any change in policy towards Israel in light of the result of the election there.

Baroness Crawley: My Lords, preliminary results show that the Likud Party won the most votes in the election. Mr Sharon will be invited to try to form a new government. We may not know the final make-up of the new government for some weeks. We want to work closely in the search for peace with the new Israeli Government, whatever the composition. In particular, we shall be looking for them to engage with the Palestinians and the international community on the implementation of the quartet road map within the time framework set out by President Bush on 24th June.

Lord Blaker: My Lords, I am grateful to the noble Baroness for that reply, and especially for her reference to the work of the quartet. Is she aware that in his State of the Union speech two days ago, President Bush devoted only one short sentence to relations between Israel and the Palestinians? When the Prime Minister meets President Bush tomorrow, will he urge him to pay more attention to removing the suspicions of so many of the Arab countries that this matter is not of interest to the United States and that the United States tends to be less than impartial in its relations between the two sides? Would it not be a useful start if President Bush were to publish his road map for peace in the Middle East and if the Prime Minister did his best to discourage some of the senior advisers to President Bush from their belief that the removal of President Saddam Hussein by force would make the solution to the Israel-Palestinian problem easier?

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