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Baroness Carnegy of Lour: I come back to the point made by my noble friend Lord Brooke arising from the discussions in the Delegated Powers and Regulatory Reform Committee, of which I am also a member. The last two lines of Clause 1, which we have been discussing, leave to regulations the definition of a hospital patient to whom Part 1 applies. The noble Lord keeps talking about the importance of flexibility. Would it not be much easier if the Bill contained a definition for England of the hospital patients to whom it applies, with the possibility for the Minister to extend that definition? That could be left to regulations for Wales. It seemed to the Delegated Powers and Regulatory Reform Committee that the Government had some difficulty making a definition for Wales, because, as the Minister has confirmed, Wales is not going to implement for the moment. The Government would not want to do that without talking to the Welsh Assembly. The Welsh tail is wagging the English dog in this case. The committee worries about that, because that is not the right way of using the powers that emerge from devolution. If it were not for Wales not wanting to implement, England and Wales could have a proper definition on the face of the Bill, which would make us much happier. The Minister looks puzzled, but I think it is a valid question. I understand that the point was discussed in the Delegated Powers and Regulatory Reform Committee.
Lord Brooke of Sutton Mandeville: The Minister kindly responded to my question. I am not suggesting for a moment that he missed the point, but when legislation covers England and Wales we were hoping that his department could set out in the explanatory memorandum accompanying the material that comes to us how far devolution has affected the particular recommendation that the Government have adopted on how the regulations should be dealt with procedurally. I am perfectly happy to take this in slower time. The issue does not need an answer today. We raised it because we can see that the dichotomy between England and Wales will be a continuing issue in all joint Bills.
Lord Hunt of Kings Heath: I certainly take the noble Lord's point. I shall make sure that the Select Committee's recommendations are brought to the attention of my department. Giving Members of both Houses as much information as possible about how regulations in those circumstances are to be dealt with would be extremely helpful on future legislation.
In response to the noble Baroness, Lady Carnegy, I looked puzzled because I was not aware that the terminology in Clause 1 was used in deference to the National Assembly for Wales, although of course our relationship with the National Assembly is as cordial as ever. We wish to have the flexibility in regulations to define a description because we currently intend to confine the Bill's provisions to those patients who are receiving acute care. We published draft regulations to accompany the debate, paragraph 2 of which sets out our definition of acute care. We want the flexibility of regulations because we hope at some stage to extend the provisions to other classes of patient. That is why there is no definition of acute care in the Bill. I am not aware that it has anything to do with the Welsh dimension.
I shall quickly add some concluding remarks. The Minister said that there was no definition of acute or geriatric care in the Bill and that, therefore, Amendment No. 5 was flawed. In fact, my amendment deliberately leaves it to the regulations to define acute or geriatric care. That was the whole point of the way in which it was phrased.
The Minister rightly drew attention to the need for investing in preventive care and action. I agree with him, but nothing in the Bill incentivises NHS trusts to invest in preventive care. That would have been to the benefit of the Bill, but I do not see it.
I do not share the Minister's enthusiasm for extending the scope of the Bill to increasingly large fines on local authorities. There will be a fundamental disagreement between us about the balance of advantage and disadvantage inherent in the charging scheme. I am all for reducing bed blocking, but not at the kind of price or risk to which this experimental scheme would give rise.
I should answer the question whether the clause will apply when an NHS patient is sent abroad under the scheme that we have for that purpose. It could apply, because the clause says that a qualifying hospital patient means,
These are probing amendments, and I hope that the Minister will give me some reassurance. I must declare an interest, as I am a hospice doctor, and the amendments focus on patients in hospices. In the light of the Minister's remarks on the European question, I hope that a similar reassurance will be forthcoming.
It is worth remembering that most patients admitted to hospices express a wish to die at home. In 200102, there were slightly more than 25,000 in-patient deaths in hospices in the UK and 33,000 deaths of hospice patients in their own homes. More than 50,000 were admitted to hospices, so we are talking about a large number of patients.
Many patients do not die in a hospice on their first or even on subsequent admissions, but achieve death at home. The risks of not including hospices in the clause are that hospital patients will be prioritised over hospice patients. If hospice beds were blocked, patients wishing to go home will probably miss the boat to get home, and patients needing to enter a hospice will not be able to get in for the symptom control that would be essential to improve their last days or weeks of life.
Will the Minister make it clear whether hospice in-patients in hospice units are included from the outset? It is worth remembering that not all hospices have a consultant in palliative medicine but have doctors of other grades, who have received training and are delivering high standards of palliative care at almost a specialist level. Therefore, they should all be included. I beg to move.
It is vital to ensure that patients accommodated in hospices are not given a lower priority for discharge than are people receiving acute care in hospitals. Our concern is that social services will prioritise NHS patients over those in hospices, in an example of precisely the kind of perverse incentive that we discussed on Second Reading, on which the noble Earl, Lord Howe, was so eloquent this morning on the radio.
The amendments also seek to clarify the regulations. Many hospice patients receive intensive medical treatment that meets the definition of acute care given in the draft regulations. Such care most often goes unsupervised by consultants. It is often impossible for hospices to offer consultant supervised care. That is another reason for the Minister to consider the amendments carefully, even though they are probing amendments.
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