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Baroness Masham of Ilton: I could not agree more with the Minister about the disgraceful delays in making adaptations and providing equipment. What will he do about trying to get more occupational therapists, who make assessments and arrange for such equipment? I agree that the delays are disgraceful and are getting worse. The Audit Commission published a report, I believe two years ago, stating just that.
Lord Hunt of Kings Heath: The noble Baroness raised an interesting question which relates to the present delay in assessing people in hospital. One of the reasons we are bringing the Bill before noble Lords is that patients are hanging around hospitals having had their acute treatment, having got better and still awaiting local authority assessment. That is unacceptable. That is why we need to have a Bill which allows for such assessments to be done in a short period of time.
Occupational therapists are important to that. We know that a number of local authorities and NHS bodies are pooling resources creating a joint occupational therapy department. We know that they will have a pivotal role to play in such joint assessments. However, again I say to the noble Baroness that the experience is that even in those parts of the country where recruitment of such professionals has proved to be difficult, those which organised themselves more successfully are able to deal with the problem. They can get the assessment done quickly. If aids and adaptations are needed, they can get people into the person's home so that that can be done as quickly as possible and discharge can take place effectively and satisfactorily. It is that good practice on which the basis of the Bill has been drafted.
Earl Howe: I thank all noble Lords who have taken part in the debate. I also thank the Minister for the offer he made. No doubt noble Lords will need to think about that. My own view is that it is not sufficient. The choice is not between introducing the Bill on 1st April and consigning the patients to further delays. It is between serious dislocation in social services and continuing with partnership working while allowing local authorities time to invest and gear up for April next year. They do need the time.
The noble Baroness, Lady Masham, need not worry about Part 2 of the Bill because my amendment proposes delaying only Part 1. The Minister suggested that the lack of capacity in the care homes sector had little bearing on delayed discharges. Perhaps I may remind him that in the original consultation paper on introducing the system, the Government gave an analysis of the reasons for delayed discharges from acute and geriatric beds during March 2002. By far the largest reason for delay, 36 per cent, was the patient waiting for a place in a care home or a specific care home of their choice. So I do not accept what he said. I do not favour delay for the sake of delay. I am arguing for a year's grace, during which time money flowing to local authorities can be directed creatively.
My noble friend Lord Lucas made two compelling points, with which I agree. However, I particularly note his well-made comment that investing in and establishing services is a long-term business. I hold fast to my belief, bolstered by the views of other noble Lords and the right reverend Prelate, that a year's delay is right. I should like to test the opinion of the Committee.
Resolved in the affirmative, and amendment agreed to accordingly.
The noble Lord said: In moving Amendment No. 13, I shall speak also to Amendments Nos. 15, 31, 62 and 119. My noble friend Lady Maddock will speak in particular on the housing issues, which are relevant to these amendments.
The amendments are about pooling the responsibilities of agencies. It is especially important that housing departments are brought into the loop, as they are responsible for administering the "Supporting People" budget, a single funding stream for social services contingent on supported housing. Funding for supported services is currently dealt with by central Government. From April 2003, local authorities will receive a grant for co-ordinating and funding local support services and the cost of providing those services, including those provided by a warden in sheltered accommodation. Those will no longer be paid for through housing benefit; instead, landlords will receive a grant from the local authority.
The stated aim of the "Supporting People" programme is to improve the quality of services for residents of sheltered and other types of supported housing. Sheltered housing is being included in the new funding regime for supported housing, despite calls for it to be excluded during the initial consultation process. The Government have given the following reason for its inclusion. Including it in the new specific grant will ensure the provision of high-quality support services to
In January 2001, the Department of the Environment, Transport and the Regions, now the Office of the Deputy Prime Minister, published Supporting People: Policy Into Practice. That document explained that the programme intended to ensure a continuation of service to existing tenants in sheltered housing. Authorities, in preparing their "Supporting People" strategy, would be required to take full account of those guarantees and existing obligations. They would not, consequently, be permitted to withdraw funding for schemes where such an action would leave the provider unable to continue to provide the support services.
The ODPM assumes that in most cases, the existing provider of support services will continue to do so. However, within the context of the "Supporting People" grant, authorities and providers will almost certainly want to discuss improvement to services as well as to negotiate the price to be paid for services. One service provider may be replaced by another. It may be impossible to disentangle support from other services in the scheme. In best value reviews, authorities and providers will want to review the strategic supply of sheltered housing within the authority, and may wish to introduce the type of remodelling or change of provision that is already taking place in some areas.
Home care and "Supporting People" are by their nature two different services aimed at meeting different needs, but it is unclear from the proposals how the single charging mechanism will be applied in a way that avoids possible conflicts of interest and ensures that users of both services are charged in an equitable and fair manner. The Government have provided the following guidance on how those different services should be treated, but there is no clear and unambiguous line between care and support.
Generally speaking, care is provided to people who are at greater risk or who have high needs. Support is provided to people who have lesser needs but are nevertheless vulnerable. By definition, services provided in accommodation registered under the Registered Homes Act 1984 include care, while services provided in registered care homes can also include services that are support, along with care services. They will continue to be funded from sources other than "Supporting People". However, care services can be provided to people living in accommodation that is not registered under the Registered Homes Act 1984, such as domicillary care provided to people in their own homes and under the Care Standards Act 2000. Might not those services be supported under "Supporting People"?
A further issue arises in relation to delays for adaptations and services that are already the responsibility of housing authorities, such as the installation of a level access shower. Here, the social services authority will have to pay the fine if a housing authority does not provide the adaptations.
Baroness Noakes: I shall speak to Amendments Nos.14, 52, 57 and 58, which are grouped. Amendment No. 13, which the noble Lord, Lord Clement-Jones, has just moved, is similar to Amendment No. 14. He focused on the relationships with housing authorities. We consider the amendments to be directed at a topic that we have already debated today: partnership working. The Minister will be aware that one reason that we regard the Bill as so unacceptable is that it undermines joint working between local authorities and the NHS. We are joined in that view by almost all the bodies that have commented on the Bill.
The Bill is a wrecking Bill that sets the NHS apart from local authorities by setting out functions that the NHS must perform alone. Amendments Nos. 13 and 14 concern a decision about discharge from hospitalwhether it is safe without community care services being made available. Of course, that is a joint decision; it is nonsense to suppose otherwise.
Amendment No. 52 is similar and would insert the local authority into the process in Clause 3(7)determining whether the patient's circumstances have changed and hence whether a Clause 2 notice should be withdrawn. Clause 3(7) appears to be based on the premise that only clinical matters within the knowledge of the NHS are relevant to the decision or that the NHS is omniscient about the patient's total circumstances. Neither premise is reasonable. I invite the Minister to tell us why local authorities are excluded from the process and ask him to confirm that partnership working should extend to the totality of planning the discharge of a patient.
The first paragraph of Amendment No. 58 requires the responsible NHS body to provide information to other NHS bodies so that they can consider precisely what they need to provide. The second paragraph of Amendment No. 58 requires the responsible NHS body not only to consult but, importantly, to agree with the local authority the services that it will provide
In different ways, the amendments are designed to ensure that the Bill becomes an instrument that will underpin partnership working, not the principal cause of the death of partnership working.
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