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Baroness Andrews: I am sure that we can improve on it in the guidance. I am grateful for the generous reference to the fuel poverty strategy. The issue of fuel poverty has been neglected for many years. The advice lines, the winter guidance and the financial assistance that are now being made available are welcome, if overdue.

I turn to the linked issue of housing. I shall come to the question asked by the noble Lord, Lord Clement-Jones, in a moment. Amendment No. 31 would require the NHS to notify not only the social services but the housing services. As I said, under Section 47(3)(b) of the National Health Services and Community Care Act 1990, social services are already under an obligation. There is also something defective in Amendment No. 119. It implies that housing authorities are responsible authorities. They are not. They do not provide community services, so it is inappropriate to include them in such an amendment.

I shall deal with the wider issues raised by the amendment. In practical terms, few discharges are delayed for housing reasons. They tend to be social care difficulties compounded by the housing situation. Of course, there will be situations in which extra help will be needed. That is an extremely important factor.

The noble Lord, Lord Clement-Jones, asked about "Supporting People". I do not know a great deal about that, but "Supporting People" requires local authorities to plan housing and care jointly. Therefore, it supports partnership working. Social services are also expected to contribute to extra-care housing by developing the care needed to support people in such housing. Extra-care housing is an area in which the Government are investing a great deal of finance. On 23rd July, the Secretary of State said that part of the additional funding for social services would go towards a 50 per cent increase over the 1997 total for extra-care housing places. Those are housing places that have a great deal of therapeutic support—extremely sheltered housing accommodation with extra medical support. That housing will be available for elderly people.

At the same time, the Government are aware of the need for joining up and being more proactive in this matter. The Department of Health and the Office of the Deputy Prime Minister are publishing guidance to develop housing strategies for older people that makes the link between housing and social care. The

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Department of Health is currently working closely with the ODPM on that. We hope that we shall see the fruits in the way that this Bill is implemented. In addition, we have home improvement agencies which will receive additional funding over the next three years.

The Government, too, are concerned about the second point that the noble Lord raised—the matter of adaptations and delays. We are aware that the disabled facilities grant tends to go towards major changes and adaptations. Smaller adaptations tend to be covered by the Chronically Sick and Disabled Persons Act. We are aware that the disabled facilities grant is often subject to delay. The ODPM is currently consulting on revised guidance to reduce the length of time taken for completion of adaptations. I hope that that will speed up the process. Some local authorities are much better than others. We want to know why they cannot all aspire to and reach the standard of the best.

The noble Baroness, Lady Noakes, said that the purpose of Amendment No. 52 was to give social services a greater say in the discharge process. Subsection (7) is intended to deal with a change of circumstances which leads the NHS to be concerned that the services which the local authority has decided to provide will no longer be sufficient for it to be safe to discharge the patient. Yes, it must be the NHS which takes the initial decision on medical grounds. However, the NHS has its own social workers. There will be a social service judgment made when the multi-professional team meet. There will be occasions when social services realise that a patient's circumstances have changed. Therefore, on those grounds, Amendment No. 52 is unnecessary because it does not enable the social services authority to do anything that cannot be done under the Bill as it stands.

There may be circumstances when the social services believe that a patient's home life has changed since the original determination. In such cases, social services are free now to bring those changes to the attention of the NHS, without the amendment. The subsequent decision of whether to discharge must rest with the NHS. Essentially, it will be taken on medical grounds. With that explanation, I hope that the noble Baroness will feel that she can withdraw that amendment too.

I turn now to Amendments Nos. 57 and 58 which propose ensuring that NHS bodies are brought into the discharge process. The essential point is that other NHS bodies should be involved—for example, the PCT, the physiotherapy services, the occupational therapy services—to ensure that they take part in all discussions which are likely to affect the patient. As drafted, Amendment No. 57 requires the responsible NHS body, which is usually the hospital trust, to:

    "consider whether it or any other NHS body should"

provide services to the patient upon discharge. They will undertake the primary consideration about whether or not the NHS should provide services, but that means that they will also make those judgments on behalf of the PCT. However, that is not for the responsible NHS body to do. The PCT is separate. The Government have a problem with Amendment No. 57 on those grounds.

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Amendment No. 58 places a duty on the face of the Bill for the responsible body—the hospital trust—to provide information to any other NHS body that it believes may provide services and for it to consult and agree with the local authority about those services. First, the hospital trust already needs to consider whether it or another NHS body should provide services to the patient upon discharge. That is implicit in Clause 3(8). It is also implicit in subsection (8) that the responsible NHS body must provide the relevant information so that it can comply with the duties. There is no need for that to be added to the Bill because it is covered in any case.

6.45 p.m.

Baroness Noakes: Is it implicit? The amendment proposes that it should be made clear and explicit.

Baroness Andrews: That is clearly a point of view. Maybe we shall return to that another time. We believe that it is sufficient as it stands.

However, the Government have another problem as regards how the proposal would work. I should remind Members of the Committee that at Report stage we revised the drafting of this part of the Bill to make it clear that any other NHS body would also have the duty to consult with social services. The amendment, as drafted, would have the effect that the hospital trust would be required to consult with the social services authority, but the other NHS bodies would not have that duty. Therefore, there is a problem in that the amendment militates against joint working.

Amendment No. 58 also states that the responsible body must come to an agreement with the social services about the services which it will provide. Again, we have a problem with that because forcing an agreement could lead to some undesirable outcomes—namely, a loophole which could be exploited by social services departments which might deliberately fail to come to an agreement in order to avoid reimbursement.

In summary, the Government believe that subsection (8), as drafted, is simpler and more effective. It allows for proper consultation and for the proper distribution of roles and responsibilities. All NHS bodies involved in discharge are under a duty to consult with the social services in deciding which services will be made available.

Amendments Nos. 62 and 63 concern joint working with the authority to agree the day of a patient's discharge. That leads us into slightly heavy weather. Obviously, we hope that agreement will be reached that discharge must take place on medical grounds—that is self-evident. The decision needs to be taken in consultation with the patient and carer; the decision needs to be taken, primarily, by the consultant, but with the support of the whole team. These amendments could have the effect of giving the local authority equal responsibility with the NHS. It would require them to agree the date of discharge.

It does not take much imagination to see that there could be a recipe here for disagreement and even deadlock. Confusion over accountability and responsibility is precisely what we are trying to avoid and

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precisely why we are trying to be clear about roles and responsibilities in the Bill. By allowing the social services to object to a discharge, we should be putting the patient at a great disadvantage. That is not something that we should want—I am sure that Members of the Committee agree. Again, I refer noble Lords to the extremely good practice identified in the hospital discharge workbook. We would want to see local authorities and hospitals following that to avoid the type of confusion and delay which I am afraid would follow from the amendment. Therefore, I hope that noble Lords will consider withdrawing the amendment.

Baroness Noakes: Returning to the question of the NHS consulting, and possibly agreeing, with the local authority in regard to services that should be provided by the NHS post-discharge, the Minister said that there would be a loophole for the social services to exploit if they unreasonably withhold their agreement. But can she explain how the social services will avoid exploitation by the NHS? What will happen in cases where the NHS decides that a patient is ready for discharge but the social services are of the strong view that a proper package of GP services, other community-based services, physiotherapy and so on are needed and do not consider that the services put forward by the NHS are sufficient?

There must be an element of agreement. It should not be a matter of the NHS saying, "We have consulted but we have decided". There must be a reciprocal element. How does the Minister see that fitting in with the Bill?

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