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Baroness Noakes: I thank all Members who took part in this short debate, including those who supported the amendments. In particular, I thank the noble Baroness, Lady Finlay, for her contribution on evidence-based approaches. The Bill is not evidence-based; it is assertion-based. We need more evidence. Amendments Nos. 67 and 68 concern evidence after the enactment of the Bill regarding its impact on patients and carers.

The right reverend Prelate spoke about patients being treated as commodities in this Bill. I say to the Minister that that is what most people believe. He and his colleagues are in denial about that and the impact that the Bill will have on people. They see it much more in terms of systems and processes, not of people, who are at the heart of the Bill.

The Minister gave an assurance that monitoring would take place under various mechanisms that already exist. But we are being asked again to accept that something is implicit in the system, rather than have an explicit commitment from the Government. We need to be clear about the impact on patients—not on processes; not on statistics; and not on the many aspects that could be covered by the inspection bodies. That is why Amendment No. 67 was drafted to ensure that the Secretary of State specifies to the inspection bodies that they should monitor the impact of the legislation on patients and carers. It is also why Amendment No. 68 would provide that the Secretary of State shall report to Parliament on the outcomes for patients.

We are always asked to accept things on trust. We are told that provision will happen; that there are existing mechanisms, and so on. I do not think that we should. The impact of the Bill on patients is just too important. I wish to test the view of the Committee.

3.48 p.m.

On Question, Whether the said amendment (No. 67) shall be agreed to?

Their Lordships divided: Contents, 110; Not-Contents, 109.

Division No. 1


Aberdare, L.
Ackner, L.
Addington, L.
Alderdice, L.
Allenby of Megiddo, V.
Alton of Liverpool, L.
Anelay of St Johns, B.
Avebury, L.
Barker, B.
Blatch, B.
Bradshaw, L.
Brightman, L.
Brooke of Sutton Mandeville, L.
Brougham and Vaux, L.
Burnham, L.
Buscombe, B.
Caithness, E.
Campbell of Alloway, L.
Carnegy of Lour, B.
Chelmsford, Bp.
Clement-Jones, L. [Teller]
Colwyn, L.
Cope of Berkeley, L. [Teller]
Cox, B.
Craig of Radley, L.
Craigavon, V.
Cumberlege, B.
Dean of Harptree, L.
Denham, L.
Elis-Thomas, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Falkland, V.
Finlay of Llandaff, B.
Freeman, L.
Gardner of Parkes, B.
Geddes, L.
Glentoran, L.
Goodhart, L.
Goschen, V.
Gray of Contin, L.
Greaves, L.
Greengross, B.
Hanham, B.
Harris of Richmond, B.
Hayhoe, L.
Higgins, L.
Holme of Cheltenham, L.
Hooson, L.
Howe, E.
Howe of Aberavon, L.
Howe of Idlicote, B.
Howell of Guildford, L.
Hussey of North Bradley, L.
Jenkin of Roding, L.
Knight of Collingtree, B.
Luke, L.
McColl of Dulwich, L.
MacGregor of Pulham Market, L.
Mackie of Benshie, L.
Maddock, B.
Mar and Kellie, E.
Marlesford, L.
Methuen, L.
Miller of Chilthorne Domer, B.
Miller of Hendon, B.
Molyneaux of Killead, L.
Mowbray and Stourton, L.
Moynihan, L.
Murton of Lindisfarne, L.
Noakes, B.
Palmer, L.
Perry of Southwark, B.
Perry of Walton, L.
Peyton of Yeovil, L.
Phillips of Sudbury, L.
Plummer of St. Marylebone, L.
Razzall, L.
Redesdale, L.
Renfrew of Kaimsthorn, L.
Rennard, L.
Roberts of Conwy, L.
Rodgers of Quarry Bank, L.
Rogan, L.
Roper, L.
Russell, E.
Saltoun of Abernethy, Ly.
Sandberg, L.
Seccombe, B.
Selsdon, L.
Shaw of Northstead, L.
Shutt of Greetland, L.
Smith of Clifton, L.
Stevens of Ludgate, L.
Strange, B.
Swinfen, L.
Tenby, V.
Thomas of Gresford, L.
Thomas of Walliswood, B.
Tordoff, L.
Vinson, L.
Vivian, L.
Waddington, L.
Wakeham, L.
Wallace of Saltaire, L.
Walmsley, B.
Walpole, L.
Warnock, B.
Williams of Crosby, B.


Ahmed, L.
Andrews, B.
Archer of Sandwell, L.
Ashley of Stoke, L.
Bach, L.
Barnett, L.
Bassam of Brighton, L.
Bernstein of Craigweil, L.
Blackstone, B.
Borrie, L.
Boston of Faversham, L.
Bragg, L.
Brooke of Alverthorpe, L.
Brookman, L.
Bruce of Donington, L.
Burlison, L.
Campbell-Savours, L.
Carter, L.
Christopher, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Corbett of Castle Vale, L.
Crawley, B.
David, B.
Davies of Coity, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Dixon, L.
Donoughue, L.
Dormand of Easington, L.
Elder, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Farrington of Ribbleton, B.
Fyfe of Fairfield, L.
Gale, B.
Gavron, L.
Gladwin of Clee, L.
Golding, B.
Goldsmith, L.
Gould of Potternewton, B.
Graham of Edmonton, L.
Gregson, L.
Grocott, L. [Teller]
Hardy of Wath, L.
Harrison, L.
Haskel, L.
Hayman, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howarth of Breckland, B.
Howells of St. Davids, B.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. (Lord Chancellor)
Jay of Paddington, B.
Jones, L.
Kirkhill, L.
Lea of Crondall, L.
Lipsey, L.
Listowel, E.
Lockwood, B.
Lofthouse of Pontefract, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
Marsh, L.
Mason of Barnsley, L.
Massey of Darwen, B.
Merlyn-Rees, L.
Milner of Leeds, L.
Mitchell, L.
Morris of Aberavon, L.
Nicol, B.
Parekh, L.
Pendry, L.
Peston, L.
Pitkeathley, B.
Plant of Highfield, L.
Prys-Davies, L.
Puttnam, L.
Ramsay of Cartvale, B.
Rea, L.
Richard, L.
Sainsbury of Turville, L.
Scotland of Asthal, B.
Sheldon, L.
Simon, V.
Slim, V.
Smith of Gilmorehill, B.
Smith of Leigh, L.
Stallard, L.
Strabolgi, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Temple-Morris, L.
Thornton, B.
Tomlinson, L.
Turnberg, L.
Varley, L.
Whitaker, B.
Whitty, L.
Williams of Elvel, L.
Williams of Mostyn, L. (Lord Privy Seal)
Winston, L.
Woolmer of Leeds, L.

Resolved in the affirmative, and amendment agreed to accordingly.

18 Feb 2003 : Column 1035

3.58 p.m.

Earl Howe moved Amendment No. 68:

    Page 3, line 45, at end insert—

"( ) The Secretary of State shall report on an annual basis to Parliament on the outcomes of patients affected by this Act."

On Question, amendment agreed to.

[Amendments Nos. 69 and 70 not moved.]

Clause 3, as amended, agreed to.

Baroness Barker moved Amendment No. 71:

    After Clause 3, insert the following new clause—

(1) The responsible NHS body and responsible authority are required to agree the following as regards the discharge of qualifying hospital patients defined in section 1 of this Act—
(a) action plans to prevent and reduce delayed discharges;
(b) joint local protocols on the administrative and practical arrangements for the implementation of the legislation defining the roles and responsibilities of all parties;
(c) local targets for reducing delayed discharges;
(d) joint administrative arrangements for the local implementation of the duties in sections 2 to 5.
(2) An action plan under this section is a document drawn up by the relevant bodies specifying action intended to reduce delayed discharges, and to change procedures and arrangements which may cause or contribute to the failure to comply with duties under section 3.
(3) Joint local protocols will include named persons responsible for co-ordinating all stages of the patient journey up to and beyond discharge, and ensuring that all necessary arrangements are put in place at the right time.
(4) Local protocols will include joint agreement on how payments made under section 4 are used to encourage a whole systems approach to services for older people, and to ensure that all stakeholders are involved in deciding how the payments are spent."

18 Feb 2003 : Column 1036

The noble Baroness said: After that overwhelming triumph, it is nice to move on to another area. One of the more depressing aspects of our debate yesterday was the Minister's dismissal of several of our proposals relating to joint working as being the sort of things that social services authorities would do to continue in their backsliding ways. That puts a wholly different complexion on the motivation behind many of the amendments from the one I would choose.

I suspect that this amendment may suffer the same fate at the Minister's hands and that would be unwarranted. Whereas the Government are taking a heavy-handed, hammer approach to joint working, I believe that the amendment embodies a positive approach to joint working.

The consultation paper states that,

    "local protocols should be developed to make sure that notifications are timely and appropriate";

and that,

    "NHS and social services must have clear joint protocols about drawing up the care plans within this time scale";

and that,

    "local protocols should be developed to make sure that notifications are timely and appropriate".

Joint local protocols are extremely important not only for the well-being and satisfaction of the people who will be called on to operate them, but for the end users of those services. The amendment seeks to make that joint working a duty. In making people work together, its approach is exactly the opposite of the Government's. It includes a requirement for there to be a joint agreement on how money raised in fines under the legislation can be used to reduce delayed discharges in future and encourage a whole-systems approach for services for older people. It ensures that all stakeholders are involved in deciding how money generated from delayed discharge is spent. I do not want to pre-empt a discussion which we shall have on a later amendment, but such an agreement is important if we are to tackle the causes of delayed discharge.

Joint local protocols could also cover the administrative and practical implementations for the legislation to ensure that all parties are clear about their respective roles and responsibilities. The whole system should be incentivised by implementing joint targets and protocols to tackle delayed discharges between the NHS trusts, PCTs and local councils.

Throughout the Bill we have referred to the inevitable changes to health and social care which will arise as a result of the reflections on the Climbie inquiry. Last week, many Members of the Committee discussed this same issue, but in relation to another client group; that is, children. How do we encourage different bodies which will continue to have different roles and functions to work together to agreed principles and to put their resources and energies behind them?

I believe that the amendment does that. It enables bodies which will continue to have different functions to maintain them, but appropriately to come together and to provide services. We talked yesterday about the

18 Feb 2003 : Column 1037

existing legal basis for joint working. It exists in law but not in practice. The amendment seeks to tackle that, and does so in a detailed way. Ultimately, a fine is a fine and while it may concentrate the mind it does not give any of the practitioners the means of bringing about what we all want: that is, better outcomes for older people.

I believe that the amendment has much to commend it, not least because it examines the issue of joint administrative practices. There is often no lack of will on the part of a social services department or a hospital to ensure that older people receive the best treatment, but often poor administrative systems are in place. Such systems get in the way of good discharge. I beg to move.

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