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Baroness Howarth of Breckland: I support the noble Earl, Lord Howe. I shall not repeat the arguments that he put so clearly about the need for clear assessment, consultation and elements of choice for people who are being discharged—some of whom will not be elderly, but may well be disabled—into alternative resources.

I want to reinforce the noble Earl's point about the need not to change the working patterns in social services. I believe that that would be hugely costly. As someone who has run out-of-hours services in local authorities and who knows the difficulties of staffing such services—which it is fair to say are at a crisis point—this would simply take away resources, again, from other services. Therefore, it is crucial that we should have at least one more day and that we do not deny the fact that social services work to a different pattern.

I am rather irritated by people who say that social services should be prepared to work at these times, when, of course, they do. The point is that their shift patterns are not based on the same kind of hour levels as those of nurses in hospitals. That is a crucial consideration.

I apologise for not being present for the debate yesterday. I was at the National Care Standards Commission, worrying about how we ensure that we have enough information to be able to make these decisions more easily in terms of the number of facilities available and the way in which standards will be implemented. That information will make the

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working of the Bill easier; but, however much information we have, we should not be shortening the time available for assessment. That point is crucial.

Lord Turnberg: I need to tip-toe carefully through this group of amendments. I have a great deal of sympathy with Amendment No. 75, but somewhat less for some of the others.

While there is no doubt that acute medical services have to be available seven days a week, 52 weeks of the year, where needs are not so acute it is more difficult to sustain an argument for a seven-day week service. It is not too revolutionary to suggest that everyone has to have some time off work. The only way in which every day of the week can be covered is to have a rota system; and for that, one needs enough staff. I believe that it would be difficult, if not impossible, for many social service departments to have the numbers needed to man such a rota and remain within the European Working Time Directive limits on the number of hours that anyone will be allowed to work. But even leaving social services staff aside, those commercial organisations that supply and fix the aids to daily living that are needed at home will not always be available or willing to work at weekends or on bank holidays. So I have some sympathy with Amendment No. 75.

However, if there is good co-operation between social services and hospital staff at a much earlier time, as everyone is seeking, the problem of a last ditch three-day sudden spurt of frantic activity will be unnecessary, because social services departments will be prepared over a longer time-frame and the resources could be put in place without the need to organise anything other than modest weekend and bank holiday cover.

That brings us back to the need for early joint working to permeate the whole ethos. But, meanwhile, I hope that my noble friend the Minister will be prepared to consider how weekend and bank holiday pressures on social services staff can be eased.

Lord Hunt of Kings Heath: This has been an interesting debate. I want to get the balance right between what is practical as regards the health service and social services and what is absolutely desirable and necessary in the case of patients stuck inappropriately in acute hospital beds.

I agree with the noble Earl, Lord Howe, that the rules need to work smoothly and equitably. I have taken note of his comment on the drafting of paragraph 11. I believe, however, that, as Members of the Committee wished to see the draft regulations, they have been helpful in informing our debates. These are draft regulations. The debates that we are having are extremely helpful in terms of informing the Government as to how we should take the regulations further forward. Issues raised by Members of the Committee in the search for clarity have indicated that we need to examine the drafting to make sure that the regulations are clearly understood by those who will have to operate them in the field.

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The noble Earl raised a point about consultation. We discussed this issue extensively yesterday. I believe that my noble friend Lady Andrews gave an undertaking that we would look very carefully at this issue—as indeed we shall. I take issue with the noble Earl for using the pejorative phrase, "any old care home will do". Let me make it clear that in a complex case, when it would not be expected that the assessment of care package could be produced in the minimum three days, we think it would be better to transfer that person to more appropriate care—that is what interim care is about. For many people, that would be far more appropriate than having to stay in an acute hospital bed. For a person so transferred, we would expect—and, indeed, insist—that the care planning arrangements continue. We are developing new targets for the time of assessments and provision of services in those cases and the cases of all other members of the public who wish to receive community care services.

On the minimum of three days, I understand that it is not easy, on first reading, to get to grips with what is contained in the legislation and the regulations. But I stress that three days is the absolute minimum. Many of the people we are discussing will be coming into the health service for elective surgery. Under Clause 2(3)(b), notice can be given up to eight days before the expected admission of that person. Equally, assuming that a patient was in an NHS bed on a Monday, if notice was given after 2 p.m., it would be deemed as having been given on the following day. From Tuesday, two days take us to Thursday. If the services were available up to 11 a.m. on the Friday, there would be no penalty charge.

Three days is the absolute minimum. Some 70 per cent of over-75s in the NHS expect to stay in hospital for longer than three days—in fact, their average stay in hospital is 11 days.

I would be concerned if, under the Bill, it was acceptable for local authorities to take a minimum of five days to assess patients and make services available for them. For all the reasons I have given about inappropriate delays, I would be concerned about putting that provision on the face of the Bill. The point is that the minimum compliance period in the Bill is a minimum. We have taken powers to make regulations that allow us to specify the minimum period, and although the draft regulations give the minimum period of two days I shall consider what has been said and whether there is a case for changing the period in the regulations, perhaps to cover some of the points made about weekends and bank holidays. That is not a commitment. I am committing myself to consider the matter further.

I understand the question raised by my noble friend Lord Turnberg and the noble Baroness, Lady Howarth, about the different shift patterns in the health service and local government. Clearly that will be a factor for local authorities in particular. It was, incidentally, referred to by the noble Lord, Lord Laming, in the Climbie report. He raised some important questions about how local authorities

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should respond to out-of-hours situations. That is another matter that local authorities will have to take on board.

On the amendment in the name of the noble Baroness, Lady Barker, I accept that good practice in many areas is that patients should not permanently enter a care home for the first time direct from an acute hospital bed. To enter a care home for the rest of one's life is a major decision. I suggest that an acute hospital ward is not the best place to maximise a person's independence or to make that decision. That is why I believe that intermediate care, rehabilitation and other such schemes give patients the time either to maximise their independence and perhaps return home or to consider the option of a care home place. Going home or to other support in the community is not a possibility when a person has been in hospital in excess of five days and has, in many cases, lost his or her independence.

The Bill is not the place in which to make the kind of exceptions about which Members of the Commitee have talked. I think that it is right to aim for a minimum period of two days. But I have undertaken to look at the draft regulations in the light of our discussions. I will not commit myself on this, but I shall look at the matter most carefully.

4.45 p.m.

Baroness Barker: I thank the Minister for his response and wish to make two points. I was envisaging people who were not in acute care for the first time. It may be a repeat episode, both they and their relatives having decided that the person concerned could not return to living independently and that the best thing for them would be to enter a care home. We are in danger of looking too narrowly at the reasons for being in hospital and the options that people may wish to follow.

I take to heart the Minister's agreement to look at weekends, and so on. In a Question last week, I mentioned some research and commend it again to the Minister and his department. The Minister said that the department was conducting research but some has already been carried out in Leicester. It was reported in the journal Nursing Older People in March 2002. There has already been an analysis of discharge and readmissions in teaching hospitals in Leicester over a three-year period. I recommend the Minister and his department to examine that very revealing research as they come to a decision.

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