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Earl Howe: I rise to speak to Amendments Nos. 126 and 131, which are grouped with Amendment No. 125.

Amendment No. 126 inserts some fairly important words at the end of subsection (2) of Clause 12, the effect of which is to require via regulations that a patient is informed of two things: first, the costs of long-term care arrangements after his free period of services; and, secondly, the assessment that is made for continuing NHS care and community care services to be provided. The provisions of Clause 12 are in general welcome. They provide for various services to be provided free of charge to patients when they are

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discharged from hospital. However, the patient also needs to be aware of what awaits him at the end of that free period, especially when he has been in intermediate care and it is intended that he move to a long-term care setting which will not be free. Patients need to know what they are letting themselves in for. That is particularly the case where means testing involves payments by individuals for their long-term care. If we are not careful, patients will be placed on a conveyor belt which leads inexorably towards care they must pay for. Once on that conveyor belt, it may be difficult for the patient to get off. Patients need information which allows them to challenge what is being provided so they are not being just dragged along.

I do not think that this is in the least fanciful. An old person was transferred to a care home without it being clear who would pay. Then, when a considerable bill was run up, the patient's family was faced with a sizeable payment demand and was confronted with either paying up or having the old person removed from the home. That is an invidious situation for everyone concerned. I hope that the Minister will welcome the opportunity for patients to be given a say in their long-term arrangements.

Amendment No. 131 largely reflects the arguments put forward by the noble Baroness, Lady Barker. I believe that the Government should think again about the cut-off point of six weeks specified in the clause. As a rule, six weeks is ample time for intermediate care but there are cases, such as serious strokes, where it is not. There needs to be flexibility to ensure that such cases can be catered for. The Department of Health's current guidance singles out strokes as an example of where intermediate care might extend longer than the six-week norm but only on the basis that the patient is fully re-assessed and the extension is authorised by a senior clinician. That is the model I propose in my amendment.

Baroness Greengross: Will the Minister clarify a point which follows from Amendments Nos. 130 and 131? If someone is in intermediate care within an NHS hospital, would a Section 2 notice still be given to the social services department? Who would pay for that? I support very much what Members of the Committee have said with regard to people who have suffered strokes for whom rehabilitation is absolutely crucial. One cannot always guarantee that that rehabilitation will not be necessary after six weeks. However, it makes a huge difference to people's rate of recovery.

7.45 p.m.

Baroness Andrews: I reassure the noble Baroness that there is absolutely no intention to make a mockery of the principle of including lists in the Bill. I am sure that the small items of equipment make all the difference. Would that everything that the NHS provided was as effective as certain small, cheap items such as bath rails, zimmer frames and so on. We are sympathetic to the intentions behind Amendments Nos. 127, 145 and 125 and, indeed, the amendments concerning community care services.

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However, whenever one tries to include a list in legislation, one always runs the risk of accidentally excluding something or accidentally restricting provision or including things inappropriately. The provision in Amendment No. 127 is based on the list in the Department of Health's community equipment guidance and it follows that list closely. However, that leaves out communication aids while including other things. I refer to walking sticks, bath mats and so on. All those pieces of equipment are of equal importance to the person for whom they are intended but the amendment would have the effect of excluding the former but including the latter. We have to be extremely careful that we do not accidentally exclude, reduce or limit the services which are provided free of charge. It is wise not to run that risk.

Amendment No. 125 refers to the department's list of community equipment services. Amendment No. 127 was based on the list; Amendment No. 125 actually refers to the list. If we accepted those amendments, we would have two slightly different lists defining community equipment services. Amendment No. 125 would exclude from free provision such items as vibrating clocks and canes. We do not include such detail on the face of the Bill or in the regulations as the purpose of the clause is not to restrict what can be given or to interfere in local authorities' decisions about the best choice of equipment. It is much better to let social services and users decide.

During the drafting of the Bill we consulted with the department's user group on community equipment services which was keen not to have a list of eligible equipment. So our approach is pragmatic. It reflects what people on the ground want. It does not dictate to local authority social services departments.

I turn to Amendments Nos. 128 and 146, where a similar problem occurs. The list in regard to intermediate care in Amendment No. 146—I am sure that this is accidental—leaves out some important aspects of intermediate care. There is no mention of rapid response teams or hospital at home schemes—two important schemes which provide immediate support to people in their own homes. We are not content to accept the amendments. However, we shall reconsider the guidance in the light of what has been said. We need to make clear what services are available and that certain equipment is free.

I shall try to answer some of the questions that have been asked. I refer to the 1,000 limit to what can be provided without the community equipment being described in terms of a disabled facilities grant. Equipment costing more than 1,000 is likely to be used in a small number of complex cases which require the installation of, for example, overhead hoists, concrete ramps, special beds and so on. Community equipment costing less than that sum tends to comprise the vast majority of items which can range from a bath board costing 15 to an alarm system costing 700. The majority of items cost less than 1,000. I understand that the average cost of items is about 70. I do not know whether the 1,000 figure includes the cost of installation. I shall have to find out about that and then inform the noble Baroness.

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The noble Baroness also asked about the limit on intermediate care. I address that point in relation to Amendments Nos. 130 and 131. Amendment No. 130 opens the prospect of another lively debate on free personal care.

The effect of Amendment No. 131 would be to make residential accommodation free of charge only for as long as local criteria stipulate that services may be provided free of charge. That raises the question of the six-week period. The six-week period makes good sense. We have good evidence from the district audit review that average lengths of stay for intermediate care services are less than six weeks. District audit in 2000–01 reviewed 213 current intermediate care services and developed a methodology. The survey showed that the average length of stay was between 12 and 26 days, well under six weeks. Even where the primary purpose was social care, the average length of stay was 29 days. That is quite a generous period. For residential intermediate care, the average was 31 days. We therefore have solid evidence that social care is typically provided for less than six weeks.

In relation to the questions raised about discretion, I want to say that the six weeks is a firm guide. However, if someone needed six and a half weeks' care, for example, we would expect social services to use their common sense and ensure that the people in need were put centre stage in terms of the decision. For example, in Ealing there is very good practice, as I am sure that there is in other places. Up to six weeks' home care there is made free as part of a scheme to maintain adults at home safely. Arrangements are made for any further needs to be picked up by the mainstream services. The pathway is very clear. There is better flexibility, and local authorities have to plan properly for onward care. If accommodation is needed, social services have the opportunity to help people out for up to eight weeks without means testing in local authority accommodation.

The noble Baroness, Lady Greengross, asked about the Section 2 notice and whether it would apply to intermediate care. It does not, as it is specifically excluded. Intermediate care is free for six weeks and we do not intend to interfere with that.

I move on to Amendment No. 126, which was spoken to by the noble Earl, Lord Howe. We are unhappy about it in two respects. I appreciate the emphasis on proper assessment at the appropriate stages. Good practice should already ensure that a care plan is drawn up for intermediate care, based on an appropriate assessment before the person leaves hospital. Obviously, it should include anticipated outcomes, a clear idea of what happens after intermediate care once the period of rehabilitation is over, and a review at the mid-point to check progress and make adjustments if necessary. We made that point in the intermediate care guidance last year, so it should be extremely clear to people who need to know it.

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The guidance issued on single assessment and fair access to care also emphasised the importance of reviews. The definition of intermediate care in the guidance refers to provision,

    "on the basis of comprehensive assessment",

and "cross professional working". Our concern is that if we add another mandatory assessment process, we will have a confusion of assessments. We already have in place the single assessment process. The local authorities already have a specific duty under Section 47 of the National Health Service and Community Care Act to assess a person's needs for community care. As we discussed yesterday on various amendments, if social services want they can refer to housing services and ask for their involvement in the assessment process. Simplicity and proportionality is important in getting the assessment process right and to avoid duplicating each other's assessments. We are backing everything up with a new target for assessments of a 48-hour commencement and four-week completion.

On the question of costs, I simply say what I said yesterday. One of the fundamental duties that stems from the fact that social services are public bodies that exercise public functions means that they must give all proper information to a person so that he can make an informed decision about whether he will accept services. That includes information about the cost of any care. If that does not happen, they are definitely failing in their duties as a public body. I hope that that will be helpful.

Intermediate care seems to work very successfully. I shall again give the figure that between 65 per cent and 90 per cent of people return home to independent living after intermediate care. It is at that point that the aids and adaptations are so critical to that successful return.

I shall speak to a series of small consequential amendments on behalf of the Government. Government Amendments Nos. 133, 135 and 137 simply tidy up the drafting of the clause to reflect the heading of Clause 12, following amendments to the clause during its passage through another place. The amendments make it clear that services to carers will be made free as well to all other people as a result of Clause 12. The change to the heading of the clause reflects the inclusion of services for carers in the clause, and we need to reflect that change in the consequential amendments. I hope that the Committee will support us in attempting to tidy up the Bill.

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