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Resolved in the affirmative, and amendment agreed to accordingly.
The noble Lord said: My Lords, in moving Amendment No. 2, I shall speak also to Amendment No. 14. They are probing amendments, based on what the Minister said in Committee, not just about the position of independent hospitals in the UK in which NHS patients are being treated but also with regard to the fact that foreign hospitals under contract with the NHS could be entitled to charge social services departments for delayed discharge. I think that it was the noble Lord, Lord LucasI am sorry that he is not in his place todaywho managed, in his inimitable way, to elicit that interesting fact from the Minister.
The situation arises because, as long as they are ordinarily resident in England or Wales, qualifying persons will place such a duty on whatever acute hospital they are in, as long as the care has been commissioned by the National Health Service. The logic of the Bill is that Clause 3, which places a duty on local authorities to pay the NHS, will apply. That is very much the logic of what the Minister said in Committee:
The implications of that ministerial statement are, as, I am sure, the Minister realised at the time, fairly large. It would involve additional administration and costs. It would mean incorporating an independent hospital abroad into legislation for England and Wales to enable ita foreign hospital, as we should not forgetto charge an English or Welsh local authority. How will that affect the commissioning of hospitals? How will it affect the administration of the Act? What guidance will be given to social services on how to deal with a notice from Baden-Wurttemberg or wherever an NHS patient is being treated? They may find that a patient whom they had not considered for surgery has had some kind of surgery that has gone wrong or involves community care. The Minister has not foreseen such a situation, and I look forward to hearing what he has to say. It is a matter of some concern to those of us on these Benches, and the Minister should explain in some detail how the system will work.
Lord Hunt of Kings Heath: My Lords, this question caused great excitement in our debates in Committee. Although the interjection made by the noble Lord, Lord Lucas, was helpful, the noble Baroness, Lady Barker, also took part in the debate on this important issue. I shall deal first with hospices, before turning to independent hospitals and the position of NHS-funded treatment overseas.
As regards hospices, I shall be meeting the noble Baroness, Lady Finlay, to discuss the issue she raised in Committee. I am sure that that will inform any debate at Third Reading. Essentially, Amendment No. 2 repeats the point made in Clause 1(1). The qualifying patient may be accommodated in,
I turn now to patients who receive NHS-funded treatment in hospitals overseas. This issue needs to be put into perspective. A small number of patientsapproximately 200have been treated either in France or Germany as part of efforts to reduce the length of time that they may have to wait for treatment in the United Kingdom. We do not expect a dramatic expansion in numbers of people receiving treatment overseas due to limits on capacity in European hospitals to treat extra patients. However, we accept that some overseas treatment can be effectivewhen the patient agrees and the treatment offers value for moneyin reducing the length of time that a patient waits for elective treatment.
Currently, patients treated abroad fall within the scope of the Bill, similar to NHS patients being treated by private providers. The reason is that the definition used of a "qualifying hospital patient" in Clause 1 includes people being treated at an independent hospital as defined in the Care Standards Act 2000. As noble Lords know, the Act does not specify that independent hospitals must be located in the UK.
I want to reassure noble Lords on how this might work. Patients selected for overseas treatment are carefully screened to check that there are no reasons, such as social care or housing needs, which would complicate their discharge. Furthermore, patients receive extra rehabilitation, which can be extended if required, as part of the in-patient stay. The overseas hospitals are all clear that patients should not be discharged until they are able to carry out daily life
As a point of good practice, the lead commissioners of Kent and Medway already advise local hospitals to alert social services that patients are going abroad under the scheme and inform them of their expected return date. Therefore, social services are involved from the beginning. The commissioners take NHS trusts through the possible situations that may arise so that they are prepared in advance.
On the basis of the operation of the scheme so far, the best information is that it is highly unlikely that a patient treated overseas will require an assessment of community care services before he returns home. The care taken should ensure that patients are more fully recovered before returning home. However, should the scenario arise, it would not be fair to separate this group of NHS acute patients from others. Each trust or PCT which is sending patients abroad retains the responsibility for co-ordinating patient discharge requirements, just as though the patient had been treated in the UK.
Turning to the issue of practicalities raised by the noble Lord, of course I recognise that it would be more complicated for social services to carry out an assessment overseas if that really were required. Therefore, the Government will obviously be considering whether to allow a longer minimum period for overseas assessment. That can be done through regulations under Clause 4. Clause 8 allows that regulations make different provision for different cases and circumstances.
I emphasise that the Bill does not mean that reimbursement charges will be paid to overseas hospitals. Any payment for delays caused by social services will go to the NHS trust or the primary care trust which had commissioned the treatment in the first instance.
In conclusion, I confirm what I said in Committee about the provisions of the Bill extending to patients treated overseas. Based on the experience of the 200 patients, the problems suggested by the noble Lord seem unlikely. The Bill as drafted extends to patients treated overseas because of the construction made in Clause 1.
Lord Clement-Jones: My Lords, I do not know whether to be reassured or surprised by the Minister's reply. He has erected a rickety structure around the proposition that patients treated abroad are brought within the ambit of the Bill. In a sense, that exemplifies the ramshackle nature of the Bill.
A whole series of exceptions is building up in order to make the Bill work. That exemplifies a key issue expressed by Members on the Opposition Benches. Every time the Minister replies, even to an innocuous probing amendment such as this, contradictions in the Bill emerge. But the Minister relies on the fact that it is highly unlikely that these patients will not be fully recoveredand there will be another exception. Under the regulations, instead of ensuring that care is available after three days, a longer period of time may be specified. There will be another set of provisions which relate solely to those patients treated in hospitals abroad.
I have elicited enough information from the Minister, but it does not reassure me. It may give rise to a series of future amendments at another stage. In the mean time, with some perplexity, I beg leave to withdraw the amendment.