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Lord Hunt of Kings Heath: My Lords, on the Chief Executive's Bulletin, I think that the point is when the new legislation will kick in. A couple of weeks ago, in Committee, noble Lords took a decision. Although I disagreed with it, I think that I intimated then that the Government had reached the view that they would be prepared to delay the Bill's introduction by six months. The Bill will go back to another place, and another place will have to decide what it seeks to do. It may well be that we will discuss this matter further on yet another Monday. I suspect that the Chief Executive's Bulletin merely reflects the points that I made about our intent with regard to introducing the Bill at the beginning of October. As ever, however, Parliament's will will be paramount and supreme.

I cannot say any more in anticipation of legislation on foundation trusts that might be coming our way. All I can say to the noble Baroness, Lady Barker, is that I very much look forward to debating that issue with her when the time comes.

Baroness Noakes: My Lords, I thank the Minister for his reply—which was perhaps not a great surprise. May I suggest that he read the Chief Executive's Bulletin, which starts off by saying in effect that the House of Lords has decided that there will be a one-year delay, "but we, the NHS, are going to plan for implementation in October"? It sends a clear signal either that the chief executive is acting on his own authority or that Health Ministers are going to ignore your Lordships' House. I also say to the Minister that I had not forgotten the £100 million—I very rarely forget about money—I just do not think that £100 million is at all relevant to the subject that I was discussing: the incentive on the NHS.

We feel that this is a one-sided Bill because it imposes only penalties on local authorities while providing the NHS only with incentives to do the wrong thing—to act simply in a way that maximises its revenue flow. That is why we are concerned that these crude penalty and incentive arrangements will operate harmfully for patients. The Minister has fallen back on an argument to which he has often resorted in discussing many aspects of performance management, but I do not think that we are impressed by the argument that this is another matter that will end up in the star ratings. Waiting lists ended up in the star ratings. Those of us who read the Audit Commission's latest report know what happens to targets that end up in star ratings—they get fiddled. So we cannot see that as a credible solution.

While I have the greatest respect for CHI's ability to monitor what goes on in the NHS, it is not operating in real time; it comes along every so often to examine a whole range of matters. In this amendment we are asking for a very targeted and very specific provision for incentives to counterbalance the impact of the Bill's structure. We have not got that from the Minister

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today. I shall take it away and think about it again. However, I think that the Minister can expect to return to the subject on Third Reading. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 47 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 48:

After Clause 4, insert the following new clause—

"DELAYED DISCHARGE PAYMENTS: SUPPLEMENTARY
(1) In prescribing an amount under section 4(4) the appropriate Minister must have regard (among other things) to either or both of the following matters—
(a) costs to NHS bodies of providing accommodation and personal care to patients who are ready to be discharged; and
(b) costs to social services authorities of providing community care services to, and services to carers in relation to, persons who have been discharged.
(2) Any payment which the responsible authority is required to make under section 4 in relation to a qualifying hospital patient shall, subject to subsection (2), be made to the responsible NHS body.
(3) In case of any description prescribed in regulations the payment shall be made to the person prescribed in relation to cases of that description."

On Question, amendment agreed to.

Lord Clement-Jones moved Amendment No. 49:

After Clause 4, insert the following new clause—

"PILOT SCHEMES
The Secretary of State or the Assembly may by order establish pilot schemes for the operation of this Part in selected areas."

The noble Lord said: My Lords, in moving Amendment No. 49, I wish to speak to the amendments with which it is grouped.

We have already had an interesting ministerial apologia with regard to the content of the Chief Executive's Bulletin and the planning of the NHS in relation to the official date of implementation of the Bill in October 2003, despite the amendment passed in this House. We on these Benches—I am sure that I speak for noble Lords on other Benches in this respect—are determined to see the implementation of the Bill delayed until 2004. I have no doubt that we shall spend many happy hours debating that matter in the future if the Bill returns to this House in a different form. The 2004 implementation date would allow local authorities to assess the impact of the changes on the rights and choices of older people and the services they receive. Delaying the implementation of the fines would allow for joint working between health and social care providers to develop further and could prompt the Government to see the introduction of fines as unnecessary. That is an optimistic hope but also, I hope, a realistic one.

The recent health ombudsman's report adds impetus to the call to delay implementation of the fines. It is likely to take some time for the recommendations of the ombudsman to be put into

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place. If there is to be a review of the guidance from the Department of Health, as suggested by the ombudsman, it is only right that it should be fully consulted on following Cabinet Office guidelines that 12 weeks should be given for such consultation. That should be the absolute minimum period. The strategic health authorities would then need to review their criteria to ensure that they were in line with any new guidance produced by the Department of Health. Staff would need to be trained to ensure that they were aware of the guidance and its effect on their decision-making. Until then, there is a danger that flawed criteria could be in use.

In Committee, I went into some detail about the fact that the system introduced by the Government in the Bill for fining for delayed discharge is untested and untried and has been used only in Sweden in very different circumstances. In Committee, the Minister justified resisting the introduction of pilot schemes by saying:

"The first point is that already the NHS and social care services have existing responsibilities to discharge patients in a safe and responsible way. We are not introducing new responsibilities in that sense".—[Official Report, 18/2/03; col. 1065.]

His second reason—also stated at col. 1065 of Hansard—was that,

"the best performing authorities . . . are already working well together to reduce delayed discharges".

The noble Baroness, Lady Noakes, pricked the bubble of the Barnsley experience. The Minister referred to the experience of both Barnsley and Bristol to justify not introducing pilot schemes. The Minister may regret choosing those examples. Perhaps we should further investigate Bristol's emergency readmission track record.

Is the argument that the best authorities are working so well in partnership that we do not need pilots? Does that mean that the Government can set up—as they seem to be doing under the Bill—a completely unworkable scheme or, indeed, a dangerous scheme without regard to the consequences, and that therefore no pilot scheme is needed? The Minister's logic appears somewhat convoluted; namely, that the implementation of the Bill's provisions is theoretical as they will not bite on the best authorities and that therefore no pilot scheme is needed. Surely one should have a pilot scheme not in the best local authorities but in less-well-performing local authorities, where the provision of a pilot might well bite. One would then see the practicality of the Bill. I suggest that as soon as the Bill's practicality and impact on partnership working are assessed, it will be quickly seen as a wholly unworkable and undesirable piece of legislation. I beg to move.

Baroness Andrews: My Lords, I have just been assured that the best arguments are the old ones. There will be an echo of some such arguments in my response.

We have serious reasons for believing that pilots are not the appropriate step at this stage. Our main objection is that many local authorities have responded to the challenge that has been laid down

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and are already creating and following good practice. A pilot project has traditionally tended to involve the small-scale, radical investigation of new ways of working that have not been put into practice. Health and social care partners already have responsibilities to discharge patients in a safe and responsible manner. The reform is simply about ensuring that they do so more effectively and more rapidly. We want health and social care partners to consider how they can invest in and provide better services and to do so now in preparation. I go so far as to say that we need the opposite of a pilot scheme; we need to universalise best practice. There are many developments in the field.

I shall risk giving another example. The noble Lord would be interested in the example of Kirklees, where a discharge service has been established to support vulnerable adults who have been identified as needing rehabilitation back into their home. That team was established using skilled in-house managers who manage focused-care programmes. The care providers are a combination of in-house staff and carers who are contracted from agencies. It is an interesting and effective example.

The Department of Health is committed to making the arrangement work—there is a practical implementation team that is being led by an ex-director of social services and assisted by practitioners seconded from the field to develop the programme. That practical support is extremely important in terms of getting it right, establishing a way in which reimbursement will work and providing a link between the department and the field. We are making as much good practice available as widely as possible. For example, last week we put model documentation on to the website, which is already active and very popular. We are trying to assist local authorities by providing as much information as possible. We are promoting best practice. People in the field say that they have never seen such an emphasis on getting it right. Attention has been concentrated on this matter. To go back to piloting the proposal would send all the wrong signals. We have been overtaken by events in terms of implementation and good practice. The implementation team is working—

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