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Baroness Finlay of Llandaff: I do not want to repeat all the arguments that have been made, as they have been most eloquent. I take a slightly different line with regard to these amendments, and the enormous changes that have been made to the Bill since it was first introduced to us.
I congratulate the Minister, but I also send congratulations to the noble Lord, Lord Hunt of Kings Heath, who is not in the Chamber today. He worked ceaselessly and tirelessly on the Bill, and the compromises that he could afford and that he negotiated have been carried on so well by the noble Baroness, Lady Andrews, who has taken over his role.
I also congratulate both Opposition Front-Benchers, who have helped to ensure that the Bill is workable. I believe that, as originally drafted, the Bill
was completely unworkable. I have been involved in shadowing health authorities, a process which can work very well. Although I appreciate the widespread reservations which will remain until the Bill has been proven to work, I acknowledge those noble Lords for a job well done.4.30 p.m.
Baroness Andrews: My Lords, I thank all noble Lords for their generous response. I do so particularly on behalf of my noble friend Lord Hunt, who put tremendous effort into the Bill. He is very happy that we have been able to achieve a workable outcome. Noble Lords in the Chamber have taken the Bill apart and to heart in different ways and I am grateful to them.
I shall try to answer some of the questions, the first of which was on money. I say to the noble Earl that the final decision on allocation will be made shortly. The matter has been considered, but it has not been decided because of the question of a starting date. We will let noble Lords know as soon as possible. As for when the £50 million grant will be available, that will have to be debated in Parliament under Section 88B of the Local Government Finance Act 1988, but we will pay it to councils as soon as practicable after that.
I hope that that goes some way towards meeting the issues raised by the noble Baronesses, Lady Finlay, Lady Howarth and Lady Barker. We need to create capacity, allow time and provide resources as soon as possible so that people can see exactly what they have to do. The extra funding will help them to be better prepared. The access grant provides for additional funding for home care, intermediate care and community care, and the first tranche will come into effect in April 2003. So resources will be available almost immediately. All I can say is that we shall be monitoring what is happening to the £50 million. I can say no more on that as it is a matter for the Secretary of State.
The noble Baroness, Lady Howarth, referred to the changes. We are conscious that we are expecting a lot from social services and that many other events are occurring in their world which require careful management. However, we embarked on this legislation in the knowledge that people were being inappropriately placed in hospital and left to become worse rather than better. The spirit behind the Bill has been to provide a better future for those people. We are aware of the dedication and hard work of social services. We have every expectation that they will be able to meet the challenge. But we do not underestimate the challenge and we are aware of the other difficulties. I hope that our changes will signal that we are aware of what they need to do and that we support them.
Earl Howe: My Lords, I thank the noble Baroness for her reply. I beg leave to withdraw the amendment.
Amendment No. 5B, as an amendment to the Motion, by leave withdrawn.
On Question, Motion agreed to.
6Page 2, line 8, at end insert—
"and
(ii) has consulted with the patient (and in the case of a carer in relation to assessment under the Carers (Recognition and Services) Act 1995 (c. 12) and the Carers and Disabled Children Act 2000 (c. 16)) to ascertain their views and preferences, informed them of the reason for the notification, and obtained their informed consent or in the case where a patient lacks the mental capacity to give such consent, has recorded on the file what steps have been taken to ensure that the patient's best interests have been duly considered" The Commons disagreed to this amendment for the following reason:
Baroness Andrews: My Lords, I beg to move that this House do not insist on their Amendment No. 6 to which the Commons have disagreed for their reason numbered 6A.
At Report stage we agreed a government amendment that places a duty on the NHS to consult the patient, and where appropriate their carer, prior to issuing a notice to the local authority of the patient's likely need for community care services under Section 2. That reinforces the existing good practice, supported by statutory guidance for Section 47 assessments as well as the single assessment process and the recently published discharge workbook. It is a key principle that the patient should be kept informed and be consulted at all stages of the assessment process. This amendment puts the matter beyond doubt by placing that requirement on the face of primary legislation.
Our amendment goes further, however, and requires consent. I understand that where the patient clearly gives or withholds consent to the question of whether social services should be notified, that would appear to be straightforward. In a previous debate, the noble Earl, Lord Howe, stated that he thought that few people would not want at least to have advice from social services on what services they might need when leaving hospital. The problem with the word "consent", however, is that the matter is not always that clear cut.
There are cases where the patient may refuse, thinking that he wants nothing to do with social services. He may be unaware of what social services can do, or afraid because he has never had any contact with social services. He may be concerned about the implications for his family, his privacy and his future life. There may be other cases in which an older person does not feel able to give a clear answer but wants to wait for a family conference before agreeing or wants someone to explain what is involved. In such cases the lack of consent would stop the NHS contacting social services. It would even prevent the social worker based in the hospital visiting, causing several days' delay in discharge planning. If consent were eventually given, it could still substantially reduce the time that social services had to assess and plan. Our amendment—
As we said, in the majority of cases patients will be happy at least to have the options explained. For those who are concerned about what social services might do in their case, the social worker may be the very person to reassure the patient. However, that process must be given a chance. The NHS body must be able to start planning for discharge and needs to be able to notify social services. I reiterate again that all that is being given to the local authority with the Section 2 notice is the patient's name. So if the social worker arrives on the ward but the patient does not agree to social services involvement, they still have a right to refuse to co-operate or to accept the services on offer. That is why we believe that the government amendment was appropriate.
Guidance for the Bill will also clearly tell the NHS what steps that consultation should involve. We have made clear in guidance exactly what steps have to be taken. I can tell noble Lords that we would also be prepared to include in regulations that the Section 2 notice must briefly record the patient's or carer's views and the outcome of the consultation. We have therefore listened to the concerns, and we believe that that proposal will meet them. It will make clear to the NHS the importance of involving patients and families at that stage and of keeping them fully informed as to what happens next in the discharge process.
I hope that, with those reassurances, the noble Baroness will feel able to withdraw her amendment.
Moved, That the House do not insist on their Amendment No. 6 to which the Commons have disagreed for their reason numbered 6A.—(Baroness Andrews.)
Baroness Barker rose to move, as an amendment to the Motion that this House do not insist on their Amendment No. 6 to which the Commons have disagreed for their reason numbered 6A:
The noble Baroness said: My Lords, I thank the Minister for that statement and for the helpful letter which the department sent last week to my noble friend Lord Clement-Jones. That letter set out many of the points that she has just made. I am glad that we have moved on from the position outlined in the draft regulations which seemed to give older people no say at all in the process. I believe that it is right to enable older people to have some influence in the process.
Always at the back of my mind was the fear that older people seeing the new system in operation as described at earlier stages would believe that if they went to hospital, nothing could be done to stop them going into an old people's home. That might seem an irrational fear to your Lordships but it is real to many older people. I am glad that it will be possible to explain to older people that such will not happen to them but that they or members of their family can be active participants.
I agree that many older people would like the opportunity of help from social services. Social workers can be of enormous help in explaining what is available. I hope that when the new system comes into force, there will still be room for flexibility and a human approach to older people in hospital—that we will not take away from nurses the ability to treat their patients holistically, which is part of good nursing. I am heartened by the Minister's comments. We have almost reached the point where I wanted us to be.
Moved, as an amendment to the Motion that this House do not insist on their Amendment No. 6 to which the Commons have disagreed for their reason numbered 6A, leave out "not.—(Baroness Barker.)
6ABecause it is unnecessary to require consent for the giving of notices containing no personal information and because Lords Amendment No. 9 makes more appropriate provision for consultation.
6BLeave out "not".
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