Community Care (Delayed Discharges etc.) Bill

House of Commons, 15 January 2003.

New Clause 8 — Free Provision of Services in Wales

Jacqui Smith (Labour, Redditch)

I beg to move, That the clause be read a Second time.

Sylvia Heal (Deputy Speaker, Halesowen and Rowley Regis)

With this it will be convenient to discuss the following:

Government amendment No. 38.

Patsy Calton (Liberal Democrat, Cheadle)

I understand that the new clause would tighten up section 12(7), but would be grateful for confirmation from the Minister.

Will the new clause give the Welsh Assembly powers simply to emulate the statutory instruments from the Secretary of State under section 12, or will it have any powers itself to produce fresh statutory instruments, within the confines of the section?

Jacqui Smith (Labour, Redditch)

It depends how Xtighten up" is defined, but the aim of the new clause is probably not to tighten up the position relating to Wales. The Government seek to balance the commitment to devolution of health matters to the Assembly with maintaining the original purpose of the new power, which was to make community equipment and intermediate services only free of charge. The new power in part 2 has been taken with specific services in mind, and with a clear purpose—to help reduce delayed discharge caused by services in which integration is hampered by charging.

The new clause, and the regulation-making power that it gives the Assembly, will allow the Assembly to decide how to use the new power in Wales. The present wording would require Wales to replicate the regulations set by the Government in England. The new clause gives the Assembly more flexibility.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I have just received an answer from the Department of Health concerning the number of Welsh patients treated in English hospitals. More than 4,000 are treated just in the five hospitals most commonly used along the border—the Countess of Chester hospital, the Royal Shrewsbury hospital, the Hereford hospital, the Robert Jones and Agnes Hunt orthopaedic hospital, the Royal Liverpool University children's hospital, the Cardiothoracic centre in Liverpool, the Central Manchester hospital, the Walton Centre for Neurology and Neurosurgery, the Royal Liverpool and Broadgreen University hospitals and the United Bristol healthcare trust.

What reciprocal arrangements will be made in regard to charging for any patients from Welsh local authorities whose discharge from English hospitals may be delayed?

Jacqui Smith (Labour, Redditch)

I understand that the Assembly has decided not to introduce in Wales the incentives that we are introducing in the Bill. As for reciprocal arrangements, I understand that the discharge of fewer than three Welsh patients in English hospitals is being delayed. Because Wales has decided that it does not want to introduce reimbursement at this time, we currently have no plans for reciprocal arrangements. If Wales decides to implement reimbursement proposals, we shall need to consider the details then.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 3 — Meaning of 'Carer' and 'Carers' Assessment'

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move, That the clause be read a Second time.

Sylvia Heal (Deputy Speaker, Halesowen and Rowley Regis)

With this it will be convenient to discuss the following:

New clause 9—Carers: duties—

'(1) Further to fulfilment of the requirements under section 2(2) and (3) it shall the duty of the responsible authority to—

(a) inform any person where it appears to them that they may be entitled under section (1) of the Carers (Recognition and Services) Act 1995 and section (1) of the Carers and Disabled Children Act 2000 to request an assessment of their ability to provide and continue to provide care;

(b) ensure that the assessment carried out under the above provisions provide sufficient information in the care plan, or to make arrangements that a provider of services to the patient can carry out an appropriate assessment, to satisfy Standards 3 and 4 of the National Minimum Care Standards for Care Homes and Standards 2 and 3 of the Draft National Minimum Care Standards for Domiciliary Care, as required by the Care Standards Act 2000.

(2) Where, for the purposes of satisfying the fitness for purpose of proposed accommodation under the Care Standards Act 2000, the assessment procedure exceeds three days, the delayed discharge period shall be disapplied.'.

Amendment No. 41A, in page 2, line 9, [Clause 2], after 'body', insert—

'to consult with the patient and his carer, if he has one, to ascertain their views and preferences, and—

(a) where informed consent is given, record that on the patient's file or

(b) in the case where a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered, and'.

Government amendment No. 27.

Amendment No. 5, in page 2, line 41, [Clause 3], at end insert—

'(3A) Before making a decision under subsection (3) the responsible authority must—

(a) consult the patient and his carer, if he has one;

(b) inform them of the cost of the proposed care plans; and

(c) obtain the consent of the patient and any carer and—

(i) where informal consent is given, record that on the patient's file, or

(ii) in the case where a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered.'.

Government amendments Nos. 28 to 30.

Amendment No. 3, in page 3, line 7, [Clause 3], at end insert—

'(6A) The responsible NHS body must consult the patient and—

(a) where informed consent is given, record that on the patient's file, or

(b) in the case where a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered,

before deciding what services (if any) it will make available following discharge.'.

Amendment No.4, in page 3, line 7, [Clause 3], at end insert—

'(6A) The responsible NHS body must take into account the views of the patient's carer, if he has one, before deciding what services (if any) it will make available following discharge.'.

Amendment No. 2, in page 3, line 9, [Clause 3], at end insert—

'(7A) The responsible NHS body must give the patient and his carer, if he has one—

(a) notice of the day on which it proposes to discharge the patient and—

(i) where informed consent is given, record that on the patient's file, or

(ii) in the case where a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered, and

(b) information about their right to request a review if they disagree with the decision to discharge.'.

Government amendments Nos. 32 to 34, 36 and 37, 39 and 40.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

This is far the largest group of new clauses and amendments with which we shall deal, and it enables us to explore quite a few of the issues we touched on in Committee. I hope we shall receive further clarification from the Government today, not least on issues raised by our amendments and those tabled by the hon. Member for Woodspring (Dr. Fox), which deal with some of Opposition Members' most fundamental criticisms of the Bill. We hope that even at this stage the Government will be minded to accept some of the amendments.

New clauses 3 and 9, and Government amendments Nos. 27, 30, 32, 39 and 40, address a number of concerns that I raised in Committee. As drafted, the Bill says nothing about the rights of carers. They are seen as innocent bystanders who are left to pick up the pieces resulting from the discharge process.

Research by Carers UK has repeatedly demonstrated poor hospital discharge practice. The new clauses are intended to ensure that carers do not bear the brunt of poor practice and are not victimised by over-zealous implementation of the Bill across the country. Research published about a year ago by Carers UK showed that anything between 70 and 77 per cent. of carers said that they had no choice about taking on caring responsibilities when the person for whom they cared left hospital. In other words, seven carers out of 10 were effectively dumped on and left to get on with it. That cannot be a satisfactory outcome of the way in which discharge is currently being handled in far too many hospitals across the country.

The guidance published by the Government over the years says that carers should be consulted about discharge planning and that they should play an integral role at each stage of a patient's progress. However, all too often that does not happen in practice. The new clauses deal with that lack of consultation and assessment of carers' needs.

Carers UK has followed up the research that it has done over the years and monitored how things have changed over time, so it is educational to look more closely at its research. For example, it has found that there has been a near doubling in the number of people being readmitted to hospital within two months of discharge—from 19 per cent. in 1999 to 43 per cent. in 2001. When the most recent survey by Carers UK asked why the rise had occurred, 45 per cent. of carers said that they felt that premature discharge was the cause of what might be considered a revolving door syndrome that meant that people returned to hospital as emergency readmissions.

The problem of premature discharge from hospital was highlighted by last year's Audit Commission report entitled XFully Equipped 2002—Assisting Independence". I referred to that report in Committee. The quotation that I shall read out now was referred to but the Minister did not then respond to the point that the Audit Commission was making. The report stated:

XIn the case of community equipment services in particular, social services departments were finding themselves under increasing pressure to cope with the demand of people being discharged earlier from acute hospitals. The policy to support the immediate needs of the NHS was putting pressure on other parts of social services' home-care budgets and driving up eligibility criteria for those who needed less intensive support to help them to stay at home—risking unnecessary hospital admissions and increasing demands on the NHS."

In other words, the policy becomes self-defeating: ejecting people prematurely from the hospital only results in them returning for additional care.

I raised the matter with the Minister in Committee, but on checking the record I found that she did not deal with the point in that debate. I hope that she will be able to do so today. By introducing a system of fines to bear down on delayed discharge problems in the NHS, new perverse incentives will be created elsewhere in the system that will distort priorities. The district auditors and the Audit Commission have found that that is already happening: the delayed discharge targets are already causing hospitals to become the priority of social services departments at the expense of others.

There is nothing in the Bill to prevent that from happening. In fact the Bill promotes it. Many people wait in their homes for assessment by social services departments, and are often in desperate need of an appropriate package of care and support. It is bizarre to discover that the Bill means that the quickest way for them to get what they need will be to get themselves admitted to hospital. The fine will cause social services to focus on their need once they are occupying a hospital bed. However, because there is no fine attached to the fact that those people are not being assessed at home, that will not be prioritised.

That is the perverse incentive that the Bill will create.

Nigel Waterson (Conservative, Eastbourne)

I am following the hon. Gentleman's argument closely. Does he accept the Alzheimer Society's contention that the point that he makes about carers applies even more strongly to those looking after people suffering from that disease? Almost by definition, such patients are unable to give any input about what should happen to them. Carers often feel under enormous pressure to allow an inappropriate discharge and subsequent placement.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Gentleman makes a good point about mental incapacity, and the amendments in the name of the hon. Member for Woodspring in part deal with that. I shall return to matters connected with dementia later in my remarks.

I want to follow up an undertaking that the Minister gave in response to an amendment that I moved in Committee that dealt with the question of charging carers for services. I pursued this matter in the previous Parliament in connection with the Carers and Disabled Children Act 2000. It remains a concern for many carers.

In Committee, the Minister acknowledged that it would not be right for carers to end up footing the bill for equipment. She said that the Government would return to the matter on Report. It is not clear which of the Government amendments under consideration deals with that point. I should be grateful if the Minister will make clear which amendment deals with the question of charging carers.

In Committee, the Minister said that she would deal with matters to do with the regulations, several of which directly affect carers. It was useful that the Minister wrote to members of the Committee setting out in summary terms the issues that the Government indented to cover through regulation.

My first question is about clause 2(4)(a), which deals with

Xthe form and contents of notices"

of likely need, and the manner in which they are to be given. The explanatory notes say:

XThe intention is that the regulations ensure that the notice given by the NHS body is brief, but still contains necessary information. The notice only need contain the patient's name and location, the name of the NHS contact, the date of admission if this has not yet occurred, and the likely date of discharge if known."

However, I hope that the Minister will reassure the House about whether carers and relatives will be notified at that stage. Neither the notes nor the Bill makes that clear. Will they be part of the process? I hope that the Minister will confirm that the regulations will recognise and acknowledge the role that carers play.

The notes also stated:

XNotice does not need to be a formal letter but will most likely consist of a fax or an email, either providing the necessary information or alerting social services to an update on a shared database".

The phrase Xshared database" reminded of last year's Audit Commission report entitled XForget Me Not", which stated:

XEffective information sharing between health and social care practitioners is a prerequisite to successful co-ordination."

No one would disagree. The report continued:

XJoint working and the single assessment process would be weakened without it. However, auditors found that shared case files, or easy access to each other's files, only existed in a tenth of areas, and partly so in only a further third . . . In other words, case notes were not shared in three-fifths of areas . . . Many agencies have developed. Or are in the process of developing, computerised patient or service user records. But auditors reported that health and social services IT systems were compatible in only a few areas."

When one goes on reading the report to see what that meant in practice, one realises that in 89 per cent. of the areas surveyed by the Audit Commission there was no compatibility between the systems—yet the Government are planning to predicate regulations on such an ability. I hope that the Minister will say a little more about that, too. How will the proposal work in practice given that the systems will hamper the sharing of information?

We on the Liberal Democrat Benches welcome amendments Nos. 27, 30, 32, 39 and 40 because they make provision for some of the concerns that Carers UK, my hon. Friend the Member for Cheadle (Mrs. Calton) and I have been raising. However, the amendments seem to fall short of placing a duty on social services departments to inform carers of their entitlement to an assessment. Indeed, Government amendment No. 27 states that the carer must ask for the assessment. In other words, the onus is placed on the carer. Surely during the stressful time in hospital associated with the planning of discharge it would not be unreasonable to place a duty on social services departments to give the carer notice of the fact that they are entitled to such an assessment if they want one.

I look forward to the debate on the Opposition amendments on consent. The Liberal Democrats strongly support their purpose. The Bill is silent not only on carers but on patients; there is absolutely no mention of patients. The provisions reflect an obsession with getting patients out of their beds as quickly as possible—and not necessarily in their best interests. The amendments are about ensuring that the interests of the patient are brought back into play. Under the Bill, the patient is seen as a passive recipient of whatever care or services the NHS or social services departments choose to supply.

The issue of consent is particularly relevant to patients with dementia, to which the hon. Member for Eastbourne (Mr. Waterson) referred. Indeed, when giving evidence last year during the Health Committee's excellent inquiry into delayed discharge, Professor Ian Philp, the national director of older people's services, made the following relevant point:

Xdementia is a principal cause of delayed discharge because of the complexity that having dementia plus a physical illness produces in terms of developing a good discharge plan."

He went on to make the point that 70 per cent. of occupants of ordinary nursing homes are elderly mentally infirm patients—people with dementia and other problems. There are serious pressures on services currently available to provide support for people with dementia and for their carers.

We know that from the Audit Commission report, XForget Me Not", in which there are some important findings on home care services, to which the hon. Gentleman also referred. Last year's report said:

XHome care is one of the key services for supporting older people with mental health problems at home, provided it is given flexibly and sensibly. However, auditors found home-care workers with additional training in mental health in only one in seven areas."

Only one in seven areas have people who are equipped with the skills to provide the services necessary to promote confidence in the fact that those with dementia will be safely discharged from hospital and will receive the support at home that they need. Surely that ought to concern the Government, although it does not appear to have been factored into the time scale for implementation of the Bill. Indeed, the Government have been hasty in introducing the legislation.

Is the Minister confident that matters have been remedied since the Audit Commission's finding just last year? Surely the patchiness of provision of services for people with dementia ought to be addressed. Even the extra resources, which are welcome and for which I and my hon. Friends voted, will not deliver from day one the extra EMI-trained staff to provide such home care and other much needed support.

Amendment No. 5, which was tabled by the hon. Member for Woodspring, would rightly ensure that patients and carers are informed about the costs of the proposed care. That raises some questions for the Minister. First, clause 3 sets up the process of partial assessments—what package of community care services ought to be provided for the carer. The assessment is not of the carer's financial circumstances, so how on earth can social services departments complete a financial assessment in the time scales proposed, especially given the intrusive nature of such assessments?

My second question is about consistency in NHS continuing care. As the Audit Commission found, there are wide variations in how the Government's guidance on continuing NHS care provision is implemented. Over the past months there have been some very damning health ombudsman inquiry findings against strategic health authorities that have acted unlawfully in saying that someone is not entitled to free NHS continuing care and therefore must instead be means-tested by social services departments. As a result people have given up resources to which they are entitled, whether by selling their home or running down their bank balance. Given such evidence, will the Minister ensure, if and when the Bill is enacted, that we can be confident that there will be an assessment of a person's entitlement to such care from the outset?

In Berkshire, the strategic health authority has been told as a result of the health ombudsman inquiries to trawl through records of the past few years to find when people have been wrongly pushed down the social services route and subjected to means-testing rather than receiving free continuing NHS care. That is the case not just in Berkshire but in Dorset, Wigan and Cambridgeshire. Will the Minister ensure that strategic health authorities will conduct those trawls, which have been requested by the health ombudsman; otherwise many people will feel that the guidance issued by the Department and the way in which it has been interpreted by health authorities run contrary to the decisions of the courts and rob people of money? People are having to pay for what is fundamentally NHS care.

Clause 3(8) deals with the circumstances for the withdrawal or cessation of the effect of a notice, where someone is awaiting discharge from hospital. If that person is told that they are not entitled to free continuing NHS care and they appeal, will the Minister confirm that the clock-on fines imposed on the local authority will stop?

We hope that the Government will be able to offer answers to some of the issues raised by the amendments that I have highlighted. I hope that my hon. Friend the Member for Cheadle will be able briefly to address Government amendment No. 37 to which I have not spoken. Unless both carers and patients are covered by the Bill and their rights are properly protected, the measure will not be satisfactory and should not pass through this House.

Simon Burns (Conservative, West Chelmsford)

I will speak to amendments Nos. 41A, 5, 3, 4 and 2, which deal with empowering patients and particularly carers. In many ways, as has been said, the amendments complement and add to the new clauses moved by the hon. Member for Sutton and Cheam (Mr. Burstow).

It is right to say from the outset that it is extraordinary that throughout what the Opposition regard as a nasty and counterproductive measure there are no references to carers and patients or any powers and entitlements granted to them. Yet it is patients who are at the receiving end of the Bill, as are the carers, who are, as no one in the House would disagree, the unsung heroes of our society because of the tremendous work that they do in looking after loved ones and family members.

Clause 3 highlights the fact that all too often carers are ignored—taken for granted—and there is an assumption that they will do their duty and look after their relatives or those whom they care for. I consider that situation to be the wrong way round, which is why I believe it so important that these amendments and new clauses put on the face of the legislation protections and aids and assistance to patients and, particularly, to carers.

Hilton Dawson (Labour, Lancaster and Wyre)

Does the hon. Gentleman accept that some of the amendments that he is speaking to are completely unnecessary, that some of what he has said is an insult to the social work profession, and that we cannot simply lay down in the House what social care professionals should do in every aspect of their work? Will he celebrate with me the fact that we can rely on the professionalism and ability of social workers in local authorities?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

What complacent rubbish.

Simon Burns (Conservative, West Chelmsford)

Unusually, I am inclined to agree with the Liberal Democrats. I think that I am right in saying that the hon. Member for Lancaster and Wyre (Mr. Dawson) was a social worker, so may I first say that, despite his cheap jibe, what I have said so far in no way criticises or attacks social workers, because they also have a very difficult job to do, and are often not given the credit for the work that they do? I think that carers' organisations and carers will be slightly surprised by the hon. Gentleman's comments, because they do feel aggrieved, and if he has bothered to take the time to read any of the briefings on the Bill from carers' organisations he will know that they do feel very aggrieved that the Bill makes no mention of carers or the role of carers.

Nigel Waterson (Conservative, Eastbourne)

Does my hon. Friend agree that the point here is not the dedication of individual social workers but the pressures that social services departments will feel under? Indeed, the Bill is designed to make them feel those pressures, which will in turn distort the priorities that they might otherwise have in terms of care and packages for individual patients?

Simon Burns (Conservative, West Chelmsford)

My hon. Friend has picked up an extremely relevant and important point. I wish the Government had better appreciated the implications of what the Bill seeks to do, because, as the Minister knows, it will be carers who bear the brunt of poor discharge procedures, and we believe that those will arise as a result of the Bill.

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

No, I will not; I want to make some progress.

We tabled the amendments because between 1999 and 2001 readmissions of patients within two months of being discharged nearly doubled, from 19 per cent. to 43 per cent. The proportion of carers who felt that early discharge was at fault rose correspondingly from 23 per cent. to 45 per cent., and 77 per cent. of carers said that they were not given a choice about taking on caring responsibilities. That is why—

Andy Burnham (Labour/Co-operative, Leigh)

rose—

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

rose—

Simon Burns (Conservative, West Chelmsford)

I will not give way.

We need to have the new clause and the amendments on the face of the Bill to enshrine in law the proper procedures.

Andy Burnham (Labour/Co-operative, Leigh)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

I am sorry; I want to make some progress.

I want to deal in order with the amendments that the official Opposition have tabled. Amendment No. 5 is intended to ensure that the patient—and, where applicable, the carer—is aware of what will be provided on discharge, so that they know whether they would wish to accept that plan. The amendment also addresses issues where the patient lacks capacity. As clause 3(3) currently reads, there is no involvement with the patient, only agreement between the national health service and social services—

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

No, I will not.

The amendment would ensure that the patient and, just as important, their carer were fully aware of the cost of their continuing care and aware that they had consented to it. The importance of such knowledge and consent is emphasised by a case that my right hon. Friend the Member for Skipton and Ripon (Mr. Curry) drew to my attention. He has a constituent who has been confronted with what I think the House would rightly agree is a grave injustice with regard to free care under the Coughlan case. A Mrs. Airey, who is the mother of my right hon. Friend's constituent and holds power of attorney, was suddenly sent a bill for #7,000 by the care home to which her mother had been transferred from hospital by social services in Yorkshire. She had made no agreement, written or verbal, to pay anything. When she replied that the contract with the care home had been made by social services, and that her mother could not be asked to pay, she received a telephone call last Sunday week from the home manager, who said that he had consulted social services and that her mother would not be able to continue in the home if she did not pay. Social services wrote last week to say that my right hon. Friend's constituent must pay Xto protect her mother's place in the home", and that she had made the contract with the home. Mrs. Airey is adamant that she had done no such thing. As the House will appreciate, there is now a major dispute as to who placed the contract and who is financially responsible for paying the bill.

I believe that an amendment like amendment No. 5, with the plans in the new clause and the other supplementary amendments, would overcome that sort of confusion and argument, because there would be greater clarity at the point of discharge.

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

rose—

Simon Burns (Conservative, West Chelmsford)

I will give way, but then I shall make progress.

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

I thank the hon. Gentleman for being so generous. He obviously has a different copy of the Bill from the one that I had. Perhaps he could point out where in the Bill it repeals legislation that already requires care plans to be in place and legislation that gives every carer the right to an individual assessment.

Simon Burns (Conservative, West Chelmsford)

The hon. Lady is missing the point because—

Hilton Dawson (Labour, Lancaster and Wyre)

No, she is not.

Simon Burns (Conservative, West Chelmsford)

She is. If I could explain for a minute, perhaps the hon. Lady will understand. The trouble is that, regardless of the legislation that the hon. Lady is referring to, the Bill will, in effect, cause serious problems by putting pressure on local authorities to ensure that patients are often wrongly or inappropriately discharged from hospital and inappropriately placed in alternative forms of care, so as to avoid a fine under the Bill. That is why I, my hon. Friends and, I think, the Liberal Democrats believe that to protect against that occurrence and to minimise that possibility, the Bill, if it reaches the statute book, should have clearly defined rights and protections for carers and for patients, so as to seek to avoid an unpleasant and unfortunate by-product of a piece of legislation that is deeply flawed.

Hilton Dawson (Labour, Lancaster and Wyre)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

No. I told the hon. Member for Sheffield, Heeley (Ms Munn) that I would take one intervention and then would make progress.

Amendment No. 3 ensures that national health bodies will consult patients as well as local authorities before it is decided what services, if any, will be made available following their discharge from hospital. The amendment ensures that the patient is informed and consents to whatever NHS services are to be provided. It also aims to deal with those people who are unable to give such consent in the absence of mental incapacity legislation.

Amendment No. 4 would place a further duty on NHS bodies simply to ensure that the views of the carer are considered when making arrangements for health services following the discharge of a patient. The wording is deliberate. The NHS body must simply take into account the views of the carer. It need not necessarily agree or act on those views, but it will have a duty to take them into account.

Amendment No. 2 would introduce a new subsection to ensure that patients and carers are also aware of when they are likely to be discharged and can ask for a review. It also aims to deal with people who are unable to give consent due to mental incapacity.

The amendments and new clauses are needed in the Bill. For that reason, and given that we discussed the subject at considerable length in Committee, I hope that the Minister has had time to reflect and is now minded to accept this strengthening of the legislation. I am sure that she will not doubt, as I certainly do not, that carers and patients need to be protected under this part of the Bill.

Glenda Jackson (Labour, Hampstead and Highgate)

If memory serves me correctly, the hon. Member for West Chelmsford (Mr. Burns) has surely come somewhat late to concerns about carers. I cannot remember one piece of Conservative health service legislation between 1992 and 1997 that enshrined the rights of carers on the face of a Bill. In that five-year period, they may have introduced the possibility of the carer's needs being assessed, but no statutory duty was placed on local authorities and they did not have to deliver.

I frankly acknowledge to the Minister that my reason for speaking to this group of amendments is anecdotal, but some of my constituents have expressed concern to me. They perceive that, as carers for someone who is frail or, in one instance, suffers from dementia, pressure could conceivably be placed upon them, as social services could be fined under the Bill if the NHS facility that is caring for their loved one says that he or she is ready to leave hospital but no alternative facilities can be provided. Even though Camden is an excellent authority in that respect, there are difficulties with finding available facilities locally. That is the overriding concern of my constituents.

In some instances, the carer is as frail as the individual who is in hospital, as I pointed out when we discussed the Bill in the House before. One such case involves a wife whose husband was in hospital. She became ill and, even though he had recovered, there was no one at home who could care for him. No interim placement was available in the locality and the couple had no relatives who could visit him in the place where he was to be temporarily cared for.

Those are the sorts of issues that are causing concern among carers and patients. They believe that undue pressure will be placed on their local authority to move their loved one from an NHS facility. In some instances, they know that the loved one will be returned not to their home, because no one there is capable of caring for them, but to a facility outside the local area.

My constituents are also concerned about what will happen when someone is to be cared for at home but the home requires a great deal of work to make it feasible for the carer to care for them, or for a carer with additional domiciliary care to do so. There again, some of my constituents believe that unnecessary pressure will be placed on local authorities as a result of the fines in the Bill and that the authority will in turn put additional pressure on them.

I hope that my hon. Friend the Minister will be able to say something to calm the fears of my constituents.

Nigel Waterson (Conservative, Eastbourne)

I speak in support of the majority of the amendments in the group, but in particular those tabled by my hon. Friends, especially my hon. Friend the Member for Woodspring (Dr. Fox)—amendments Nos. 41A, 5, 3 and 4 on the consent of patients and their carers.

Those of us who were members of the Committee and who tried to improve the Bill were disappointed not least at this important—indeed, central—flaw in the legislation. The Bill is a consent-free zone. Patients are treated as a sort of commodity, or as counters to be moved around the board to the best advantage of the agencies involved. It does not ensure that they or their families or carers will be consulted, let alone have their views taken into account when it comes to the timing of their discharge and the sort of care that they will be discharged into.

We will return to that issue, but as hon. Members on both sides of the House said on Second Reading and in Committee, it is extraordinary that the Government want to introduce this sledgehammer measure at a time when there are encouraging signs throughout the country and in east Sussex in particular—part of which I represent—of closer working between the different agencies. There have been problems. I do not think that any sensible observer of that aspect of the care scene would argue otherwise. However, there is now much greater evidence of better organisation within the different bodies and of greater co-operation. For example, although there continues to be a problem with bed blocking and delayed discharges in my area, the figure is much lower than it was a year ago. Indeed, my local hospital, Eastbourne District General, recently opened a discharge suite that is designed to ease the transition of patients out of beds that they no longer need to occupy earlier in the day and to the form of care to which they are to move.

Hilton Dawson (Labour, Lancaster and Wyre)

Does the hon. Gentleman regard those new levels of co-operation as a new Labour achievement? They were certainly not evident in any Tory legislation or policy during the 18 years for which the Tories were in power.

Nigel Waterson (Conservative, Eastbourne)

The hon. Member for social workers, or whatever his constituency is, misses the point again. If the Government are going to try to take credit for solving the problem, they should certainly take the credit for creating it in the first place. In my part of east Sussex, the problem can solely be placed at the door of the Government.

There has been closer working between the agencies, in particular since control of the county council changed hands. The Tory administration has gone to great lengths to work more closely with the NHS and so forth. If blame is to be allocated locally—perhaps an element of consensus may spring up across the Chamber on this—the eight years during which the Liberal Democrats ran the county council contributed to the problem.

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

Opposition Members have short memories. I was first introduced to the term Xbed blocking" during my social work training back in 1985–86, under a Government of the political persuasion of the current official Opposition. The problem has existed for many years. Why, after all this time, are the Conservatives so concerned about the fact that the Government have decided to do something about it, especially in areas where the progress made is not as it should be?

Nigel Waterson (Conservative, Eastbourne)

I have not had the benefit of social work training—I am sure that that is a massive failing on my part. Two things need to be said. First, there has always been bed blocking, although the title attached to it has changed over the years. However, my constituency experience during the past 10 years is that whereas it used to be largely a winter phenomenon, it has become an all-year-round phenomenon of substantial proportions. At different times in the past couple of years, my local hospital has had the equivalent of two or three wards full of people who should not be in hospital. It is one of the lasting monuments to the Labour Government that they have created waiting lists not only to get into hospital but to get out.

Secondly, the Government appear to be convinced that the Bill is the solution, even though what they propose flies in the face of the conclusions reached by everyone else with any experience of the problems—not only Conservative Members of Parliament, but the Local Government Association, the Association of Directors of Social Services and the NHS. The Bill has not a friend in the world, apart from some Labour Members, and quite a few of them have expressed disquiet since the idea was stumbled across. It is another example of the Government's knee-jerk reaction to problems. All I can say to them is, XWelcome to Government." Normally, there are no simple solutions to complex problems.

If the hon. Lady is saying that the Bill is the answer—that some genius boffin at the Department of Health has produced a wonderful solution to the problem—why not pilot it? Why not follow the advice of bodies such as Age Concern and not implement the Bill across the board until 2004? Why not try it first in one or two areas? By all means choose those areas where the problem is perceived to be chronic. The Minister will concede, if she has not already done so in previous debates, that good progress is being made in east Sussex, but if there are pockets where the problem is extremely bad, why not pilot the provisions of the Bill in those areas and wait and see, rather than wasting the time, effort and resources of hard-pressed social services departments and NHS staff throughout the country?

Moving on to the practical details, I have already said that the Bill has no friends, but in an intervention on the hon. Member for Sutton and Cheam (Mr. Burstow) I mentioned what the Alzheimer's Society has to say. The society is extremely worried. It makes the point that

XThere are over 700,000 people with dementia in the UK",

and that

XThree-quarters of people in long term care have Alzheimer's or another form of dementia."

In its briefing, the society rightly states:

XThe Bill makes no reference to issues of consent",

and adds that

Xthe proposals place undue pressure on unpaid carers."

The concerns that were rightly expressed by my hon. Friend the Member for West Chelmsford (Mr. Burns) and the hon. Member for Sutton and Cheam about carers generally apply in spades to carers of people with Alzheimer's or other forms of dementia. The Alzheimer's Society briefing continues:

XMany carers feel pressured into moving a person with dementia into a care home that they feel is unable to care appropriately for the needs of the person with dementia."

The briefing ends:

XThe Alzheimer's Society is concerned that the proposals will increase pressure on people with dementia and their carers to accept care that is inappropriate."

Andy Burnham (Labour/Co-operative, Leigh)

The hon. Gentleman talks about what carers have to fear from the Bill. Surely carers in this country have far more to fear from a 20 per cent. cut in public spending, proposed by Opposition Front-Bench spokesmen just before Christmas? What would that do to social services budgets and what could carers expect as a result of such cuts?

Nigel Waterson (Conservative, Eastbourne)

The hon. Gentleman is behind the game. Despite the assurances of the Prime Minister, it has been made clear that no Opposition Member is suggesting a 20 per cent. across-the-board cut, or anything like it. I am talking about the Labour Government's loony proposal to charge fines—the Minister was careful not to use the word Xfines" in Committee; she used various other, somewhat cuddlier, expressions—

George Young (Conservative, North West Hampshire)

Incentives.

Nigel Waterson (Conservative, Eastbourne)

I am grateful to my right hon. Friend—I think that that was the word the Minister used. There would be charges to Xincentivise" people, although I doubt that any criminal who is fined regards himself as being incentivised. In any event, the game was blown when the Secretary of State used the old term Xfines" in the Chamber the other day. The Government are erecting a tremendous bureaucracy to fine social services departments—but may give back the fines because they are also setting up various appeal tribunals—to deal with a problem that in some places is visibly being tackled by the agencies themselves.

The next brief we received is from Help the Aged, which makes similar points. It says that the Bill

Xfails to recognise the involvement of the patient in determining their future care."

As I pointed out in Committee and on Second Reading, the Bill cuts right across the requirements of the NHS plan and the national service framework for older people. I do not know why Ministers publish all those worthy documents if they have no intention of paying any attention to them in legislation.

Age Concern provides a powerful voice for the sort of people who will be most adversely affected by the Bill and whom the Opposition parties are trying to help by amending the Bill. The organisation does not pull any punches, stating:

XWe believe that there is a stark omission from the Bill of the rights of the patient."

It refers to the finding of the Select Committee on Health inquiry into delayed discharges, that

Xit is essential that patients should as much as possible be partners in the discharge process."

There is no talk of partnership in the Bill—patients will not necessarily be told what is to happen to them, and neither they nor their carers will be asked about it. Age Concern talks about the need for the consent of the patient and their carer, for the provision of adequate and proper information, for consultation and advocacy, for the patient to have the right to dispute the discharge decision, and for details of what will happen to the patient when there is a dispute—a subject that we will discuss later.

I return to what I have said throughout our consideration of the Bill. Consent of the patient, let alone the carer, is entirely absent from the Bill. We can only assume that it is a wholly Treasury-driven measure. It has nothing to do with the care of patients. It is designed to save money. As I have also said, in the area that I represent the problem is very much one that has been created by government.

Alan Simpson (Labour, Nottingham South)

We should all welcome the recognition of the problems that are faced by carers, however late it has come. We must also recognise that legitimate points are being raised by organisations representing older people as well as by organisations representing the interests of carers.

The specific concerns that I would like the Minister to address do not revolve around personnel issues in terms of a care package but relate to the circumstances in which people were admitted to hospital in the first instance and to the place to which they will be returned. Those points were made by my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson). I would welcome a reference from my hon. Friend the Minister to the way in which these matters fit in with our approach to a fuel poverty strategy that will tackle the root cause of many elderly people's admission to hospital. No matter how much personal care we build into a return package, fuel poverty will be the cause of further readmissions.

For a long time, many of us have been concerned about the revolving-door syndrome in terms of hospital admissions for older people. Much of the blocking of discharges relates not to the specific illness but to home conditions that may make it almost certain that the illness will recur. Will the Minister clarify whether she will be issuing fresh guidance about home circumstances. I think that the issue is covered in amendment No. 27, which refers to the need to identify Xany services" that

Xneed to be made available to the carer in order for it to be safe to discharge the patient".

We have been the first Government ever to introduce statutory targets for the elimination of fuel poverty in the home. Home warmth, home conditions and home safety are central to the health interests of older people and to safety when discharging older people from hospital to return to their homes. The amendments that were tabled in my name and in the names of other Members on a cross-party basis have not been selected, but perhaps the Minister will be kind enough to set out her proposals in the context of recognising that it is not only the human care package but the physical care package that needs to be considered in removing or addressing the bed-blocking problem?

I would hate us to find that we had merely moved the problem from one location to another. I would not want us to replace the revolving-door problem with a pass-the-patient problem that surfaced in temporary locations to which a discharged patient was moved, not least because the people concerned may have been asking for a long time what help they can get from the Government or the responsible agency to make their life-long home a safe place in which to live.

Patsy Calton (Liberal Democrat, Cheadle)

My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) and I support the remarks of the hon. Member for Nottingham, South (Alan Simpson). We added our names to the amendments to which the hon. Gentleman referred, which sadly have not been selected. We would have liked them to be debated as well. We hope that the Minister will take notice of the hon. Gentleman's comments and take them up when she replies.

We shall press amendment No. 37 to a Division, because it has the effect of ensuring that accommodation and personal care do not have to be free for more than six weeks. Effectively, that means that responsibility is thrown back to local authorities after six weeks. Liberal Democrats disagree with that approach. We believe that personal care should be free for as long as it is necessary. We have never pretended that it does not have to be paid for, but comments about charging that were made in Committee should be addressed.

In May 2000, the Audit Commission's document XCharging with Care" said that 94 per cent. of councils were charging for care compared with 72 per cent. in 1992–93. The charges were raising #225 million and funding 12 per cent. of the costs of care, compared with 8 per cent. in 1993–94. It is acknowledged that that income helps councils to maintain and improve services and target subsidies. It is also acknowledged that demand is increasing. Much is made also of the differences in the amount of care that people could expect to get for the same money throughout the country.

Councils have had the power to charge for social services care since the enactment of the National Assistance Act 1948. The current powers to charge were set out in the Health and Social Services and Social Security Adjudications Act 1983, which was introduced by a Conservative Government. It gave wide discretion to councils, but they had to be reasonable, and reasonably practicable, in what they brought in. In 1994, an advice note from the social services inspectorate provided further clarification, and a series of legal challenges established case law.

The Government's current funding formula assumes that a proportion of costs can be recovered through charges. A note from the Library makes it clear that, for the first time, in 1999–2000—under a Labour Government—the way in which the revenue support grant was distributed to local authorities took into account the fact that they have different capacities to cover costs by raising charges for domiciliary services. In other words, councils were expected to make charges if they could do so.

Until 2000, only 6 per cent. of councils—

Jacqui Smith (Labour, Redditch)

Is the hon. Lady suggesting that distribution should not take into consideration councils' ability to raise charges, given that, as she said, that has been the legal position since 1948? Is she suggesting that we should not bear that in mind when we are distributing—in other words, that we should disadvantage those local authorities whose communities are poorer and less able to pay charges?

Patsy Calton (Liberal Democrat, Cheadle)

I thank the Minister for her intervention, but I would have much more sympathy with her point of view if she acknowledged the level of unmet need throughout the country—in local authority areas considered affluent, and in those considered less affluent. The level of need is simply not being met because the indicators used are not sensitive enough to recognise it.

Against the background of grants allocated on the basis that charges would be made, and of reductions in grant to that end, 94 per cent. of councils were clearly not in a position to avoid charging.

Meg Munn (Labour/Co-operative, Sheffield, Heeley)

This time last year, my father needed care at home, and because of his level of disability at that time he was entitled to claim a higher rate of attendance allowance. Both my mother and father considered it only right that that allowance be used to contribute towards the services that they received, and it is clear that many people are in that position. Is the hon. Lady suggesting that that is not a legitimate way for the Government to proceed?

Patsy Calton (Liberal Democrat, Cheadle)

I am grateful for that intervention, but I need to make progress as we want to press several of the amendments tabled to a vote. Obviously, there will be those who feel able to pay, but I am talking about the most disadvantaged, who are not able to do so.

Andy Burnham (Labour/Co-operative, Leigh)

Will the hon. Lady give way?

Patsy Calton (Liberal Democrat, Cheadle)

No. As I said, I intend to make progress. I have taken several interventions.

Successive Governments have been disingenuous on this front. It suited them to blame local councils, whereas in reality they were pulling the strings. We should remember that we are talking about services that involve assisting people in going to the toilet, using a bedpan, keeping the skin around catheters and stomas clean, changing incontinence pads, and keeping their skin clean because of their incontinence; assisting people with food; dealing with immobility; and medical treatments such the application of creams, lotions, eye drops and dressings. At the moment, people have to pay for all those things. Dressings, surgical appliances, prostheses, getting up and going to bed—all of those count within free personal care.

The Liberal Democrats have never suggested that such care could be provided without funding, and it was covered in our last costed manifesto. Given that it is a priority for us, it will undoubtedly be costed for the next manifesto as well.

In Scotland, all parties—Labour, the Conservatives, the Scottish National party and the Liberal Democrats—universally supported that move forward. It is a great pity that the Government have not used this opportunity to ensure that free personal care is provided for those who need it in England and Wales. Indeed, they have made it impossible for themselves to do so without further primary legislation.

Jacqui Smith (Labour, Redditch)

Opposition Members have made much of their concern for individuals and carers, but perhaps I should return to the very principle of the legislation, which they oppose. We introduced the Bill precisely because we recognise that the prime concern of many older people who are trapped in hospital—they tell us this when they come to our constituency surgeries—is that they want to get out, but that the facilities that they need to do so are not available. I am afraid that when it comes to concern about individuals and carers, talk is cheap for Opposition Members. As my hon. Friend the Member for Leigh (Andy Burnham) pointed out, it has to be cheap for the Conservative party, given their plans to cut the public spending that we are pledging.

As we shall see later, the Liberal Democrats seem to think that the problem can be solved with a few more plans. I am sorry, but every single older person who is trapped in hospital and wants to get out is an argument for a change to the system. Opposition Members can talk as much as they like about individuals, but if they are willing neither to invest nor to reform in order to make the necessary difference, that talk is hollow.

Andy Burnham (Labour/Co-operative, Leigh)

When I intervened on the hon. Member for Eastbourne (Mr. Waterson), he responded that he was not aware that any Opposition Member was suggesting public spending cuts. I draw my hon. Friend's attention to a comment made by the Opposition's Treasury spokesman:

XI am digging through current spending, finding opportunities for cuts. It is too early to say how much but it could be up to 20 per cent."

That was what he told The Daily Telegraph on 28 December.

Jacqui Smith (Labour, Redditch)

My hon. Friend makes a very important point. That is why I say that talk is cheap for Opposition Members.

There has been much talk about carers and issues relating to consent. I should like to address some of those issues, and I hope to provide some reassurance. My hon. Friend the Member for Hampstead and Highgate (Glenda Jackson) said that the Government's attitude to carers was different from that of previous Governments. We are committed to supporting carers in the vital care that they provide. Between 1999–2000 and 2001–02, the number of carers' assessments carried out increased. The carers grant introduced by the Government in 1999 provided an extra #140 million over three years to increase the number of breaks for carers. It has now been extended to provide #85 million this year and #100 million next year, and will continue to 2006. During that time, it will more than double to #185 million to provide extended care and 130,000 further breaks for carers.

This is a Government who are willing to put resources behind concern about carers. However, I understand the concern that the Bill may not have taken into account some of the previous legislation that we introduced in relation to carers' rights. We tabled Government amendments Nos. 27, 28, 29, 30, 32, 33, 34, 39 and 40 to remedy an omission from the Bill that would have meant that carers and carers' services were not fully provided for. As the Bill is drafted, the financial incentive promptly to carry out an assessment and provide services will apply to individuals in hospital, but not to their carer.

It was never our intention that the services that need to be provided to the carer to ensure safe discharge should be considered a lesser priority than the services to be provided to the individual. As my hon. Friend the Member for Hampstead and Highgate rightly pointed out, there may well be important cases where services provided to a carer are crucial in order to enable the safe discharge from hospital. Carers' needs are important in ensuring that an individual receives the services that he needs when he needs them and in the most appropriate place.

The amendments add the carer's assessment—upon request from the carer—and decision about provision of services to the carer to the duties of a local authority when it receives a notice under section 2. Amendment No. 27 states that a carer's assessment should be carried out either when it has been requested by a carer—in response to the hon. Member for Sutton and Cheam (Mr. Burstow), I can say that we have issued section 7 guidance, alongside the Carers and Disabled Children Act 2000, which outlines carers' entitlement to be informed about their right to assessment—or when a carer has had an assessment in the previous year, in order to check whether the carer's needs have changed or to identify those services specifically necessary for the safe discharge of the person cared for.

The amendments therefore mean that if any carer's services necessary for a safe discharge are not in place by the end of the relevant day, the local authority will incur a charge in the same way as if community care services were not in place, and provide a strong incentive for local authorities to ensure that the needs of the carer are given priority when the patient discharge from hospital is being arranged.

I am pleased to say that the amendments are strongly supported by Carers UK, which rightly raised the concerns that I have outlined. It believes that they will do much to improve current practice with respect to carers and hospital discharge. The amendments will ensure that carers' needs are taken into account, looking holistically at what they realistically can and cannot manage, and that services are put in place to meet those needs prior to the patient's discharge from hospital.

The hon. Member for Sutton and Cheam raised a point that I made in Committee: that, although services are provided free to individuals, under the Bill as drafted equivalent services provided to a carer would not also be free. Amendment No. 36 rectifies that error, which has the effect that, although local authorities will no longer be able to charge individuals for the provision of certain community care services, they will still be able to charge their carers. It was never our intention that local authorities should remain able to charge carers for the same services that could be provided free of charge to the individuals themselves. The amendment will ensure that those services, whether provided to carers or to individuals, will be free in a similar way.

Given those Government amendments, I agree with my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) that new clause 3 is otiose. It seeks to overload the Bill with unnecessary definitions. The definitions in the first two subsections are taken into consideration by Government amendments. Subsections (3) and (4) place further duties on local authorities that are unnecessary and achieve nothing over and above what the Government have achieved through their amendments.

The Carers and Disabled Children Act 2000 already provides that carers are entitled to request assessment of their ability to provide care, and I can assure hon. Members that statutory guidance on the Act will state that carers are entitled to be informed that they have that right.

Similarly, section 1 of the Carers (Recognition and Services) Act 1995 already provides that the local authority is under a duty to take into account the results of any assessment of the carer's ability to provide care when deciding what community care services it will provide to the person cared for. It is unnecessary to repeat that duty here. The single assessment process and the hospital discharge workbook will also reinforce that good practice.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

On the publication of the workbook, it has been almost two years since the Government first said that they were working on revising it. Is it the case that the Department has not done the necessary work to enable the workbook to be published sooner because it has been distracted by drafting this Bill?

Jacqui Smith (Labour, Redditch)

No, that is not the case. Secondly, legislation that ensures that older people get out of hospital more quickly and get the care that they need when they need it is not a distraction. I consider it a rather important part of Government business.

The hon. Member for Sutton and Cheam repeated quite a few of the discussions that we had in Committee. First, on the concern about levels of readmission, may I emphasise for hon. Members the points that I made earlier? While the Government have had considerable success in reducing levels of delayed discharge, levels of readmission have remained pretty stable. We also know, for example, that more than a third of local areas have below average rates of delayed discharge and below average rates of emergency readmission. That shows that it is possible to perform well on both indicators. As I have said before, however, we take that potential risk seriously, which is why we will be covering it in the hospital discharge workbook and the statutory guidance that we will publish alongside the Bill. Both will make it clear that discharge must be properly planned, patients must not be discharged until it is safe to do so, hospitals will be judged, and, therefore, rewarded on the basis of their ability to control readmission rates, and, under new financial flows, acute trusts will not receive funding for patients who are readmitted to hospital within a certain period. A financial incentive therefore exists for those trusts to ensure that a patient is genuinely ready for discharge before leaving an acute hospital bed.

The hon. Member for Sutton and Cheam also raised concerns about whether patients in the community will be disadvantaged. Perhaps I could remind hon. Members of the context within which the Government propose to introduce this legislation: one of significant extra funding for older people's services. That will provide additional carer services, as I have spelled out, 500,000 more pieces of community equipment, 70,000 more social care intermediate care services, and 30,000 more home care services of five or more hours a week. If the hon. Gentleman's point is that, given the inheritance of the previous Government's spending on local authority social services, social services departments have had a difficult job, I agree. This Government, however, are significantly increasing investment in ensuring that social services departments can provide precisely the sort of community alternatives and support necessary for people to come safely out of hospital and to be where they tell us that they want to be—in their own home or in extra care supported accommodation. In that context, it is also right to ensure that the responsibilities of local authorities are carried out in a timely fashion and that older people are placed at the centre of care and not relegated to being trapped in hospital, a practice that Opposition Members would seem to want us to continue.

My hon. Friend the Member for Nottingham, South (Alan Simpson) made some important points about the need to ensure that action is taken on fuel poverty for older people in particular, and that people have the kind of changes made to their homes that enable them to continue living in them and to keep well. I assure him that, for example, my Department's XKeep Warm Keep Well" campaign, in partnership with Help the Aged, Age Concern, National Energy Action, the Women's Royal Voluntary Service, the Department for Environment, Food and Rural Affairs and the Department for Work and Pensions, which was launched again this year, provides an advice line, a free winter guide and advice about financial assistance available, such as that offered by the warm front team, which helps people to heat and insulate their homes.

I also assure my hon. Friend that the Department of Health is, for the first time, investing more money in home improvement agencies precisely to make some of the changes to housing that will enable people to leave hospital more safely. We are also investing in intensive home care packages and extra care accommodation, which may well provide a safer and more secure environment for older people while allowing them to maintain their independence.

Let us consider consent and involvement. It is important to involve and inform patients and carers and obtain consent when appropriate. However, as my hon. Friend the Member for Sheffield, Heeley (Ms Munn) rightly pointed out, the Bill does not alter existing legal or good practice requirements for social services or the NHS to inform, involve and, when necessary, obtain patients' or carers' consent.

Amendment No. 41A proposes that local authorities should consult patients and carers before informing social services of a possible community care need and obtain their consent to that notification. When exercising their functions, the NHS and social services must give people all proper information to enable them to decide whether to accept care or services. Those fundamental duties stem from their status as public bodies that exercise public functions. Of course, good practice dictates that the patient should be kept informed and consulted at all stages of the assessment process. The statutory guidance for the Bill will also make it plain that patients, carers and families should be kept fully informed and consulted at every stage of the discharge process.

The revised hospital discharge workbook includes a chapter specifically on patient and carer involvement. We expect the NHS and social services staff to follow it. However, the Bill does not alter the existing right of the NHS to notify social services of a person's need of such services. I do not believe that giving people a veto over the ability of the NHS to notify social services will help us either to provide the sort of care that people need to leave hospital safely or to plan better the care that especially older people require. The Committee accepted that that early notification of social services would help everybody to plan such care better.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Will the Minister confirm whether the regulations under clause 2(4)(a) that deal with notification include carers? Will carers and patients be notified?

Jacqui Smith (Labour, Redditch)

I assure the hon. Gentleman that we believe that the need to involve carers is crucial. That will be spelt out in the statutory guidance and the hospital discharge workbook. However, it may not be possible to give carers the same legal right as patients when patient confidentiality is involved.

Glenda Jackson (Labour, Hampstead and Highgate)

Could a carer or a patient veto a plan that cannot be provided locally? If there is no carer and the patient is incapable of making a decision, will there be an advocate? There should be an advocate for an individual who cannot make decisions. Will the advocate be informed of the plan?

Jacqui Smith (Labour, Redditch)

My hon. Friend raises several issues. Circumstances in which people cannot get the care that they need locally are partly due to existing provision and investment. A key purpose of the measure is to ensure investment in providing local alternatives. Of course, carers' rights to ask for an assessment of their needs, and to have that taken into consideration when the care plan for the older person is prepared, remain in place. In fact, as I suggested, the position will be improved by some of the Government amendments.

Of course, individuals' rights to raise concerns about the package put together by a social services department remain through the complaints system as well. Therefore, while I am not sure I can give my hon. Friend all the reassurance that she wants, I can reiterate that nothing in the Bill removes rights that currently exist, and in fact the Government amendments will improve the position of carers with respect to their role in discharge. 4 pm

John Bercow (Conservative, Buckingham)

Will the regulations covering the form and content of notices be subject to the affirmative procedure of the House or to its negative counterpart?

Jacqui Smith (Labour, Redditch)

As I said in the letter that I wrote to members of the Committee, in all of those cases they will be subject to the negative procedure. We had quite a lengthy discussion about this matter in Committee.

I move on to Opposition amendments Nos. 2, 3, 4 and 5.

Amendment No. 2 is unnecessary. It would require the NHS to inform the patient and carer of the proposed discharge date. This of course should be covered in guidance and is not something that it is necessary to state in the Bill. Throughout guidance to the NHS, since Patient and Public Involvement in the NHS, published in 1999, and including the new hospital discharge workbook, we have made it clear that that sort of information should be provided to both patients and carers. Any guidance for the Bill will make it clear that the patient is to be provided with information and advice throughout the discharge process.

Amendment No. 3 seeks to place on the NHS a duty to gain a patient's consent to services being provided following discharge. Just as with any treatment provided by the NHS, a patient has the right to withhold consent to services that the NHS plans to provide when the patient leaves hospital. The Bill does not alter the existing requirement for the NHS to gain this consent when discussing with the patient his or her future care.

Amendment No. 4 seeks to place on the NHS a duty to involve carers. I have covered that in the points that I have made so far.

The proposals in amendment No. 5 are already standard practice, most recently emphasised in statutory guidance on the single assessment process and fair access to care services. The amendment proposes that social services must inform patients of the cost of care plans—presumably, the cost to the individual. Social services must already, in exercising their functions, give all proper information to the person so that he or she can make an informed decision as to whether or not to accept services. That includes information about the costs of any care that they will receive. That has been part of statutory guidance to councils since at least the 1991 community care changes.

I have outlined where existing legislation remains to safeguard the position with respect to the consent and the rights of both patients and carers, and I have outlined how the Government action being taken today will improve the position of carers. I hope that I have provided some reassurance to hon. Members. I have also outlined the position with respect to both the hospital discharge book and the statutory guidance to be published alongside the Bill, and the emphasis that that will place on ensuring that patients and carers are fully consulted.

The hon. Member for Sutton and Cheam raised specific points about continuing care that I think we covered in Committee. As to his question whether someone involved in a dispute over the right to continuing care would be able to remain in hospital, I think I gave that assurance in Committee. I would add that of course, as we have made very clear, the first decision that should be made in the assessment process is whether patients are eligible and entitled to NHS continuing care, and clearly if they are there will be no responsibility on the social services department. If patients want to dispute that, they can appeal to the continuing care panel. We are currently producing directions to strategic health authorities to outline the need to ensure that they produce continuing care criteria and that any such decision is taken very quickly, within two weeks.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I want to ask the Minister two questions. First, can she confirm therefore whether there will be a charge, or fine, to the local authority during the appeal process on continuing care? Secondly, can she confirm whether the Department will follow the health service ombudsman's requirements for individual health authorities to carry out trawls to find those people who have been wrongfully denied access to free continuing care?

Jacqui Smith (Labour, Redditch)

On the first question, the Bill makes it clear that a charge would apply only if there were no social services provision in place; therefore, if health service provision were also not in place, a fine would not exist.

Simon Burns (Conservative, West Chelmsford)

A fine.

Jacqui Smith (Labour, Redditch)

The hon. Gentleman has succeeded.

Clearly, to reinforce a point that I made earlier, people also have the right to stay in hospital while decisions about the continuing care criteria are made.

On the question about health service ombudsman cases, my understanding is that those final judgments have not yet been produced. Clearly, it would be important to take those judgments into consideration as strategic health authorities determine their continuing care criteria.

Government amendment No. 37 will make it clear that personal care may not be provided free for more than six weeks. As my hon. Friend the Member for Sheffield, Heeley made clear in her contribution, this is a matter of choice. As a Government, we have made a choice to spend significant new resources on improving the equality and range of care services provided to older people, providing services that deliver what most older people say that they want: independence, support in their own homes, services tailored to their needs and not to remain in hospital unnecessarily when they can be cared for elsewhere.

When I suggested that this is about choice, the hon. Member for Sutton and Cheam said from a sedentary position that the Liberal Democrats have made a different choice from that of the Government, so he has a responsibility to explain to his constituents that they would not therefore benefit from what we have decided to spend the extra #1 billion on: 130,000 additional carer services, 500,000 more pieces of community equipment, 70,000 more intermediate care places, 30,000 more home care places, 6,000 more residential care places supported by councils and nearly 7,000 extra care housing places.

I am afraid that government is about making choices. The Government have chosen to extend choice, opportunity and services. The Bill will ensure that that extra investment is spent for the benefit of older people, so that they receive the right care at the right time and in the right place.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Having listened very carefully to what the Minister has had to say in response to this group of amendments, I wish to say briefly that it is our clear view that the Government have not addressed our main concern: the onus should be on social services departments to ensure that assessments are given to carers; they should not have to ask for them. We do not accept the Government's argument, so we wish to press the motion to a Division and, later, to vote on Government amendment No. 37.

New Clause 5 — Action Plans and Joint Local Protocols

Patsy Calton (Liberal Democrat, Cheadle)

I beg to move, That the clause be read a Second time.

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

With this it will be convenient to discuss the following: new clause 6—Written discharge plan—

'.—(1) Further to the fulfilment of the requirements under section 3(3)(a) and (b) a written discharge plan shall be produced and taken to include—

(a) an assessment of community needs within the meaning of section 47 of the National Health Service and Community Care Act 1990, and arrangements for aftercare; and

(b) where the patient has an intending carer, within the meaning of section 1(1)(b) of the Carers (Recognition and Services) Act 1995, an assessment in compliance with section 1 of that Act.

(2) Regulations may prescribe the form of a written discharge plan.'.

Government amendment No. 26.

Amendment No. 42, in page 2, line 19, at end insert—

'(1a) The form of a written discharge plan.'.

Government amendment No. 31.

Amendment No. 43, in page 3, line 11, at end insert—

'(2a) The form of a written discharge plan.'.

Patsy Calton (Liberal Democrat, Cheadle)

New clause 5 is intended to enhance joint working. The thrust of the Bill has been to disturb absolutely everyone who has anything to do with this area of work. All the organisations have expressed the view that the Minister's planning measures will worsen joint working arrangements. We want joint action plans, joint protocols between social services and other agencies, joint targets and joint administration arrangements. The new clause would ensure that there would be a named person to co-ordinate the patient journey, and that joint planning would take place on how fines or payments were used to encourage a whole-system approach.

Subsection (2) of the new clause states:

XAn action plan under subsection (1) above is a document drawn up by the relevant bodies specifying action intended to reduce delayed discharges".

Let me ask the Minister a question to which I have still not had a reply so far, although it was asked in Committee. Has the Secretary of State or the Minister assessed the success of plans that had to be submitted by social services departments last August to reduce delayed discharges? A special grant report was produced in July 2002, and we heard then that money was being made available. We still do not know whether the plans made then have benefited the situation. We believe that the Bill is premature, given that measures introduced only in this financial year remain to be properly assessed.

New clause 6 would require the preparation of a written discharge plan that would include an assessment of community needs, arrangements for after care, and carers. I listened to what the Minister said earlier, and have been somewhat reassured, so I shall not rehearse all the points raised by carers organisations and Age Concern. However, those organisations have been in touch with all hon. Members and have made it clear that they are unhappy with what is being proposed.

Government amendment No. 26 deals with the bodies that appear to the NHS to be the ones to which notice is supposed to be given. We are concerned that all decisions will rest, arbitrarily, with the NHS. Because the amendment allows for no give and take, the process will be all one way.

Amendments Nos. 42 and 43 are consequential on new clauses 5 and 6. Government amendment No. 31 would require consultation to ensure safe discharge, but does not say when the consultation should take place. Would it be before the section 2 notice is served, or after?

I look forward to the Minister's responses to the questions that I have raised.

Simon Burns (Conservative, West Chelmsford)

One of the main problems that Opposition Members have with the Bill is that we believe that the imposition of fines would have a damaging impact. I am glad that the Minister has come to accept that the word Xfines" properly defines what the Government propose. The Secretary of State used the word Xfines" in the House on 11 December so perhaps, after that slap on the wrist, the Minister decided that she would have to swallow her pride and accept that fines are what the Bill is all about.

The Opposition have always argued that the introduction of fines would disrupt and have an adverse impact on the discharge process, and that it would seriously damage the partnerships built up over the past decade or 15 years, when the NHS and social service departments have worked more closely together. That closer working has been a genuine and positive step forward, and has helped to create a seamless service that will be undermined and adversely affected by the fining proposals in the Bill.

I appreciate the motives behind new clauses 5 and 6. They are meant to protect and encourage joint working, but they are far too bureaucratic and costly to warrant inclusion on the face of the Bill. For that reason, I believe that more work needs to be done. I support the broad aims and aspirations of the new clauses, but the clauses themselves are the wrong vehicles, for the reasons that I have given. So I warn the Government that we will certainly want to look at the issue in another place and try to come up with proposals that will advance and enhance joint working, but not in such a bureaucratic and costly way. For that reason, I fear that I shall not be able to support the new clauses.

Jacqui Smith (Labour, Redditch)

That was a pretty short-lived consensus between the Opposition parties.

I agree with the analysis by the hon. Member for West Chelmsford of new clause 5 in particular. It is designed to impose another layer of bureaucracy on the NHS and social services; it is a planner's charter. The sum total of the Liberal Democrat approach to the matter is to come up with the idea that producing a few more plans would somehow help us to ensure that older people received the care that they deserve. I do not believe that that will do the trick, and it is of course just what staff on the front line do not want.

We in the Department have worked hard to reduce and streamline the planning requirements on the NHS and social services. We have been removing the requirement for social services to submit plans to central Government as part of grant conditions or other monitoring, so that the number of plans submitted will reduce from 13 to two between 2001–02 and 2002–03. A new gateway procedure was introduced in December to reduce the planning burden on the NHS and ensure that the focus is on core priorities.

The hon. Member for Cheadle asked what assessment we have made of the plans. My definition of success is the difference that we have made to the people who depend on the service. For that reason, the fact that we have been successful in reducing the number of delayed discharges of patients of all ages from 7,065 in September 2001 to 5,385 in September 2002 is much more important than whether somebody has produced an elegant plan.

Patsy Calton (Liberal Democrat, Cheadle)

I am somewhat surprised to hear that the Minister does not think that plans are such a good idea, given that they were precisely what social services departments were asked to produce last July. I agree that the proof of the pudding is in the eating. I suspect that September 2002 was too soon to make a judgment, but I shall leave that to her.

Jacqui Smith (Labour, Redditch)

The hon. Lady has reinforced her position as planning supremo for the Liberal Democrat party.

Suggesting that we can solve the problem with planning is very much at odds with the approach that we are trying to take. In XDelivering the NHS Plan", for example, we pointed out that, although ring-fenced grants—the #300 million—and close central monitoring had brought about a significant drop in the number of delays, such top-down targeting was not sustainable. It does not fit with the new approach in the NHS and local government of devolving responsibility and earning autonomy through good performance.

The publication in October of the priorities and planning framework for the NHS and social services set clear priorities for the next three years so that local partnerships can plan with confidence.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Has the Minister withdrawn the guidance, XReflecting the True Patient Experience", issued by the Department in 2001, which did require NHS chief executives and directors of social services to draw up joint protocols around discharge, to minimise waiting times and so on? Given that that requirement was part of the guidance then, what was wrong with that? Why have the Government withdrawn it? Have they withdrawn it?

Jacqui Smith (Labour, Redditch)

I do not think that I am wrong when I say that we have not withdrawn that. If the hon. Gentleman is saying that at a local level it is a good idea for partners to work together and develop protocols, I have no argument with that. I do have an argument with the Liberal Democrat approach, which appears to consist of opposing what the Government propose in the Bill and supposing that we shall solve the problem merely by asking for a few more plans and protocols. I identify that as a weakness of new clause 5.

The hon. Members for West Chelmsford and for Cheadle both mentioned partnership between health and social care. I agree that partnership is an essential element in delivering the right care for an individual. At the moment, delays can occur because health and social care partners have not communicated very well or because they are unclear or are arguing about responsibility, or even because one is trying to shift costs to the other. The Bill gives areas where partnership is not very well developed the incentive to get all these things right, and to ensure that locally the partnership is totally clear about procedures—who is responsible for which actions.

Much has been said about the Bill damaging partnership, as though partnership was an aim in itself. In fact, the Bill will strengthen partnerships, and strengthen them in order to deliver results. Strong partnerships are based on shared priorities, clearly agreed roles and responsibilities, and a joint commitment to progress, all of which the Bill will strengthen. However, we do not want partnerships for partnership's sake; we do not want partnerships simply to be able to produce a plan. The real test of the partnership is: what is it delivering? Have local people noticed the difference in the services that they receive? The proof of partnership is in delivery, not in planning.

For that reason we have made older people's services a core priority, not by increasing the planning burden but by making this area one of the priority areas for investment and reform. Over the next three years there will be #1 billion of new resources for older people's social care services and for the reform to the system that the Bill will enable us to bring about with respect to delayed discharge.

I address the following point to the hon. Member for Sutton and Cheam (Mr. Burstow). If people locally want to make further detailed local arrangements, that is up to them, but we are introducing the reimbursement system and the new resources because a system of incentives backed up with resources should be more effective than a further raft of plans and protocols. We need to take a proactive approach; the Bill enables us to do so. New clause 5 should be opposed, because it does not fit the need to make a difference or the new approach to devolving responsibility and developing earned autonomy.

New clause 6 would place a further requirement on social services to produce a written discharge plan that must take into account two assessments, once the NHS has notified them of likely patient need for community care services. I suspect unintentionally, the new clause is so drafted that failure by social services to meet those new duties would also act as a trigger to the reimbursement charge if a patient was delayed. I do not believe that we want to create that additional trigger for the charge.

The biggest problem with the amendment is that it is unnecessary. In the first instance, written records of the results of assessments are already standard practice as part of carrying out an assessment under section 47 of the National Health Service and Community Care Act 1990. Clause 3(9) of the Bill already provides that assessments undertaken by social services in receipt of a section 2 notice must be regarded as part of a section 47 assessment, and the section 47 duties still apply. So we expect people to get a written plan outlining what needs to be in place for them to have a safe discharge.

The requirement to include a carer's assessment in the written discharge plan is also not necessary. It is already the case that carers are entitled to request assessment of their ability to provide care, and existing good practice already directs that carers will be fully consulted in the patient's assessment process.

I was a little disappointed by the reason given by the hon. Member for Sutton and Cheam for pushing new clause 3 to the vote. I think that I said specifically that statutory guidance issued around the Carers and Disabled Children Act 2000 had pointed out to local authorities their responsibility to inform individual carers of their right to request an assessment. Local authorities are already required to take account of the results of such an assessment of the carer when deciding what community care services they will provide to the patient.

The provisions of new clause 6 are already covered by current arrangements and new clause 5 would do nothing more than introduce planning requirements with little emphasis on what those would achieve, so I hope that the hon. Member for Cheadle will feel able to withdraw the new clause. If not, I hope that hon. Members will vote against it.

Patsy Calton (Liberal Democrat, Cheadle)

I thank the Minister for tackling some of the issues that I mentioned. Perhaps this was just an omission, but I am concerned that she did not mention our proposal that a named person should co-ordinate the patient journey. The Government have said that they would be in favour of that in other respects and it would be useful if it were a part of the Bill.

I am also concerned that the opportunity to provide for joint planning on how to use payments or fines to encourage a whole-system approach has also been missed. I accept what the Minister says about the preparation of a written discharge plan and I am pleased if that is already expected. Clearly, we think that it is important.

On the assessment for carers, I agree that carers can already request a separate assessment, but all too often that does not happen and the Minister should have some regard to the question of ensuring that it does. It is clear from reading all the evidence from carers that they are not being consulted and assessed every step of the way as they should be.

The Minister said that the Bill would strengthen partnership. In one respect, I think I can agree that it may do so in the sense that it provides a common enemy. Sometimes, a common enemy in the form of the Government may well be what is needed to bring organisations together when they are warring with each other.

Kevin Hughes (Labour, Doncaster North)

Will the hon. Lady give way on that matter?

Patsy Calton (Liberal Democrat, Cheadle)

I have almost finished. That remark was made with tongue in cheek; I hardly think it needs to be taken too seriously.

We would have liked to press the new clause to a vote, but, with your permission, Mr. Deputy Speaker, we will withdraw it, as we understand that time is limited this afternoon and we expect our arguments to be revisited in the other place.

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

Government amendments Nos. 26 to 34 agreed to

Clause 4 — Liability to make Delayed Discharge Payments

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 7, in page 4, line 30, at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—

(a) #120, in the case of a social services authority in, or adjacent to, Greater London, or

(b) #100, in any other area.'.

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

With this it will be convenient to discuss amendment No. 8, in page 4, line 30 [Clause 4], at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—

(a) #12, in the case of a social services authority in, or adjacent to, Greater London, or

(b) #10, in any other area.'.

Simon Burns (Conservative, West Chelmsford)

I want to make it clear at the outset that although I will speak to both amendments in the group, I will press only amendment No. 8 to a Division. Before the Minister has fun at my expense, let me make it clear that the reason why both were tabled is, first, that I do not have the advantage of having the Government's lawyers and draftsmen at my disposal and, secondly, that those in opposition never know in advance which amendments will be selected. To be frank, I thought that even though amendment No. 8 is far more important and relevant to local authorities throughout the country, it would be pushing my luck to presume that it would be selected. You cannot imagine my unbridled joy, Mr. Deputy Speaker, when I noticed yesterday evening that it had been selected.

The nub of the Conservatives' opposition to this nasty and unnecessary Bill is the concept that the Government are introducing fines on local authorities—fines that are across the board in their application, regardless of whether there is any justification for them. As we said in Committee, circumstances will quite frequently arise in which for various reasons it will not be a local authority's fault that a person does not leave a hospital bed and go to either domiciliary or residential care, whichever is the most appropriate, yet the Government are to impose fines of, we understand, #120 per day for those living in London and the south-east, and #100 for those living elsewhere.

We believe that that is wholly the wrong way to try to overcome the problem of bed blocking. Like many outside the House, we believe that the Bill will set the national health service against social services and vice versa, and undo the great strides forward accomplished in the past decade or so in terms of those agencies working together to provide a seamless service for patients. Regardless of the announcement made by the Secretary of State on 11 December of extra money for three years, we believe that the legislation will result in local authorities being penalised financially. Anyone who asks social services departments in England for their estimate of the potential cost to them of the fines will be given a figure that far exceeds the #100 million that the Government are making available.

The departments' estimate also far exceeds the results of the calculations done on the back of an envelope by the hon. Member for Sutton and Cheam (Mr. Burstow), who is no longer in his place. All of us who know the Liberal Democrats know that they never let a fact get in the way of a XFocus" or a press release, especially if that press release can be got into a national newspaper by conning some journalist who does not want to do the research himself—after all, the Liberal Democrats, with their clipboards and their anoraks, are the font of all accuracy in surveys and calculations of a mathematical nature.

Claire Ward (Labour, Watford)

There is a man who has been scarred.

Simon Burns (Conservative, West Chelmsford)

Too right, I have been scarred. I have had to deal with that party for 10 years. Fortunately, the people of West Chelmsford saw through the Liberal Democrats long ago. From getting within 378 votes of capturing Chelmsford in 1983—I might add that that was before I was the candidate—they are now a very poor third behind Labour. The clipboard experience has disappeared from our streets.

Patsy Calton (Liberal Democrat, Cheadle)

I can only think that a figure like 25 per cent. is making a difference. Would the hon. Gentleman like the Liberal Democrats' support for the amendment? I think that it would be useful and perhaps entertaining for us to know.

Simon Burns (Conservative, West Chelmsford)

I shall answer the hon. Lady in two ways. First, on the mathematics, the hon. Lady has proved my point, although I may be arguing unwisely in a way, given that Liberal Democrats can never get any mathematical calculation right. The hon. Lady said 25 per cent. The Government say 20 per cent. I think that the hon. Lady meant 20 per cent. rather than 25 per cent.

Secondly, the hon. Lady asks whether the Conservatives want the hon. Lady's support on the amendment. The Conservative party, for reasons that I am outlining, has produced a first-rate amendment to minimise the damage that the Government can do to social service departments with their fines. I would advise not only Liberal Democrat Members but Members of any Opposition party—and any Labour Member who has listened carefully to their social services department, although given those Members who are in their places, I suspect that they have not—to join us in seeking to help social service departments and other organisations throughout the country so as to ensure that we minimise the damage that the Bill would do to social service departments.

Kevin Hughes (Labour, Doncaster North)

The hon. Gentleman may recall that on Second Reading I produced the figures for Doncaster, which has been working really well on this issue and has an extremely good record. These matters start at the front end, not the back end. Instead of trawling round social service departments looking for negatives, the hon. Gentleman might be better trawling round looking for positives, and asking what will be done to ensure that our constituents receive the treatment that they deserve in hospitals and get out when they no longer need medical treatment.

Simon Burns (Conservative, West Chelmsford)

If the hon. Gentleman were correct in his assumption, his point would be valid, but I can assure him that I did not trawl social services departments for bad news stories. Instead, and at random, I telephoned social services department after social services department. Amazingly—or not amazingly, given the damage that the Bill will do—they all had the same complaint, which was that there would be a problem with fines to some degree.

As for the hon. Gentleman's second point, he is absolutely right. We all want a system whereby people do not have to remain in hospital for a day longer than they otherwise should. Unfortunately and regrettably, owing to a number of circumstances including the crisis in long-term care—the closure of more than 60,000 beds and of 2,000 homes since 1997 and the fact that in certain areas there are not enough beds available—there are bound to be some delayed discharge cases.

None of us wants that. Of course social services departments and the national health service have been seeking to minimise delayed discharges for a considerable time. However, factors beyond their control have thwarted them in achieving anywhere near a 100 per cent. success rate in eliminating the problem. I am saying, as my party is saying—

Kevin Hughes (Labour, Doncaster North)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

No.

We want to come up with positive and sensible ideas to seek to overcome the problem. We do not believe that the best way to achieve that is through fines. That is why to my mind amendment No. 8 is the most attractive alternative within the scope of the Bill. We believe that it will deal with the problem. Bringing down to a more or less nominal level the fines that the Minister is seeking to introduce and including that figure in the Bill would prevent the Chancellor from using the proposals as a new form of stealth tax. Without primary legislation, he could not seek to increase the level annually, or whenever the Government wanted to raise more money.

Kevin Hughes (Labour, Doncaster North)

rose—

Andy Burnham (Labour/Co-operative, Leigh)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

I am sorry, but I cannot.

It is for those reasons that I hope that my right hon. and hon. Friends will join me in the Division Lobby. I further hope that any other hon. Members who care about coming up with positive solutions to the long-term care crisis, and who have said consistently on the Floor of the House and in Committee that they oppose the fining system, will join us in seeking to thwart the Government's intentions.

Patsy Calton (Liberal Democrat, Cheadle)

I shall be very brief. The Liberal Democrats will support the amendment, but in spite of, rather than because of, the arguments advanced by the hon. Member for West Chelmsford (Mr. Burns). I should correct him on one point—I realise that I did not make myself clear: the figure of 25 per cent. referred to the opinion polls, rather than to whatever it was that he thought it referred to.

Jacqui Smith (Labour, Redditch)

I was glad to see some of the Opposition harmony return at the end of the debate. The hon. Member for West Chelmsford (Mr. Burns) was a little unfair. After talking about Liberal Democrat clipboards and anoraks—amusing though that was—he proceeded to talk about his own survey. I do not know whether he used a clipboard; it is more likely that he got someone else to carry out the survey, and perhaps they used a clipboard.

Simon Burns (Conservative, West Chelmsford)

Perhaps I can help the Minister. No, I did not use a clipboard, because I try to distance myself from the Liberal Democrats as much as possible. Directors of social services were telephoned in their offices, and they provided the information. I put it on a piece of paper and added it up, and I got a total. [Interruption.]

Jacqui Smith (Labour, Redditch)

As has just been pointed out, I am sure that the hon. Gentleman would never be seen wearing an anorak, either.

The Bill seeks to provide an incentive for local authorities to supply prompt onward care for patients who are ready to leave hospital by introducing a charge that broadly reflects the cost to the hospital of providing a bed for a delayed patient. We had some lengthy discussions in Committee about the justifiable basis for expecting that, where the responsibility rests with social services departments to provide for a person's needs—usually, it is an older person—it is not unreasonable to expect them to take responsibility for payment as well, given that they will receive the necessary funding from the Government. The alternative is a system that is effectively a fine on the NHS, because the NHS is expected to pay the costs of people whose needs would be better served out of hospital, but who remain in hospital because alternatives are not available in the community. Anybody who opposes that principle must answer the question of whether it is justifiable for the NHS to bear costs for which it has neither legal nor practical responsibility. Nor, indeed, is it best suited to provide that particular form of care.

George Young (Conservative, North West Hampshire)

Let us accept for one moment the principle that the Minister has just enunciated. Why does it not work the other way around? When the NHS imposes costs on social services, why does it not pay them?

Jacqui Smith (Labour, Redditch)

I would be interested to know what examples the right hon. Gentleman has in mind. We explored in detail in Committee the principles of some of the financial incentives that are being introduced into the NHS. I made the point that it is possible to introduce financial incentives through the sort of financial flows work that we will be introducing into the NHS, some of which I spelt out earlier, without legislation. However, the interface between social services and health is such that we need to legislate in order to introduce financial incentives in that context.

I return to my original question, which has not been satisfactorily answered by anybody who opposes the legislation. The incentive is that the daily charge that we propose is higher than the daily costs that the local authority would otherwise incur in providing either residential or domiciliary care for the person in question. I hope that hon. Members will understand that there are very good reasons why the Bill makes no mention of the actual reimbursement charge.

We have chosen to set out the charge in regulations rather than in the Bill, as that will give us greater flexibility to amend the rates in line with inflation or other cost pressures. The hon. Member for West Chelmsford was either on a flight of fancy or lacks understanding about the nature of the charge, which is a transfer from one part of the public system to another reflecting the costs that have been borne. It is not raising money for the Government, but focusing the attention of social services departments on areas in which they already have responsibility and ensuring that they spend the extra investment that the Government are making available to them on the sort of alternatives that older people want to enable them to get out of hospital more quickly.

In the letter that I sent to members of the Standing Committee about the regulations, I spelt out that the charge will be based on the cost to the NHS of providing bed, board and personal care in an acute environment, but having removed indirect overheads and the cost of capital medical input and specialist nursing in order to reflect the lower costs of caring for a patient at the end of a hospital stay when medical needs have been reduced. In most cases, the figure will also represent a higher charge to the local authority than the daily costs of providing community care in a residential setting or in the person's home. Our intention is to remove what sometimes operates as perverse incentive in the system, enabling local authorities not to live up to their responsibilities, with the NHS bearing the costs of people's care because the necessary alternatives are not in place.

In our consultation, we asked whether a charge of #100 a day and #120 in London and the south-east would be appropriate. Responses suggested that that seemed about the right amount to create the incentive that we want. We will issue the regulations for consultation and consider any further responses about the amount of the charge and the boundary for the higher rate.

The hon. Member for West Chelmsford made clear what the amendments are about. They are not a serious attempt to consider the incentive effect or the appropriate level for the charges that will justifiably be put in place. They are simply wrecking amendments that continue for the Opposition the approach on which I commented during the debate on the previous group of amendments but one. Opposition Members are keen to oppose our proposals, but have no ideas about how we can cut delayed discharge. I am afraid that they are therefore letting down the older people who depend on all of us to provide a better system to ensure that they get the right care in the right place.

Simon Burns (Conservative, West Chelmsford)

I listened carefully to the Minister, and it will come as no surprise to the House that I was not convinced by her arguments. Moreover, her comments towards the end of her speech were absolute and unadulterated rubbish. Therefore, I beg to ask leave to withdraw the amendment and I ask my right hon. and hon. Friends to join me in the Lobby in support of amendment No. 8.

Amendment, by leave, withdrawn.

Amendment proposed: No. 8, in page 4, line 30, at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—

(a) #12, in the case of a social services authority in, or adjacent to, Greater London, or

(b) #10, in any other area.'.—[Mr. Burns.]

Clause 6 — Dispute Resolution

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 6, in page 4, line 42, leave out clause 6.

Alan Haselhurst (Deputy Speaker, Saffron Walden)

With this, it will be convenient to consider Government amendment No. 35.

Simon Burns (Conservative, West Chelmsford)

Because of pressure of time, I shall not detain the House for long.

Clause 6 deals with the appeals procedure. I think that seeking to delete it is the right way forward, but not because I believe that there should not be an appeals procedure. I believe that there should, because, given what the Government are doing with fines, there is an urgent need for it; I fear that, as a result of the breakdown of partnerships and working together, the arguing between the health service and social services over whether a fine will be paid will be so intense that an appeals procedure needs to be in place.

What I do not find attractive about the Government's proposal, as many of my right hon. and hon. Friends said in Committee, is that unfortunately the way in which they are going about it is to set up the procedure though the strategic health authorities, so that in effect the health service will be both judge and jury. That cannot be right, in the interests of fairness and justice.

What we have always argued, and what I remain committed to, is that there should be an appeals procedure, but that it should also include social service departments or local authorities on an equal footing with the health service, with an independent chairman—or chair, in the current politically correct language. The Bill would be greatly enhanced by that. Unfortunately, because of the lengthy discussions in Committee, it would not have been in order to re-table the amendment that we proposed in Committee, and regrettably this is the only way in which one can seek to persuade the Government to think again and adopt a more even-handed approach.

I am sure that the Minister will say that it would be nonsense to take the whole appeals procedure out of the Bill, and I would agree. But I should like to persuade her and the House that removing the clause from the Bill now would give the Government time to reflect further on our eminently sensible suggestions of an even-handed approach to an appeals procedure, so that they could reinstate in another place a clause that was more acceptable to my right hon. and hon. Friends and, I suspect, many social service departments, which see this as potentially a fix where justice will not be seen to be done.

For those reasons, I hope that the Government will accept the amendment, solely as a temporary measure while they reflect on introducing their own amendment. If they do not, my noble Friends in another place will be in a position to do so instead.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We rehearsed a lot of these concerns and arguments in Committee before Christmas. The Liberal Democrats fundamentally share the Conservative position: the arrangements for setting up the dispute panels under strategic health authorities do not guarantee the independence of those panels. Indeed, I noticed that, in Committee, the Minister acknowledged the need to reconsider the independence issue. Simply keeping on saying that the chairmen should be independent does not make them independent. She said that she would consider how to secure such independence and

Xhow we guarantee that in the regulations which, like all regulations, will be subject to consultation."—[Official Report, Standing Committee D, 12 December 2002; c. 88.]

I want to dwell on that issue.

The notes that the Minister has circulated, which give a glimpse of what might be covered in the regulations under clause 6, raise a couple of issues, and I hope that she might be able to give us some further information on them. The first point relates to clause 6(2)(a) on the constitution of the panels. Paragraph 24 of the notes says:

XThe regulations can provide that local authority and PCT are represented in equal numbers and that representatives of any organisation involved in the dispute(s) to be discussed at any meeting of the panel are excluded from the panel."

Why has the Department used the word Xcan" in drafting that document? I hope that the Minister can assure us that the regulations will provide for equal numbers of members from local authorities and primary care trusts. It is important to get that confirmation from the Minister today, as that document gives us the opportunity to test further whether that is the intention behind the policy.

The second issue relates to paragraph 22 of the notes, which says:

XThe local authority which received a section 2 notice from the NHS will still need to put in place arrangements for an individual's on-going care within the time frame set out in the legislation, even if a dispute is in progress, or face a payment."

It is not unreasonable to say that someone who needs a package of care should have one arranged. However, if there is a dispute about whether a package of care is needed and that matter goes to the dispute panel, what happens if the panel upholds the social service department's position? Who will reimburse the social services department for the expenditure that it incurs to avoid the fine? If it chooses to pay the fine, will the money be repaid to the department? That is not clear in the details that the Minister has given to us, and it would be helpful if she could clarify that.

Having said all that, we wish to support the Conservative proposal to delete clause 6 simply because that clause will not be effective in ensuring that dispute resolution is fair and free of the bias that will exist if such issues are vested in the NHS.

Glenda Jackson (Labour, Hampstead and Highgate)

I should like to make a brief contribution. I cannot support the argument to remove the clause that relates to appeals panels, nor do I share the somewhat cynical view, voiced by the hon. Members for West Chelmsford (Mr. Burns) and for Sutton and Cheam (Mr. Burstow), that strategic health authorities or primary care trusts are so single-minded and blinkered that they believe that they have to preserve their vested interests, if that is what they perceive their responsibilities to be, to the exclusion of all else. My experience of the individuals in my strategic health authority or, indeed, PCT is that they are more than aware that there has to be particularly close working with social services on such issues to ensure that the patient drives the reforms in the NHS.

I wish to ask my hon. Friend the Minister a question, and I hope that she can reassure me. It would be good if the chairmen of the panels were independent, but whomsoever serves on them, it is important that someone must speak for patients and carers. One of the problems that I have come across in my constituency is that—with the best will in the world—medical professionals often speak to an individual about their illness, or their care requirements once they leave hospital, in a language that is totally foreign to them. It is entirely understandable that they often speak in a form of professional shorthand. There must be brought to bear in the dispute panels an informed perspective of what is being discussed, from the perspective of the health professionals and of those who work within social services, but it is important that the individual or carer at the centre of the discussion should have someone who can speak a language that everyone understands and who can understand the concerns of the individual in the case. I hope that my hon. Friend the Minister will be able to reassure me on this.

Nigel Waterson (Conservative, Eastbourne)

I find myself agreeing with much of what the hon. Member for Hampstead and Highgate (Glenda Jackson) has just said. I hope that that will not cause too much damage to her socialist credentials. She is absolutely right. If nothing else, the Bill is consistent, and anyone with any optimism turning to a clause headed XDispute resolution" is going to be severely disappointed because all that the Bill is concerned about is arguments between two or more public authorities. The words Xpatient" and Xcarer" are simply missing again. This provision involves two faceless bureaucracies fighting it out in front of a panel. That disappointment is reflected in the comments of Age Concern, which states that

Xour concern remains that the Bill does not offer a speedy dispute resolution process for the patient, if they disagree with the discharge plan being offered."

No such process is being proposed here.

I want to raise a few points about the practicalities of the proposals, particularly in view of all the bureaucracy involved, and I endorse some of the points already made on that by the hon. Member for Sutton and Cheam (Mr. Burstow). The proceedings of this panel have the smell of something that could go on for a long time, with all the arguments going on between the public authorities, so there is no prospect of any quick decisions being taken. There is certainly nothing here for the patient or carer who says that what is being proposed for them for today, tomorrow or next week is inappropriate, and who wants someone else to appeal to. I do not believe that that kind of time scale is being envisaged, although if the Minister thinks otherwise, she will no doubt say so.

Amendments were also tabled in Committee at the behest of Age Concern and Help the Aged about having a fast-track complaints process for just this kind of situation, but, as is so often the case nowadays, they did not get debated due to time constraints. Age Concern also reflects concerns that have been expressed by at least two hon. Members in this debate when it asks whether

Xa panel established by a strategic health authority can be independent in resolving disputes between the health service and social services."

It asks the Government

Xto clarify whether the proposed panel's decisions will be binding, or simply for advice only."

It was helpful, up to a point, to have the Minister write to us following the Standing Committee about the likely contents of some of the regulations under the Bill. It was helpful, but it raised a whole series of other questions. Her document talked about the constitution of the panels under clause 6(2)(a), saying:

XThe panel will seek information from the relevant professional staff (hospital, social services, PCT) and from the patient and family"—

here come the key words—

Xif appropriate."

Who can imagine a more damning comment, albeit one buried in the small print, on this legislation? How can any reasonable person envisage a situation in which it would not be appropriate to get information from the patient, the family or any other carer? Will a patient or carer be allowed to address the panel? Will they be allowed to be represented? What sort of evidence will be required? What standards or burdens of proof will be required? How is all that going to be dealt with? If people are still unhappy at the end of these proceedings, will the process be subject to procedures such as judicial review or other complaints procedures within the NHS, or could those procedures take place in parallel with the new arrangements for a panel?

How many layers of dispute resolution are we talking about? Ostensibly, we are discussing a panel hearing, but the document on the likely regulations also says:

XThe regulations could provide, for example, that a panel should not be established to hear a particular case unless the staff involved . . ."—

again, that reflects the Bill's philosophy, which is that it is all to do with the staff and nothing to do with the patient—

Xcannot reach agreement on an informal basis".

There we have alternative dispute resolution, as the lawyers would call it—an informal way of trying to establish a solution to a dispute, although one would hope that that would happen automatically in the real world. The document goes on to talk about the dispute being resolved at

Xa higher management level between the relevant healthcare provider and the local authority."

Those seem to be steps to be addressed before the panel is even convened.

Finally, the document says:

XThe regulations will provide that neither party can take the dispute to court until they have attempted to resolve it via the panel."

What is Xattempted" supposed to mean? How far does the panel have to go in considering all the evidence and all the arguments to allow parties to go on to the next stage of a legal challenge? When we read the small print, we see that we are being asked to establish not only a new bureaucracy and a new panel to determine such matters, but, on the face of it, a series of hoops through which people have to leap, none of which will happen in a hurry.

Jacqui Smith (Labour, Redditch)

I am pleased that the hon. Member for West Chelmsford (Mr. Burns), in moving the amendment, recognised that it is right and responsible to have in place a system for dispute resolution, because, of course, disputes can already exist between health and social services. In fact, it is sometimes precisely because of such disputes that people are delayed inappropriately in hospital. Through the Bill, we are trying to ensure that the relative responsibilities of health and social services are clearly understood and that there is a process to ensure that individuals are not stuck in hospital, losing out because disputes cannot be sorted out.

I am not quite clear whether the hon. Member for Eastbourne (Mr. Waterson) was suggesting that people should not try to settle disputes before they reach the panel. Of course, that is the obvious way to settle them. Many disputes are settled between the staff concerned in an individual case of discharge or by managers from health and social care. Disputes do not inevitably need to be discussed formally by a panel and the guidance will point out that, for reasons of time and resources, it is desirable to have a system under which two public bodies are encouraged to reach an amicable agreement rather than have constant recourse to the panel.

Senior health and social services managers want to resolve matters, wherever possible, before spending time on dispute mechanisms, but we need a body that can arbitrate to achieve a satisfactory resolution if informal attempts to resolve problems are unsuccessful. In England, we think that the right body for that is the strategic health authority. The hon. Member for West Chelmsford repeated some of his concerns about whether that will create a bias to the NHS. I do not believe that it will. It is a practical response to the situation and the system.

Strategic health authorities are, as the House would expect, strategic bodies. They do not have operational responsibility and they will not be running the acute hospital trusts that may be involved in a dispute. They have a performance management function one step removed from the day-to-day workings of the NHS. There is no equivalent strategic body for councils, so it makes sense for strategic authorities to be the bodies with responsibility for setting up the panels. They also have an interest in ensuring that acute trusts and PCTs meet their obligations, but not through rewarding the NHS at the expense of local authorities.

I hope that I can reassure Members that the intention is that the panel will be composed of a local authority and an NHS representative with an independent chair. I have confidence in the integrity of the people who will be appointed to that panel. Being charged with such a function, the panels will of course have to act properly and in accordance with the rules of natural justice . The regulations will ensure that panel members are not from the bodies that are in dispute, and that the chair is independent of both NHS and local authority. There is no reason to suppose, therefore, that the panel will look more favourably on the NHS than on local councils.

The regulations will also cover situations in which not all the bodies in dispute are located in the same strategic health authority. They will probably follow a simple rule, such as the rule that a dispute should be heard by the panel of the strategic health authority in whose area the hospital is situated.

Several Members have asked about the particular rights of individuals. Clause 6 does not affect an individual's right to complain to either the NHS or social services about the care he or she has received, using the normal complaints procedures already established, or to take legal action in the courts. The panels are not being established to divert individuals from the complaints procedures—although when they or their families have information that may help to resolve a dispute, they may be involved.

Perhaps I can give some reassurance, at least to my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson), by describing some of the improved safeguards—especially those relating to advocacy, about which my hon. Friend was concerned. Individuals wanting to know whether they should receive fully funded continuing NHS care should be informed as part of the assessment process. As I said earlier, the single assessment process and all other guidance make it clear that that is the first question NHS and social services need to consider when assessing the ongoing needs of someone who, potentially, has a primary need for health care. If an individual wishes to dispute an NHS decision that he or she is not a case for fully funded NHS care, the decision should be made within two weeks, and the individual can remain in hospital while the continuing care panel considers the case.

If individuals wish to complain about the services offered by social services departments, that should be dealt with by the social services complaints system, which was established to enable individuals to make such representations. If they are not satisfied with the local authority's response, they can go to the local government ombudsman. If they are concerned about the whole care package and about whether it is safe for them to return home with that package, they should be able to raise that at an early stage with both NHS and social services representatives.

The current system requires all trusts to have patient advocacy liaison services to give exactly the kind of support demanded by my hon. Friend. People raising what will clearly be difficult issues may well need such support. The representatives I have mentioned may be able to change the package, or to reassure patients and their families about its adequacy. There may be further recourse to the complaints provision, which will depend on the nature of the concerns involved.

I hope I have reassured Members that our proposals are logical and sensible. I am not suggesting that the complaints procedure should be biased in favour of the health service; I am saying that the strategic health authority is the appropriate body to convene the complaints panel, which itself will be represented equally by the NHS and local authorities. It will also have an independent chair. Nothing about the panel will undermine what I agree is the important ability of individuals to raise concerns and complain when that is necessary.

Simon Burns (Conservative, West Chelmsford)

I listened carefully to the Minister, and I appreciate that she is seeking to reassure the House, but I remain unreassured. I get the impression that she is talking about an idealised world, but things do not work out that way in the real world. We should improve the Bill now rather than repent when it is too late.

No one doubts that dispute panels are needed. Heaven knows, we will need them if the Bill becomes law. However, I am still worried about making them the responsibility of the strategic health authorities—in other words, the NHS, which has half of the vested interest in the problem. Even if every panel reached a judgment of Solomon in 100 per cent. of cases, the suspicion would remain among individuals and social services departments, if they did not like the decision that was reached, that a fair decision was impossible because of the way the panel was set up.

I do not believe that there is a major difference between us on this matter, but I do not understand why the Minister has not agreed to bring the local authorities in to work on an equal footing with the strategic health authorities on the panels, subject to the regulations to be issued by the Minister. No accusation that the Government had fixed the system—and made the NHS, through the strategic health authorities, the judge and jury in a dispute—would then have an iota of justification.

I should have thought that the Minister would welcome my advice. I am only trying to help to improve and enhance a rotten Bill. Despite my entreaties, it seems that the Minister is not going to budge. I am hurt about that, but it is an unfortunate fact. As a result, I intend to press the amendment to a Division. I invite my hon. Friends to join me in the Aye Lobby in an attempt to save the Minister from herself.

Clause 12 — Free Provision of Certain Community Care Services

Jacqui Smith (Labour, Redditch)

I beg to move, That the Bill be now read the Third time.

Throughout Second Reading, in Committee and during today's deliberations, we have given this Bill fair and measured consideration, and I want to thank all who were involved in Committee for that. Combined with a significant package of extra funding for older people's services, the Bill will bring an end to widespread delayed discharges, and ensure that older people get the services that they need when they need them. It is a Bill that is about the approximately 5,000 mainly elderly people who are delayed unnecessarily in an acute hospital bed. We know that an acute ward is very much the wrong place for someone to be when they are no longer in need of acute hospital care. To be delayed on an acute ward is demoralising for the individual; it can damage their confidence and their prospects for living independently or returning home in future. It is worrying for their families and carers, and bad for the taxpayer and the NHS, and that is why we are determined to tackle the problem.

We have made progress. Fewer people are delayed in hospital now than in 1997, but each person stuck in hospital when they want to be out is an argument for change. Throughout the passage of the Bill, Opposition Members have been quick to oppose but slow to suggest alternatives. As we have heard this afternoon, the Liberal Democrats propose lots of plans, but they have been short on solutions. We know that the Conservatives, who we have learned are the new-found friends of local government, oppose the extra investment that the Government propose—they voted against it—but they cannot even claim to be reformers. In their opposition to the Bill, they certainly cannot claim to be the friends of older people.

The Bill reflects our determination to match our extra investment with reform of the system to ensure that the needs of older people come first. It will do that, first, by creating a strong financial incentive for local authorities to comply with their existing duties to assist the needs of individuals who are likely to need community care services on discharge from hospital and to provide services to those individuals.

Secondly, the Bill strengthens partnerships and brings about increased co-operation between the NHS and local authorities by introducing new duties for them to consult each other in assessing the patient's needs and deciding what services they will make available within set time scales.

Thirdly, by removing local authorities' power to charge for community equipment and intermediate care, the Bill simplifies the existing charging system, making it easier for users to understand and easier for local authorities and the NHS to provide those vital services jointly. Contrary to the concern that has been expressed today about partnership between health and local authorities, I believe that the Bill will lead to increased co-operation and joint working. For the first time, there will be a strong incentive for partners to get together to ensure that their discharge procedures work.

In certain ways, the Bill is already having a positive impact. Local authorities and their NHS partners are coming together in order to find common solutions to common problems and acknowledging the different parts that they have to play in achieving success. We know that planning for the implementation of reimbursement has led many partners to agree, for example, that they need to speed up their plans to implement fully a single assessment process. I feel confident that with so much good work and innovation already going on around the country, by the time reimbursement is implemented later this year, many local authorities and their NHS partners will have been able to find new and creative solutions to the problem of delayed discharge.

Opposition Members have worked hard during the Bill's passage to paint local authorities as victims. In fact, there is only one victim—the older people who are stuck in hospital when they should be out there getting the sort of services and support that we know they want and deserve. Let us be clear: the Bill does not place new responsibilities on local authorities. It simply seeks to add maximum time scales for the assessment and provision of services for which local authorities already have responsibility and places communications between a hospital and a local authority about a patient's case on a formal legal basis.

Of course, the Bill places new responsibilities on the NHS to inform local authorities when someone may need ongoing care in order to leave hospital and when people are fit to be discharged. We know that the NHS has not always taken its responsibilities to communicate with social services departments as seriously as it should. The Bill rectifies that and places the responsibility for payment where the responsibility for provision already lies.

As I have said already, these are not new responsibilities. Councils have had 18 months and #300 million in building care capacity grant, which has provided vital funding for councils to invest in the services and capacity needed to prevent delays. That investment has brought results. Almost 7,000 older people were trapped in hospital in March 1997, but by September last year that level had been reduced to 4,147. However, we have recognised that there are funding pressures for social services. That is why, in addition to the #1 billion package for older people announced on 23 July and the local government allocation announced on 5 December, on Second Reading my right hon. Friend the Secretary of State announced that an extra #100 million per full year of the scheme will be transferred from the NHS budget to local authorities in order to help them to build the capacity that will help them to avoid the costs of reimbursement and, most importantly, ensure that people will get the services that they need.

There has quite rightly been a focus during our debates here and in Committee on the needs of individual patients and their carers. That is right, because it is that focus that is at the centre of the Bill.

As I have explained this afternoon, the Bill does nothing to weaken a patient's right to consent or not to treatment. By creating a financial incentive for local authorities to carry out their duties, it will help to ensure that the needs of individual patients are met more quickly, and it will increase the choice that is available to them in terms of the services that they receive.

In the amendments that we have tabled today we have recognised the concerns about the needs and role of carers. We have also ensured that carers' services for discharge will need to be in place and that carers can benefit from free community equipment where they need it for their caring.

Reimbursement and other proposals in the Bill will lead to increased quality and choice for older people. If local authorities are to avoid delays, in the long term they will need to use the extra investment made available by the Government to invest in a wide range of services and capacity so that they can respond flexibly to an individual's needs, not just with residential care but also with intermediate and interim care, extra sheltered housing, equipment and adaptation services, and packages of intensive support at home, among other provisions.

The Bill presents an important opportunity to end widespread delayed discharge and to ensure that thousands of older people do not wait needlessly on an acute ward every day but are provided with a range of high quality community care services to meet their needs as soon as they are ready to leave. Ultimately, a safe transfer from an acute ward to a place where their needs can be more appropriately met is the minimum that older people should be entitled to and expect. That is what the Bill will ensure happens and I commend it to the House.

Simon Burns (Conservative, West Chelmsford)

To listen to the Minister, one might think that the Bill, which has almost completed its passage through this House, had emanated from a group of young Labour researchers meeting in some chi-chi wine bar in Islington, who, as the chardonnay got to them, thought they had come up with the most wonderful wheeze to deal at a stroke with the problem of delayed discharges. More worryingly, it seems that when they awoke the next morning they did not realise that the hazy wheeze of the night before was not such a good idea, and proceeded to pass the idea on to Ministers who, desperate for a quick fix, immediately embraced their ridiculous proposal and got the parliamentary draftsmen to produce a Bill which the Minister tells us is a series of incentives. We all know that the Bill is not a series of incentives: it is a straightforward system to fine local authorities.

On 11 December 2002, the Secretary of State gave the game away when, in answer to an hon. Member's question on a statement in the House, he referred quite blatantly to fines. The Minister, heroically—partly, I suspect, because she does not read Hansard on a daily basis—continued to maintain the myth that the Bill was an incentive measure. Even she finally slipped up today. She saw truth staring her in the face and the F-word passed her lips. She admitted that the Bill was a series of measures to fine local authorities.

What is so deeply disturbing about the Bill and the complacency of Ministers in the Department of Health is that the Bill in no shape or form recognises the crisis in long-term care in Britain—a crisis that has been gathering speed since 1997. Nowhere does the Bill address the problem of the loss of more than 60,000 care home beds, the closure of more than 2,000 care homes, or the fact that 100,000 households are no longer receiving domiciliary care compared with five years ago. That is what is so disgraceful about the Bill. It is a wasted opportunity.

By creating a system in part 1 that will effectively bamboozle local authorities into ensuring that patients are discharged from hospitals to avoid a fine, the Government think they have found a panacea, whereas in fact it is a short-term fix that will end in disaster. I predict now that in the next two years readmission rates for elderly people leaving hospital will increase at a higher level than the current rises. People will be taken from hospital and placed in what is not necessarily the most appropriate care for their needs because the local authority may be charged a fine.

The Government have got it wrong; that is not the right approach. As hon. Members have said, it will undo and damage partnerships between the health service and social services, which have taken a long time to achieve because of natural problems and jealousies in relation to who is responsible for funding. Under the previous Government—and, to their credit, this Government—the process of breaking down the barriers between the health service and social services has moved significantly forward, which is to be welcomed. This Bill will do great damage to that process, as it will create tensions between the two sides and reintroduce a blame culture that we all hoped was being banished as a thing of the past.

Although the Government have made money available for three years for local authorities to try to offset, in theory, the impact that the fines will have on social service funding and spending, there are also problems with that, as the fines are to be introduced on 1 April this year, as is the money. If we had had more time on Report we could have debated this matter, but if the money is to come in on 1 April 2003, and if the legislation is passed and the Government proceed with their cock-eyed scheme, the policy should have been to introduce the fines in April 2004 to give local authorities a 12-month breathing space to seek to resolve further the problems of delayed discharges. Bringing in those measures at the same time is a mistake. In addition, I believe that the money that the Government are making available will not match the level of fines that local authorities think they may incur, particularly in the early stages of the new policy.

For all of those reasons, I remain implacably opposed to part 1 of the Bill. I am disappointed that the Government have not been prepared to listen more carefully to those who oppose the Bill and who have highlighted its failings. I am a realist—I know my lot in life—and I understand that the Minister of State, charming as she is, will not necessarily listen to my helpful advice. But she does not have to listen to my advice: from her point of view, there are far more credible critics of this policy. There are Back-Bench Labour Members with great experience of social services and local government or the health service who are gravely concerned about this aspect of the Bill. There is the Local Government Association, whose leader, Sir Jeremy Beecham, unless I am wrong, is the Labour leader of Newcastle city council. There are most of the voluntary groups and charity groups in the long-term care sector. The care home owner associations and operators also believe that the Bill is a disaster. Many local authorities throughout the country genuinely believe that the Government are wrong and that the Bill will not solve the problems that they expect it to tackle.

I do not know whether the Minister has had an opportunity to phone social services departments in England and Wales. My office had a charming conversation with her social services department. We also contacted that of the Under-Secretary, the hon. Member for Salford (Ms Blears) and of the other Minister of State. We even spoke to the social services department in the Prime Minister's constituency. Not one had a smidgen of enthusiasm for fines, and they were worried about the amount that they might have to pay in fines in the next 12 months. Despite that, Ministers have not been prepared to reconsider.

We are now beginning the last 25 minutes of debate in the House on this nasty and flawed measure. Of course, it will leave the House with a majority in the next hour and go to another place. I assure the Minister that we shall continue to oppose it there, because we believe that there is a serious problem that needs tackling. I agree with her that the real losers are the patients who experience delayed discharge from hospital. However, the Bill is not the way in which to help them and minimise the problem. I therefore urge my hon. Friends to join me in vehemently opposing Third Reading.

David Hinchliffe (Labour, Wakefield)

The Government deserve much credit for the steps that they have taken and the measures that they have introduced to improve collaborative working between health and social services departments. However, the Bill does not deserve credit and I agree with some of the points that the hon. Member for West Chelmsford (Mr. Burns) made and the anxieties that several hon. Members have expressed.

The Health Committee examined delayed discharges, and we did not receive evidence from any source—health departments, social services departments or voluntary organisations—in support of the principles at the heart of the Bill. Not even Department of Health officials appeared especially enthusiastic about it. I made my anxieties known on Second Reading, but the Minister did not respond to them. She is a competent Minister, for whom I have a high regard, but I remain convinced that the Bill does not tackle those concerns.

The model is based on the policies that were applied 10 years ago in Sweden. It was interesting to visit that country shortly before Christmas and discuss with political colleagues in the Swedish Parliament whether the measure could work. I admit that some improvements have occurred in Sweden, but colleagues were concerned about the number of people whose discharge from hospital was delayed. In Sweden, county councils run hospitals and municipalities run social services, and integration is being considered.

I humbly suggest that the Government may eventually want to consider that the lack of an integrated health and social care system is the genuine problem. An increasing number of Labour Members who have examined the matter are beginning to agree that integration is the way forward.

I cannot support the Bill. It is a bad measure that has not been thought through. It will damage the good, positive relationships between health and social services departments that the Government have created in some areas. I hope that, even at this late stage, they will see sense and take advantage of opportunities in another place to withdraw the measure.

George Young (Conservative, North West Hampshire)

I hope that the Government will take to heart the very measured comments that we have just heard from the Chairman of the Select Committee on Health.

I preface my brief remarks by saying that, given the terrible hand the Minister was dealt in being asked to take the Bill through, she did so with competence and patience, both in Standing Committee and on Report.

I said on Second Reading, which seems very recent, given the speed at which the Bill has gone through the House, that the Bill was one of the worst I had seen in some 30 years. Despite the heroic attempts by the Opposition parties and the welcome amendment that we have just passed on carers, I think that it is one of the worst Bills to go through the House in those 30 years. If there is one discharge that should be delayed, it is the discharge of this Bill from the other place.

I hope that the Government will find that their ambitions to get the Bill through quite quickly, by April this year, are dashed by the very serious consideration that those in another place give it. We have not had proper time to consider it. There were chunks that we did not debate in Standing Committee. We lost an amount of time on Report because of the statements that, understandably, were made.

Not only has the Bill been rushed through, but the timetable for implementation is very challenging. The Minister has ignored the many pleas from those who have to implement the Bill to delay it until April 2004. That was a concession that she might well have made.

Of course, the Bill is unwanted by local authorities, but it is also unwanted by the health service. We heard in Standing Committee of representatives of the NHS Confederation and of the medical profession saying that they did not want it either, because it will damage the relationships that they value between them and social services.

The Bill has been condemned by all the voluntary organisations. Just today, we heard from Help the Aged, Age Concern and the Alzheimer's Society. I cannot think of a single voluntary organisation that has welcomed the Bill. The point made by those to whom I have referred is that the Bill is misguided, because it focuses on one very narrow part of the problem—the discharge from hospital to care in the community, a care home—instead of standing back and taking a holistic look at the problem from start to finish.

The Bill is unfair and unilateral. It involves a unilateral fine by one part of the public sector on another, with no opportunity for that other sector to obtain reimbursement when it faces costs because of delays by the NHS. If there is a dispute, as we heard earlier today, the jury is not wholly unbiased.

The Bill ignores the role that the Government have played in reducing the capacity in the care home sector, which is one of the strategic reasons behind delayed discharges. It will distort local government priorities. Local authorities will spend less time and energy on prevention to avoid the fines. As we heard today, if one wants to get somebody into a care home, the best way to do it now is to get them into hospital first. The law of unintended consequences and perverse incentives will apply.

On Second Reading, the Bill was virtually friendless on the Government Benches. Indeed, the only contribution from Labour Members on Third Reading has been deeply hostile. At a time when the NHS needs less bureaucracy it will get more, with invoices flying backwards and forwards between social services and the NHS. I know of no right-wing economist in this country who ever proposed an internal market of this nature to deal with the problem.

I believe that the Bill is flawed in concept and will be divisive in its consequences. I shall walk through the No Lobby with a spring in my step to register in the only way still available to me my deep-rooted objection to this legislation.

Kevin Hughes (Labour, Doncaster North)

I welcomed the Bill on Second Reading, and I assure my hon. Friend the Minister that I shall support her in the Lobby tonight.

The Bill is an instrument, albeit a blunt instrument, as described by the Select Committee of my hon. Friend the Member for Wakefield (Mr. Hinchliffe), to concentrate people's minds.

The hon. Member for West Chelmsford (Mr. Burns) and my hon. Friend the Member for Wakefield, for whom I have a great deal of time and respect, seem able to see only the negative points. They seem to think that the Bill will create a combat atmosphere between social services and the health services. I do not see it that way. The Bill will concentrate people's minds on better co-operation.

George Young (Conservative, North West Hampshire)

Like the Whips Office.

Kevin Hughes (Labour, Doncaster North)

No, not like that.

We are talking about people, mostly old people, being trapped in hospital, and some social service departments and health authorities are doing very little to tackle that. Fortunately, in my constituency, they are doing something. Planning for discharge starts before patients are admitted for elective surgery, and that is how it should be. The team that works in Doncaster can call on a range of options. If necessary, it can use an intermediate care ward, which has been provided by joint funding, as well as aids, adaptations and all the rest of it. The proposals need not be combative at all; they can lead to more co-operation.

Let us not forget that the Bill is about getting people out of the hospital beds in which they are trapped even though they no longer need health care treatment. That is why I shall walk through the Lobby tonight in support of my hon. Friend the Minister and the Government.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I note that the hon. Member for Doncaster, North (Mr. Hughes) will not walk through the Lobby with a spring in his step, unlike the right hon. Member for North-West Hampshire (Sir George Young).

I thank the hon. Member for Wakefield (Mr. Hinchliffe) and his Select Committee for the report on delayed discharge that they published last year. It is an invaluable piece of research, which I found very useful in Committee, and many of the questions put to officials during the inquiry provided useful answers. As I read through the evidence given to the inquiry, it suggested to me that there was a great lack of enthusiasm among officials and, indeed, anyone who gave evidence about this approach. Indeed, officials said that delayed discharges are a symptom of a wider, whole system problem and that we are lacking in capacity, in planning and in preventing admissions in the first place. Four Committee sittings and consideration on Report later, nothing fundamental has changed in the Bill.

Rather than building on and continuing to encourage the partnership between the NHS and social services departments that hon. Members on both sides of the House would wish to develop, the Bill will create an adversarial approach of game playing and cost shunting between the two. Worse still, it will turn the patient into a commodity to be haggled over by social services departments and the NHS. There is no room in the Bill for informed consent.

As the Bill has progressed through the House, I have been drawn to the conclusion that it is about beds, not the needs or interests of patients. It is a strange sort of partnership that gives one partner a stick to beat the other. That sounds rather more like domestic violence than addressing the real needs of the health service.

The Bill, as it leaves the House, will put in place a system of fines, as the Minister has confirmed from the Dispatch Box today, that will distort the spending priorities of local social services departments. Those departments will have to prioritise hospital patients for assessments and services, because a fine is attached, at the expense of those who are hidden, frail and isolated, in their own homes and who count only when they wind up in hospital because of a fall or some other mishap.

In Committee, the Minister talked about the introduction of financial flows—she did so again today—that will lead to hospitals picking up a penalty if emergency admissions take place. She conveniently did not mention that that reform would not start until April 2004. She did not tell us that the single assessment process will not start until that date; nor did she tell us that, although some extra cash for some councils will arrive in April this year, councils did not know the details of those budgets until December and are only now beginning to find out what they mean for them and their communities in terms of council tax rises and investment in services. It is hardly surprising that the services to bridge the gap in capacity have not yet been put in place. The Minister has remained blind to the issues of capacity throughout this debate.

When the Bill makes its way to the House of Lords, I can assure the Government that my colleagues on the Liberal Democrat Benches will do all that they can to ensure that it does not have a safe passage through the other place. I thank my hon. Friend the Member for Cheadle (Mrs. Calton) and my staff for their hard work on the Bill. This is a bad Bill, and the Liberal Democrats reject it. It puts beds before patients and sets the NHS up against social services. It makes it much more likely that, in future, more people will get the wrong care in the wrong place at the wrong time.

Andy Burnham (Labour/Co-operative, Leigh)

I have sat here all afternoon listening to an unending stream of negativity and doom from the Opposition Benches. I feel compelled to rise to speak, because the Bill offers two major benefits to which the two Opposition parties have given no regard whatever. First, it will lead us, as a society, to support more people at home and lead to much less reliance on institutional care than at present. Secondly, it will bring down the average length of stay in acute beds, which will allow more patients to be treated on the NHS. All Opposition Members agreed that it would bring down the average length of stay, yet they seemed to suggest that that was purely negative. I put it to them that it might actually be positive.

Why will the Bill help more people to live at home for longer? My own family experience tells me that, once a patient has been deemed fit for discharge—that is, once a clinical decision has been made to discharge them, so there is no question of their being forced home too early—it is in the patient's direct interest that that discharge should happen as soon as possible. We have all seen examples of people who have languished in hospital for too long, then drifted into residential or nursing care and lost the opportunity to go back home and be supported there. The Bill will expedite the discharge process and, together with the provision of free aids and adaptations, get more people home once they are able to cope.

Unlike some on the Conservative Front Bench, I do not believe that nursing homes are a good place to be. I saw my grandmother deteriorate rapidly after she went from a long stay in hospital to residential care and then to nursing care. Her personal possessions were stolen while she was in residential care, and her wedding ring was ripped off her finger in the last days before she died. Nursing homes are not a good place to be. We need to encourage more people to live independently at home, which is what I believe the Bill will allow us to do.

The Bill will bring down the average length of stay in NHS beds, which will allow us to treat more NHS patients. Like the Health Committee Chairman, I, too, went to Sweden. We visited the Huddinge university hospital and heard from Dr. Lars Collste.

Simon Burns (Conservative, West Chelmsford)

Will the hon. Gentleman give way?

Andy Burnham (Labour/Co-operative, Leigh)

The hon. Gentleman did not go to Sweden, so I will not let him intervene.

Dr. Collste told us that, before the cross-charging system was introduced in Sweden, the average length of stay for an in-patient episode was seven to eight days. After the system was introduced, it went down to 4.8 days. His view was that the system worked.

Simon Burns (Conservative, West Chelmsford)

Will the hon. Gentleman give way?

Andy Burnham (Labour/Co-operative, Leigh)

I will not, because other Members want to speak.

We also heard, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, that the system was being reviewed by the Swedish Parliament. That is true. It is looking at ways in which the cross-charging system can be reconciled with more co-operation. It is not ditching the system; it is simply looking at how municipalities and counties can co-operate more when the system is introduced. I do not think that that is a bad thing, and the Department might like to look at the experience in Sweden before the measures in the Bill are finalised.

I congratulate the Minister on her skilful steering of the Bill through Parliament, and I look forward to it bringing the two major improvements that I have outlined to my constituents.

Joan Humble (Labour, Blackpool North and Fleetwood)

I welcome the opportunity to speak on this important issue. I shall preface my remarks by saying that I fully support the aims of the Bill. I have listened to my hon. Friend the Minister speak with some passion about the needs of elderly people trapped in hospital beds who ought not to be there and who need an appropriate form of care. It is absolutely vital that those people get the care appropriate to their condition or illness, whether that be a hospital bed, a nursing home bed, a place in a care home or intermediate care home, or support in their own home.

I rehearsed some of my concerns on Second Reading, and I still have concerns about the implications for local authorities, but one aspect of the Bill that I welcome is the introduction of new, robust joint assessment procedures. As I have said to my hon. Friend the Minister before, in my local area we have good working between health and social services, which I want to continue, but I am aware that the situation nationwide is variable, so it is vital that we have a new and comprehensive assessment procedure to benefit patients in hospitals.

Will my hon. Friend the Minister look carefully at the implementation timetable and listen to the concerns of local authorities, the health service and, especially, those elderly people who all need caring for? Will she carefully consider the comments that she is getting back to ensure that she is properly monitoring the implementation timetable so that local authorities, health services and, above all, the elderly people we represent are not disadvantaged?

Desmond Turner (Labour, Brighton, Kemptown)

I echo the plea of my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble) for clemency for local authorities such as mine, which have been doing their damnedest to do exactly what the Government have asked. They are producing the close working, but, none the less, they face problems and circumstances that are totally beyond their control, such as shortages of nurses and elderly mentally infirm beds as well as trained care workers to provide domiciliary care services. That means that punitive measures in clause 4 will cost them about #1 million a year if they are implemented this spring.

The authorities need more time, and it would be folly and very sad if the #100 million that the Government are giving to extend care capacity for this purpose were simply taken back in fines. That would achieve nothing. Therefore, sensitive timing of the implementation of the more difficult measures is essential.

Glenda Jackson (Labour, Hampstead and Highgate)

On Second Reading, I paid tribute to the absolute commitment of Camden, my local authority, to creating a multi-faceted, properly integrated, high-quality service for elderly people. Indeed, my hon. Friend the Minister paid tribute to Camden and, I believe, Croydon on Second Reading and in Committee for their abilities in reducing delayed discharges, but I must tell her that my local authority's concerns are by no means stilled or quieted. I add my voice to those of my hon. Friends who have urged the Government to pay particular attention to the timetabling of the introduction of these measures.

On going into the fine detail, my local authority discovered that, far from getting a 6 per cent. increase, it is receiving only a 3 per cent. increase in social services funding. Certain authorities suffer from a shortage of available places, because the majority of elderly people undoubtedly want to remain in their locality, which can be a particular difficulty for an inner-London authority such as mine. There are also concerns in my local authority over the costs of implementing the examination of throughput on the issue. It urges the Government to allow it time properly to track how it can better integrate the more-than-one service required to ensure that elderly people are not left in hospital past the point required by their medical care.

I urge the Government to delay, if possible, the introduction of the measures until all local authorities have properly examined such questions. I accept that not all local authorities are as effective or committed as Camden, but I do not believe that the effective and committed local authorities should be punished because others have still not got their act together.