Previous Section Home Page

Column 865

Mr. Kevin Hughes (Doncaster, North) : It makes a change to take part in a debate in which there are few differences between the Conservative party and the Opposition. However, that has its drawbacks, as it tends to attract little, if any, media attention. The issues, which we have already debated in Committee and on Second reading, are important to those they affect. It is unfortunate that, as there is little difference and not much political fighting between the parties, there will be little media coverage.

Amendment No. 1 seeks to ensure that a person in residential care such as the Bill provides is given a care plan. In the context of community care, the provision's central plank is high-quality care for vulnerable adults who require it. While much emphasis is placed on the care needs of those living in their own homes, there is a danger that the needs of those in residential care will take a back seat, so enabling such residential establishments to be seen as a place of last resort. That is unacceptable.

4.30 pm

As I said in Committee, residential care should be a positive choice made by the resident, the carer and, ideally, the care manager who helps to put together the care package. There should be plenty of time for people to shop around and see which care home is appropriate for their needs. They should have time to look at the inspection reports of various homes and make a positive choice of which one they prefer to live in. If that is done properly, care plans--emphasising the needs and views of the person involved--can be made. The informed choices and expectations of the individual should be followed wherever possible.

Care plans should recognise the rights of individuals to achieve the highest possible quality of life and, where appropriate, to receive a range of therapeutic and remedial services to maximise and maintan levels of independence. They should be able to exercise choice about how they live and ensure their dignity and self-respect, including their physical, emotional and spiritual needs.

Research has shown that most older people do not wish to live in residential care. It is widely acknowledged that, given a choice, they would prefer to live in their own homes. The importance of residential care as a stepping stone back into the community has been neglected. A good care plan would seek to achieve that preferred option for the individual where appropriate. That would apply particularly to many of those who live in the smaller residential homes to which the Bill relates.

However, there is no incentive for private residential homes, particularly smaller ones, to have a care plan that envisages using those homes as a stepping stone back into the community. I do not want to repeat the arguments adequately made by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) in Committee. Due to the funding that private residential homes receive, there is no incentive for them to work towards getting people back into their own homes and into the community.

National health service hospitals and trusts should not be allowed to divest themselves of their responsibility to provide continuing care where appropriate. It is unacceptable to place pressure on vulnerable adults and their carers to accept a standard of care that is inappropriate for them. If it is to have real meaning, the concept of choice and seamless care requires recognising an individual's needs as paramount.

Column 866

Mr. David Lidington (Aylesbury) : I agree with the hon. Gentleman about the need for close co-operation between NHS trusts and county or borough social service departments, which is exactly what is happening in my own authority, Buckinghamshire. Will the hon. Gentleman and his hon. Friends give the House an assurance that they will do all in their power to encourage and persuade

Labour-controlled local authorities to consult those in NHS trusts about how they can work together to provide the highest quality of care?

Mr. Hughes : I am grateful for that intervention, because it gives me the chance to tell the hon. Gentleman that I spent five years chairing the social services committee of Doncaster metropolitan borough council. The consultation process that took place in Doncaster, a Labour-controlled authority, included as many bodies as possible--the area health authority and voluntary and private sector organisations. Some Conservative Members get carried away by their own propaganda and forget the facts of real life.

I had a meeting with the management of the Doncaster Royal Infirmary and Montagu trusts a week ago at which I asked board members why they never sent delegates to the joint committee meetings. I was none too happy with their answer.

All the services in Doncaster have opted out, which is unfortunate because it will now be even more difficult to put together seamless services for vulnerable and elderly people. So many organisations have to be consulted : social services departments, district health authorities, the Doncaster Royal Infirmary trust, the priority and community care trusts, South Yorkshire ambulance service, GPs and GPs who have become fund holders. The list is becoming endless. I think that we all agree that under this legislation we are trying to do away with many of these problems. The customer should enjoy a seamless service and not suffer from the unfortunate arguments that can take place between the organisations that I have mentioned. The establishment of the trusts in Doncaster--the DRI and the priority and community care trusts--with their emphasising cost- effectiveness and increased bed throughput, has led to considerable anxiety among many professionals that too many rushed and unplanned discharges are taking place. Some of these discharges are into residential care, with no discussions, no choice and no care plans. If matters are not to deteriorate further, the production of an individual care plan and the provision of the time in which to ensure that it is effectively implemented are essential.

A care plan is not carved in tablets of stone. It needs to be subjected to regular review and, if necessary, renegotiated. The process must involve those concerned and especially the residents. Systems of review must ensure their full participation and must be structured accordingly. It is essential to recognise that many residents will need a formal or an informal advocate to assist in the process. Such involvement should be covered by the legislation, to ensure that residents can exercise their rights and not have their future left to the sole discretion of the professional workers. We must put a stop to the agist attitude that seems to prevail in our culture which presumes that professionals and others can make decisions for people without seeking their opinion or consent.

Column 867

Mr. Hugh Bayley (York) : I had not planned to speak on this amendment, but I want to respond to one or two of the comments of the hon. Member for Macclesfield (Mr. Winterton)--I see that he is smiling, so I must have got his constituency right. It is a peculiar tradition that we do not use people's names in the same way as anyone else would.

I agree with the hon. Gentleman's comments on the fears that have been expressed about a move away from a mixed economy of public and private sector care to a reliance on private-sector accommodation. That implies a lack of choice between the types of regime offered by the public and private sectors.

About two years ago I conducted a study into care for the elderly which involved interviewing 1,300 elderly people in nursing and residential homes, sheltered housing and health service long-stay accommodation. We asked people in public sector homes whether they had considered entering a private sector home and we found that fewer than one in 20 had even considered such a home. We put the same question to people in private sector homes and found that they were even more determined about the rightness of their choice. Fewer than one in 30 had considered moving into public sector homes. I fear that the choice will be reduced if the number of public sector places continues to be reduced. North Yorkshire county council is considering divesting itself of 20 of its part III homes to a private or voluntary sector body. That will change the nature, pattern and mix of the accommodation that is available in the county.

Mr. Nicholas Winterton : Developments similar to that which the hon. Gentleman describes in his county are taking place in many counties, not least in Cheshire where the county council has contracted out the running and management of its part III residential homes to a non-profit making charitable organisation but has retained ownership of the capital assets. Has that happened in North Yorkshire? Labour controls Cheshire county council with Liberal Democrat support and has engaged in contracting out in order to avoid being capped. It has transferred the cost of provision to the Department of Social Security until 1 April 1993. Has North Yorkshire county council disposed of all its capital assets as well as its revenue costs?

Mr. Bayley : That is a perceptive comment. North Yorkshire county council has commissioned a firm of consultants to carry out a study and is examining the option that the hon. Member for Macclesfield (Mr. Winterton) describes. However, for whatever reason, Cheshire has for some time had the benefit of being able to transfer the cost of part III accommodation from the poll tax payers' budget to the Department of Social Security budget. Even if North Yorkshire county council moves with lightning speed--an uncharacteristic speed for that council--transferring the budget would benefit it for only a month or two.

Mr. Hinchliffe : Is my hon. Friend aware that the Government have taken steps to stop local authorities taking action of the kind that the hon. Member for Macclesfield (Mr. Winterton) describes? The Minister may correct me, but I understand that the Department of Social Security has prevented claims for income support for people placed in local authority trust homes. It has blocked the loophole that allowed the sort of policy development that took place in Cheshire.

Column 868

4.45 pm

Mr. Bayley : I think that my hon. Friend is right and therefore I should withdraw the comment about a month or two of benefit for North Yorkshire county council if it gets its skates on.

It is not just a matter of playing with figures in the budget but of the type and quality of care that an authority is able to provide. One of the sets of data collected in the study to which I referred was a standard form of dependency assessment for residents. We were able to compare dependency over time because of an earlier survey carried out in the authority area in which we were working. We discovered that although the overall dependency of public and private sector residents was similar, the physical dependency of those in private sector homes tended to be greater. However, what might be called the mental state dependency of people in public sector homes was greater and getting greater than that of people in private sector homes.

The private homes were good at dealing with the physically frail but mentally alert, while the public sector homes were left to deal with a growing proportion of the mentally frail and confused. That meant that the nature of the regime in the public sector homes in Lincolnshire, the county in which we undertook our study, was changing. The quality of life was deteriorating in public sector homes because people who are mentally alert prefer to be surrounded by others who are mentally alert, albeit physically frail, than by people who are confused and who may exhibit unnerving behaviour. If the North Yorkshire plan goes ahead, the council will divest itself of more than half its homes, and that will speed up the process of concentrating the confused elderly in public sector homes.

The hon. Member for Macclesfield expressed surprise that relatives of those elderly people from east London who were placed in a home in Skipton had not complained that they found it difficult to visit. Many people in long- stay residential and nursing care receive no visitors at all. Our study showed that one in 10 residents were never visited. They are on their own. We also found that one in three received fewer than one visit a month. Many people will be lost unless local authorities take action to befriend them.

Some of the people whom I interviewed said, "There is no way out." They were in places such as old rectories and probably 3 miles from a main road and 15 miles from a town. They said, "I have no one to turn to and if I have a complaint I have no means of redress." Later amendments address that extremely worrying issue.

Mrs. Alice Mahon (Halifax) : I should like to address the need for a care plan based on what we should have learnt from our past mistakes and from the wholesale institutionalisation of a generation of elderly people. That happened because the Government were ideologically committed to closing parts of the national health service and to waging war on local government authorities because most local authorities were Labour controlled. Over the past 13 years, some destructive policies have resulted from the Government's rather bigoted and narrow-minded approach to community care.

I shall concentrate on an excellent document produced by the Royal College of Nursing. It is called "A Scandal Waiting to Happen--Elderly People in Nursing Care in

Column 869

Residential and Nursing Homes". I commend it to every hon. Member as a well thought out document showing not only what has happened in the past but what we can expect to happen in the future if the Government are not truly committed to community care.

Over the past decade, there has been wholesale privatisation of care for the elderly. To all those who shout, "You can trust the Government", I say that, when I took part in a series of "World in Action" programmes in 1985, I was more or less marginalised by health managers and Conservative politicians, who said that I was telling scare stories and making things up about the care of the elderly in the NHS. I have been completely vindicated. The Government closed NHS beds and starved local authorities of precious resources. The elderly had to vacate long-stay beds, and were left with no choice but to enter private nursing homes.

We all know of the huge amounts of income support paid by the Treasury to prop up the private sector. That is meant as a wholesale criticism not of the private sector but of the Government's privatisation of the elderly.

The Royal College of Nursing is concerned at the amount of money allocated to local authorities to implement the National Health Service and Community Care Act 1990. They argue, as we have done many times, that those resources should be ring-fenced, and there remains a desperate need for that to be done. Care plans are also needed if past mistakes are not to be repeated. The RCN's report highlights many reasons why that is important

One of the 1990 Act's pruposes was to shift the emphasis away from institutional care to care in the community. The RCN's report points out that there are inadequate resources to allow people to remain in the community. Their institutionalisation flies in the face of the cross-party consensus on keeping the elderly in their own homes. Because local authorities were given insufficient funds, care packages that would have provided home helps and intensive care--by ensuring that nurses were available to put people to bed and to nurse them early in the morning--were not made available to district or community nurses.

The royal college's report highlights that many elderly people were institutionalised when there was no need. Its report quotes a community nurse manager saying that the elderly were admitted to residential homes because community care could not be provided. That is a real tragedy. That manager stated :

"Too great a demand is placed on the district nursing service, and they are operating with unsatisfactory accommodation and with insufficient resources, placing an ever-increasing strain on neighbourhood budgets."

We know that the elderly are being shifted into residential care at great personal cost, and at a high financial cost to the Treasury and the taxpayer.

The absence of any care plan also means that some of the elderly are given inappropriate assessments of their nursing needs and accommodation. A plan would take such factors into account. I repeat that I criticise not the homes themselves but the system that has developed. The RCN report adds :

"Others were readmitted to residential homes from hospital because of pressure on health service beds."

We know that many of the elderly are not given a choice, and that many NHS forms list only private homes.

There is no plan either to meet the changing health and social needs of those in residential homes. Like the rest of

Column 870

us, their lives do not stand still, and a medical condition will often develop further. Residential homes often do not have staff who are sufficiently trained to identify the progression of the many illnesses and disabilities to which the elderly are prone. The RCN's excellent report highlights many of the problems created by the Government's disastrous policies over the last 13 years. If the Government fail to grasp the nettle and to do something, even at this late stage, there will be depressing consequences. I do not trust the Government when it comes to community care. There is no evidence that we will get from them anything but nice words, glossy pamphlets, and lots of press releases. I do not know about other right hon. and hon. Members, but I am sick of receiving copies of Department of Health press releases that mean nothing.

The Royal College of Nursing's report concludes that, as the elderly population increases, there is mounting unease that their health and social needs will not be met. Nor are the financial difficulties encountered by the elderly when they move into private homes being dealt with by the Government, who are abandoning their responsibilities. The gap between the cost of public and private care is growing wider, and someone has to pick up the bill. It should be the Government, and it is time they took their responsibilities more seriously.

The Government's own guidelines in health circular HC 895 are being ignored. The elderly are being offered no choice. Nothing is on offer to those who choose to remain at home. It is no secret that many concerns have been expressed about the standards of care in some residential and nursing homes--notably in a "Panorama" report in January. The Government have yet to make a convincing response to some of the criticisms highlighted in that programme. I am pleased that the Royal College of Nursing's report chose to mention it. Sadly, I expect that there will be grounds for similar criticisms in future.

I want the growing number of elderly people in nursing or residential homes matched by an increase in nursing resources, so that we can correct the scandalously inadequate treatment, because staff are not properly trained, of elderly people suffering from illnesses associated with old age. Unless the Royal College of Nursing's recommendations are acted upon, the elderly will continue to suffer--until a major scandal forces the Government to take action.

Ms. Tessa Jowell (Dulwich) : This is almost a technical amendment--a statement of good practice. It has been tabled because common-sense arrangements arefrequently not observed. One of the difficulties of developing high-quality community care and of creating around the elderly or disabled person a set of arrangements that maximise the quality of that individual's life is that their effectiveness is only as strong as the weakest link in the chain.

Someone must take responsibility for specifying who will implement the various elements of a care plan. Someone must also be named as the person responsible for implementing the plan. Arguably, that is the job of the care manager, who should be independent and speak, in a partisan way, on behalf of an elderly or disabled person. He or she should safeguard the interests of such a person, and ensure that the needs identified in the assessment are met with practical care and support.

Column 871

5 pm

There is a good deal of evidence that people have been placed in residential care and nursing homes a long way from their own homes. As other hon. Members have pointed out, that results in their not being visited and leading isolated lives. Such people may derive no more benefit from the new policy than they derived from the old one. Earlier this week, a constituent rang me in tears, having just been discharged from hospital. She had not been placed in residential care ; she had gone home. No plans seemed to have been made for her support, and she telephoned me in desperation. When I visited her, she was writing to her only relative, a daughter living in Cheshire. Cheshire is a long way from Dulwich, and my constituent--desperately frail and ill--was left with no means of support. That is one of many such instances, which show that nothing can be left to chance. We cannot simply hope that, because there has been so much talk suggesting that this is the best way of managing people's care, it will prove to be so.

A care plan creates a specific set of guarantees for elderly people and their relatives, who will then know what to expect. We know that there will be a discrepancy between the assessment of people's needs--led by the local authorities--and the resources that are likely to be available. Broadly speaking, people accept the inevitability of that, but they need to know what they can rely on. An elderly person once said to me, "One promise is better than 30 maybes." We need to remember that ; it is an important mechanism for the achievement of the commitment to more user-centred community care that I know is shared by hon. Members on both sides of the House.

The establishment of a specified care plan is also an important way of turning the needs and experiences of hundreds of thousands of elderly and disabled people into the big decisions that bring about changes in the nature of services. The information should be fed into the community care plan, which can then be used constantly to audit the quality and range of provision. The amendment proposes good practice. It commends user-centred community care, and it will be welcomed by elderly and disabled people all over the country.

The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : The hon. Member for Wakefield (Mr. Hinchliffe) appeared still to doubt the Government's determination to proceed with the implementation of stage 3 of our "Care in the Community" policies. Let me make what I hope is an unequivocal statement, which has already been made by my right hon. Friend the Secretary of State, my hon. Friend the Minister of State or me each time one of us has spoken from the Dispatch Box since the general election. Stage 3 of the implementation of "Care in the Community" will go ahead in April 1993. It is on target, and there has been no change in either the policy or the timetable. The local authorities will assume their enhanced responsibilities at the time of

implementation--responsibilities that will include assessing individual needs and arranging for them to be met.

Mr. Bayley : When will the Government tell local authorities what additional resources they will receive? The new regime will begin in exactly nine months, but it is almost impossible for authorities to plan if they do not know what resources they will have.

Column 872

Mr. Yeo : Local authorities can be assured that the funding of the policy will be fair. The details will be available to them in the autumn.

We believe that one of the consequences of giving local authorities an enabling role will be the introduction of a larger element of market forces in the provision of community care. I am sorry that that has caused the hon. Member for Wakefield so much dismay. I am confident that it will drive standards up, and ensure that we receive the best possible value for money. The Government want all local authorities to make the fullest possible use of the independent sector.

Mrs. Mahon : Has not the Minister learnt any lessons from the Royal College of Nursing report, which states that the independent sector is not equipped to deal with some of the health problems of elderly people?

Mr. Yeo : There is abundant evidence that the arrangements that we have put in hand for the inspection of nursing and residential care homes run by independent sector organisations are adequate to ensure that standards are maintained at a high level.

I am pleased to see my hon. Friend the Member for Macclesfield (Mr. Winterton) in the Chamber, and I am grateful for his contribution. He is well known in the House for his expertise in this regard. He and I served together for a number of years on what used to be the Select Committee on Social Services ; I did not serve for quite as long as he did, but I recall his robust and independent contributions with much pleasure. His style has not changed at all since those days. My hon. Friend raised a serious point about possible changes in the national health service. He need not fear that the NHS is losing interest in provision and becoming interested only in treatment. It remains the duty of all health authorities to arrange to meet the health needs of the population in the districts that they represent. As health needs and social needs are so closely related--in some cases, they are intertwined--we have required local authorities to consult health authorities when drawing up their community care plans, under the terms of the National Health Service and Community Care Act 1990. We have also required them to consult the voluntary organisations, and the same applies to users and carers.

The hon. Member for Wakefield mentioned NHS trusts. It is highly desirable for trusts, as well as other bodies, to become involved in local community care planning if they are involved in the provision of community care services. The hon. Member for Doncaster, North (Mr. Hughes) was rather smoked out by an intervention from my hon. Friend the Member for Aylesbury (Mr. Lidington), which finally exposed his underlying hostility to NHS trusts.

The hon. Member for Wakefield mentioned a cut in the number of NHS beds. It is true that the number of geriatric beds in the NHS has fallen, but the hon. Gentleman did not mention the enormous increase in the number of nursing home beds, which has risen from 28,000 to 119,000. There has been a similar increase in provision in private residential homes, and a substantial proportion of the occupants of those beds are funded by income support payments--a quarter of a million people, compared with 10,000 13 years ago.

Mr. Hinchliffe : Does the Minister not accept that that is precisely the example of privatisation of the national

Column 873

health service that the Opposition gave during the general election campaign? It is happening in my area and in every other area. Individuals previously received a free service from the national health service ; now they have to pay for it. Many people in my area do not have a penny to spare after all their income support and pocket money has been spent on their care fees. Is that acceptable to the Minister?

Mr. Yeo : When people are funded by income support payments, that is not privatisation. The hon. Gentleman knows that the cost to the Department of Social Security has risen from £10 million to getting on for £2 billion today. If people's fees are paid from income support, that is not privatisation. It is not a definition of privatisation that any of my hon. Friends could even begin to understand.

Mrs. Helen Jackson : Does the Minister agree that privatisation is about the operation of a service? It is not about how the client of the service gets the money. The question, as I understand it, is whether a privatised industry is run for profit. The private nursing homes that we are talking about are, in that sense, privatised institutions.

Mr. Yeo : I shall not be inclined to give way again if there are to be somewhat arcane debates about what the word "privatisation" means, but according to my book--and, I believe, according to all my hon. Friends--as long as the Government accept responsibility for assessing needs and for funding the provision of those needs, that is not privatisation. Indeed, I positively welcome the fact that we now have a much greater variety of providers many of whom are in the private sector. Some come from voluntary organisations ; others remain in the statutory sector. That is a wholly welcome development.

Mr. John Gunnell (Morley and Leeds, South) : Will the Minister give way?

Mr. Yeo : No, I must make some progress. I have already given way a great deal.

The hon. Member for Rochdale (Ms. Lynne) raised an important point about the shortfall between income support levels and the cost of residential care. We expect that, after April next year, local authorities will be able to negotiate very good terms in order to keep the costs of residential care down. We have acknowledged, however, that there is a gap between income support levels and the actual cost in some areas of residential and nursing home care. We shall take that gap into account when we make decisions about funding.

Mr. Nicholas Winterton : Will my hon. Friend deal with the point that I raised during my contribution to the debate on the amendment : that people are being discharged from national health service hospitals into accommodation in the independent private or charitable sector and that, as the hon. Member for Rochdale (Ms. Lynne) pointed out, there is a gap between what people will get from the Department of Social Security through income support and the fees that they or their families may be responsible for paying? Is it not wrong that they should be discharged from, perhaps, a geriatric ward, where all the costs are met through the taxation system, and put into a system whereby they as individuals, or their families, have to pick up an additional bill for their accommodation?

Column 874

5.15 pm

Mr. Yeo : The policy is that nobody should be discharged into a private sector establishment against his or her will, unless the full costs are to be met from public funds. If a contribution is required, the agreement of the individual will be needed.

Mr. Winterton : Does that apply only at the time of the person's discharge, or does it also apply if the cost of the accommodation goes up?

Mr. Yeo : It is difficult to envisage being able to define at the moment of discharge every conceivable possibility that might arise in the years ahead, but in general I do not think that we shall have a significant number of cases where the rate at which costs go up exceeds the rate at which public funds are available to meet those costs. From April next year, anyone discharged in that way for whom the local authority accepts responsibility will find that the local authority has to negotiate, year on year, the cost of maintaining that provision.

The hon. Member for Sheffield, Hillsborough (Mrs. Jackson) referred to the role of the health authorities. Their role is to secure provision where there are continuing medical needs. As the hon. Lady acknowledged, that does not have to be in a hospital. It could be in a nursing home. Nevertheless, where medical needs continue, the health authority has a continuing responsibility.

Ms. Ann Coffey (Stockport) : If I may return to the point made by the hon. Member for Macclesfield (Mr. Winterton), does the Minister agree that, contrary to what he said about being unable to envisage the cost of private care rising to the point at which it cannot be publicly funded, that is exactly and precisely what has happened over the past few years? Public funds that have been made available through Department of Social Security grants have been insufficient to meet the actual cost of care. The resulting gap has caused enormous difficulties for a great number of people. Does the Minister not accept and envisage that that might continue to happen, even though the funding is being transferred from the Department of Social Security to the local authority?

Mr. Yeo : From April next year, if discharge is to an independent sector establishment and the local authority accepts responsibility for funding, it will be for the local authority to provide the resources to cover any increase in charges. I hope that the local authorities will use their strong position as negotiators in contracting with the private sector to ensure that any increases are kept to a minimum.

Mr. Gunnell : Will the Minister give way?

Mr. Yeo : No, I really must make some progress. I have already been speaking for 13 minutes.

If I may comment specifically on the amendment--I sympathise with the principle behind it--I believe that it is unnecessary in the context of the Bill. When the National Health Service and Community Care Act 1990 is fully implemented, local authorities will have this responsibility for assessing individual needs, for designing care arrangements and for securing them within the available resources. That will include all individuals requiring public support who are discharged from hospital into private and voluntary residential or nursing home care. Our intention is to ensure that all individuals, whether in hospital or

Column 875

referred from the community, receive a proper assessment of their needs and that an individual plan is put together for the care that should be provided.

Mr. Roger Sims (Chislehurst) : Is my hon. Friend aware that, in the London borough of Bromley, assessments along the lines of the guidance issued by his Department are already being carried out and that they are not considered complete until the assessment itself and the care package proposals have been completed and agreed by the client? Does my hon. Friend not think that that is good practice which could be adopted generally?

Mr. Yeo : I certainly agree with my hon. Friend that it is good practice and it is certainly our intention that where an assessment has been made the results of that assessment should be shared with the client. I am glad to hear of the practice already adopted by my hon. Friend's authority.

Work is in hand to develop arrangements for the introduction of needs-based assessment. It is a key task for local authorities. It is one on which they should co-operate closely with health authorities and other agencies. We have made it clear that authorities should make effective arrangements to inform the public about the details of any new arrangements for assessment and care provision. Effective arrangements for community care require robust agreed procedures for discharging patients from hospital--either, where possible, back into their own homes with the right package of support and care or, if appropriate, into nursing home or residential care. We have issued guidance to health and local authorities about discharge. Discharge arrangements are also covered by the patients charter. We have encouraged health authorities to undertake a sample quality audit of their discharge arrangements to get a better understanding of how these policies work in practice.

The new arrangements for assessment and the provision of care that are being introduced next April will address the concerns behind the amendment. Social services authorities will assess the needs of individuals who are about to leave hospital and who are in need of residential or nursing home care and will plan a package of care accordingly. Contracts with providers will reflect those care plans and specify the service which they are to provide to the resident. These arrangments, including individual assessment of need and the agreement of a care plan, will cover those patients discharged from hospital into nursing home and residential care who require public support. Most local authorities and health authorities are working hard now to ensure that those new arrangements are introduced smoothly and that across the board they work closely to ensure a seamless provision of care. For all those reasons, I believe that this well-meaning but unnecessary amendment should be rejected by the House.

Mr. Alun Michael (Cardiff, South and Penarth) : The debate shows the importance that the Labour party attaches to care in the community. That is why we have given the Bill a speedy passage through the House, but taken the opportunity, as we do again now, to voice concern about the danger of failing to get community care right. It was an instructive Committee stage and I appreciated the opportunity, with my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) and others, to probe the Government on a series of points. It

Column 876

is notable that many new Members played a significant part in Committee, and it is clear today that we have a remarkable number of hon. Members in the Chamber, considering the hour and the nature of the debate.

In moving the amendment, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) has brought us to the heart of concern over the implementation of community care ; a principle that is supported on both sides, but which is meaningless unless we will the means, the resources and the methods.

The amendment looks at method at the difficult interface between health provision and care provision and suggests that no arrangements should be made for a person being transferred into accommodation from an NHS hospital or trust.

"unless the voluntary organisation or other person concerned has ensured that that person is provided with a care plan and the authority is satisfied that such arrangements will facilitate this plan."

The amendment seeks to place those clear obligations on the organisations concerned in decision making. Advocacy is involved in the next amendment, but in this debate we are stressing the need for personal consideration and real care for the individual.

The hon. Member for Macclesfield (Mr. Winterton) responded to the amendment by demonstrating the breadth of concern on this issue. He made a thoughtful contribution and it is sad that, apart from the Minister, his was the only speech from the Conservative benches, unless one counts the intervention from the hon. Member for Aylesbury (Mr. Lidington), which I can describe only as a petty party political sound bite. He has clearly spent too long working for Conservative Members and I hope that in time he will learn to listen to Opposition Members who have knowledge and experience. In fairness, that is the spirit in which the Minister approached the Committee stage and appears to be approaching today's debate, although I disagree with some of the points he made in his response.

My hon. Friend the Member for Sheffield, Hillsborough (Mrs. Jackson), who has direct experience of residential care, made it clear that we are dealing with the way in which individuals see their placement--as the place in which they live, their home. She was right to do so and to say that the patient and the family should be involved. It is easy to say that, but it is difficult to achieve and even more difficult to guarantee. She is right to stress that as a reason for the amendment.

My hon. Friend the Member for Doncaster, North (Mr. Hughes) made a valuable contribution to the Committee, and emphasised the need for choices to be positive choices, not just to be imposed on the individual as a matter of convenience, without attention to the long-term care and needs of that individual.

When he responded to the debate, the Minister confirmed the Government's determination, as he put it, to implement the rest of the community care provisions in April 1993. We still wonder whether he and his colleagues will do it properly. Will the cash be there? My hon. Friend the Member for York (Mr. Bayley) asked about that, and the Minister answered with as near to a straight face as he could manage. If, as he suggests, the resources and cash are to be there, why is the Secretary of State for Health finding it so difficult to achieve ring fencing?

Some of my hon. Friends who have been dealing with this Bill were also members of the Committee dealing with

Column 877

the National Health Service and Community Care Bill. From the outset, we told the Government, "If you are going to do this properly and if you are serious in pursuing the idea of care in the community, you must ensure that the resources are provided and seen to be provided." We still wait for a positive response to that. It seems that the Secretary of State for Health has been convinced of the case we made in Committee. I do not know whether she was convinced by the golden tongues of Labour Members or by experience since becoming Secretary of State. The important thing is that she appears to understand the point we were making at that time, which is still the kernel of our concern.

I regret that the Minister characterised the comments of one of my hon. Friends as antagonism to trusts. Throughout the consideration of trusts, we have said that we do not believe that they will work to the benefit of the community and the individual. We are making predictions about what will happen as a result of the pressures on those running trusts, however well meaning they may be. At the time of the privatisation of water, we predicted precisely the behaviour of plcs, and we have seen our words justified. If one is to introduce trusts, one must put in place the systems to protect the individual in the market that is being created.

The Minister also said that it was not the Government's intention to see discharges into residential care at a cost greater than that available for public funds. As has been said by several of my hon. Friends, that is not what happens in practice. Often, families with a loved one in care or being cared for in one of a number of circumstances, are under great pressure and find themselves filling a gap to avoid that relative being moved and unsettled. It is not just a question of convenience of placement to fit the finance available : we are talking about the loss of someone's home.

There is also the issue of the loss of disposable assets. That is a matter for this Minister and for the Department of Social Security. It is not good enough to leave it to the local authority to tighten the screw on providers, which is effectively what the Minister is saying. A theory that the Government have applied in a variety of circumstances is that, if one places a cap on the money, magic will create greater efficiency, and an improved quality of service will be provided for less money. Good practice needs resources. We all applaud the search for efficiency, but too much capping will distort the quality of service provided. In his response, the Minister described the Government's intention to cap the funds available for care in the community.

My hon. Friend the Member for Halifax (Mrs. Mahon) referred to the effects of policies that may look fine on paper but which fail to provide individual care. She referred to the worrying report that has been produced by the Royal College of Nursing. Another example is day surgery. That is promoted on the grounds of efficiency, but it is risky if community support and care are not adequate.

My hon. Friend the Member for York made a clear distinction between the needs of different clients or patients and the importance of the environment in which individuals find themselves. He was right to underline the position of those who are never visited. He said that they are on their own. At certain times during this debate, and, I suspect, in later debates, the Minister will start to

Next Section

  Home Page