§ 14. Mr. ChisholmTo ask the Secretary of State for Scotland how many NHS continuing care beds for the elderly there were in 1985; how many there are now; and how many he expects there to be in 10 years' time. [24238]
§ Lord James Douglas-HamiltonIn 1985, there were 12,064 geriatric and psycho-geriatric beds in Scotland. There are now 12,950 beds in those categories. There has, however, been a reclassification of beds over that period. There are no centrally imposed targets for long-stay bed provision in the NHS.
§ Mr. ChisholmDoes the Under-Secretary realise that there is fear and dismay in Lothian because the number of long-stay beds for the elderly is to be more than halved by the end of the century, with the prospect of eight beds in 10 disappearing by 2005? Does he accept that the main result will be not more care in the community but more elderly people paying for nursing home care? Having paid once through tax and national insurance contributions, why should many elderly people have to pay yet again, some having to sell their homes to do so?
§ Lord James Douglas-HamiltonI welcome the fact that Lothian health board and the relevant NHS trusts are looking carefully within Lothian at all elderly, long-stay admissions to hospitals and, where appropriate, arranging for suitable placements in the community. Clearly, however, elderly people who need long-stay NHS care will receive it. Guidance has been issued on the subject and, if an element of patients' needs cannot be readily met, quite simply they should not and will not be discharged. We are to consult shortly on Scottish provisions on the NHS role in continuing care and on 898 provision for appeals against a clinician's assessment for continuing NHS in-patient care, because, on occasions, some of the disputes relate to decisions made by clinicians. I shall bear in mind the hon. Gentleman's points, as will my right hon. and learned Friend the Minister of State.
§ Mr. KirkwoodIn the consultation that the hon. Gentleman has just announced, will he take into account the concern that is felt by many people who occupy NHS continuing care beds, who face the prospect of being transferred into the social work care in the community package and who, in the course of so doing, have not only their needs assessed but their means tested? Will he give a categorical assurance that Scottish health boards will have enough finance to ensure that transitional protection elements are in place, so that there are no costs to existing patients in continuing care in the NHS? During the consultations, will he undertake a review to ensure that benefit thresholds are relaxed so that people's inheritances do not in future have to pay for their continuing care?
§ Lord James Douglas-HamiltonSome of the matters that the hon. Gentleman raises should be addressed to the Department of Social Security, but we regard it as extremely important that sufficient resources are made available. There has been enhanced mainstream funding of £158 million this year from the transfer of former DSS funds. Some £14 million has been transferred under the mental illness specific grant scheme, and £50 million has been transferred from the health boards to the local authorities. We anticipate that the transfer could be about some £200 million early in the next decade. We cannot state the exact sum at this stage because much of what happens will depend on the judgment of clinicians.
§ Mr. StewartMy hon. Friend will be aware that in my constituency Greater Glasgow health board has increased the number of continuing care beds compared with its original plans. Does that not show that health boards are responding in real terms to the consultation and constructive points made by communities?
§ Lord James Douglas-HamiltonMy hon. Friend is right. Greater Glasgow health board received a general allocation for revenue expenditure this year of £585.66 million which, together with efficiency savings, gives an increase of 3.76 per cent. over the year before. I am delighted that such progress has been made in my hon. Friend's constituency.
§ Mr. McAllionWill the Minister try to understand that the quality of those NHS continuing care beds that do survive depends entirely on the people who staff those beds—the doctors, nurses, radiologists, ancillary workers and other NHS workers? Will he try to understand above all that those dedicated people will not be bought and sold like cattle in a marketplace? We need a guarantee from the Minister that no NHS job will be put up for sale to the private sector in open competition in Stonehaven or anywhere else in Scotland. It is simple: either he rules out or he rules in privatising the people who are the NHS in Scotland. Which is it to be?
§ Lord James Douglas-HamiltonThe private finance initiative is certainly not about privatising the health service. It involves sharing the risk with the private sector, giving incentives for better performance and providing services as well as capital to support the NHS. The whole 899 purpose of the scheme is to make public sector funds go much further by bringing in private sector funds to make it certain that high standards will be implemented.
§ Lord James Douglas-HamiltonIt is the best service for the people who are being served—the patients. The interests of those at the sharp end of the system must be constantly kept in mind.