Intermediate Care Services

HC Deb 29 February 2000 vol 345 cc140-3

3. Mr. Jim Cunningham (Coventry, South)

If he will make a statement on the development of intermediate care services. [110855]

6. Mr. John Austin (Erith and Thamesmead)

If he will make a statement on the development of intermediate care services. [110858]

The Secretary of State for Health (Mr. Alan Milburn)

The national beds inquiry, which I published earlier this month, outlines the case for development of new services, especially for older people. Intermediate care services can prevent unnecessary hospital admissions and enable people to regain independence in their own homes after a period of active rehabilitation. That is why the Government will develop those services.

Mr. Cunningham

How does my right hon. Friend intend to expand the number of intermediate care beds, not only to take patients out of hospital acute beds, but, more importantly, to ensure that elderly people receive the proper treatment that they deserve?

Mr. Milburn

My hon. Friend is right. The results of the national beds inquiry show that there are a lot of older people in hospital beds who need not be there. They have gone into hospital for an operation and then found themselves trapped in a hospital bed because there is nowhere else for them to go. They face a bizarre choice between staying in a hospital bed or going home without adequate support. That is why it is important to build a bridge between the hospital and the home by developing new care services. That means that we have to invest in more active rehabilitation and recovery services than we have in the past. We can do that partly in NHS hospitals, partly by giving new life to cottage hospitals, and partly, when necessary, by entering into new arrangements with the private sector to develop intermediate care services.

Mr. Austin

I draw my right hon. Friend's attention to the excellent work being done at the Bevan intermediate care unit in Thamesmead, which provides high-intensity nurse and therapist-led treatment, care, recuperation and rehabilitation, with medical input from general practitioners, thereby providing greater job satisfaction for the staff involved and giving a more appropriate form of care at approximately a third of the cost of an acute bed in a district general hospital. Will he make a special allocation of money or ring-fence money following the beds survey for the development of intermediate care?

Mr. Milburn

As I understand it, the Bevan centre in my hon. Friend's constituency has ring-fenced some of the funding available to it. Such active rehabilitation and recovery services are popular among staff and could give a new role to nursing and physiotherapist staff, getting them working at a level appropriate to their skills. The services are also very popular with patients. That, and how effective they are, counts more than cost. I am slightly more doubtful about ring-fenced funding. It is important to try to overcome some of the fragmentation in funding that there has been in the past. That certainly characterised the old internal market. We must recognise that hospitals, community services, intermediate care services, primary care services and social services are part of one system, rather than being separate systems. The funding structures must support that rather than inhibiting such developments.

Mr. Nick Harvey (North Devon)

I welcome the announcement of new intermediate beds, but I should like more detail on what they will comprise. Will the Secretary of State reassure us that there will not be a return to geriatric wards, which tended to be dumping grounds for the elderly? Is there an opportunity for a reprieve for some of the community hospitals under threat of closure? Some of them have been closed even while the inquiry was going on. Will there be a rehabilitative role for the new beds? Will there be an expansion in occupational therapy and physiotherapy to ensure that there is genuine progress and that we do not just move along the bed blocking problem?

Mr. Milburn

The hon. Gentleman is right on two counts. The new intermediate care services have the potential to give a new lease of life to cottage hospitals, but it is pointless retaining cottage hospitals unless they perform a useful function in the care system. Some do and some do not. We want to move away from passive systems of care that assume that older people in particular are going to deteriorate. We should assume that the care system can rehabilitate them and literally get them back on their feet so that they can have what we all want—an independent life in our own home. Intermediate care services can do that. We shall put in investment to make that happen.

Part of the solution is to ensure that we have the appropriate numbers of staff doing the right things. The hon. Gentleman is right to raise the issue of physiotherapists, occupational therapists and other nursing staff. As I was able to say yesterday, there is good news in that area. We are making progress and beginning to turn the corner on nursing shortages. Of course, there is still some way to go, but if we continue our policies of giving nurses and other staff decent pay rises and changing the way in which they are employed to use their skills to best effect, we shall continue to make progress.

Mr. Stephen Dorrell (Charnwood)

I welcome the Secretary of State's ideas for the development of intermediate care. They follow on from work that was going on before the general election, including the development of some community hospitals in Devon, to which he might have drawn attention. I hope that he will not lose sight of the opposite pressures in the health service—for example, overcentralisation in acute services such as maternity care and sometimes accident and emergency care. In developing his welcome ideas for intermediate care, will he explain some of the disciplines that he intends to introduce to ensure that we have some check against the natural tendency to overcentralise care in large acute hospitals?

Mr. Milburn

I suppose that it was predictable that the right hon. Gentleman would claim credit for the development of intermediate care services. However, in too many parts of the country such services are absent altogether. Indeed, this morning, when I visited St. Thomas's hospital with my right hon. Friend the Prime Minister, staff from the accident and emergency department to the acute sector were telling us that, in addition to real pressures in the system—

Mr. Bob Russell (Colchester)

Was it a media opportunity?

Mr. Milburn

It was not a media opportunity; it was an opportunity to speak to the staff. If Liberal Democrat Members took that opportunity more often, they would have a rather more sensible health policy.

The staff told us, quite rightly, that throughout the health care system, at all levels, there is a lot of pressure, and that in addition patients are placed inappropriately within the system. That needs to be freed up and to do that we have to build a new level of care. That is precisely what we are doing. As for the overcentralisation of services, of course that has to be resisted. We have to ensure that when we design services in the NHS the patients' point of view must be paramount. The service exists to serve patients, not any other interests—including, sometimes, professional interests.

Mr. Philip Hammond (Runnymede and Weybridge)

The Secretary of State referred to the national beds inquiry report. The numbers of beds have continued to fall under the present Government. Will he demonstrate the commitment of which he has spoken by giving an undertaking today that he will not approve any further proposals by health authorities that result in a net loss of beds in that health authority area?

Mr. Milburn

No, I will not do that. Sometimes there are good reasons for changes in the beds system. Let me give the hon. Gentleman an example. At the moment in Norwich, there is a hospital that dates back to the 18th century. It operates on two sites. It is inappropriate in the 21st century, so we are going to replace it with a brand new hospital. We are doing that for a simple reason: it is not possible to deliver 21st century health care in some hospitals that were built in the 20th century or, indeed, the 18th century.

Mr. David Hinchliffe (Wakefield)

I do not know whether my right hon. Friend has had the opportunity to look at reviews in the press today of a book called "A Tourist Guide to the British", which was published yesterday and includes the following disgraceful slur: A rare smile on the face of a Yorkshireman will be a sign only of impending breaking wind. As you know, Madam Speaker, there are many other things that bring a smile to the face of a Yorkshireman, such as receiving free rather than means-tested care. In developing the concept of intermediate care, are the Government any nearer ending the nonsensical distinction between means-tested social care and free nursing care, which would bring smiles to the faces of Yorkshiremen?

Mr. Milburn

I am glad that my hon. Friend went off in that direction rather than the one that I anticipated. As he knows, I announced to the House last December that we were looking seriously at a proposal by the royal commission on long-term care on free nursing care. We are looking at that proposal in the round because it is important that we consider it in the context of what we should do about elderly care services generally. Of course, we have to sort out some of the funding anomalies, but it is equally important that we make sure that the quality of care that elderly people receive, whether it is in the social care sector or the health care sector, is always provided at the highest possible standard. That is precisely what we shall do. As I said to the House last year, following the spending review announced in the summer we shall announce our final conclusions on the royal commission and publish a White Paper.