HC Deb 01 April 2003 vol 402 cc861-73

The Lords do not insist on their amendment No. 2, to which the Commons have disagreed, but propose the following amendment in lieu thereof—

No. 2B, in page 6, line 23, leave out from "regulations" to end of line 24 and insert or an order under this Part is exercisable by the appropriate Minister by statutory instrument".

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The Minister of State, Department of Health (Jacqui Smith)

I beg to move, That this House agrees with the Lords in the said amendment.

Madam Deputy Speaker (Sylvia Heal)

With this, it will be convenient to discuss Lords amendments Nos. 2C to 2E.

Jacqui Smith

In our previous discussions on this matter, Opposition Members argued that mental health patients should be permanently excluded from the provisions of the Bill because it would not be possible to carry out an assessment and arrange a care plan for such patients within a minimum time scale, because their needs differed from those of others. That argument took no account of the fact that the Bill already allows us to make different provision for different cases. Of course, as I pointed out earlier, permanently excluding such patients would mean that we ran the risk of being seen to discriminate permanently against patients with mental health problems.

However, I listened—as I always do—to the hon. Member for West Chelmsford (Mr. Burns), who said: The group could be included in the future, but it should not be included at the moment."—[Official Report, 19 March 2003; Vol. 401, c. 963.] We would have agreed with him if he had said "should be included." In another place, the Government proposed the group of amendments that we are considering. They would enable Parliament to scrutinise inclusion when the group of patients is included in the future, and the arrangements for doing that. The amendments therefore require any regulations that bring patients who receive mental health care within the definition of "qualifying hospital patient" to be subject to affirmative procedure.

We have added a requirement to clause 8 to provide that regulations that prescribe mental health care must be subject to affirmative procedure. That means that we also need to define mental health care. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) made that point powerfully in our previous debate on the subject. It is therefore necessary to add an order-making power to deal with the problem of definition in the most straightforward way. We intend the order to prescribe mental health care as care that is received by a patient who is under a consultant psychiatrist. Two further consequential amendments would affect clauses 9 and 11.

When it is appropriate, we will lay before the House regulations that bring patients who receive mental health care within the scope of the definition of "qualifying hospital patient". Parliament will then be able to debate—and, if it wishes, disagree to—any such regulations.

Mr. Simon Burns (West Chelmsford)

Has the Minister any time scale in mind for reaching that point?

Jacqui Smith

No, we do not have a time scale. As we said throughout our discussions, we should take a pragmatic approach to ensuring that we develop the policy in the most appropriate way. I would want to consider what I anticipate to be the success of the approach for those in acute care as we examine its further extension.

I believe that we have taken the right approach. The Bill does not exclude the patients whom we are considering, but Parliament will be able to scrutinise the timing and the basis of their inclusion. I therefore hope that hon. Members will agree with Lords in their amendments.

Mr. Burns

I sincerely thank the Minister for her kind and generous comments about me. It was refreshingly unusual and especially gratifying because she is admitting, as we approach the Bill's last parliamentary stage, that she agrees with the arguments that my hon. Friends and I have presented on the subject of our discussion.

I was fascinated to hear the Minister say that the Government had sought throughout our proceedings to take a "pragmatic approach" on the way in which to progress. It is unfortunate that the Minister did not extend her bonhomie towards my views further because my hon. Friends, the hon. Member for Sutton and Cheam (Mr. Burstow) and I have urged the Minister and the Department from the start to take a pragmatic approach. We suggested that they got rid of the Bill because it will not achieve the Minister's hopes. It will simply set the health service against social services through fines, if I may use, for the final time, the f-word about which the Minister has been in denial most of the time. However, we always welcome a sinner who repents, and the Minister repenteth with a vengeance. We do not hold that against her, as it shows what we have suspected for a long time: if common sense stares her in the face and she is told often enough, the desired effect will result. However, rather sadly for me, she said during our previous proceedings that she had heard my speech many times before, although that shows that it was worth repeating.

I certainly do not want to rub the Minister's nose in it, but she has, very graciously, conceded the points that the Opposition have been putting to her. I am only saddened that, due to other commitments, the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Health Committee, cannot be present. I imagine that he may be deliberately absent, because although he argued vigorously last time that the proposal was wrong and his Government have now conceded the point, once again we see the Labour Chairman of that Committee out of synch with his Secretary of State and his Government on a health matter.

To all intents and purposes, the amendment goes along with what we have been urging with regard to patients suffering from mental health problems. We have always said that there are a number of reasons for such patients being treated differently from those with acute illnesses and needs for surgery due to the nature of their illness and the problems associated with mental illness. That is why we tabled amendments originally and why we have pressed them so vigorously on the Government.

We believed that exempting sufferers of mental illness or postponing until the appropriate time, as the Minister said, their being brought into the ambit of the fining regime would help to enhance a fairly poor Bill. I am glad that the Government have agreed to what are, in effect, amendments to amendments, which will ensure that sufferers from mental illness do not come within the Bill's ambit until, at some later stage, the Government consider issuing a statutory instrument that will, I believe, go through both Houses of Parliament. That is good news, because the Government have recognised a real problem with the care of the mentally ill. I warmly welcome that.

Also, there is a knock-on effect. For a variety of reasons, not least the damage that could be done to the rest of the health service and social services, the legislation will probably no longer be relevant when the time comes—if it ever does—for it to take effect in this respect, as the Government may be seeking to use another approach or the problem may have gone away, which would make the legislation redundant. I cannot predict which of those scenarios might happen, but I am pleased that the Government have, in principle, conceded the point and I welcome the way that they are seeking to address it.

The Minister talks about regulations being made under section 1 of the legislation and the Government perhaps wanting to include people who suffer mental health problems, but what rather amuses me is the fact that that will be done through a statutory instrument. This is novel: we had regular debates upstairs in Committee, the Bill was considered on Report on the Floor of the House and the Government listened to our arguments, but, sadly, they did so in isolation.

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The amendment says that the regulations under section 1 may not prescribe a description of care which is, or includes, mental health care unless a draft of the regulations has been laid before … Parliament. That is perfectly straightforward, and the terminology is correct. It is the rest of the sentence that is significant, as the Minister will know from our earlier debates—debates that she has cruelly claimed to have heard many times before. The words that I left out just now are and approved by a resolution of, each House of". That constitutes a clear statement that the order will be subject to the affirmative procedure. There will be no back-door publication of an order slipped through on the basis of a negative resolution, allowing, if we are lucky, a 90-minute debate in Committee—by which time the order would probably be in force. Now it cannot come into force until it has been subject to an affirmative resolution.

I congratulate the Minister from the bottom of my heart on seeing sense and finally conceding that secondary legislation emanating from important primary legislation should be subject to the affirmative procedure in both Houses. What disappoints me is the fact that she has conceded that point so late in the day. As my right hon. Friend the Member for North-West Hampshire (Sir George Young) will recall, in Committee we engaged in debate after debate on all the other secondary powers in the Bill that would be dealt with through the negative procedure—although they related to issues of great concern and significance—because they flowed from what could be described as a skeleton of a piece of primary legislation, and the power to determine and implement the fleshing out of that skeleton must come from statutory instruments. The Minister was adamant that it was unnecessary to deal with the matter other than through the negative procedure. I am sorry about that, because I believe that the House should have the right to debate important secondary legislation and question Ministers on it. As I have said, I am glad that the Minister has accepted our arguments, but wish that she had done so earlier.

I thank the Minister for being prepared to think again. Notwithstanding what she may have said in the past and what some of her Back Benchers have said, she was—"tough enough" is probably the wrong term, and "man enough" certainly is—magnanimous enough to realise that the Opposition were saving her from herself and improving the Bill, while also improving the care of the mentally ill. She recognised reality when it stared her in the face, and gave us the amendments to the amendment.

My colleagues and I will not oppose this change to the Bill. We look forward to seeing it on the statute book, because we believe that our initial gut reaction was right and that this is in the best interests of those who suffer from mental illness.

Mr. Paul Burstow (Sutton and Cheam)

This is the last gasp for consideration of this Bill and today's consideration of Lords amendments is all about banking the concessions, reassurances and undertakings that have been given by Ministers at the Dispatch Box here and in the other place. We should thank the Minister for making those concessions and I place on record my appreciation of the hard and diligent work undertaken by my noble Friends Baroness Barker and Lord Tim Clement-Jones, who pursued several of the concerns that I and my hon. Friend the Member for Cheadle (Mrs. Calton) raised in Committee—not least the question of how the Bill will operate. We certainly welcome the concessions, not least the fact that the amendments will allow both Houses to consider the matter through the affirmative procedure. Conservative Front-Bench Members and I raised that issue in Committee, and we are pleased that, in this last stage of consideration, it will be built into the Bill.

I should like to ask the Minister about the operation of amendment No. 2C, which states that regulations may not prescribe a description of care which is, or includes, mental health care unless a draft of the regulations has been laid before, and approved by a resolution of, each House of Parliament. By dint of the drafting, could a person living in a care home as part of a period of intermediate care be excluded if he also had dementia? If Ministers were minded to include care home settings in future regulations on discharge arrangements—I believe that that was intended in other clauses—and if a person receiving intermediate care in a care home setting also had dementia, thus receiving mental health care services as part of the overall package, would any such regulations have to be subject to the affirmative procedure if the Bill's powers were extended beyond the acute sector into the care home sector? Will the Minister clarify whether that is the Government's intention? On a quick reading, it would be possible to interpret the amendment that way, so it would help if the Minister clarified the position.

As I said, we shall not oppose the amendment and we shall bank the other concessions gained from the Minister, and in the other place, over the past few weeks.

Jacqui Smith

I do not intend to respond to much of the contribution of the hon. Member for West Chelmsford (Mr. Burns). I simply reiterate the constructive approach that I have adopted throughout the legislation by saying that the principle is right. Although we will probably—though not necessarily—start with predominantly older people whose discharge from acute hospital care is delayed, it has always been our intention to consider the extension of the provisions if they prove, as I believe that they will, successful in providing incentives to ensure that people get the right care at the right time in the right place. We have always recognised that different people in different circumstances may need a slightly different approach—for example, in respect of the period of time necessary for an assessment, or the level of charge appropriate to particular circumstances.

The amendments that we are debating today are our attempt to assure hon. Members that we recognise such differences. In the context of the specific issues or concerns pertaining to mental health, it is appropriate that, when and if we get to that particular stage, we examine proposals in detail and allow Parliament to do so as well.

The hon. Member for Sutton and Cheam (Mr. Burstow) raised a specific matter. The Bill will already allow the provisions in part 1 to be extended to people in care homes. He is right to say that we discussed in Committee the circumstances in which that might happen. People delayed in intermediate care could well be in a position where it would be appropriate to extend the part 1 provisions to them.

As I made clear in my introduction, the extent to which that would be subject to the affirmative procedure would depend on the primary reason for the care. The regulations would be extended to mental health patients in circumstances where the qualifying patient was under the care of a consultant psychiatrist. That is our definition, and it would be the determining factor as to whether subsequent regulations would be subject to affirmative resolution.

The hon. Gentleman also wondered whether we would need to consider the specific circumstances involved in extending the provisions in part 1 to intermediate care, and whether I accepted that such care often had an impact on people with dementia. I assure him that the answer to both questions is yes. Whether the affirmative resolution procedure and these particular amendments will be involved depends specifically on whether a person is under the care of a psychiatric consultant.

Mr. Burstow

The Minister has spoken about the involvement of consultant psychiatrists, but the mental health of older people is often dealt with by psychogeriatricians. They deal with dementia particularly, but with other conditions as well. Is the Minister specifically excluding reference to psychogeriatricians, or are we talking only about psychiatrists in this respect?

Jacqui Smith

The amendments deal only with the circumstances in which the affirmative resolution procedure would be necessary. All the way along, our argument has been that there might be a variety of people—including those older people under the care of psychogeriatricians—for whom it would be appropriate to use the provisions in the Bill. When we come to extend the provisions of part 1 to those suffering from mental health problems, we will need to define what we mean by the phrase "qualifying patient". It is in that context that I said that it seemed appropriate to define them as being those people who are under the care of a psychiatrist. That does not mean that other patients would not be able to benefit from the provisions of the Bill—either now, if they fit the definition of "qualifying patient", or in the future.

I hope that the House will feel able to agree with the Lords in the amendment.

Lords amendment agreed to.

Lords amendments Nos. 2C to 2E agreed to.

Jacqui Smith

I beg to move, That this House agrees with the Lords in amendment No. 26B, an amendment to Lords amendment No. 26, as amended: in line 26, at end insert— (7A) Until 31st March 2005 the period of two days referred to in subsection (7) is exclusive of Sundays and public holidays in England and Wales. In Committee, we discussed the inclusion or exclusion of week ends and public holidays from the minimum interval—the time following notification in which social services must assess and arrange services for a patient. I said that I did not believe that we should state on the face of the Bill that it was acceptable for local authorities to take five days as a minimum period to assess patients and make services available for them. It is worth reminding ourselves that we are talking about a minimum period, and the Bill makes it clear that a discharge would begin only from the end of the minimum period or from the point at which somebody was ready to be discharged.

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As I pointed out in Committee, the Bill already ensures, owing to better communication between the NHS—particularly hospitals—and social services, that it is likely that somebody going into hospital for an elective operation would already have had their potential need for social services notified to the local authority beforehand, providing a longer period than in many cases exists at the moment. If they went in as an emergency patient, current figures suggest that only 30 per cent. of such patients come out within three days. We are talking about setting a minimum period that would probably not affect most patients, who will have a longer period.

Opposition Members have asked us to enshrine in the Bill the possibility that it could take much longer to assess a patient and to make services available so that they can safely leave hospital. A delay does not become any more acceptable to a patient and their family just because it takes place at the weekend or on a bank holiday. A person in an acute hospital bed who no longer needs to be there is not at less risk of the consequences or less vulnerable because social services do not work at weekends. It has been argued that although many social services departments are improving, and are sometimes able to operate for seven days a week, they cannot immediately be expected to perform those functions outside the normal working week. Although I firmly believe that social services should be moving towards a more flexible approach to working hours that means that the needs of individuals for community care services can be more effectively met, I accept that that will take time.

The amendment requires the regulations on the minimum assessment period to exclude Sundays and public holidays from that period until 31 March 2005.

Mr. Burns

Let me seek clarification so that there is no misunderstanding. The Minister says that the amendment excludes Sundays and bank holidays, but if she looks at subsection (7), she will see that it refers to at least two days excluding Saturdays, Sundays and public holidays. Did she erroneously forget to mention Saturdays?

Jacqui Smith

I think, dare I say it, that the hon. Gentleman is looking at the wrong amendment. Our amendment, instead of excluding Saturdays, Sundays and public holidays, inserts new subsection (7A), which says: Until 31st March 2005 the period of two days referred to in subsection (7) is exclusive of Sundays and public holidays in England and Wales. We have replaced the provision on Saturdays, Sundays and public holidays that was previously in the clause with the provision that until 31 March 2005 the regulations will exclude Sundays and public holidays.

Mr. Burns

I am grateful to the Minister, and I am happy to confirm that she is absolutely right. However, given that she has conceded two thirds of the loaf, why did she not include Saturdays?

Jacqui Smith

I was explaining how I had been somewhat reluctant even to concede two thirds of the loaf. We are talking about the minimum period of time within which we expect social services departments and health providers, working together, to determine an appropriate package of care that ensures that somebody can leave hospital safely. My argument throughout has been that modern social services departments should work over weekends. I do not think it appropriate to say to an older person, "I'm afraid you're going to have to stay in hospital because we're not in a position to sort out your package of care this weekend."

The amendment seeks to acknowledge the fact that we are in a period of transition and that, given the considerable extra investment that the Government are putting into social services departments, it is likely that the departments will build up their ability to assess people, build up the flexibility of their assessments, and build up their ability to offer services over weekends. It is therefore reasonable of us to say that we will extend the minimum period up to 31 March 2005 so that it does not include Sundays and public holidays. That will mean that local authorities have from now until January 2004—given the other changes that were made in the other place on the point at which charging will start—to plan and prepare for Saturday working before charging kicks in. They will have at least another 15 months after that to move to a seven-day service. We will mirror that in the regulations to do with notices. Although Sundays and public holidays are not part of the planning period, they will not count in the time scale of any notices that are given by the NHS to local authorities. That is a compromise. I do not believe that anyone would want the Bill to contain the message that it is acceptable for older people routinely to wait five or more days in hospital for an assessment of the services required. However, by excluding Sundays and public holidays until 2005, we are giving local authorities time to change their working practices and minimise delays for individual patients.

I think—dare I say it—that what I have said reflects the constructive approach that we have taken throughout the process while at the same time maintaining our commitment to put in place a system that ensures that people are not trapped in hospital when they are ready to leave as a result of a failure to put in place community care alternatives. As the Bill has gone through both Houses, we have responded in a variety of areas where improvements to the legislation were possible. The principle has been maintained all the way through, but I hope that hon. Members will feel able to support this compromise and agree with the Lords amendments.

Mr. Burstow

The issue of bank holidays and weekends was first pursued first in Committee in this House and then quite vigorously by my noble Friend Lord Clement-Jones in the other place. The proposal had all-party and Cross-Bench support in the other place. That was important, as it allowed us to reach the point that we are at today—with two thirds of the loaf ready to be considered. On the basis of the consideration in the other place and the points that have been raised by the Minister today, I feel that a further delay in implementing this change in respect of Sundays and bank holidays is very welcome. However, it gives rise to some questions that I would like to put to the Minister.

The Minister is right to say that none of us wants a situation in which a person is unnecessarily left languishing in a hospital bed. We want all efforts to be made to ensure that a person who is ready to be discharged does not stay in hospital unnecessarily. For the benefit of those hon. Members who are able to listen to me, I want to ask the Minister about the cost of moving from a five-day-a-week service to a seven-day-a-week service. From reading the Lords deliberations on the clause it is not entirely clear whether the Government have any idea of the cost of moving to a seven-day-a-week service. It cannot be cost free. Can the Minister tell us whether the cost will be contained in the additional resources that are being allocated through the comprehensive spending review"? In that case, the resources would be tied up in doing the same thing for more days of the week rather than in doing new things, so I hope that the Minister will not claim that the Government will be doing lots of additional, new things with money that has been earmarked to enable us to move to a seven-day-a-week service.

We do not entirely reject the argument for moving to a seven-day-a-week service, not least because of some of the points about children's services made recently by Lord Laming in his report. In some cases, people need services that are available 24 hours a day and, in respect of discharge, seven days a week. The amendment would allow us to move towards that situation in an orderly fashion, which is certainly welcome.

The delay is welcome, not least because it affords us the opportunity further to understand how the assessment process will work out. During consideration of these and other amendments in the other place, there was some discussion about the planning of the discharge process and the production of care packages. For example, after a person was discharged to their own home, there would be further assessment after two weeks to see whether everything was working as intended. However, it was not made clear during those deliberations whether that would apply to someone who was discharged to a care home. It would be helpful if the Minister could confirm that it will not apply only to someone who is discharged to their own home. People discharged to care homes would also benefit from such an assessment. Sometimes placing someone in a care home is the wrong decision and the person could recover more effectively and lead a more independent life in their own home with an appropriate care package.

Finally, I draw the attention of the House to the fact that the amendment will have the useful effect of delaying for several years the introduction and implementation of the Bill's provisions in respect of Sundays and public holidays. It is rather amusing that the whole Bill was meant to come into effect today—April fool's day. The legislation should have been implemented this year and it behoves the Minister to acknowledge that that timetable was never realistic if there was to be adequate parliamentary scrutiny of the measure. Parliamentary scrutiny has resulted in the improvement of the Bill, which means that most of its provisions will not be implemented until next January. That is welcome progress from the point at which we began our proceedings on the Bill many months ago.

We are willing to accept the amendment. Two thirds of the loaf is certainly better than nothing.

Mr. Burns

I echo the words of the hon. Gentleman, who rightly reminded the House that April fool's day 2003 was the day on which the Government intended the Bill to come into force—the day on which the fines were to start. In her heart, if not through her mouth, the Minister will agree that we have saved the Government from being the ultimate April fools. If it were not for my noble Friends who tabled the amendment that postponed the legislation, we should not have seen the Government climb-down that has led to its coming into force on 1 January 2004. I am sure that the hon. Lady will accept that we have done her and her Government a great favour by imposing common sense on them.

The Minister rightly said today that she had tried to take a constructive approach throughout all the proceedings on the Bill, as well as on this amendment. It is wonderful how constructive one's approach can be if the Opposition parties have been even more constructive in showing the Government the error of their ways, and when common sense prevails in another place. As any student or follower of the saga of this legislation knows, in Committee, on Report and in another place we have explained time and again to the Minister that not to exclude Saturdays, Sundays and Mondays would be a mistake, because there is essentially a five-day service at present, and to extend that service to seven days would, certainly in the short term, cause considerable problems—not least in funding, as the hon. Member for Sutton and Cheam (Mr. Burstow) said.

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Although I urge the Minister to resist her usual rant on the subject, it would be interesting if she would address the points made concerning the funding of the service when it in effect changes from a five to a seven day service, because in the real world, as the Minister is aware, services tend to slow down over the weekend and over bank holidays. That is rightly or wrongly a fact of life, and that is why we have pushed so hard and so long with this amendment, to try to save the Government from not facing the reality of the current situation.

As I told the Minister in an intervention, we have two thirds of a loaf rather than the whole loaf, but then, as the Minister could with some justification say because she will have heard it numerous times before, when one is in opposition and the Government have an overall majority of about 165 seats, any crumb that falls from the Minister's table is more than welcome. In fact, it could be seen as a considerable victory.

I do not want to dwell on the narrow party political point, because this is not so much a party political victory as a victory for common sense. It is a victory for patients. a victory for social service departments and probably a victory for the NHS, so I too welcome what the Minister has said and agreed to with this two thirds of a loaf.

In conclusion, I have one final question for the Minister, which I dearly hope she will be prepared to answer so that we may end on a satisfactory note. The amendment seeks to give leeway for Sundays and public holidays over the assessment process to help social service departments to avoid incurring fines through no fault of their own. The Minister—except once or twice when she had serious lapses—has refused to use the f-word. She has used her thesaurus and the Labour spin machine and she has come up with every word under the sun to describe what the Bill does and what the amendment seeks to minimise. She has used the euphemism "incentives". She has used the word "charging". She has used other words, but except when she has had a lapse she has never used the word fines. But to the Minister's embarrassment, her own Secretary of State, in his statement to the House the day after the Budget, used the f-word. He was quite blatant. He said that the fines imposed under the legislation would, "x, y, zee." Why does the Secretary of State use the word fines when the Minister has steadfastly refused to do so? Will the Minister now face the reality of the situation and accept that the Bill is just a cackhanded way in which to penalise one public service—social services departments—at the expense of the NHS by imposing fines?

As my hon. Friends and I have two thirds of a loaf and are not greedy, we will not press any amendment in this group to a Division because, once again, we are grateful to the Minister for taking our advice in a very constructive a way—we gave the advice—and tabling the amendment.

Jacqui Smith

As we come to the "zee" of this legislation, I hope that we can bring it to a successful conclusion. I shall respond first to some of the points made by the hon. Member for Sutton and Cheam (Mr. Burstow). He asked me about the cost of seven-day working. I reiterate what I said in my introductory remarks: some social services departments are already successfully ensuring that, within three days, they assess and put in place the package of care necessary to get people safely out of hospital, so calculating the cost of bringing everyone up to that level is not straightforward.

We could argue that everyone should be at that level already, but we recognised that social services departments needed more funding for that aspect of work, among others. That is why the access and systems capacity grant, in particular, highlights the need to improve the number of people involved in assessment and the speed with which assessment takes place, as my right hon. Friend the Secretary of State made clear in his statement in July last year. We have made it clear that that considerable extra investment will contribute to that function.

Although I can take such comments from the hon. Member for Sutton and Cheam, the hon. Member for West Chelmsford (Mr. Burns) has a bit of a cheek in returning to money again. However, he begged me not to be too confrontational, so I will not be. I shall simply remind hon. Members that the extra investment in social services departments, which enables us to have our high aspirations about ensuring that people get out of hospital and receive the right care when they need it, is possible because of the Government's investment plans, which were not supported by Opposition Members.

In response to the concerns that were raised about people returning to their own homes and then perhaps struggling or being concerned about whether the package of care was adequate, we said that two-week reviews would be undertaken when people return to their own homes. That concern is not so likely to relate to people in care homes, although I recognise the point that we often need to ensure that people do not automatically go into care homes when, with a bit of support, they could return to their own homes. I am glad that the hon. Member for West Chelmsford is nodding.

The Government have therefore not only defined the idea of intermediate care in the national service framework, but invested significantly in it. That is why last week we were able to report a considerable increase in the number of people who benefit from intermediate care, when we celebrated the fact that the national service framework was published two years ago. That type of opportunity will ensure that older people get the care that they need, as well as the chance to regain their independence.

Opposition Members have tried to claim victories today, and I am certainly willing to say, as I did earlier, that we have taken a constructive approach throughout the debates on the Bill. For example, we recognised the need to strengthen the provisions on carers in the amendments that we proposed. We also realised that we needed to ensure that the Bill—which is so much about putting patients, particularly older people, at the centre of care—explicitly recognised that fact in the way in which it makes requirements to ensure that people are consulted, for example, before social services are notified and involved in the process. We have made changes and we have clarified the position as we have gone through this process.

Mr. Burns

The Minister has been constructive in accepting Opposition points of view and in tabling amendments. Would she have been so constructive and made so many changes to the Bill if our Parliament was a single chamber Parliament?

Jacqui Smith

If hon. Members will forgive me, I will not even start down that route.

Mr. Deputy Speaker (Sir Michael Lord)

Order. The hon. Lady would be well advised to take her own advice and stick to the amendment.

Jacqui Smith

Thank you, Mr. Deputy Speaker. I have outlined some of the issues on which we have made progress. The Bill comes out of the process the better for that.

I also remind hon. Members that we have maintained at the centre of the Bill—in part 1—the principle that we set down at the beginning. It is right to put in place a system of incentives that ensures that predominantly older people get the right care at the right time and in the right place. We should focus on making sure that health and social services work together better than they have previously so as to make sure that the community alternatives are in place. The Bill that the hon. Member for West Chelmsford has described as horrible on various occasions will, in the very near future, become an Act. That principle will be enshrined and, as I have argued throughout, it represents—along with part 2, which will make community equipment services free and ensure that intermediate care, wherever it is placed, is free—an important step forward. It will enable the Government to continue the progress that they have made in reducing delayed discharge and will make sure that the additional investment that we are putting in place has the effect that it should have. Older people and others can be more confident that they will get the right care in the right place and at the right time. On that basis, I commend the Bill and ask the House to support the amendment.

Amendment agreed to.

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