HC Deb 15 January 2003 vol 397 cc746-51

'.—(1) The responsible NHS body and responsible authority are required to agree the following as regards the discharge of qualifying hospital patients as defined in section 1 of this Act—

  1. (a) action plans to prevent and reduce delayed discharges;
  2. (b) joint local protocols on the administrative and practical arrangements for the implementation of the legislation to ensure that all parties are clear about their respective roles and responsibilities;
  3. (c) local targets for reducing delayed discharges;
  4. (d) joint administrative arrangements for the local implementation of the duties in sections 2, 3, 4 and 5 in this Act.
(2) An action plan under subsection (1) above is a document drawn up by the relevant bodies specifying action intended to reduce delayed discharges, and to change procedures and arrangements which may cause or contribute to the failure to comply with duties under section 3. (3) Joint local protocols will include named persons responsible for coordinating all stages of the patient journey up to and beyond discharge, and ensuring that all necessary arrangements are put in place at the right time. (4) Local protocols may include joint agreement on how payments made under section 4 are used to encourage a whole system approach to services for older people, and to ensure that all stakeholders are involved in deciding how the payments are spent.'.—[Mrs. Calton.]

Brought up, and read the First time.

Mrs. Calton

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

Mr. Deputy Speaker (Sir Michael Lord)

With this it will be convenient to discuss the following: new clause 6— Written discharge plan— '.—(1) Further to the fulfilment of the requirements under section 3(3)(a) and (b) a written discharge plan shall be produced and taken to include—

  1. (a) an assessment of community needs within the meaning of section 47 of the National Health Service and Community Care Act 1990, and arrangements for aftercare; and
  2. (b) where the patient has an intending carer, within the meaning of section 1(1)(b) of the Carers (Recognition and Services) Act 1995, an assessment in compliance with section 1 of that Act.
(2) Regulations may prescribe the form of a written discharge plan.'. Government amendment No. 26.

Amendment No. 42, in page 2, line 19, at end insert— '(1a) The form of a written discharge plan.'. Government amendment No. 31.

Amendment No. 43, in page 3, line 11, at end insert—' (2a) The form of a written discharge plan.'.

Mrs. Calton

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

Subsection (2) of the new clause states: An action plan under subsection (1) above is a document drawn up by the relevant bodies specifying action intended to reduce delayed discharges". Let me ask the Minister a question to which I have still not had a reply so far, although it was asked in Committee. Has the Secretary of State or the Minister assessed the success of plans that had to be submitted by social services departments last August to reduce delayed discharges? A special grant report was produced in July 2002, and we heard then that money was being made available. We still do not know whether the plans made then have benefited the situation. We believe that the Bill is premature, given that measures introduced only in this financial year remain to be properly assessed.

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

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

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

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

Mr. Burns

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

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

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

4.30 pm
Jacqui Smith

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

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

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

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

Mrs. Calton

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

Jacqui Smith

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

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

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

Mr. Burstow

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

Jacqui Smith

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

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

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

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

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

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

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

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

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

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

Mrs. Calton

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

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

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

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

Mr. Kevin Hughes (Doncaster, North)

Will the hon. Lady give way on that matter?

Mrs. Calton

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

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

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

Government amendments Nos. 26 to 34 agreed to

Forward to