§ Lord Morris of Castle Morris asked Her Majesty's Government:
§ Whether it is the case that there is no general duty on a health authority to provide in-patient medical or nursing care to every person who needs it.
§ Baroness Denton of WakefieldMy Lords, Section 3 of the National Health Service Act 1977 lays on the Secretary of State a duty to provide, to such extent as he considers necessary to meet all reasonable requirements, hospital accommodation and such other services as are required for the diagnosis and treatment of illness. In general, the Secretary of State discharges his duties by delegating the responsibility for provision of service at local level to NHS authorities.
§ Lord Morris of Castle MorrisMy Lords, I am grateful to the Minister for that Answer. Is she aware that there is deep anxiety among a wide variety of people about the obligations of the health service to provide care for people with long-term illnesses? Without a community care programme—and if the comment of the National Health Service chief executive that there is no duty on health authorities to provide such care is correct —who is responsible for caring for people with long-term illnesses?
§ Baroness Denton of WakefieldMy Lords, under this Government NHS spending has risen by 55 per cent. in real terms. There is a concern for people of all ages in intensive, emergency and long-term situations.
§ Lord CarterMy Lords, is the Minister aware that Mr. Duncan Nichol, chief executive of the health service, has said that if in a doctor's professional judgment a patient needs NHS care there is a duty upon the health service to provide that? If a patient is discharged from hospital into a private nursing home, which now happens a great deal, who is responsible for providing the continuing medical care?
§ Baroness Denton of WakefieldMy Lords, one of the prime areas of the new National Health Service reforms is that GPs keep contact with their patients throughout their illness. They have a responsibility.
§ Baroness Gardner of ParkesMy Lords, is it not a fact that nowadays fewer people are being treated as in-patients and, therefore, that there are changing patterns in medical treatment?
§ Baroness Denton of WakefieldMy Lords, we have heard in this House on many occasions how medicine has changed so that there is much less in-patient care. More people are at home and able to be with their families because of the developments in medical techniques.
§ Lord CarterMy Lords, I am a little confused by the Minister's answers. She stated correctly that the 1977 Act places a duty on the Secretary of State to provide comprehensive health care. However, that duty does not extend to health authorities. The Minister has now said that GPs should be responsible. If the duty does not extend to health authorities how do GPs have such a responsibility?
§ Baroness Denton of WakefieldMy Lords, I apologise. The National Health Service works with both the health authorities and with the family health services.
Lord Bruce of DoningtonMy Lords, will the Minister answer this question? If an elderly person who is extremely ill and immobile needs nursing care but cannot afford to pay for that privately, whose responsibility is it to ensure that that person receives the necessary proper nursing care?
§ Baroness Denton of WakefieldMy Lords, the health care services will ensure that such a person receives the care necessary.
§ Lord Cledwyn of PenrhosMy Lords, the Minister said that patients are discharged and are able to be at home with their families and the whole House will agree that that situation is desirable. However, in a sense it is going back 100 years or more to the time when families looked after sick relatives, in particular parents who were becoming old. Today, great difficulties are suffered by families, particularly when people are out at work. Will the Minister ask her right honourable friend to look again most carefully at the matter?
§ Baroness Denton of WakefieldMy Lords, of course I shall draw attention to the anxiety expressed by the noble Lord, Lord Cledwyn. However, I must point out that health authorities can enter into contractual arrangements with independent sector nursing homes whereby the patient remains the responsibility of the NHS. We are extremely conscious of the load that illness puts on the carer.
§ Lord McColl of DulwichMy Lords, does my noble friend agree that no patient in this country who needs medical care is ever denied it? Therefore, there is not a problem and the questions asked by Members on the other side of the House are merely confusing the issue.
§ Baroness Denton of WakefieldMy Lords, I agree with my noble friend that people's needs within the health service are met increasingly well.
§ Lord Morris of Castle MorrisMy Lords, I am grateful to the Minister for all those replies, although she will not be surprised to learn that we on this side 487 of the House find them a little disappointing and perhaps confusing. Will she, for example, define what she means by "the health authorities" in each case?
§ Baroness Denton of WakefieldMy Lords, rather than give a cold definition, I will say that the various stages within the health service will look after the concerns of the patient. If a patient is discharged from a home he will, like any other citizen, be entitled to look to the NHS for help through his general practitioner. If he has need of a home the district health authority will arrange that the home in which he is looked after is to its high standard.
§ Lord GridleyMy Lords, is the Minister aware that there is a procedure, certainly where I live, whereby doctors have sent letters to all patients on the register asking them to let them know whether they would like it to be recorded that they have asked a doctor to visit? That is to help the people concerned. It seems to me therefore that doctors are carrying out their duties within the National Health Service.
§ Baroness Denton of WakefieldMy Lords, I thank my noble friend for that remark. It illustrates that the best way of looking after people is at local level, where needs are recognised. My noble friend pays tribute to the great work which is being done in our health service.
Baroness Faithful!My Lords, does the Minister not agree that when people are discharged from hospital, that fact is reported to social workers by the social services department within the hospital? It is then possible to provide the service within the community, at the patient's home, through the various services which the social services departments run in conjunction and in partnership with the health service.
§ Baroness Denton of WakefieldMy Lords, my noble friend identifies the situation as it is, as she so often does. The responsibilities are clearly reaffirmed in the booklet Caring for People.