NHS: Long-term Care (Hansard, 22 February 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, it is for local authorities to assess the needs of people leaving hospital. Together with health authorities, they should agree their respective responsibilities for long-term care.

§ Lord Chapple
My Lords, I thank the Minister for that Answer. My concern arises from personal experiences and those of other people which have been communicated to me that old people in hospital are often harassed (to the point where great anxiety is caused to their families and friends) to leave hospital and seek care in residential homes although it is well known that they are in need of medical care which is not provided in those homes.

§ Baroness Cumberlege
My Lords, if old people are harassed, that is unacceptable. Our policy is quite clear: if people need professional healthcare— and that is a judgment made by a clinician— they should get that care within the National Health Service.

§ Lord Dean of Beswick
My Lords, but is it not the case that the care provided depends on geographical location? Some members of the public are far more fortunate and have a far better chance of being allowed a long stay in hospital when that is necessary than people who live in other parts of the country where, per capita, the availability of such beds is much lower. If that is the case, will the Minister take this point on board and see what can be done to redress the imbalance?

§ Baroness Cumberlege
My Lords, we leave the question of to where people are discharged to local decision-making. That decision has to be made in 514 discussion not only with the patient concerned, but also with their carers and families. Many people prefer to be cared for at home, given enough support. Indeed, our results show that they actually recover more quickly at home.

§ Lord Molloy
My Lords, I acknowledge that this is a difficult problem for the department, but could the Minister examine the possibility of seeking closer help from local authorities and certain very well known voluntary organisations which, if they were approached, would be only too happy to help?

§ Baroness Cumberlege
My Lords, yes. The whole purpose of the National Health Service and Community Care Act, the provisions of which came into force in entirety in April of this year, is to ensure that local authorities, health authorities and voluntary organisations work closely together. Our initial monitoring shows that that is beginning to happen in a much more real way than previously.

§ Baroness Jay of Paddington
My Lords, does the Minister acknowledge the report of the ombudsman on the Leeds healthcare trust case (when the healthcare trust was criticised for precisely the kind of action to which my noble friends have referred), which suggested the need for a national policy? Is not this another area in which the dispersion of authority from the National Health Service to local trusts is resulting in the breakdown of the National Health Service?

§ Baroness Cumberlege
My Lords, no, I do not believe that there is a breakdown of the National Health Service. It has never been better, never had more resources and never had more people working in it. The Leeds case took place before the new community care Act came into force. The Leeds health authority has accepted responsibility for what happened. Et has paid an ex gratia payment and is looking after the patient concerned. I believe that far from falling apart, which is what was predicted by those who were full of doom and gloom when the community care Act was introduced, the Act is proving to be far more successful than anybody anticipated.

§ Baroness Jay of Paddington
My Lords, may I press the Minister a little further on this? Is she saying that the Leeds healthcare trust case was totally isolated? Is it not, in fact, part of a pattern which is growing?

§ Baroness Cumberlege
My Lords, the Leeds case took place several years ago and, as I have said, long before the community care Act was introduced. Although I cannot give an absolute undertaking that in every single case everything will work perfectly— after all,7.5 million people are admitted to hospital every year— we now have discharge procedures whereby arrangements are made with the families, carers and patients concerned. No patients should be discharged until those procedures are fully implemented and there is agreement between all the parties concerned.

§ Lord Chapple
My Lords, will the Minister take note of the fact that the issue raised in the Question has arisen since last April when the community care Act 515 came into force? It seems to me that what is lacking is a more widespread knowledge of what that Act actually amounts to. When elderly people are in hospital, something should be done to acquaint their families with their rights, which the Minister has outlined.

§ Baroness Cumberlege
My Lords, I absolutely agree with that. As in other cases, I am always very willing to take up a particular case to ensure that things have gone right and, if they have not gone right, we should learn from that. The chief executive of the NHS Management Executive wrote to all hospitals, trusts, health authorities and social services departments about hospital admissions and discharges saying that they should keep their procedures constantly under review.

§ Lord Rea
My Lords, I am pleased that the Minister agrees that the National Health Service has a continuing responsibility to look after the numerous cases of long-term chronic illness which need low-tech but definite healthcare rather than care by untrained people. Does the Minister agree that such care should preferably be provided in the community and be run, if possible, by general practitioners and nurses locally, close to the patients' home? Can she say whether any such units have been commissioned or built in London prior to the closing of hospitals, as suggested in the Tomlinson report?

§ Baroness Cumberlege
My Lords, yes, there is a need for a variety of provision. Some of the hospital-at-home schemes are proving to be not only extremely effective, but also popular with those whom they look after. We have clear discharge policies and if those policies are not being followed, I would want to know.