NHS Health Care: National Standards (Hansard, 8 March 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, on 23rd February the Government issued guidance on NHS responsibilities for meeting continuing health care needs.

§ Lord Ashley of Stoke
My Lords, does the noble Baroness agree that if such standards were established by the Government, clinical teams throughout the country would have to decide solely on the basis of medical need whether a person should be in hospital, as they should do? But will she confirm that the Government refuse to establish those standards because they know that some trusts are poorer than others, so the Government allow variations in health care not on the basis of medical need but because of cash? Is not that situation entirely wrong?

§ Baroness Cumberlege
No, my Lords, that is not the case. Take the case of a person who has had a stroke. The result may be that that person can live a normal life but will have a limp. On the other hand, a person who has had a stroke may be so paralysed that he will have to have long-term care. It must be left to local clinicians to make the decision as to what care is required in conjunction with both the patient and the family.

§ Baroness Jay of Paddington
My Lords, is the Minister aware that many patients and their families were reassured by some of the guidance suggesting that there would be a right of appeal under the new system? For example, if someone felt that he might be pushed out of an NHS bed and into means-tested social care, he would have a right of appeal. But how can that appeal system possibly work fairly if there are no national criteria?

§ Baroness Cumberlege
My Lords, the guidance sets out a broad framework. When it was published it was very 271 much welcomed by a number of bodies, including the Association of Directors of Social Services, the National Carers' Association and the National Association of Health Authorities and Trusts. So it has been warmly welcomed. It sets criteria in that framework. As the noble Baroness said, there is an opportunity for people to appeal. If they feel that the eligibility criteria published by individual health authorities are not met in their case, they will have the right of appeal to an independent panel.

§ Baroness Gardner of Parkes
My Lords, is it not a fact that in the past many acute hospital beds were occupied by people with long-term and unimproving conditions that were not suitable for continuing hospitalisation over a long period? Was that not one of the reasons why changes were made?

§ Baroness Cumberlege
Yes, my Lords. We believe that the National Health Service has a responsibility for continuing care. But it must be based on health needs. Where social care is required, we believe that it is the responsibility of the social services.

§ Baroness Fisher of Rednal
My Lords, in her reply the noble Baroness did not draw the attention of the House to the cutbacks in local authorities' funding, which means that they cannot pick up the jobs that health care is giving them. Does she agree that the real problem is that, although local authorities may want to do the job, they cannot do so unless the necessary cash is given to them?

§ Baroness Cumberlege
My Lords, there is a total increase in social services funding for 1995–96 from £6.3 billion to £6.9 billion. Funding for community care services will increase from £4.6 billion to £5.1 billion. Funding for local authorities' new community care responsibilities will increase from £1.3 billion to £1.8 billion. I have a table giving those figures which I shall be pleased to put in the Library if it will help your Lordships.

§ Lord Ashley of Stoke
My Lords, the noble Baroness is always fair. However, I am very surprised at her Answer. Why does she think that the British Medical Association's spokesman in effect has said that it is the end of the free National Health Service? Does she believe that he was talking nonsense on behalf of his colleagues? Has she read the abundant evidence which shows that clinical teams throughout the country are being guided by the lack of cash allocated to them by the Government? Does that not mean that people needing hospital care are not receiving it, not because of the doctors but because of the Government's allocation of funds?

§ Baroness Cumberlege
My Lords, the guidance reinforces NHS responsibilities. I am not sure whether the noble Lord has had an opportunity to read it in detail. It makes clear that health authorities must arrange and fund within their resources a full range of services to meet continuing health care needs. But it goes on to say that it depends on the complexity and the nature and intensity of those needs. I feel that the BMA also misunderstood the guidance.