§
26 After Clause 3, insert the following new clause—
Duties of responsible NHS body following notice under section 2
(1) The duties under this section apply where notice of a patient's case under section 2 has been given.
(2) The responsible NHS body, and any other NHS body which is considering whether to provide services to the patient after discharge, must consult the responsible authority before deciding what services (if any) it will make available to him in order for it to be safe to discharge the patient.
(3) The responsible NHS body must give the responsible authority notice of the day on which it proposes to discharge the patient.
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(4) The notice under subsection (3) remains in force until the end of the relevant day, unless it has previously been withdrawn.
(5) The responsible NHS body may withdraw the notice under subsection (3) at any time before the end of the relevant day by giving notice of withdrawal to the responsible authority.
(6) For the purposes of this Part "the relevant day", in relation to a qualifying hospital patient, is the later of—
(7) Regulations may prescribe a period as the minimum interval after a notice under section 2 is given; but that period must—
(8) If the notice under subsection (3) is withdrawn before the end of the relevant day—
(9) Regulations may provide for—
§ The Commons agreed to this amendment with the following amendment:
§ 26A Line 25. leave out "excluding Saturdays. Sundays and public holidays"
§ Baroness Andrews rose to move that the House do agree with the Commons in their Amendment No. 26A to the Lords Amendment No. 26 and do propose the following further amendment to Lords Amendment No. 26:
§
26B 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.
§ The noble Baroness said: My Lords, throughout the Bill, we have discussed the inclusion or exclusion of weekends and public holidays from the minimum interval—that is, the time within which social services must assess and arrange services for a patient. The argument has been made that social services departments cannot and should not be expected to perform these functions outside of the normal working week.
§ However, as the noble Baroness, Lady Greengross, pointed out in our previous debate on this subject, we should surely be looking forward to a time when ways of working have changed and health and social care 989 really do work together and support each other. She said that keeping people in hospital, for whatever reason, longer than is absolutely necessary is not acceptable in this day and age and that to put this requirement on the face of the Bill would not help patients.
§ An older person delayed in an acute hospital bed does not disappear or become any less vulnerable to the consequences of a delay simply because the weekend occurs and social services do not work at weekends. I believe that we 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. We believe that excluding Saturday, Sunday and public holidays from the face of the Bill would send entirely the wrong message about what is acceptable and what we expect in the future for our older people.
§ However, I know that many local authorities are not yet in the position where they would be able to provide services, for example, over the Easter bank holiday weekend. Although I believe that all local authorities should aspire to the practice of the best, which already provide assessment teams with extended hours and at weekends, I am prepared to give a commitment that we shall exclude Sundays and public holidays from the minimum compliance period in the first instance.
§ The amendment tabled by the Government would require the regulations to exclude Sundays and public holidays from the minimum period until 31st March 2005. That means that local authorities have nine months from now, without financial consequence, to prepare for Saturday working—something that most social services are already moving towards. But, because we accept that not all social services currently provide a seven-day service and could not move overnight to doing so, social services will have more time—until April 2005.—to plan for this. I also want to emphasise that April 2005 is the earliest date that seven-day working could be introduced.
§ The amendment gives only the date before which the regulations cannot be changed; it does not specify that the regulations will change on that date. Furthermore, we shall also state that any notice given by the NHS to the local authority in respect of a patient on a public holiday will be treated as if it were given on the following day. That means that there will be an extra day before the Section 2 notice informing the local authority of the patient's likely need for community care services and before the Section 5 notice informing it of the discharge date become effective.
§ I hope that noble Lords recognise that this represents a positive compromise. I hope they will accept that we do not want to give the message on the face of the Bill that it is acceptable for older people routinely to wait in hospital five or more days for an assessment or for services to be in place, which would be the case if the whole weekend were also excluded.
§ But I am happy to put on the face of the Bill that the regulations will exclude Sundays and public holidays until 2005 and will therefore give local authorities more time to adjust to new ways of working. I reflect 990 again on what the noble Baroness, Lady Howarth, said about the need to recognise the pressure that local authorities are under. They will now have more time to carry out their duties from implementation. I hope that noble Lords will agree with the change. I hope that they will feel that they no longer need to insist on their amendment and will accept the government amendment in lieu. I beg to move.
§ Moved, That this House do agree with the Commons in their Amendment No. 26A to Lords Amendment No. 26, and do propose Amendment No. 26B to Lords Amendment No. 26.—(Baroness Andrews.)
§ Lord Clement-JonesMy Lords, the Minister has rehearsed the arguments. We have had them at every stage of the Bill. This has been one of the most closely argued areas of the Bill. I do not propose to go into all the rebuttals. There is much that I disagree with in what the Minister said. I still think that the arguments are strongly felt on both sides. The concerns on both Opposition Benches are about unsafe discharge at weekends and the problems of staffing in local authorities, which would have a knock-on effect on the patients. None of our arguments has been about the convenience of local authorities. They were about patients. We have to agree that that is common ground. The arguments were about what was best for patients.
In the best of all possible worlds—I think the noble Earl, Lord Howe, used that phrase earlier—we would press the amendment. We would like weekends and bank holidays to be excluded permanently as long as the Bill is in effect. However, we all recognise that the Minister has made a fair compromise. Time will tell whether local authorities can change their practices and whether discharge will be safe. They will at least have a fair run at it of a year and six months to get their house in order and see whether they will be able to start up at bank holidays and weekends as if they were ordinary working days.
I am pessimistic about that, but on the other hand, as with all these things, it is a matter of how far amendments should be pushed back and forth between the Commons and the Lords. We have reached the point at which insisting further would not be fruitful. We need to see the outcome of the proposals. The Government have come up with an elegant interim solution. Let us see whether it works.
§ Earl HoweMy Lords, I have a question to add to the remarks of the noble Lord, Lord Clement-Jones. If the Government see fit at some stage to introduce regulations that would bring about seven-day working, it is terribly important that local authorities are given adequate and reasonable notice. It would be helpful to hear from the noble Baroness that the Government will bear that point closely in mind should they decide to introduce seven-day working.
§ Baroness Howarth of BrecklandMy Lords, I welcome the noble Baroness's compromise, but I should like to put straight on the record some of the 991 underlying assumptions. I agree with the noble Lord, Lord Clement-Jones, that none of us wants to put the convenience of services above the needs of consumers, patients or users of any kind. That is the underlying position.
I am concerned that an impact assessment may well not have been carried out to look at workforce planning and the availability of staff over these periods. After all, social services run a number of seven-day services, including residential services for children and home care services. However, those workforces are already seriously in difficulty, as the noble Baroness will know from the various taskforces looking at workforce planning in that area. Like my colleagues, I am gravely concerned that we will be in difficulties and will be discharging people unsafely unless we have made that impact assessment before we move to a different work pattern.
§ Baroness AndrewsMy Lords, we all share the concern that discharge should be as safe as possible. That is one reason why we have given such careful thought to the ideas that noble Lords put forward. I assure the noble Earl, Lord Howe, that we will certainly consult local authorities on any further changes and take advice, as we have done before.
I am conscious that the noble Baroness, Lady Howarth, knows more about good practice in social services than does any other Member of the House. She has rightly spoken about the need for proper workforce assessment and planning to determine the impact. Many professions are changing the way they work. Social services have already done so. The changes that we are proposing will be a natural development from where social services are at the moment, taking into account where they want to be in the future. I hope that in time the changes will be positively welcomed in the modernisation of the profession.
§ On Question, Motion agreed to.