§ 10. Mr. Julian Brazier (Canterbury)How many elderly were in an NHS hospital as a result of a delayed discharge in the last quarter for which figures are available. [137451]
§ The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)Some 4,710 adult patients remained in an acute hospital bed on any one day as a result of delayed discharge in June 2003, and 3,150 of those patients were aged 75 or over.
§ Mr. BrazierIs the Minister really comfortable with the introduction in Kent in January of fines for bed blocking under the Community Care (Delayed Discharges etc.) Act 2003? He knows as a Kent MP that the devastation in the care homes sector wrought by the botched Care Standards Act 2000 has badly affected the county, and he also knows about the rotten local government settlement. Is it fair that Kent county council should be penalised for the bed blocking in NHS hospitals, when central Government have done so much to make finding places for many elderly people impossible?
§ Dr. LadymanI think that the situation in Kent is fair. I have talked about the situation with the director of 156WH social services in Kent county council, who vehemently denies the charge that there is a shortage of care homes. He can buy his care home places at a particular price because there is overcapacity in Kent. That is the price that the council deals at, and the director is perfectly happy with the situation. Care home owners may not be happy with it, however, because the market is forcing their prices down.
As for the Community Care (Delayed Discharges etc.) Act, every council in the country has been given a grant to cover their reimbursements. If they do the job efficiently and with a certain measure of good planning, the grant will be sufficient for them to deal with delayed discharges, pay any fines that may result and make a profit.
§ Mr. BrazierThe Minister must know, as a Kent MP, that what he said is a severe distortion of the facts. Kent elderly people are in nursing homes side by side with people from London who receive funding from central Government that is, in some cases, up to twice as much per capita as that received by Kent. The Minister also knows that Kent runs one of the slimmest operations anywhere in the country in terms of overheads. Is he seriously asking the Chamber to believe that Kent's problems with funding are due to inefficiency, rather than to one of the three worst settlements in the country, which delivered an increase in real terms for every constituency represented by a Cabinet Minister?
§ Dr. LadymanI did not say that Kent would have problems caused by inefficiency. I said that Kent was not going to have problems—it does not need to, because Kent county council is efficiently run. I work closely with Kent and I take great exception to the hon. Gentleman's implication that I am distorting the situation there. I can tell him from my own experience that, at the height of the problems that were caused by bed blocking two or three years ago, eight fully equipped nursing home beds in a nursing home in my constituency stood empty in the middle of winter, because it was not in Kent county council's interest to help to get people out of hospital and into those beds. The situation has changed throughout the country as a result of the Community Care (Delayed Discharges etc.) Act. For the first time, councils have a real financial imperative to work with the NHS to get people out of hospital beds and into the places where they can be properly cared for. That will happen, and it will be a great success.
§ Alistair Burt (North-East Bedfordshire)Does not the Minister recognise the concern behind the remarks made by my hon. Friend the Member for West Chelmsford (Mr. Burns) that the pressure in respect of delayed discharges is exacerbated by the loss of care home beds, and that it is not relieved by some notion of a national surplus if there is an especially acute problem in a particular local area? Mike Glynn of the Bedfordshire Care Homes Association told me that at a meeting last week. The members said that Bedfordshire care homes were running at a capacity of 95 per cent. or more, which gives them precious little leeway if a problem arises in the coming winter. How does the 157WH Minister intend to avoid a crisis in delayed discharges during the coming winter if the margin for getting people into care homes is as tight as that?
§ Dr. LadymanFirst, I apologise to the hon. Gentleman if, inadvertently, we did not tell him that his Question 12 had been grouped with an earlier question. I take full responsibility for that, and I will ensure that the question is dealt with.
We gave substantial sums to local councils. We gave them a capacity-building grant to allow them to start preparing for the delayed discharge grant, so that they ensured that there was sufficient local capacity. This year, we also gave local councils throughout the country a delayed discharge grant of £50 million for six months while the Community Care (Delayed Discharges etc.) Act operates in shadow form. We gave them that money because there will be no reimbursements during that six-month period, and they can use it to build capacity locally. The reimbursements start only from next year.
I believe, and I have no evidence to suggest otherwise, that all councils that undertake proper capacity planning and that are willing to alter the amounts that they sometimes pay, if that is what the local market requires, can prepare for the reimbursement system in such a way that they can avoid paying more money in fines than they have received in grants. I ask the hon. Gentleman to let me know if he has evidence to the contrary, or if there is an absolute shortage anywhere in the country. I will then talk to the local council in that area and find out what they have done with the capacity-building grants that we have given them.
§ Mr. David Drew (Stroud)Does my hon. Friend accept that considering the care home sector in isolation is the wrong way in which to approach the problem? My local authority, and I am sure that local authorities throughout the country are doing the same, is considering other ways in which to provide care, mainly at home but in another setting if necessary, which includes rehabilitation and respite. The NHS forgot about rehabilitation and respite for a long time, but it is vital that we consider those matters, because locking people into the care home sector, much as it does valuable work, and I have no reason to cast aspersions on it, is not the right solution for everyone. There is a need for greater flexibility, and I hope that my hon. Friend will tell us how that can be achieved.
§ Dr. LadymanMy hon. Friend is right: we need to consider the matter with better eyes and focus on more than the care home sector. We have done that. We have, for example, prevented local councils from charging for adaptations to homes, so that people can adapt their homes in order to stay at home if they need to. One reason why I took such exception to the hon. Member for Canterbury (Mr. Brazier) saying that I was accusing Kent county council of inefficiency was that I am working with that council on an innovative scheme that it is leading and that will involve 11 councils throughout the country. They have set themselves the target of preventing 30 per cent. of the admissions of older people into hospital by doing exactly the sort of things that my hon. Friend mentioned.
158WH Only yesterday, I was in Torquay looking at something called the crisis, assessment and rapid reablement intervention for the elderly team, which is a rapid response team. When an older person has an event that would, under normal circumstances, require acute treatment, the CARRIE team moves in quickly, ensuring that the care the person receives enables them to stay at home to deal with it and that they do not need a hospital bed. We must consider admissions, discharges, home care and intermediate care provision in order to build a picture of how to deal with the wider problem.