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15 Jan 2003 : Column 737—continued

Mr. Burstow: On the publication of the workbook, it has been almost two years since the Government first said that they were working on revising it. Is it the case that the Department has not done the necessary work to enable the workbook to be published sooner because it has been distracted by drafting this Bill?

Jacqui Smith: No, that is not the case. Secondly, legislation that ensures that older people get out of hospital more quickly and get the care that they need when they need it is not a distraction. I consider it a rather important part of Government business.

The hon. Member for Sutton and Cheam repeated quite a few of the discussions that we had in Committee. First, on the concern about levels of readmission, may I emphasise for hon. Members the points that I made earlier? While the Government have had considerable success in reducing levels of delayed discharge, levels of readmission have remained pretty stable. We also know, for example, that more than a third of local areas have below average rates of delayed discharge and below average rates of emergency readmission. That shows that it is possible to perform well on both indicators. As I have said before, however, we take that potential risk seriously, which is why we will be covering it in the hospital discharge workbook and the statutory guidance that we will publish alongside the Bill. Both will make it clear that discharge must be properly planned, patients must not be discharged until it is safe to do so, hospitals will be judged, and, therefore, rewarded on the basis of their ability to control readmission rates, and, under new financial flows, acute trusts will not receive funding for patients who are readmitted to hospital within a certain period.

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A financial incentive therefore exists for those trusts to ensure that a patient is genuinely ready for discharge before leaving an acute hospital bed.

The hon. Member for Sutton and Cheam also raised concerns about whether patients in the community will be disadvantaged. Perhaps I could remind hon. Members of the context within which the Government propose to introduce this legislation: one of significant extra funding for older people's services. That will provide additional carer services, as I have spelled out, 500,000 more pieces of community equipment, 70,000 more social care intermediate care services, and 30,000 more home care services of five or more hours a week. If the hon. Gentleman's point is that, given the inheritance of the previous Government's spending on local authority social services, social services departments have had a difficult job, I agree. This Government, however, are significantly increasing investment in ensuring that social services departments can provide precisely the sort of community alternatives and support necessary for people to come safely out of hospital and to be where they tell us that they want to be—in their own home or in extra care supported accommodation. In that context, it is also right to ensure that the responsibilities of local authorities are carried out in a timely fashion and that older people are placed at the centre of care and not relegated to being trapped in hospital, a practice that Opposition Members would seem to want us to continue.

My hon. Friend the Member for Nottingham, South (Alan Simpson) made some important points about the need to ensure that action is taken on fuel poverty for older people in particular, and that people have the kind of changes made to their homes that enable them to continue living in them and to keep well. I assure him that, for example, my Department's XKeep Warm Keep Well" campaign, in partnership with Help the Aged, Age Concern, National Energy Action, the Women's Royal Voluntary Service, the Department for Environment, Food and Rural Affairs and the Department for Work and Pensions, which was launched again this year, provides an advice line, a free winter guide and advice about financial assistance available, such as that offered by the warm front team, which helps people to heat and insulate their homes.

I also assure my hon. Friend that the Department of Health is, for the first time, investing more money in home improvement agencies precisely to make some of the changes to housing that will enable people to leave hospital more safely. We are also investing in intensive home care packages and extra care accommodation, which may well provide a safer and more secure environment for older people while allowing them to maintain their independence.

Let us consider consent and involvement. It is important to involve and inform patients and carers and obtain consent when appropriate. However, as my hon. Friend the Member for Sheffield, Heeley (Ms Munn) rightly pointed out, the Bill does not alter existing legal or good practice requirements for social services or the NHS to inform, involve and, when necessary, obtain patients' or carers' consent.

Amendment No. 41A proposes that local authorities should consult patients and carers before informing social services of a possible community care need and obtain their consent to that notification. When

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exercising their functions, the NHS and social services must give people all proper information to enable them to decide whether to accept care or services. Those fundamental duties stem from their status as public bodies that exercise public functions. Of course, good practice dictates that the patient should be kept informed and consulted at all stages of the assessment process. The statutory guidance for the Bill will also make it plain that patients, carers and families should be kept fully informed and consulted at every stage of the discharge process.

The revised hospital discharge workbook includes a chapter specifically on patient and carer involvement. We expect the NHS and social services staff to follow it. However, the Bill does not alter the existing right of the NHS to notify social services of a person's need of such services. I do not believe that giving people a veto over the ability of the NHS to notify social services will help us either to provide the sort of care that people need to leave hospital safely or to plan better the care that especially older people require. The Committee accepted that that early notification of social services would help everybody to plan such care better.

Mr. Burstow: Will the Minister confirm whether the regulations under clause 2(4)(a) that deal with notification include carers? Will carers and patients be notified?

Jacqui Smith: I assure the hon. Gentleman that we believe that the need to involve carers is crucial. That will be spelt out in the statutory guidance and the hospital discharge workbook. However, it may not be possible to give carers the same legal right as patients when patient confidentiality is involved.

Glenda Jackson: Could a carer or a patient veto a plan that cannot be provided locally? If there is no carer and the patient is incapable of making a decision, will there be an advocate? There should be an advocate for an individual who cannot make decisions. Will the advocate be informed of the plan?

Jacqui Smith: My hon. Friend raises several issues. Circumstances in which people cannot get the care that they need locally are partly due to existing provision and investment. A key purpose of the measure is to ensure investment in providing local alternatives. Of course, carers' rights to ask for an assessment of their needs, and to have that taken into consideration when the care plan for the older person is prepared, remain in place. In fact, as I suggested, the position will be improved by some of the Government amendments.

Of course, individuals' rights to raise concerns about the package put together by a social services department remain through the complaints system as well. Therefore, while I am not sure I can give my hon. Friend all the reassurance that she wants, I can reiterate that nothing in the Bill removes rights that currently exist, and in fact the Government amendments will improve the position of carers with respect to their role in discharge.

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4 pm

Mr. John Bercow (Buckingham): Will the regulations covering the form and content of notices be subject to the affirmative procedure of the House or to its negative counterpart?

Jacqui Smith: As I said in the letter that I wrote to members of the Committee, in all of those cases they will be subject to the negative procedure. We had quite a lengthy discussion about this matter in Committee.

I move on to Opposition amendments Nos. 2, 3, 4 and 5.

Amendment No. 2 is unnecessary. It would require the NHS to inform the patient and carer of the proposed discharge date. This of course should be covered in guidance and is not something that it is necessary to state in the Bill. Throughout guidance to the NHS, since Patient and Public Involvement in the NHS, published in 1999, and including the new hospital discharge workbook, we have made it clear that that sort of information should be provided to both patients and carers. Any guidance for the Bill will make it clear that the patient is to be provided with information and advice throughout the discharge process.

Amendment No. 3 seeks to place on the NHS a duty to gain a patient's consent to services being provided following discharge. Just as with any treatment provided by the NHS, a patient has the right to withhold consent to services that the NHS plans to provide when the patient leaves hospital. The Bill does not alter the existing requirement for the NHS to gain this consent when discussing with the patient his or her future care.

Amendment No. 4 seeks to place on the NHS a duty to involve carers. I have covered that in the points that I have made so far.

The proposals in amendment No. 5 are already standard practice, most recently emphasised in statutory guidance on the single assessment process and fair access to care services. The amendment proposes that social services must inform patients of the cost of care plans—presumably, the cost to the individual. Social services must already, in exercising their functions, give all proper information to the person so that he or she can make an informed decision as to whether or not to accept services. That includes information about the costs of any care that they will receive. That has been part of statutory guidance to councils since at least the 1991 community care changes.

I have outlined where existing legislation remains to safeguard the position with respect to the consent and the rights of both patients and carers, and I have outlined how the Government action being taken today will improve the position of carers. I hope that I have provided some reassurance to hon. Members. I have also outlined the position with respect to both the hospital discharge book and the statutory guidance to be published alongside the Bill, and the emphasis that that will place on ensuring that patients and carers are fully consulted.

The hon. Member for Sutton and Cheam raised specific points about continuing care that I think we covered in Committee. As to his question whether someone involved in a dispute over the right to continuing care would be able to remain in hospital,

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I think I gave that assurance in Committee. I would add that of course, as we have made very clear, the first decision that should be made in the assessment process is whether patients are eligible and entitled to NHS continuing care, and clearly if they are there will be no responsibility on the social services department. If patients want to dispute that, they can appeal to the continuing care panel. We are currently producing directions to strategic health authorities to outline the need to ensure that they produce continuing care criteria and that any such decision is taken very quickly, within two weeks.

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