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Lord Hunt of Kings Heath: I am grateful to the noble Earl, Lord Russell, for raising those points. I understand what he means by picking targets that negate whole-system approaches—as referred to in jargon terms—to health and social care. It is not the aim of the Bill suddenly to put in place an arbitrary target that will have adverse knock-on effects throughout the rest of the health and social care system. It is trying to tackle the big problem of around 5,000 people a day stuck inappropriately in acute beds. We know that many will lose their independence the longer they wait in an NHS acute-bed hospital. We know that many are at risk of infection because of the risks in hospitals. We also know that good local authorities and good NHS hospitals have been able to get round some of those issues to produce effective delayed discharge procedures. There is a case for codification and producing a system that makes it

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abundantly clear to both the NHS and local government that they must deal with the matters professionally.

The transfer of 100 million in a full year will enable local authorities to plan the additional services required and to provide continuity of services. Barnsley is an example of where good work has been carried out. The authorities there recognise that long-term investment is necessary, perhaps in the private sector, to deal with the problem and to ensure that there are available care-home beds. Bristol has an aids and adaptation team, which enables patients to be discharged by installing aids in, and adapting, their homes in a matter of hours. When one sees such examples of good practice, one begins to see how the system will work in the future, which gives me confidence. The Bill is not meant to put in place confrontational arrangements or to get in the way of an integrated approach to providing health and social care.

Lord Lucas: It may be all right in Barnsley or in King's Heath under the latest local government assessment, but those who live in the south face a 20 per cent rise in council tax and even that will not provide enough money to cover inflation and the legislative requirements on councils. It is hard to imagine how councils will find the money to put in place the sort of dreams that the noble Lord, Lord Hunt of Kings Heath, delightfully wishes they would dream.

The noble Lord said that the Bill bore down as heavily on the NHS as on local councils. Will the NHS be fined when it does not provide sufficient intermediate care? Will it be fined when, because of inefficiencies in the primary care system, it places people in hospital who should never have been there, rather than working with the local authority to keep them out of hospital? Will it be fined for discharging people too early? I may be reading the wrong part of the Bill, but I cannot see that that will happen.

4 p.m.

Lord Hunt of Kings Heath: The noble Lord anticipates a debate that, I suspect, will occur later on the question of penalties on the National Health Service.

The answer is "No". The incentives for the NHS to get its act together are clear. First, if the NHS does not sort the problem out on its side, it will not be able to free up beds for the treatment of acute patients. The Government put tremendous pressure on the NHS—I am usually criticised from the Benches opposite for applying that pressure—to speed up the process and treat more people so that we can reduce waiting times. There is no incentive for the NHS to fail to deliver its side of the bargain.

The other allegation often made is that the NHS will push to have patients discharged more quickly than they ought to be. Over the next two to three years, we are bringing in a new system of funding called "financial flows". If NHS policy leads to the

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readmission of patients, it will be financially penalised because it will have to treat those patients again and will not receive additional funding for that. So the right incentives are in place to make sure that the NHS plays its part.

I come to the situation in the South East. By the way, King's Heath is in Birmingham, and I am afraid that, at the moment, I would not hold up the Birmingham social services department as one of the best in the country, although its record on delayed discharges is better than its record on some other services. There are local authorities in the South East that face some of the pressures to which the noble Lord referred. There is pressure on services; there are funding pressures; and there is the question of the recruitment and retention of social workers. None the less, those authorities appear to be able to deal effectively with discharge.

It is not simply a question of the number of care home places; it is a question of organisation. If an authority can organise itself effectively, build in long-term relationships with the care sector, develop interim care and systems to ensure that admission to hospital need not take place in some cases, it will be able to deal with the issue.

Lord Clement-Jones: I thank the Minister for his several replies. It has been a crucial debate and demonstrates the extent to which the Committee is doubtful about the premise on which the Bill is based.

The Minister has not grasped the nettle in the amendment. Many noble Lords have made the point that close working and partnership between the NHS and social services is needed. The interface between the NHS and social services is crucial. Yet, in the context of the Bill, greater clarity will be needed in matters such as delayed discharge and eligibility for discharge. That is not in the Bill at present.

The Minister may say that responsibilities have not changed, but there will be a fundamental change in the dynamics and practice of discharge. The whole edifice of the Bill is based on discharge and the question of when a patient is eligible for discharge. We must have a suitable definition in guidance or in primary legislation. Whether the approach taken should be multi-professional or multi-disciplinary is a matter for debate, but unless there is clarity and certainty in the definition there will be huge uncertainty. The Bill will set social services at the throat of NHS acute trusts and other parts of the NHS.

The Minister has not gone halfway to doing what is needed in this part of the Bill. He says, "The amendment is unnecessary because we don't talk about delayed discharge in the Bill". The title of the Bill contains the words "delayed discharges"; how much more central to the Bill could it be? We will return to the issue. My noble friend Lord Russell put his finger on the need for definition, on the basis of his recent experience. The experience of many noble Lords, as professionals and as patients, prompts them to urge the Minister at least to reconsider the issue.

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If the Minister wishes to make some further points at this stage, I shall give way. Otherwise, I leave it at that for Amendment No. 1. We shall need to return to the matter in due course. The most ungracious remarks that the Minister made in his response were those blaming the parliamentary draftsman for the confrontational nature of the Bill rather than placing the blame on the Government's intentions.

Lord Hunt of Kings Heath: That is unfair. I have views about the parliamentary draftsman, but I am not prepared to share them with the Committee. I hold the draftsman in the greatest respect.

I did not make any criticism of the parliamentary draftsman. I simply made the point that, given the essentially legalistic nature of such legislation, it might appear that the Bill is confrontational. In fact, the Bill is aimed at encouraging the closest possible effective working between the Health Service and local government.

Lord Clement-Jones: The balance of iniquity is on the side of Ministers rather than that of the poor old parliamentary draftsman. That may seem like one lawyer defending other lawyers, but it is possible to adopt much friendlier language in trying to create a better care system.

The Minister's response to Amendment No. 2 was a classic of its kind. It was so convoluted that no one here will be able to understand exactly how the Minister assumes the system will work without referring to Hansard. The Minister's reply demonstrated the unnecessary complexity of the Bill. Like the rest of the Committee, I shall study the Minister's reply. I have no doubt that his answer satisfied the technical aspects of the Bill; of course, care trusts have the status that he described. However, the toing and froing of responsibilities that he described, as he went through the procedures, is a cause of great concern. The lack of clarity is great. I dare say that we shall also return to that issue at every stage.

The Minister wants it to be an integrational Bill. I think that that is what he said. He wants it to be a non-confrontational Bill. Our discussion on the first two amendments has demonstrated that that goal is a long way off. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 2 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 3:


    Page 1, line 10, after "means" insert ", subject to subsection (2),"

The noble Lord said: In moving Amendment No. 3, I shall speak also to Amendment No. 10. These are technical amendments and are necessary to provide clarification of the fact that the Bill does not apply to any person who is ordinarily resident outside England and Wales. The amendments do not affect the substance of

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the Bill but serve simply to avoid any future misunderstanding about which patients the Bill applies to.

I should like to take this opportunity to apologise to the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, for not giving due notice and sending an explanation. I beg to move.


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