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Lord Hunt of Kings Heath: I understand the nature of these probing amendments. All Members of the Committee are clear about the contribution that hospices make to health care in this country.

The noble Baroness, Lady Finlay, referred to comments made by my honourable friend Jacqui Smith in another place, when she said that,

That is the case for most patients in hospices, either because the hospice is registered as a care home or because the patient is not there in pursuance of arrangements made by an NHS body—that is, that the patient is receiving NHS services and being funded by the NHS in the hospice. One group of patients in hospices could come under the Bill: those patients who are in independent hospices but whose placement is fully funded by the NHS.

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I understand the point raised by the noble Baroness. She reflects the concern felt by some hospices that, if all the focus is put on delayed discharge from acute NHS hospitals, it might reduce the emphasis that local authorities would place on the support that they would want to give to patients in hospices. No one would wish to see that happen.

I can offer the Committee this. My department can have discussions with the hospice movement on these issues, to see how we can best work with the NHS and social services to address them. However, although I recognise the issues that the hospices have raised, the hospices are independent organisations. Unless we are talking about patients in hospices who are wholly funded by the NHS within the terms of Clause 1, my reading is that the Bill cannot apply to them. I do not believe that we should extend the Bill to include all patients in hospices, as that would go outside the current remit. As I said, however, I should be very happy to ensure that my department urgently meets representatives of the hospice movement to discuss some of the other issues they have raised concerning the support that they undoubtedly require from statutory agencies in the discharge of their patients from hospices.

Baroness Finlay of Llandaff: I thank the Minister for his reply. However, I am extremely concerned at his statement that only patients whose placement is fully funded by the NHS will be included. Extremely few hospice patients are fully funded by the NHS. In fact, hospice patients are vastly subsidised by the charitable sector and fund raising. The backlog would be even worse if all those patients remained in NHS beds. The obvious implication of the Minister's remarks is that no hospice should accept a patient unless a discharge package for after his or her stay has been arranged. That would make the whole situation farcical.

The proposals would also exclude those with the greatest need, as only self-funders would be able to go into hospices. As we know very well from data from the Hospice Information Service, patients from areas of deprivation often have the greatest need. However, those patients already tend to use hospices less because hospices are usually not established in areas of severe poverty.

I appreciate the Minister's offer to discuss the Bill's implications with the hospice movement, and I am prepared to withdraw the amendment pending such discussions. However, we need to return to this topic, which causes great anxiety in the hospice movement. I feel that I must sound a warning bell that there may be a further patient backlog, and that another awful situation may arise. Patients may be sent home, although no provision has been put in place, because another patient has greater need of symptom control. They may then bounce back into the acute sector and end up dying in an A&E department. We are already beginning to see that situation. It is a tragedy for those patients and their families.

Lord Hunt of Kings Heath: I would be the last to want to see the hospice movement or patients in hospices adversely affected by the enactment of this legislation. If

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we are truly developing an integrated, whole-systems approach, the hospice movement must be involved not only in the discussions at national level but in the discussions at local level between the health service and local government in regard to effective discharge procedures. I was reflecting on the fact that it is difficult to see how, given the architecture of this clause, the great bulk of hospice patients can be included. Independent hospital patients can be included only in pursuance of arrangements made by an NHS body. As the noble Baroness, Lady Finlay, will know, that is not the case for most patients in hospices. However, I am very happy to discuss this further with her and with representatives of the hospice movement.

Baroness Finlay of Llandaff: I thank the Minister for that reply. We should discuss this matter further and in great detail, without consuming the time of the Committee. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 5 to 9 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 10:

    Page 1, line 15, at end insert—

"(2) The term "qualifying hospital patient" does not include any person who is ordinarily resident outside England and Wales."

On Question, amendment agreed to.

[Amendment No. 11 not moved.]

Clause 1, as amended, agreed to.

5.15 p.m.

Clause 2 [Notice of patient's possible need for community care services]:

Earl Howe moved Amendment No. 12:

    Page 2, line 5, after "hospital" insert "after 1st April 2004"

The noble Earl said: Much as many of us may deplore this Bill, our job in this revising Chamber, in the words of the Beatles, is to take a sad song and make it better. That is what I shall be asking the Committee to do in moving this amendment.

It is the Government's intention, or at least their stated intention, to bring Part 1 of the Bill into force in less than six weeks' time, on 1st April. I am absolutely convinced that that very ambitious timetable will lead to serious dislocation. I believe that the Government should think again about it. If the system were to be introduced as planned, it would hit local authorities at a very low point in their financial fortunes. Social and community care services have suffered for years from sustained underfunding. Very many local authorities substantially and consistently overspend their SSAs. It is perhaps necessary to point out that these local authorities are under-resourced not just in terms of money but also in terms of people on the ground. Indeed, it is in partial recognition of that that we are to see a 6 per cent increase in social care funding during the coming financial year.

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The consequences of underfunding are evident in the community care statistics. Between 1992 and 2001, the number of households receiving home care decreased by 28 per cent. At the same time, the number of hours of home care paid for by local authorities increased by more than 70 per cent. What that means is that local authorities are concentrating their resources on people with high-level need to keep them out of hospital. Those with lower-level need are often not receiving the care they require because there simply are not the resources or the personnel to deliver it.

The Government's policy of incentivising local authorities in order to reduce bed blocking was announced in spring 2002. The period since then may seem a perfectly adequate time to make the necessary preparations for something like this, and certainly that has always been the Government's line when asked about it. However, the timetable is very rushed. Local authorities tell us that they are currently far from being fully prepared. That has nothing to do with what one might term the mechanics of the system. I have no doubt that it could be put into operation, if that were what Parliament decided should happen—but at what penalty? Is it really reasonable to expect local authorities to hit the ground running, on 1st April, when they will not have had any time at all in which to invest new funds into support services for older people leaving hospital or in preventative programmes which make hospital admission unnecessary? These things cannot be conjured up overnight. What is desperately needed in many areas is extra capacity—not just care home capacity, which is a relatively long-term issue, but capacity in domiciliary care and in additional personnel trained to bring the new system smoothly and efficiently into practice.

In fact, 6 per cent is not as large an increase as it might sound. Laing and Buisson recently showed that addressing the existing underfunding of care homes would alone consume all the new money. On top of that, national insurance increases, due to come on stream in 2003, will have a serious impact on social care budgets where people's salaries are the main category of expense. The value of the increase in social care funding will therefore not be anything like the headline figure that has been quoted. If the delayed discharge penalty system were to be railroaded in on 1st April, there would, in my view and that of the LGA, be a distinct risk that older people's services and services for other vulnerable groups might have to be reduced in certain localities.

In this amendment I suggest that the earliest date on which the new system of penalties should come into play should be 1st April 2004. That is the date proposed by a number of bodies including Help the Aged and, interestingly, the BMA. I do not think that it would be realistic or helpful to propose an earlier date. September 1st, just supposing the Minister were to suggest that as a compromise, would be midway through the financial year and there would be practical difficulties associated with it for that reason. But, more substantively, six months would not be long enough for

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local authorities to gear themselves up to meet the new requirements being placed upon them while ensuring that other statutory services do not suffer.

The idea of financial penalties being used as a driver for reducing the number of blocked beds came, we are told, from Sweden. In Sweden, however, where the situation is a good deal less complex than it is here in terms of the pattern of provision of health and social care, it took a full two years for the system to be fully up and running. Let that be a warning to us, or rather let that be a warning to the Government. I hope very much that they will take the cue that I am now offering and agree to a year's postponement. We may not see eye to eye on the Bill itself but if the new system is not to fall on its face, that must be the right and sensible thing to do. I beg to move.

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