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Lord Hunt of Kings Heath: Although I am afraid that I cannot go so far as agreeing to the amendments, I accept that the noble Baronesses, Lady Noakes and Lady Barker, are absolutely right to bring to our attention—

Baroness Finlay of Llandaff: I would like to speak to the amendments, particularly to Amendment No. 61, which I tabled.

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As has been outlined, there is a requirement for a carer's assessment to be undertaken on request and for account to be taken of a carer's decision. However, there is a real problem for carers, which is that they do not get taught a lot of the issues about which they need to know.

Amendment No. 61 specifically deals with the problem of safe lifting and handling techniques. When patients are in hospital, carers are not taught such techniques. Indeed, the risk assessment in a hospital mitigates against carers learning manual handling techniques most of the time, for several reasons. One is that if the patient should slip or fall to the floor, the hospital itself could be liable. The other problem is that very few staff are currently trained and are therefore permitted to teach manual handling. As well as a lack of personnel, the time is not available either.

What happens is that patients are discharged home. It is reasonable and sensible to teach carers how to use a hoist if one is required in the home, but it is not sensible for a patient to be discharged, a hoist then to be delivered and carers then be taught how to use it to move that patient safely in their own home. Patients slipping to the floor is a common reason for calling out the ambulance service, either to help lift patients back into bed or sometimes to readmit them to hospital. When patients fall to the floor, carers feel that they simply cannot cope.

Anyone who has done domiciliary visits will be appalled at how carers often help their relatives sit up. They are well meaning, but their manual handling techniques are appalling. I have seen many a patient hauled up by their wrists, which is not safe for the patient or the carer. There is an old adage, "See one, do one, and teach one". I am sure that many carers could help in the teaching process once they have learnt safely some manual handling techniques for patients at home.

The other difficulty is that hospital beds go up and down, but domestic beds do not. Hospital beds are almost always single beds. Many people sleep in the middle of a rather saggy mattress in a large double bed that is quite low on the ground and often pushed against the wall. It can be extremely difficult for carers to get around and help people to move. It is because of the difficulties and the danger of back and other injuries to the carers themselves that Amendment No. 61 has been tabled.

Lord Hunt of Kings Heath: The speeches have been very interesting, and I have two points to make. As suggested by the noble Baroness, Lady Barker, part of the debate, particularly that on the question of consulting, is covered by the response that my noble friend made to an earlier amendment. The noble Baroness said that she would look at the issues raised. The same point arises in relation to carers, so far as consultation is concerned.

The second point to make is that the booklet on discharge from hospital has a very good section on involving patients and carers. Clearly, much of what has appeared in this debate is covered by the philosophy enunciated in the booklet.

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I know that it is frustrating for noble Lords that I am resisting some of the amendments put forward. I do so because, as I said earlier, the Bill covers no new ground in relation to statutory responsibilities. It seeks to encourage health and local authorities to do the job that they should have done over many years but did not do, despite much guidance from governments from this and the opposite side of the Chamber.

Therefore, I resist accepting amendments for which there is no basis because the existing provisions cover the ground very clearly. For example, in respect of carers' assessments, under the Carers and Disabled Children Act 2000, local authorities have a statutory duty to carry out an assessment upon request. The Bill then ensures that the local authority provides any necessary service to the carer in time for discharge or pays a charge if the patient is delayed.

Further statutory guidance issued in conjunction with the 2000 Act informs local authorities that they are expected to make carers aware of their rights. In addition, under Clause 3(5)(b) of this Bill, any carer who has requested an assessment from a responsible authority in the previous 12 months will automatically receive an assessment of his needs without having to ask for it. I am glad that noble Lords made reference to the amendments made to the Bill during Report stage in another place. The amendments in respect of carers ensure that carers' needs are properly assessed and taken account of during the discharge process. I believe it is important to retain the link to existing legislation, which sets out the responsibilities of local authorities and other public bodies towards carers.

I turn to the interesting questions raised by the noble Baroness, Lady Finlay. I believe that she is right to raise, in particular, the question of lifting. That is a problem not only for carers but also for staff in the NHS generally, judging by the number of back injuries that our staff have suffered over the years. I do not believe that this is an issue which is capable of being dealt with on the face of the Bill.

However, I accept that a number of issues need to be teased out by the health service and by local government in relation to carers in this area. I believe that there is a risk in saying, for example, that if the carer has not received training, a person cannot be discharged. That could risk enormous delay entering the process. On the other hand, there is a risk in asking carers to do things that they should not be asked to do.

Those are two very important points. The noble Baroness, Lady Finlay, will see that I do not consider the Bill to be the right place to deal with those matters. I believe that guidance on good practice is the right place. I should be very happy to discuss that point with the noble Baroness between Committee and Report stages because it is clearly an important issue.

Baroness Finlay of Llandaff: I appreciate the Minister's response and I look forward to those discussions. However, he referred to things that carers should not be asked to do. I want to point out that carers have enormous capacity to care and are very

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keen to learn safe ways of caring. But something must be done to force recognition that educating carers adequately forms part of the duty of care.

Baroness Barker: With these amendments, as with many others, I find myself returning to the dilemma of the Hospital Discharge Workbook and the force that that document will carry. I have no doubt that it represents good, or best, practice. But I am unsure about the extent to which good practice should be tied up in a document such as that rather than in regulations and in guidance. I know that the Minister has written to me today saying that the document will be followed up with guidance.

Even with the announcement we have had today about consulting carers, I retain concerns as to whether in practice services will follow from such consultation. However, on that basis I shall take away the Minister's comments and carefully read Hansard tomorrow. I have every sympathy with the noble Baroness, Lady Finlay. I believe that she gets right to the heart of a difficult problem. She may not be giving us ideal legislation but she may, in effect, be saving the NHS a great deal of money in the longer term by preventing inappropriate actions by carers. On that basis, I beg leave to withdraw the amendment but shall return to it at a later stage.

Amendment, by leave, withdrawn.

10 p.m.

[Amendment No. 42 not moved.]

Baroness Barker moved Amendment No. 43:

    Page 2, line 42, at end insert "; and

(c) have a written discharge plan, including an undertaking that an assessment of community needs within the meaning of section 47 of the National Health Service and Community Care Act 1990 (c. 19) (assessment of needs for community care services) will continue according to patient needs, and arrangements for aftercare.
( ) Where the patient has an intending carer, within the meaning of section 1(1)(b) of the Carers (Recognition and Services) Act 1995 (c. 12) or section 1 of the Carers and Disabled Children's Act 2000, an assessment and a written plan of support services will be provided."

The noble Baroness said: Noble Lords will guess what I am about to say. The consultation paper suggests that notice of the discharge process should be contingent on a care plan being produced. That does not appear in the draft Bill, although it does state that there will be a set length of time to put together a care plan for discharge. We suggest three days including weekends and public holidays. We shall return to that matter in due course.

That plan will summarise the care and setting which the patient will need, or is likely to need, in the case of elective treatment as soon as treatment in the acute hospital setting is complete. Contained within the amendments is a service plan for carers. None of the other amendments so far discussed has touched on the point that when an elderly person leaves hospital, the likelihood is that the carer will be an elderly person who, although not needing care may need services to

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help them through the process of enabling the person who has been in hospital to regain health or to adjust to reduced circumstances, for example following a stroke.

I came across an example the other week of an 87 year-old carer of an 88 year-old who had been discharged. She wanted meals on wheels on just two days per week; the days on which she wanted to do the washing. However, in that borough, one could have meals on wheels seven days per week or not at all—an all too familiar problem. I rather suspect that if we were to realise that one of the many keys to successful discharge and rehabilitation is to have planned services for a person's care and for that to be written down, we might move forward.

That is the gist of the amendments. Much of what we have said so far about the fact that the proportion of carers being consulted has fallen in recent years and that only half of carers are being told the sort of care that will be needed on discharge shows that there is still a long way to go. It is right to have something in writing for the protection of all carers, and for their protection alone. Their needs are different from those of the people being discharged. That is the aim behind the amendments. I beg to move.

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