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Baroness Masham of Ilton: My Lords, I support the noble Lord, Lord Morris of Manchester. He has an immense amount of experience in relation to disabilities of all kinds. If the Government want beds to be unblocked in acute hospitals, it is important to speed up assessments without which patients cannot get the help that they need. I hope that the Government will accept the amendment.

Lord Hunt of Kings Heath: My Lords, it is tempting to accept my noble friend's amendment because he speaks with great authority, but I shall ask him to withdraw it. He was being unduly modest when he described himself as a serial legislator. I have always seen him as the architect, author and promoter of the

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Chronically Sick and Disabled Persons Act 1970 which has had a profound impact on society. I always listen to him with great care.

Importantly, he dealt with the issue of commodity. Noble Lords will know that I objected forcefully when, in Committee, it was suggested from the Bishops' Bench that the Bill aimed to treat a patient as a commodity. At the moment we have a major problem in that every day thousands of people are inappropriately stuck in NHS acute beds. The longer they stay there the greater their lack of independence, the more institutionalised they become and the harder it is for them to be discharged back into the community and to their homes. That is why we need to ensure that the health service and local government get their act together and sort out a proper assessment process and as quick a discharge process as is possible.

Certain patients will have complex care needs which it will not be possible to deal with in a short time. However, such people can be transferred to more appropriate care than is provided in an acute hospital. I share the concern of my noble friend and of the noble Baroness, Lady Masham, that in this House we have voted to delay the implementation of the Bill by a whole year. It is a pity, as I believe that the Government have taken a constructive approach. We have tried to meet the concerns that have been expressed. We have met concerns over the issue of consultation on hospices. We have just discussed the issue of decisions on eligibility for continuing care, before a Clause 2 notice is issued. In the spirit of trying to make this Bill work in the House of Lords, we intimated that we would be prepared to see a delay in its introduction by six months. However, that was not to be, and I regret it.

I know that there are concerns about the ability of the health service and local government to make the Bill work effectively. All I will do is repeat what I have said previously. We know from the experience of a number of local authorities that when people are determined to make delayed discharge procedures work well, they can be made to do so. Why should we be denying to members of the public the benefit that this Bill will bring? That was the point my noble friend Lord Morris put so forcefully.

My other point relates to the matter raised previously by the noble Baroness, Lady Barker. She talked about the problem of new staff not being updated with current guidance—whether relating to continuing care eligibility, or good discharge procedures. I agree with her. That must be the conclusion that should be arrived at by reading the Climbie report by the noble Lord, Lord Laming. It pointed to a lack of attention to detail, a lack of procedure, a lack of ability to follow those procedures, a lack of supervision, and above all a seemingly chronic inability among some professional staff to write things down. She knows that I am as critical of the NHS as I am of social services or the police. All of those points are very well taken. However, I contend that this Bill will put in place much more robust procedures—both in the health service and local government. That is why I believe that the Bill is an advance on current arrangements.

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Although I have immense sympathy with the comments of my noble friend Lord Morris, I cannot support the exact wording of his amendment. However, he has made some very important points.

Baroness Masham of Ilton: My Lords, will not this amendment speed things up, especially as there has been a delay of a year?

Lord Hunt of Kings Heath: My Lords, I think the problem is that the way the amendment is worded would mean that if the local authority failed to carry out an assessment, the NHS could do so on its behalf. There must be some question about whether the NHS would have that ability. Apart from anything else, the assessment under Clause 4(2)(a) is to be treated as a Section 47 assessment. I am afraid that under Section 47, only a local authority social services department can carry that out. So there is a practical issue. There is always an issue about the wording of the amendment, but the point my noble friend Lord Morris is making—which will no doubt be considered very carefully in another place—is whether it is right to delay the introduction of this Bill for six months. The only people who will suffer are the very people we are trying to help. They are the 5,000 people prevented every day from being discharged effectively. I say "only" in parenthesis. It is important that we do not focus on the problems of bureaucratic statutory authorities. We have heard much about the problems of health services and local government. I think we should focus on those individuals. That is the point my noble friend has raised.

Lord Morris of Manchester: My Lords, I am grateful for the support of my good and noble friend, Lady Masham. Like my good friend, the noble Baroness, Lady Darcy de Knayth, she made her maiden speech in 1970 on my Chronically Sick and Disabled Persons Bill. No one knows more fully than they do how true to the parliamentary record the assessment of the Bill by the noble and learned Lord, Lord Lloyd of Berwick, was when he gave his opinion on the Michael Barry case in 1997. I understand why the Minister asks me not to press the amendment. He was very responsive to the case I made, and I trust the amendment may still have the effect I sought as the Bill proceeds. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Andrews moved Amendment No. 7:

    Page 4, line 38, leave out "him" and insert "the patient"

On Question, amendment agreed to.

3.45 p.m.

Lord Rix moved Amendment No. 8:

    Page 5, line 15, at end insert—

"(12A) In the case of any person having a learning disability, irrespective of the age of the person and of whether or not that person has other disabilities, the NHS body and the responsible authority shall take account of that person's learning disability in ensuring the person's supported return to their previous home or, where this is impossible, their support in an alternative placement."

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The noble Lord said: My Lords, according to St. Matthew, Chapter 20, the would-be grape-pickers who presented themselves at the eleventh hour received rather a good deal. My eleventh hour amendment which is designed to protect the position of people with learning disabilities, who are being discharged from hospital, is tabled in hope of similar treatment.

Helpful conversations have taken place with the Minister. There has been an exchange of correspondence, and I have seen the Department of Health's excellent new guidance on hospital discharges. So I live in hopeful expectation of a favourable response—although not necessarily an acceptance of the amendment as it stands. I beg to move.

Lord Hunt of Kings Heath: My Lords, it is always good to welcome the noble Lord, Lord Rix to our debates, even though it is indeed the eleventh hour. However I suspect that this Bill has a little more time to run. He has raised a very important issue. His amendment seeks to place a requirement for local authorities and the NHS to take account of the needs of an individual's learning disability, when arranging their discharge. Of course I agree that is essential, but I believe that it will be achieved without the need for it to be explicit in the Bill.

I understand his concerns about people with learning disabilities who are admitted to hospital for acute treatment. They can then find themselves unable to return to the home from which they came, and then perhaps placed in inappropriate care. I believe that the strength of the assessment systems put in place by this Bill, combined with the revised good practice guidance, will ensure that people with learning disabilities can receive the package of care that most meets their needs upon discharge from hospital. This could mean return to their original home, or a placement somewhere else more appropriate.

The hospital discharge workbook contains good practice that will ensure that an individual's learning disabilities will be taken fully into account when assessing the patient's often complex needs and putting services in place. Appendices 5.6 and 5.7 of the workbook in particular set out good practice and guidelines when dealing with someone with a learning disability. I am confident that this practice will be followed well in the field. It is essential that an individual's learning disability is taken into account. To do otherwise would be negligence by the statutory agencies, as it would be highly unlikely that the individual's discharge would be successful, or that appropriate care would be provided.

The duties that the Bill places on the NHS and social services to work together, in carrying out those assessments, will ensure that there are no gaps in the package of services that are put together. With that assurance I hope that the noble Lord, Lord Rix, will feel that the position of people with learning disabilities is well catered for, and will not press this amendment.

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