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Lord Clement-Jones: I thank the Minister for giving us the benefit of his thoughts and considerations during the past few days. Clearly his opinion, and that of the department, has hardened against the amendment. I say to the noble Baroness, Lady Greengross, and to the Minister that no one in the House has a monopoly of compassion for the individual patient. We clearly have a difference of opinion as to how the Bill will operate in respect of particular patients and whether by coercing local government into certain actions that will be to the benefit of the patient. It is a fundamental difference of opinion and I propose to seek the opinion of the House.

4.7 p.m.

On Question, Whether the said amendment (No. 10) shall be agreed to?

Their Lordships divided: Contents, 134; Not-Contents, 119.

Division No. 1


Aberdare, L.
Addington, L.
Ampthill, L.
Anelay of St Johns, B.
Astor, V.
Astor of Hever, L. [Teller]
Avebury, L.
Baker of Dorking, L.
Barker, B.
Beaumont of Whitley, L.
Biffen, L.
Blaker, L.
Blatch, B.
Bowness, L.
Bradshaw, L.
Brooke of Sutton Mandeville, L.
Brougham and Vaux, L.
Burnham, L.
Buscombe, B.
Caithness, E.
Campbell of Alloway, L.
Carnegy of Lour, B.
Cavendish of Furness, L.
Chadlington, L.
Clement-Jones, L. [Teller]
Coe, L.
Colwyn, L.
Craig of Radley, L.
Crickhowell, L.
Dean of Harptree, L.
Dholakia, L.
Dixon-Smith, L.
Eden of Winton, L.
Elis-Thomas, L.
Elles, B.
Elliott of Morpeth, L.
Ezra, L.
Falkland, V.
Fearn, L.
Fookes, B.
Fowler, L.
Gardner of Parkes, B.
Gilmour of Craigmillar, L.
Glentoran, L.
Gloucester, Bp.
Goodhart, L.
Gray of Contin, L.
Hamwee, B.
Hanningfield, L.
Harris of Richmond, B.
Henley, L.
Hodgson of Astley Abbotts, L.
Hogg, B.
Howe, E.
Howe of Aberavon, L.
Howell of Guildford, L.
Hunt of Wirral, L.
Hurd of Westwell, L.
James of Holland Park, B.
Jenkin of Roding, L.
Kimball, L.
Laing of Dunphail, L.
Lawson of Blaby, L.
Lester of Herne Hill, L.
Livsey of Talgarth, L.
Lucas, L.
Lyell, L.
McColl of Dulwich, L.
MacGregor of Pulham Market, L.
Mackie of Benshie, L.
McNally, L.
Maddock, B.
Marlesford, L.
Mayhew of Twysden, L.
Miller of Hendon, B.
Monro of Langholm, L.
Mowbray and Stourton, L.
Moynihan, L.
Murton of Lindisfarne, L.
Noakes, B.
Northesk, E.
Northover, B.
O'Cathain, B.
Onslow, E.
Park of Monmouth, B.
Patten, L.
Perry of Southwark, B.
Perry of Walton, L.
Peyton of Yeovil, L.
Phillips of Sudbury, L.
Plumb, L.
Plummer of St. Marylebone, L.
Rawlings, B.
Razzall, L.
Reay, L.
Redesdale, L.
Rennard, L.
Renton, L.
Roberts of Conwy, L.
Rodgers of Quarry Bank, L.
Roper, L.
St John of Fawsley, L.
Sandberg, L.
Sanderson of Bowden, L.
Scott of Needham Market, B.
Sharp of Guildford, B.
Sharples, B.
Shaw of Northstead, L.
Shutt of Greetland, L.
Skelmersdale, L.
Smith of Clifton, L.
Soulsby of Swaffham Prior, L.
Steel of Aikwood, L.
Stevens of Ludgate, L.
Strange, B.
Strathclyde, L.
Swinfen, L.
Taverne, L.
Thatcher, B.
Thomas of Gresford, L.
Thomas of Walliswood, B.
Thomson of Monifieth, L.
Tordoff, L.
Tugendhat, L.
Vivian, L.
Waddington, L.
Wallace of Saltaire, L.
Walmsley, B.
Warnock, B.
Wigoder, L.
Wilcox, B.
Williams of Crosby, B.
Windlesham, L.
Wolfson, L.


Acton, L.
Ahmed, L.
Amos, B.
Andrews, B.
Archer of Sandwell, L.
Ashley of Stoke, L.
Ashton of Upholland, B.
Bach, L.
Barnett, L.
Bassam of Brighton, L.
Bernstein of Craigweil, L.
Bhatia, L.
Blackstone, B.
Boothroyd, B.
Borrie, L.
Bragg, L.
Brooke of Alverthorpe, L.
Brookeborough, V.
Brookman, L.
Bruce of Donington, L.
Campbell-Savours, L.
Carter, L.
Chorley, L.
Christopher, L.
Clark of Windermere, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Cohen of Pimlico, B.
Corbett of Castle Vale, L.
Crawley, B.
David, B.
Davies of Coity, L.
Davies of Oldham, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Dixon, L.
Dormand of Easington, L.
Dubs, L.
Elder, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Falconer of Thoroton, L.
Falkender, B.
Farrington of Ribbleton, B. [Teller]
Faulkner of Worcester, L.
Filkin, L.
Fitt, L.
Fyfe of Fairfield, L.
Gale, B.
Gibson of Market Rasen, B.
Gladwin of Clee, L.
Golding, B.
Goudie, B.
Gould of Potternewton, B.
Grabiner, L.
Graham of Edmonton, L.
Greengross, B.
Gregson, L.
Hardy of Wath, L.
Harrison, L.
Haskel, L.
Hayman, B.
Hilton of Eggardon, B.
Hogg of Cumbernauld, L.
Hollis of Heigham, B.
Howells of St. Davids, B.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Chesterton, L.
Hunt of Kings Heath, L.
Jeger, B.
Jones, L.
Jordan, L.
King of West Bromwich, L.
Lea of Crondall, L.
Lipsey, L.
Lofthouse of Pontefract, L.
McCarthy, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
MacKenzie of Culkein, L.
Masham of Ilton, B.
Mason of Barnsley, L.
Merlyn-Rees, L.
Milner of Leeds, L.
Mishcon, L.
Mitchell, L.
Morgan, L.
Morris of Manchester, L.
Orme, L.
Parekh, L.
Pendry, L.
Peston, L.
Pitkeathley, B.
Ponsonby of Shulbrede, L.
Puttnam, L.
Ramsay of Cartvale, B.
Rendell of Babergh, B.
Richard, L.
Rix, L.
Sainsbury of Turville, L.
St. John of Bletso, L.
Sheldon, L.
Simon, V.
Slim, V.
Smith of Gilmorehill, B.
Strabolgi, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Thornton, B.
Turner of Camden, B.
Uddin, B.
Warwick of Undercliffe, B.
Weatherill, L.
Whitaker, B.
Wilkins, B.
Williams of Elvel, L.
Woolmer of Leeds, L.

Resolved in the affirmative, and amendment agreed to accordingly.

17 Mar 2003 : Column 29

4.17 p.m.

Lord Hunt of Kings Heath moved Amendment No. 11:

    Page 6, line 4, leave out "new" and insert "fresh"

On Question, amendment agreed to.

Clause 6 [Liability to make delayed discharge payments]:

Lord Hunt of Kings Heath moved Amendment No. 12:

    Page 6, line 25, at beginning insert "the patient has not been discharged and"

On Question, amendment agreed to.

Clause 7 [Delayed discharge payments: supplementary]:

Baroness Noakes moved Amendment No. 13:

    Page 7, line 31, at end insert—

"( ) Section 6 shall not come into force until 30 days after the Secretary of State has determined that the systems of incentives within NHS bodies operate to discourage NHS bodies from discharging patients inappropriately."

The noble Baroness said: My Lords, we come to a crucial amendment in ensuring that the Bill is balanced when it leaves your Lordships' House. When the Bill arrived here from another place, it was not a balanced Bill. Your Lordships have rectified some of that imbalance. In particular, patients and carers who were marginalised by the Bill in the form that it arrived here will now get a better deal.

17 Mar 2003 : Column 30

We now need to address the imbalance between the NHS and local government. The Minister may seek to deny that the Bill is heavily weighted against local government but denial of the Bill's consequences has been a consistent theme from Ministers throughout our deliberations. They blame local government for causing delays in discharging patients—especially the elderly—from hospital. The Government have rightly encouraged local authorities and the NHS to work in partnership to solve the problems, which is exactly what has been happening. Not all parts of the country have been as effective as the best. Some local authorities are still struggling to overcome the decimation of the care home sector that is the result of government policies—but real progress has been made. However, the Government have always acted as if Rome could indeed be built in a day and, before the new partnership agreements have had a chance to prove themselves, they have changed tack again and decided that a system of fines would sharpen the mind of local government.

Your Lordships will know that financial penalties indeed concentrate the mind; but also that unless penalties are carefully designed, they are likely to overwhelm other system drivers. In this case, they are likely to result in a complete failure of the partnerships that have so carefully been built up. Revealingly, the Minister spoke during our debate on the previous amendment of local authorities taking the maximum time to arrange discharges allowed under the Bill. It is clear from his comments that the Government now assume that partnership working will be killed by the Bill.

Putting that to one side, the system of fines is not even neutral for the NHS. The fines become a revenue stream for a hard-pressed NHS. Do not be fooled by government claims of large amounts of money going to the NHS. Most of the NHS is struggling to balance its books and is achieving precious little extra activity from the money. The fines will be a real financial incentive to the NHS to discharge patients as soon as possible.

So what is the problem with that? There is a major risk that discharges from hospitals will be premature and patients will end up as emergency readmissions. That is a thoroughly miserable prospect for elderly people. We may hear from the Minister another denial of the linkage between early discharge and emergency readmission, but he cannot deny that, following the Government's various initiatives to date on delayed discharge, readmission levels are at record levels and that rates are now as high as they have been since the Government came to power. We fear that the fines will lead to a rocketing readmission rate. That is simply not good enough for patients.

That is why the amendment mentions a system of incentives to prevent the NHS discharging patients inappropriately. At present, the Bill creates an adverse incentive. We need a positive incentive scheme in the NHS to encourage it to do the right thing, not the wrong thing. We need incentives not just to prevent

17 Mar 2003 : Column 31

premature discharge but the NHS avoiding its long-term obligation to provide NHS care by rushing to discharge patients into the responsibility of local government.

At various stages of the Bill's passage, the Minister has given us several versions of incentives that may or may not operate in the NHS. He began by relying on some technical financial flows incentives, possibly starting from 2005-06. But those have been unmasked as potentially illusory and certainly have no immediacy. He has also prayed in aid the system of star ratings, the performance management apparatus, the periodic reviews by the Commission for Health Improvement and even the 100 million promised for the Bill that has still not been handed out to local government. I doubt that any noble Lord who took part in earlier debate on the Bill was impressed by any of that.

Amendment No. 13 is simple. The fining aspect of the Bill—although, I stress, no other—would be delayed until the Secretary of State had determined that a system of incentives within NHS bodies operated to discourage them from inappropriately discharging patients.

I hope that, even at this late hour, the Government will understand that this is a reasonable, balancing measure, I beg to move.

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