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Division No. 2


Aberdare, L.
Addington, L.
Ampthill, L.
Anelay of St Johns, B.
Astor, V.
Astor of Hever, L. [Teller]
Avebury, L.
Barker, B. [Teller]
Beaumont of Whitley, L.
Biffen, L.
Blaker, L.
Blatch, B.
Bowness, L.
Bradshaw, L.
Bridgeman, V.
Bridges, L.
Brooke of Sutton Mandeville, L.
Brougham and Vaux, L.
Burnham, L.
Buscombe, B.
Byford, B.
Caithness, E.
Campbell of Alloway, L.
Carnegy of Lour, B.
Cavendish of Furness, L.
Chadlington, L.
Chalfont, L.
Clement-Jones, L.
Colwyn, L.
Cox, B.
Craig of Radley, L.
Crickhowell, L.
Dean of Harptree, L.
Dholakia, L.
Dixon-Smith, L.
Eccles of Moulton, B.
Eden of Winton, L.
Elis-Thomas, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Ezra, L.
Falkland, V.
Fearn, L.
Finlay of Llandaff, B.
Fookes, B.
Fowler, L.
Gardner of Parkes, B.
Gilmour of Craigmillar, L.
Glentoran, L.
Gloucester, Bp.
Goodhart, L.
Gray of Contin, L.
Greengross, B.
Hamwee, B.
Hanningfield, L.
Harris of Richmond, B.
Henley, L.
Hodgson of Astley Abbotts, L.
Hogg, B.
Holme of Cheltenham, L.
Howe, E.
Howe of Aberavon, L.
Howell of Guildford, L.
Hunt of Wirral, 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.
Masham of Ilton, B.
Mayhew of Twysden, L.
Miller of Hendon, B.
Monro of Langholm, L.
Mowbray and Stourton, L.
Moynihan, L.
Murton of Lindisfarne, L.
Newby, L.
Newton of Braintree, L.
Noakes, B.
Northesk, E.
Northover, B.
Oakeshott of Seagrove Bay, L.
O'Cathain, B.
Onslow, E.
Park of Monmouth, B.
Patten, L.
Perry of Southwark, B.
Perry of Walton, L.
Plumb, L.
Plummer of St. Marylebone, L.
Razzall, L.
Reay, L.
Redesdale, L.
Renfrew of Kaimsthorn, L.
Rennard, L.
Renton, L.
Roberts of Conwy, L.
Rodgers of Quarry Bank, L.
Rogan, L.
Roll of Ipsden, L.
Roper, L.
Ryder of Wensum, L.
St. John of Bletso, 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.
Stevens of Ludgate, 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.
Weatherill, L.
Wigoder, L.
Wilcox, B.
Williams of Crosby, B.
Windlesham, L.
Wolfson, L.


Acton, L.
Ahmed, L.
Amos, B.
Andrews, B.
Archer of Sandwell, L.
Ashton of Upholland, B.
Bach, L.
Barnett, L.
Bassam of Brighton, L.
Bernstein of Craigweil, L.
Blackstone, B.
Borrie, L.
Bragg, L.
Brooke of Alverthorpe, L.
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.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Elder, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Falconer of Thoroton, L.
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.
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.
Janner of Braunstone, L.
Jeger, B.
Jones, L.
Jordan, L.
King of West Bromwich, L.
Kirkhill, L.
Lea of Crondall, L.
Lipsey, L.
Lofthouse of Pontefract, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
MacKenzie of Culkein, L.
Mason of Barnsley, L.
Merlyn-Rees, L.
Milner of Leeds, L.
Mishcon, L.
Mitchell, L.
Morris of Manchester, L.
Orme, L.
Parekh, L.
Patel of Blackburn, L.
Pendry, L.
Peston, L.
Pitkeathley, B.
Prys-Davies, L.
Puttnam, L.
Ramsay of Cartvale, B.
Rendell of Babergh, B.
Richard, L.
Sainsbury of Turville, L.
Sawyer, L.
Sheldon, L.
Simon, V.
Strabolgi, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Temple-Morris, L.
Thornton, B.
Turner of Camden, B.
Uddin, B.
Walker of Doncaster, L.
Warwick of Undercliffe, B.
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 36

4.48 p.m.

Clause 9 [ Dispute resolution]:

Lord Hunt of Kings Heath moved Amendment No. 14:

    Page 8, line 26, leave out "under this Part"

On Question, amendment agreed to.

Clause 10 [Adjustments between social services authorities]:

Lord Hunt of Kings Heath moved Amendment No. 15:

    Page 8, line 43, leave out from "incurred" to "from" in line 46 and insert—

"(i) in the performance of functions under this Part in relation to a qualifying patient;
(ii) in the provision of community care services which are the subject of a decision under section 4(2)(b); or
(iii) in the provision of services to a carer which are the subject of a decision under section 4(4)(b),"

17 Mar 2003 : Column 37

On Question, amendment agreed to.

Earl Howe moved Amendment No. 16:

    After Clause 20, insert the following new clause—

(1) Subject to subsection (2), Part 1 of this Act shall cease to have effect at the end of five years beginning with the date on which it comes into force.
(2) If the Secretary of State is satisfied that it is necessary for social services authorities to continue making payments in cases where the discharge of patients is delayed for reasons relating to the provision of community care services or services for carers, he may make an order providing that Part 1 of this Act shall continue in force for a further five years.
(3) An order may not be made under subsection (2) unless a draft of that order has been laid before, and approved by resolution of, both Houses of Parliament."

The noble Earl said: My Lords, the objections that we in the Opposition have to the Bill are many. Some objections are based on considerations which we know are valid, even in advance of the Bill coming into force. We deplore the way in which it makes local authorities the whipping boys for the problem of delayed discharges without in any way recognising the role which they play day in, day out, in preventing inappropriate admissions to hospital in the first place. We deplore a policy that moves us away from the letter and spirit of shifting the balance of power and imposes a system of micro-management from the centre. We deplore the pointless churning of public money around the system. We deplore the additional bureaucracy and the cost of that bureaucracy.

However, many of our objections to the Bill come under a somewhat different heading—the fact that this whole measure is a giant experiment. The Government profess to be confident that the Bill will achieve what is intended of it. I do not know on what considerations they base that confidence. The idea of penalising local authorities came originally from Sweden. Sweden is the home of many good ideas, but this is one that has not worked. Even after operating the scheme for a number of years, and even with spare capacity in its care home sector, Sweden still has a higher incidence of delayed discharges in both relative and absolute terms than we do in the UK. Against that background, the Government's confidence for the Bill looks somewhat bold.

That is one dimension of the risk, but we fear, too, that the Bill will introduce perverse incentives which may frustrate rather than assist the aim it is designed to achieve. We fear that the sword of Damocles hanging over social services will serve to encourage care homes to ratchet up their charges, thus restricting even further the resources available to meet the needs of patients.

We fear that the Bill will distort priorities in that local authorities will not be able to devote the time and resources they should towards helping people in their own homes when they are faced with the imperative of avoiding fines for patients stuck in hospital. Partly because of that, we fear that more elderly patients who need some form of social care will be referred to hospital as the one place where they are guaranteed to have their needs seen to, thus swelling the numbers of patients who are blocking beds. We foresee the creative, collaborative

17 Mar 2003 : Column 38

relationship between the NHS and local authorities that is now increasingly in evidence being transformed into a wary, confrontational relationship—again, to the detriment of patients.

The risk that patients and their carers will be denied a proper degree of choice has, at least in part, been forestalled by amendments to the Bill which the House approved last week. But this measure does not have the patient's voice at its core. It is a Bill about the system and about the acceleration of processes. We are assured by Ministers that it would be unthinkable for patients not to be involved in decisions made about what happens to them and for their confidentiality to be breached. But we are not at all confident about those assurances in the face of the financial imperatives and dictates that the Bill introduces.

In looking at the Bill, we are faced with a balance of risks and probabilities. We can only make educated guesses about what will happen. Certainly the Government are not in a position to assert with confidence that the Bill will succeed, by which I mean that it will succeed in the broadest sense. They may not want any of the unintended consequences to happen, but little can be done if they do. That is why I have tabled the amendment. It proposes that we give the Bill a finite life of five years. At the end of that time, the Government would have to present an affirmative resolution to Parliament if they believed that it was necessary to keep the provisions of the Bill in force. I have not set the hurdle any higher than that; it seems a perfectly reasonable proposal. Five years is a reasonable period of time. By then, the effects of the Bill will be measurable. If it has succeeded in delivering a genuinely better system for patients and has encouraged new investment in capacity without the adverse consequences I have referred to, no one in Parliament will argue against its continuation.

So, in the scale of risks for the Government, the risk of accepting the amendment is minuscule. They say they are confident of the Bill succeeding in its purpose. In that case, they have nothing to fear from a review after five years. Equally, in the face of this giant experiment, Parliament, I believe, is entitled to an insurance policy. I beg to move.

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