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The Chairman of Committees (Lord Brabazon of Tara): My Lords, is the noble Baroness moving the amendment?

Baroness Barker: My Lords, yes I beg to move.

On Question, Whether the amendment shall be agreed to?

Baroness Barker : My Lords, no, the amendment is not moved.

[Amendment No. 14B not moved.]

The Chairman of Committees: My Lords, in that case the Question is that the House do not insist on their Amendment No. 14 to which the Commons have disagreed.

On Question, Motion agreed to.

LORDS AMENDMENTS

15Page 2, line 41, after "body" insert "and the qualifying patient" The Commons disagreed to this amendment for the following reason:


15A Because it is unnecessary to add additional requirements in relation to community care assessments under clause 3(3) and it is undesirable to differentiate between assessments under clause 3(3) and other assessments carried out under section 47 of the National Health Service and Community Care Act 1990.
16Page 2, line 42, at end insert— "( ) Before making a decision under subsection (3), the responsible authority must—


(a) consult the patient and his carer, if he has one;
(b) inform them of the cost of the proposed care plans; and
(c) obtain the consent of the patient and any carer and, where informed consent is given, record that on the patient's file, or if a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered."

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The Commons disagreed to this amendment for the following reason:


16ABecause it is unnecessary to add additional requirements in relation to community care assessments under clause 3(3) and it is undesirable to differentiate between assessments under clause 3(3) and other assessments carried out under section 47 of the National Health Service and Community Care Act 1990.
18Page 3, line 8, after "consulting" insert "the carer and obtaining the informed consent of the carer to the proposed care plan and after consulting" The Commons disagreed to this amendment for the following reason:


18ABecause it is unnecessary to add additional requirements in relation to carers' assessments under clause 3(4) and it is undesirable to differentiate between assessments under clause 3(4) and other assessments carried out under the Carers and Disabled Children Act 2000.

Baroness Andrews: My Lords, I beg to move that the House do not insist on their Amendments Nos. 15, 16 and 18 to which the Commons have disagreed for their reasons numbered 15A, 16A and 18A.

Moved, That the House do not insist on their Amendments Nos. 15, 16 and 18 to which the Commons have disagreed for their reasons numbered 15A, 16A and 18A.—(Baroness Andrews.)

On Question, Motion agreed to.

LORDS AMENDMENT

23Page 3, line 37, at end insert— "( ) The responsible NHS body must give the patient and his carer, if he has one—


(a) notice of the day on which it proposes to discharge the patient, and where informed consent is given, record that on the patient's file, or if a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered, and
(b) information about their right to request a review if they disagree with the decision to discharge." The Commons disagreed to this amendment for the following reason:


23ABecause the decision to discharge should not be subject to the consent of the patient and it is undesirable to discriminate on this issue between patients who are subject to the Bill and other hospital patients.

Baroness Andrews: My Lords, I beg to move that the House do not insist on their Amendment No. 23 to which the Commons have disagreed for their reason 23A.

The amendment raises the important issue of the information received by the patient and carer about the date of discharge. It is extremely important that the NHS gives the patient and their carers all the information they need to make discharge as safe and co-ordinated as possible. We agree that the patient and the carer need information about the discharge date as much as social services. I submit that they need that information just as much for every discharge, regardless of whether it is a discharge conducted according to the processes of this Bill, or whether a routine discharge is involved, by which the patient goes back to the care of his or her family. I again refer to the revised Hospital Discharge Workbook, which makes it clear that every patient is to be provided with information and advice throughout the discharge process, not just about the date but about the care that

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they will receive after discharge. As a further way of reinforcing that, I can confirm today that the regulations around the notice of the discharge date will require that the hospital confirms that that information has also been given to the patient.

Amendment No. 23 is seeking to go beyond that by placing an entirely new duty on the NHS to gain the patient's consent to discharge. As we said previously, that raises serious questions for the NHS as a whole and its general ability to function and to manage admissions and discharges on a rational basis. It would undoubtedly increase delayed discharges and the length of hospital stays.

If a patient had a right to consent to discharge, they would effectively have a legal right to remain in a hospital bed indefinitely. The decision that a patient is ready for discharge is one for the NHS body, but it needs to be taken in consultation with the patient/carer, social services and other health professionals by a suitably qualified member of hospital staff with responsibility for discharge. The guidance for the Bill will make it plain that the decision to discharge is one that must be taken in consultation with all relevant parties, including the patient/carer. That will be made clear in guidance. I would argue that even without that guidance, acting in that way is part and parcel of the NHS's general duty.

I cannot therefore accept that the patient must give informed consent to discharge. However, I understand the real concern that patients may leave hospital with an inadequate care package. The first step, which we have already debated, involves proper discussion between social services and the patient about the adequacy of care.

I know that noble Lords opposite are also concerned about older people who may be desperate to get home and therefore accept a care plan, which turns out, in practice, to be inadequate. We have responded to those concerns: the Section 7 guidance in the Bill will state that where the discharge plan is a care package in the person's own home, social services are to review the discharge care package, including that provided to the carer—if there is one—within a maximum of two weeks to check that the post-discharge care has been adequate and is working. The Section 7 guidance will include advice to monitor the arrangements in an even shorter time if there appears to be any concern that the post-discharge situation might be unstable. That means that any perverse effects that may arise can quickly be identified and addressed on an individual basis in a very short period of time.

There is much flexibility in that arrangement. Each patient's progress through the stages of assessment and care planning may differ and where there is an ongoing assessment, that will in itself be a review. The care plan can be updated as a result of that ongoing assessment. In those circumstances, the short-term review may not be needed or will become part of the longer-term review. A complex assessment could be carried out in interim care or it could be that the

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discharge plan involved a period of intermediate care, which in itself includes a review. Either way, we are providing for all eventualities in terms of home care.

On the other hand, we want that good practice of review after a short time to extend to other points in the care pathway; for example, where the person goes home after a period of care, such as intermediate care. We will introduce that through cross-references between guidance on the Bill and guidance on the single assessment process. We will be consulting fully on all that—we realise that it is a new element in the process, which I am sure noble Lords will welcome.

On the NHS side, we will make it clear in directions that every patient should be assessed against local criteria for fully funded NHS continuing care before social services are contacted about providing community care services and that patients should be fully informed about those criteria and that they can request a review. That will be confirmed in the regulations governing the Section 2 notice. We have also made it clear that the directions about the conduct of continuing care reviews will mean that those reviews must be conducted within 14 days. We have symmetry between the period of reviewing. During this time, if the patient is in hospital, he can remain there. I hope that that relieves some of the serious reservations of noble Lords.

Moved, That the House do not insist on Amendment No. 23 to which the Commons have disagreed for their reason numbered 23A.—(Baroness Andrews.)

[Amendment No. 23B not moved.]

On Question, Motion agreed to.


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