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Baroness Greengross: Amendments Nos. 138A and 142A standing in my name are grouped with Amendment No. 12 as they also relate to the Bill's commencement. In speaking to Amendment No. 138A I shall be brief. It is a probing amendment and some of the issues have already been raised.
As we know, inappropriate discharge will often be caused by the hospital itself, as has already been mentioned. At Second Reading I mentioned an example of a hospital that discharged a patient without notice to the local social services department despite the fact that it knew that that department was trying to arrange a care plan. But thus far I have not seen what additional responsibilitiesby that I mean obligationseither as a result of a legislative requirement or a direction from the Secretary of State for Health are to be placed on the NHS other than nominating an NHS officer to be responsible for discharge. Other Members of the Committee have tabled some later amendments which spell that matter out a little more. But, to be frank, I had hoped by now to see something from the Government.
Last week I was most encouraged to receive and read the newly published updated Department of Health Discharge from Hospital pathway process and practice workbook. I hope that it is given a snappier title as I do not think that the present one will be very popular. It seems to me that that substantial document covers
Baroness Barker: I wish to echo many of the comments made by the noble Earl, Lord Howe, and to make one or two other points. Bad practice is easy to implement quickly. That is the big fear that many of us have with regard to the Bill. Much that is going on at the moment is good. There is much joint working which is laudable. I have listened to the Minister's comments all afternoon but I am not convinced that as regards a Bill which seems to be based on apportioning blame it is possible to be as confident as he is not only that existing good practice will not be undermined but also that bad practice will not come into play.
I wish to mention timing in particular. I believe that the Bill involves immense planning distortions. Good authorities will by now have begun to plan their community care services for most of next year. I do not see how, at such short notice, they will be able to conjure up new places, as the noble Earl, Lord Howe, said. The Minister made much of the statistical breakdown of reasons for delayed discharge. I have spent some time examining them and very interesting reading they are, too. Although it is true that performance varies between authorities and areas, and although it is also true that there are many reasons for that, both in percentage terms and actual terms, the consistent reason an authority has a problem is that people are awaiting residential and nursing home care placements. I do not believe that it is wrong to focus on that. I know that there are many reasons to hope that people will not go into residential care but will go home, but when that is such a consistent and obvious problem across the country it is wilful to ignore it.
The Minister said earlier that the Government have not decided how they will allocate the additional resources. Frankly, the lack of notice with regard to the £100 million cannot but help distort prices within local care home economies. If I were a care home owner at the momentit is a difficult business to be inI should ratchet up my prices in the knowledge that some of that money would come my way and my places would be at a premium.
The Minister has said all afternoon that there is as big an onus on the NHS to change as there is on social services. Indeed, and in many cases within the NHS discharge practice is not good. It will take the NHS some time to get itself organised and to tackle some working practices which have been around for aeons; namely, that no matter what the lowly discharge officer says, what a consultant says goes. That is one of the biggest causes of delayed discharges in hospital.
The Minister has already this afternoon drawn our attention to the Victoria Climbie case, and so will I. Over the past six months I have said many times in this Chamber that any social services department which does not intend to increase its children's services this year must be mad. Social services departments are trying to tackle that matter in addition to the matter we are discussing. But there is one reason above all else why I believe that we should defer the measure. At the end of January the department's consultation paper on client confidentiality was produced. It is full of good and interesting material about one of the key issues in healthcare at the moment and contains laudable aims and objectives as regards the handling of information, particularly information which is conveyed by electronic means. However, the measure will not be anywhere near being in practice until 2004 at the very earliest. In many cases, it will not be introduced until 2006.
Behind thatit is implicit in the Bill, not explicitis the transfer of information. In the noble Lord's response to me about self-funders he talked, although not in great detail, about the fact that people who may not wish it may have personal details handed over to social services departments.
There is a great deal that is not explicit in the Bill, which is deeply worrying. I do not see why older people, merely because they are old, should be subjected to standards of information that are not acceptable for other people. For that reason perhaps above all, we ought to take a year and consider better the Bill and some of the deep ethical issues in it, and how we can enable people to turn services into what they ought to be, which is services that prevent hospital admissions in the first place.
On Merseyside, we know that we already have a number of delayed discharges of older people. The immediate acquisition of intermediate care beds in an acute hospital is a short-term measure to avoid paying a proportion of the fine. However, fines for those who are not accommodated in the intermediate care beds will have to be paid.
Clearly, there is a lack of residential care and facilities. The £100 million that the Government are putting towards helping intermediate care beds to be made available is short of the £180 million needed, according to the Association of Directors of Social Services.
Members of the Committee have mentioned the other important issue, which is capacity for domiciliary care and the support for health visitors for older people living in the community. My noble friend Lady Greengross made a useful proposal that the NHS should be audited to ensure that plans were in place. That could be done only if we delayed the implementation of the Bill for a year.
The noble Baroness, Lady Barker, says that what a consultant says goes, to which I reply, "Not always". That is sometimes unfortunate, because there is a fear of backlash among staff if a risk foreseen actually occurs. Sometimes when the informed wish of patients is to go home, that is to relatively unsuitable surroundings with very high risk. However, if that is what they want to do and they take an informed decision, they should be supported in doing what they sincerely wish to do.
I have a deep fear that unless the Bill is thought through and the systems are in place to drive up standards, the people who will suffer will be the patients, and what will be sacrificed is patient choice right at the outset. We may have a dumbing down rather than a raising of standards.
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