Community Care (Delayed Discharges etc.) Bill
Lord Hunt of Kings Heath (Parliamentary Under-Secretary, Department of Health; Labour)
My Lords, I first welcome the opportunity to debate mental health issues. Although I recognise that it would be inappropriate to extend the Bill's provisions to mental health patients at the same time as we intend to do for those who are receiving acute care, I cannot agree to the amendment, which would mean that mental health patients would be excluded for all time from the provisions. I am well aware of the pressures and issues that face those running mental health services and the impact that that has on the services' users.
The noble Earl, Lord Howe, is absolutely right to say that over-extended stops in mental health hospitals is a cause of real concern. I echo the point that he cited from the Sainsbury Centre for Mental Health—an organisation for which I once worked—describing some aspects of hospital care as non-therapeutic. None the less, many mental health patients continue to require treatment in hospitals. As a matter of general principle, the core of the Bill, which is to allow for effective and speedy discharge when it is safe, ought to extend to mental health patients at some point in future.
I want to make clear, as I did in Committee, that we intend in the first instance to prescribe acute care as the type of care that patients must be receiving to qualify, and then, later, to extend the Bill to other types of care where there is a problem with delay. Mental health is one of the types of care excluded from the Bill by draft regulations that have been circulated. We have chosen to take a pragmatic approach because we do not want to overload local authorities, which are preparing to implement the system as a whole.
There is no automatic decision to expand the scope of the Bill to cover mental health, but if we made that decision at some stage, I assure noble Lords that that would not happen without full and proper examination of whether it would be beneficial to mental health patients and the mental health sector as a whole. We should want to consider whether the level of reimbursement should be set differently to provide the right incentive for mental health patients, and whether the minimum compliance period should be extended to reflect the difficulties described by the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, which may arise when assessing mental health patients or providing services.
The Bill has been drafted to allow for expansion. It does not commit us to do so; nor does it restrict us to extending the reimbursement scheme in its current form, because Clause 8 enables us to make different provision for different cases. That will enable us to avoid the perverse incentives mentioned by both noble Lords. We do not have a timetable in mind for such an extension. The decision whether to apply reimbursement to the mental health sector will be taken after the system has had time to bed down in the acute sector.
However, it would be a mistake explicitly to exclude mental health patients from the Bill. It is much to be regretted when such patients have unduly to extend their stay in hospital because of issues such as those raised by the noble Earl, concerning community services. It is important that we retain the ability to extend the benefits of the Bill to mental health patients at some stage, if that is what is decided.
My department has received representations from many mental health professionals who are concerned that their patients should be included in the Bill's provisions as soon as possible, and who want them to benefit from the more timely provision of services that should result. Although we are not prepared to go down that route, we should enable ourselves later to extend the Bill's provisions to mental health patients. Would it be justified to say that we should ring-fence mental health from a scheme that will start with acute patients and can be extended to other parts of NHS service provision—to say that mental health patients should not receive those benefits? That would be unjustified.
I hope that I have given reassurances that if it were decided to extend the Bill to mental health patients, that would not be done without careful discussion and consultation with appropriate stakeholders—many of whom have argued that it should extend to mental health patients right from the start.