Clause 4 — Liability to make Delayed Discharge Payments

Community Care (Delayed Discharges etc.) Bill – in the House of Commons at 4:30 pm on 15th January 2003.

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Photo of Simon Burns Simon Burns Shadow Spokesperson (Health) 4:30 pm, 15th January 2003

I beg to move amendment No. 7, in page 4, line 30, at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—

(a) #120, in the case of a social services authority in, or adjacent to, Greater London, or

(b) #100, in any other area.'.

Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means)

With this it will be convenient to discuss amendment No. 8, in page 4, line 30 [Clause 4], at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—

(a) #12, in the case of a social services authority in, or adjacent to, Greater London, or

(b) #10, in any other area.'.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health) 4:45 pm, 15th January 2003

I want to make it clear at the outset that although I will speak to both amendments in the group, I will press only amendment No. 8 to a Division. Before the Minister has fun at my expense, let me make it clear that the reason why both were tabled is, first, that I do not have the advantage of having the Government's lawyers and draftsmen at my disposal and, secondly, that those in opposition never know in advance which amendments will be selected. To be frank, I thought that even though amendment No. 8 is far more important and relevant to local authorities throughout the country, it would be pushing my luck to presume that it would be selected. You cannot imagine my unbridled joy, Mr. Deputy Speaker, when I noticed yesterday evening that it had been selected.

The nub of the Conservatives' opposition to this nasty and unnecessary Bill is the concept that the Government are introducing fines on local authorities—fines that are across the board in their application, regardless of whether there is any justification for them. As we said in Committee, circumstances will quite frequently arise in which for various reasons it will not be a local authority's fault that a person does not leave a hospital bed and go to either domiciliary or residential care, whichever is the most appropriate, yet the Government are to impose fines of, we understand, #120 per day for those living in London and the south-east, and #100 for those living elsewhere.

We believe that that is wholly the wrong way to try to overcome the problem of bed blocking. Like many outside the House, we believe that the Bill will set the national health service against social services and vice versa, and undo the great strides forward accomplished in the past decade or so in terms of those agencies working together to provide a seamless service for patients. Regardless of the announcement made by the Secretary of State on 11 December of extra money for three years, we believe that the legislation will result in local authorities being penalised financially. Anyone who asks social services departments in England for their estimate of the potential cost to them of the fines will be given a figure that far exceeds the #100 million that the Government are making available.

The departments' estimate also far exceeds the results of the calculations done on the back of an envelope by Mr. Burstow, who is no longer in his place. All of us who know the Liberal Democrats know that they never let a fact get in the way of a XFocus" or a press release, especially if that press release can be got into a national newspaper by conning some journalist who does not want to do the research himself—after all, the Liberal Democrats, with their clipboards and their anoraks, are the font of all accuracy in surveys and calculations of a mathematical nature.

Photo of Claire Ward Claire Ward Labour, Watford

There is a man who has been scarred.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Too right, I have been scarred. I have had to deal with that party for 10 years. Fortunately, the people of West Chelmsford saw through the Liberal Democrats long ago. From getting within 378 votes of capturing Chelmsford in 1983—I might add that that was before I was the candidate—they are now a very poor third behind Labour. The clipboard experience has disappeared from our streets.

Photo of Patsy Calton Patsy Calton Liberal Democrat, Cheadle

I can only think that a figure like 25 per cent. is making a difference. Would the hon. Gentleman like the Liberal Democrats' support for the amendment? I think that it would be useful and perhaps entertaining for us to know.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I shall answer the hon. Lady in two ways. First, on the mathematics, the hon. Lady has proved my point, although I may be arguing unwisely in a way, given that Liberal Democrats can never get any mathematical calculation right. The hon. Lady said 25 per cent. The Government say 20 per cent. I think that the hon. Lady meant 20 per cent. rather than 25 per cent.

Secondly, the hon. Lady asks whether the Conservatives want the hon. Lady's support on the amendment. The Conservative party, for reasons that I am outlining, has produced a first-rate amendment to minimise the damage that the Government can do to social service departments with their fines. I would advise not only Liberal Democrat Members but Members of any Opposition party—and any Labour Member who has listened carefully to their social services department, although given those Members who are in their places, I suspect that they have not—to join us in seeking to help social service departments and other organisations throughout the country so as to ensure that we minimise the damage that the Bill would do to social service departments.

Photo of Mr Kevin Hughes Mr Kevin Hughes Labour, Doncaster North

The hon. Gentleman may recall that on Second Reading I produced the figures for Doncaster, which has been working really well on this issue and has an extremely good record. These matters start at the front end, not the back end. Instead of trawling round social service departments looking for negatives, the hon. Gentleman might be better trawling round looking for positives, and asking what will be done to ensure that our constituents receive the treatment that they deserve in hospitals and get out when they no longer need medical treatment.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

If the hon. Gentleman were correct in his assumption, his point would be valid, but I can assure him that I did not trawl social services departments for bad news stories. Instead, and at random, I telephoned social services department after social services department. Amazingly—or not amazingly, given the damage that the Bill will do—they all had the same complaint, which was that there would be a problem with fines to some degree.

As for the hon. Gentleman's second point, he is absolutely right. We all want a system whereby people do not have to remain in hospital for a day longer than they otherwise should. Unfortunately and regrettably, owing to a number of circumstances including the crisis in long-term care—the closure of more than 60,000 beds and of 2,000 homes since 1997 and the fact that in certain areas there are not enough beds available—there are bound to be some delayed discharge cases.

None of us wants that. Of course social services departments and the national health service have been seeking to minimise delayed discharges for a considerable time. However, factors beyond their control have thwarted them in achieving anywhere near a 100 per cent. success rate in eliminating the problem. I am saying, as my party is saying—

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)


We want to come up with positive and sensible ideas to seek to overcome the problem. We do not believe that the best way to achieve that is through fines. That is why to my mind amendment No. 8 is the most attractive alternative within the scope of the Bill. We believe that it will deal with the problem. Bringing down to a more or less nominal level the fines that the Minister is seeking to introduce and including that figure in the Bill would prevent the Chancellor from using the proposals as a new form of stealth tax. Without primary legislation, he could not seek to increase the level annually, or whenever the Government wanted to raise more money.

Photo of Andy Burnham Andy Burnham Labour, Leigh

Will the hon. Gentleman give way?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I am sorry, but I cannot.

It is for those reasons that I hope that my right hon. and hon. Friends will join me in the Division Lobby. I further hope that any other hon. Members who care about coming up with positive solutions to the long-term care crisis, and who have said consistently on the Floor of the House and in Committee that they oppose the fining system, will join us in seeking to thwart the Government's intentions.

Photo of Patsy Calton Patsy Calton Liberal Democrat, Cheadle

I shall be very brief. The Liberal Democrats will support the amendment, but in spite of, rather than because of, the arguments advanced by Mr. Burns. I should correct him on one point—I realise that I did not make myself clear: the figure of 25 per cent. referred to the opinion polls, rather than to whatever it was that he thought it referred to.

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health

I was glad to see some of the Opposition harmony return at the end of the debate. Mr. Burns was a little unfair. After talking about Liberal Democrat clipboards and anoraks—amusing though that was—he proceeded to talk about his own survey. I do not know whether he used a clipboard; it is more likely that he got someone else to carry out the survey, and perhaps they used a clipboard.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Perhaps I can help the Minister. No, I did not use a clipboard, because I try to distance myself from the Liberal Democrats as much as possible. Directors of social services were telephoned in their offices, and they provided the information. I put it on a piece of paper and added it up, and I got a total. [Interruption.]

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health

As has just been pointed out, I am sure that the hon. Gentleman would never be seen wearing an anorak, either.

The Bill seeks to provide an incentive for local authorities to supply prompt onward care for patients who are ready to leave hospital by introducing a charge that broadly reflects the cost to the hospital of providing a bed for a delayed patient. We had some lengthy discussions in Committee about the justifiable basis for expecting that, where the responsibility rests with social services departments to provide for a person's needs—usually, it is an older person—it is not unreasonable to expect them to take responsibility for payment as well, given that they will receive the necessary funding from the Government. The alternative is a system that is effectively a fine on the NHS, because the NHS is expected to pay the costs of people whose needs would be better served out of hospital, but who remain in hospital because alternatives are not available in the community. Anybody who opposes that principle must answer the question of whether it is justifiable for the NHS to bear costs for which it has neither legal nor practical responsibility. Nor, indeed, is it best suited to provide that particular form of care.

Photo of George Young George Young Chair, Standards and Privileges Committee

Let us accept for one moment the principle that the Minister has just enunciated. Why does it not work the other way around? When the NHS imposes costs on social services, why does it not pay them?

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health 5:00 pm, 15th January 2003

I would be interested to know what examples the right hon. Gentleman has in mind. We explored in detail in Committee the principles of some of the financial incentives that are being introduced into the NHS. I made the point that it is possible to introduce financial incentives through the sort of financial flows work that we will be introducing into the NHS, some of which I spelt out earlier, without legislation. However, the interface between social services and health is such that we need to legislate in order to introduce financial incentives in that context.

I return to my original question, which has not been satisfactorily answered by anybody who opposes the legislation. The incentive is that the daily charge that we propose is higher than the daily costs that the local authority would otherwise incur in providing either residential or domiciliary care for the person in question. I hope that hon. Members will understand that there are very good reasons why the Bill makes no mention of the actual reimbursement charge.

We have chosen to set out the charge in regulations rather than in the Bill, as that will give us greater flexibility to amend the rates in line with inflation or other cost pressures. The hon. Member for West Chelmsford was either on a flight of fancy or lacks understanding about the nature of the charge, which is a transfer from one part of the public system to another reflecting the costs that have been borne. It is not raising money for the Government, but focusing the attention of social services departments on areas in which they already have responsibility and ensuring that they spend the extra investment that the Government are making available to them on the sort of alternatives that older people want to enable them to get out of hospital more quickly.

In the letter that I sent to members of the Standing Committee about the regulations, I spelt out that the charge will be based on the cost to the NHS of providing bed, board and personal care in an acute environment, but having removed indirect overheads and the cost of capital medical input and specialist nursing in order to reflect the lower costs of caring for a patient at the end of a hospital stay when medical needs have been reduced. In most cases, the figure will also represent a higher charge to the local authority than the daily costs of providing community care in a residential setting or in the person's home. Our intention is to remove what sometimes operates as perverse incentive in the system, enabling local authorities not to live up to their responsibilities, with the NHS bearing the costs of people's care because the necessary alternatives are not in place.

In our consultation, we asked whether a charge of #100 a day and #120 in London and the south-east would be appropriate. Responses suggested that that seemed about the right amount to create the incentive that we want. We will issue the regulations for consultation and consider any further responses about the amount of the charge and the boundary for the higher rate.

The hon. Member for West Chelmsford made clear what the amendments are about. They are not a serious attempt to consider the incentive effect or the appropriate level for the charges that will justifiably be put in place. They are simply wrecking amendments that continue for the Opposition the approach on which I commented during the debate on the previous group of amendments but one. Opposition Members are keen to oppose our proposals, but have no ideas about how we can cut delayed discharge. I am afraid that they are therefore letting down the older people who depend on all of us to provide a better system to ensure that they get the right care in the right place.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I listened carefully to the Minister, and it will come as no surprise to the House that I was not convinced by her arguments. Moreover, her comments towards the end of her speech were absolute and unadulterated rubbish. Therefore, I beg to ask leave to withdraw the amendment and I ask my right hon. and hon. Friends to join me in the Lobby in support of amendment No. 8.

Amendment, by leave, withdrawn.

Amendment proposed: No. 8, in page 4, line 30, at end insert—

'(10) The amount prescribed under subsection (4) shall not exceed—

(a) #12, in the case of a social services authority in, or adjacent to, Greater London, or

(b) #10, in any other area.'.—[Mr. Burns.]

Question put, That the amendment be made:—

The House divided: Ayes 188, Noes 317.

Division number 51 Community Care (Delayed Discharges etc.) Bill — Clause 4 — Liability to make Delayed Discharge Payments

Aye: 188 MPs

No: 317 MPs

Ayes: A-Z by last name


Nos: A-Z by last name


Question accordingly negatived.