My Lords, the Government take the issue very seriously. The National Service Framework for Older People, published in March 2001, sets the elimination of age discrimination in assessing National Health Service or social care as a priority. To help to achieve that, it provides a programme of actions and milestones to be achieved over the next 10 years.
My Lords, I welcome that reply in part, but does not the King's Fund report illustrate the belief of senior managers that ageism is endemic in the health service? Whatever the facts of last week's incidents at the Whittington hospital, would not the Government be well advised to change their mind—as they have done on a number of other occasions—about whether to introduce a duty of age equality into the health service?
My Lords, I believe that the King's Fund report is a valuable contribution to the development of policy in this area. It shows that practitioners in the NHS and personal social services recognise that there is a problem of age discrimination. I believe that the establishment of the 10-year National Service Framework to ensure that the issues will be tackled consistently throughout the country is the best approach.
My Lords, does my noble friend agree that the codes of conduct and practice recently issued by the General Social Care Council will be very important tools in ensuring that discrimination of any kind is not acceptable to those who work in social care and to those who employ them? In putting that question, I declare an interests as the interim chair of the General Social Care Council.
My Lords, I am glad to pay tribute to my noble friend's work as the interim chair of the General Social Care Council. I am sure that she is right. The King's Fund report shows that more can be done to raise awareness among practitioners and managers of the impact and manifestation of age discrimination. Some of the examples that have been given include low referral rates to particular services and unthinking and insensitive treatment from individual members of staff. As my noble friend has suggested, codes of practice and training regimes may be one of the ways in which we can bring to the minds of all staff the need to be very much aware of the potential for age discrimination.
My Lords, does the Minister agree that age discrimination in health and social care has a lot to do with structure and organisation? For example, I know of patients with serious mental illnesses who may have been dealing with one team of workers throughout their lives, but who, at the age of 65 or 66, are told that that team can no longer look after them because of the age that they have reached. Does the Minister agree that that has nothing to do with person-centred care?
My Lords, I agree that arbitrary cut-offs are completely unacceptable. The National Service Framework for Older People makes it absolutely clear that discrimination on the basis of age in relation to treatment options is not to be tolerated. As for the noble Baroness's specific question on different policies in different parts of the National Health Service, I think that the work of the NSF shows that different approaches are taken in different parts of the NHS. The important point, however, is that all staff are trained to provide services to older people so that, regardless of how the services are provided, there is indeed a continuum of care.
My Lords, can the Minister throw any light on the number of older people, mostly women, who are in hospital when they should not be? Does he agree that the term "bed blocker"—which is hardly a human term at all—applies to such people, who are in hospital simply because there is not sufficient capacity for them outside hospital? Is that not a disgrace?
My Lords, I could not agree more with the noble Baroness that the term "bed blocker" is very much to be deplored. I think that the terminology currently being used is "delayed discharge". The noble Baroness will know that the Government have placed an extra £100 million into the system in recent months to allow for more places to be provided outside hospitals, and that intermediate care is designed to ensure that people are not stuck in hospital but rehabilitated and enabled to go back into their own homes. That is the broad thrust of the Government's policy in dealing with that particular problem.
My Lords, is the Minister aware of the front-page article last week in my local newspaper about one such case in which social services said point-blank that it did not have any money to transfer the elderly patient back into the community—where the medical staff at the hospital said that she ought to be?
My Lords, I do not have the benefit of reading the noble Lord's local newspaper. However, on the issue of the local authority's policy, I point out to him that, for next year, local authorities will be receiving 3.9 per cent extra in real-terms growth for social services. I should also mention the additional money that we have put into the system this winter. We believe that, ultimately, the resources are there to ensure that local authorities can make the right decisions in relation to providing support in the community.
My Lords, one concern raised in the King's Fund report is the current lack of specialist palliative care. Does the Minister recognise the severe funding difficulties being experienced by the hospice movement? What steps are the Government taking to reverse the diminishing level of public funding for hospices?
My Lords, as the noble Earl will know, the Government have taken various steps to ensure that the funding needs of hospices are taken fully into account by health authorities as they develop palliative care plans for their local health communities. He will also know that we are expecting to see increased expenditure in palliative care services which will benefit both services provided directly by the NHS and those provided by voluntary organisations. Of course we recognise the enormous contribution that the voluntary sector has made in this area. We expect that, because of renewed and local discussion between voluntary providers and health authorities, we shall achieve greater stability and certainty in funding support, which will be of benefit to the voluntary sector.
My Lords, I think that it is the turn of this corner. Is the Minister aware that older people are not only concerned about clinical discrimination but very concerned about the way in which they are treated in hospital wards? As he will be aware, they are concerned about being treated in mixed-sex wards. We were promised that such wards would be eliminated by 2002. We have reached 2002. Will the Minister give me a progress report and tell me whether mixed-sex wards have indeed been banished from the National Health Service?
My Lords, what I would say to the noble Lord in that corner is that the target to which he referred is to eliminate mixed-sex accommodation in 95 per cent of NHS trusts by December 2002. My understanding is that we are well on track to meet that target.
My Lords, is not the increase in the number of elderly people needing intermediate care greater than the 3 per cent real terms increase that the Government have given local authorities?
My Lords, intermediate care is a crucial part of the strategy to provide services for older people. As for resources and funding, we expect to spend by 2003-04 an extra investment of £900 million annually for intermediate care. We reckon that, by the end of the current year, compared with 1999-2000, we shall have an additional 2,400 intermediate care beds, more than 6,000 non-residential intermediate care beds and 137,000 people in receipt of intermediate care services. I think that noble Lords will see from those figures that intermediate care has indeed provided additional services and that, overall, with the extra money we have put into the system this winter to deal with the discharge problem, considerable improvements and progress are being made.