Clause 2 - Notice of patient's possible need

Part of Community Care (Delayed Discharges etc.) Bill – in a Public Bill Committee at 12:15 pm on 10 December 2002.

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Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health 12:15, 10 December 2002

I am coming to the point—it relates to something that the right hon. Member for North-West Hampshire (Sir George Young) said—about how to ensure consultation between social services and housing, and where responsibility lies. I hope that that will answer the hon. Gentleman's question.

One of our technical concerns about the amendment is that it would not bring about closer working between health, social care and housing. In fact, it would be divisive. We are talking about notification. The amendment's drafting would mean that the NHS body had a choice of giving either the social services authority or the housing authority in whose area the patient was ordinarily resident notice of the patient's potential need for community care services on discharge, so that that authority became the responsible authority.

In practical terms, it would clearly be nonsensical for the NHS to have to make such a choice. If it chose the housing authority, that, too, would be a nonsense. As hon. Members have pointed out, an authority cannot assess for community care services unless it is a unitary authority—unless it has both housing and social services responsibilities. Such an assessment would clearly be led by social services as an assessment of community care needs.

Few discharges are delayed for reasons entirely connected with housing. Social care is nearly always the main need. However, it may not be possible to care for the person in the place where they were living before they entered hospital, so although we agree that housing is important in the context of the Bill, it will be for social services to involve the housing authority where it is obvious that there is a housing need. That is the first stage in responding to the concerns that have been raised.

Under section 47(3)(b) of the 1990 Act, relating to assessment responsibilities, social services are already under a duty to notify the housing authority if, during their assessment, it appears to them that people may need services from the housing authority. Through guidance on the Bill and through our other work to stimulate the provision of innovative care and housing packages, we will continue to emphasise the importance of housing solutions in giving older people what they want—independence and their own home, as well as confidence that they will receive any care that they need in their own home.

Responsibility in the event of failure to provide a housing adaptation, as in the case mentioned by the right hon. Member for North-West Hampshire, will depend on the definition of housing adaptations—he rightly identified different legislative bases for different sorts of housing adaptations—and on the definition of minor adaptations. We intend clearly to outline those

definitions in regulations, which we will discuss under clause 12. We will define both community equipment and minor adaptations, which it will be the responsibility of social services to provide, and for which, as a result of the Bill, they will no longer be able to charge.

Obviously, if such adaptations have not been provided, social services will have to pay the charge. For example, failure to provide a rail to help someone get in and out of the bath or another sort of assistance that clearly falls in the same category would result in a charge to social services. However, if such a major housing adaptation is required that it must be provided by the housing department, such as a stair lift or a walk-in shower—that might be the sort of housing adaptation to which the right hon. Gentleman was referring—but has not been provided by the time when the NHS anticipates that the person will be ready for discharge, that would count as a change of circumstances in the context of the original discharge plan compiled by the NHS and social services. If the NHS thinks that without the adaptation it would be unsafe to discharge the person to their home, it must renotify social services so that a discharge plan that takes account of the lack of adaptation can be produced. Then, because they were renotifed, social services would not be charged for the delay.

Of course, interim care in a residential setting might be possible—I am not referring to the case mentioned by the right hon. Gentleman—if the adaptation required is to make the home, bathroom or bedroom accessible. Alternatively, when social services and the NHS reassess what is necessary for that person to be safely discharged from hospital, it could be appropriate to provide additional personal care to help with bathing, for example, if major adaptations to the bathroom are necessary. Clearly, where there is a failure to provide a housing adaptation that was determined in the original discharge plan, it would be inappropriate to charge social services, but it would be appropriate for the hospital to renotify social services so that an assessment could be carried out to determine the best way of providing the package that will enable the patient to leave hospital.