Sir George attacks the Government's Social Care Policy
29 Nov 2002
This is the full text of Sir George's speech on November 28th, taken from Hansard.

Sir George Young (North-West Hampshire): The hon. Member for Wakefield (Mr. Hinchliffe) was the fifth speaker in the debate. So far, only the Secretary of State's speech has supported the principles of the Bill. The score is therefore 4-1; it will be 5-1 when I sit down.
In nearly 30 years in the House, I have seen many Bills. In a competitive field, the Bill that we are considering is one of the worst. It is divisive and mean-spirited and has no place in social care in the 21st century. It will poison the atmosphere between the two key organisations that should engage in a spirit of partnership to improve the quality of life of elderly people. Instead of joint incentives to co-operate, there will be a unilateral power to fine. At a stroke, the Bill destroys much of the language of seamless government, pooled decision making, joint budgets and integrated teams.
As the hon. Member for Wakefield said, even those who work for the NHS—the supposed beneficiary of the scheme—do not support the Bill. The NHS Confederation described it as a retrograde step. The Royal College of Nursing
"remains unconvinced that charging Social Services for delayed discharges from hospitals will lead to better discharge planning."

Scarce funds that were voted for the care of elderly people will disappear into the maw of the NHS, possibly to be spent on other groups.
There will be yet more bureaucracy in a system that is buckling at the knees under paperwork. There will be perverse consequences as people find ways through and around the new rules. For example, care home providers may exert further pressure and increase prices when they know that the authority faces the threat of a fine, thereby diminishing the amount of care that can be bought.
We heard from one doctor today and another in the debate on the Queen's Speech what GPs will do. Those whose patients need access to a care home will have an incentive to admit them first to a hospital so that they reach the front of the queue. Social services departments will cut some of their preventive work to protect their budget from the fines for which the Bill provides, which will make elderly people more likely to end up in hospital.
The proposals might be tenable in an atmosphere where relationships had broken down, people were not working together and there was a refusal to co-operate. The previous Conservative Government were driven to introduce rate capping when the relationship between parts of local government and central Government had broken down. Nobody who follows health and social care matters could begin to argue that such an atmosphere prevails between health and social services. We simply have not reached that stage.
There is a temptation to consider the Bill from the viewpoint of the NHS or from that of social services departments, but the right place to start is the viewpoint of the client, customer or patient. He or she wants an overall package of reform or investment that supports independence at home when possible, and in residential or nursing care when it is not. Of course it is wrong for elderly people to stay in hospital for longer than necessary. They lose the living skills that they had before admission and they become exposed to hospital-acquired infection. There is therefore no dispute about objectives.
The reimbursement system, however, will place the patient and the carer in an untenable and often stressful position. Patients and the carers, who may already be distressed and disoriented, will become pawns in a professionally combative and hostile environment.
Patients want a continuum of care from a variety of institutions, provided in a spirit of partnership. They want the people on whom they depend to work together and not against each other. The sole focus on delayed discharge, which is one stage in the spectrum of care, will inhibit efforts to build on services that prevent hospital admissions and investment in longer-term solutions. It will not contribute to building up capacity in the care sector. The client will feel the tensions that the regime creates.
The regime that we are debating highlights publicly the contrast between Government rhetoric about the rights of carers and person-centred care and the lack of individual protection that will result from the proposals. Kevin Terry of Age Concern expressed that well on 14 November. He said:
"The proposals for reimbursement are ill-conceived and, we believe, impractical."
The proposal is one sided; only one partner will be fined. When the NHS fails to admit a patient for a hip replacement or other operation on a pre-determined date, it faces no fine, although the delay may impose financial costs on others. I recently received a letter from my NHS trust. An image intensifier had broken down and a constituent was consequently unable to receive treatment for back pain. The chief executive wrote:

"The piece of equipment . . . costs £100,000. A bid has been submitted to fund a replacement . . . a decision will not be known until later in the year . . . I will ensure you are kept informed as to when we hope to be able to progress with your treatment."

My constituent and everyone else will not be treated until the local trust gets around to buying another intensifier. There are no penalties for the failure of the NHS to provide the quality of care that it should.
The explanatory notes give a further example of one-sidedness. Paragraph 31 states:
"If for some reason the patient is not discharged at this point, then the social services authority is not liable to make any further payment, as it is not responsible for any further delay."
That is fair. However, if the social services department has reserved and paid for a bed in a home and the NHS fails to discharge the patient, the former will be out of pocket but receive no reimbursement from the latter.
As several speakers have pointed out, one key assumption underpins the Bill: a delayed discharge is the fault of social services. Many delays are caused by other factors such as self-funders awaiting the home of their choice, lack of community health services or a transfer to a specialist service in the NHS. The fault may lie with the housing department rather than the social services department. In many counties that have a two-tier authority, the housing authority is often at fault but the social services department will take the hit.
As the hon. Member for Wakefield said, the social services department is the under-resourced partner in the equation. It has not received the same increases as the NHS. Let us consider the extra resources that the Secretary of State mentioned. What the Chancellor has given through the comprehensive spending review the Deputy Prime Minister will remove through the redistribution of grant. Many counties have been promised the same grant in cash terms for next year as they received last year. That is no basis for further investment in education and social services.
In the south-east, despite all the investment that the Government mentioned in rehabilitation and community services and the good working relationship between the two departments, the overriding reason for delayed transfers is simply capacity. The problem has been exacerbated by inadequate funding in an environment of increasing demand for services for older people. Simply fining social services will not address the core problem. If the Government want faster progress, as I believe they do, the Department of Health ought to be giving positive assistance to Hampshire county council and other councils that want to expand the capacity of their nursing home sectors.
We need a holistic approach with incentives, not a narrow approach with fines. I am amazed that Labour Members who have sat on local authorities and who are close to these issues are letting their Government get away with this. If the Conservatives had introduced this measure, they would have walked all over us, complaining about internal markets and all the rest, yet they are not stopping their Government. I genuinely believe that this is a mistake, and I urge the Government, even at this late stage, to think again.
 
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Copyright Sir George Young Bt. 2015