Patients 'should have more say' about after care

Under the Community Care (Delayed Discharges) Bill, local councils will face fines for failing to get elderly patients out of hospital quickly enough.

The scheme is unpopular with both Tory and Liberal Democrat peers who have already won crucial votes for regular monitoring and implementation to be delayed by a year to April, 2004.

But now the Conservatives are planning to challenge the government to make the bill more "patient friendly" with more consultation about future care arrangements.

We have got to have something on the bill to ensure patients wishes are taken account of Earl Howe

They hope to prevent local authorities and NHS trusts coming to blows in the hurry to discharge elderly patients from hospitals into care homes.

They say local authorities should have equal representation on dispute panels dealing with arguments over penalties imposed by the NHS.

They will also push for mentally ill patients to be excluded from early release from hospital.

Discharges of other patients should take place over three working days, to limit staffing costs, and not at weekends or on Bank Holidays, opposition peers will say.

Services 'at odds'

Earl Howe, Tory spokesman on health in the Lords, told BBC News Online: "Everybody agrees that this problem of delayed discharges is a very serious one - it's how we deal with it.

"We don't want people to occupy beds unnecessarily - we want people to be treated.

"But to set one branch of the public services at odds with another, by fining local government, is the wrong way to do it."

When the bill reaches report stage in the Lords on Monday, the Tories will be pressing for greater consultation with hospital patients about where they want to go next.

If it doesn't succeed in driving down the number of delayed discharges, then it shouldn't remain on the Statute Book Earl Howe

Earl Howe said this will be particularly important if, for example, a Jewish patient asks to go to a Jewish care home, or someone asks to be looked after at home.

"The bill requires the NHS and local authorities to take certain actions, but in the middle is the poor old patient who is not consulted about any of this," said Earl Howe

"We have got to have something on the bill to ensure patients wishes are taken account of.

"I am not saying the patient should have a veto, but where the request is reasonable, then I think the local authority and the health service, should have a duty to note that preference."

Neutral chairman

Tories will also call for local authorities and the NHS to have equal representation on dispute panels.

"The trouble is, the way the bill reads, local authorities will not have any say who goes on them and whether the chairman of the panel is acceptable," said Earl Howe.

"The chairman should be acceptable to both sides - otherwise the whole thing will not command confidence."

Earl Howe said his party wants to nip in the bud government suggestions that rules on hospital discharges should be in future extended to other patients.

"Many mentally ill people are a risk to themselves - a very few are a risk to other people - and what we shouldn't countenance is any encouragement of the NHS to discharge such patients too early from hospital."

4,000 patients

Tories will also be pressing for the proposed legislation to be time-limited to five years.

"If it doesn't succeed in driving down the number of delayed discharges, then it shouldn't remain on the Statute Book," said Earl Howe.

"If it does succeed, at the very least, ministers should review this after a period of time."

Earl Howe stressed: "Our argument with this bill is it acts fundamentally against the spirit of partnership working between the NHS and local government.

"Our fear is the bill will cut right across that. It will introduce an element of confrontation, rather than creative thinking."

A Department of Health spokeswoman said ministers will be seeking to overturn opposition plans for a one-year delay to the implementation of the bill to April 2004.

In the meantime, more than 4,000 elderly people remain in hospitals in England despite being fit to leave.