A government Bill to fine social service departments if they were judged to be responsible for delaying the discharge of patients from hospital was condemned by senior MPs and health experts from all parties.
Former Conservative health and social security minister George Young said the Community Care (Delayed Discharges etc) Bill was one of the very worst he had seen in almost 30 years in the commons.
'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'.
Despite a Conservative move to reject the Bill, it was given a second reading by 237 votes to 135. However, judging from the strength of opposition from all sides of the commons and the number of absent Labour MPs, it faces a rough ride if it is to reach the Statute Book.
Health secretary Alan Milburn said delayed discharge from hospital occurred when partnerships did not work. For too long social services had often been the poor relation of the health service, but that had been changed. Today, social service funding was growing by more than 3%; from next April, the rate of growth would double to an average of 6% a year for the next three years. The government expected local government to use the extra resources to build up the extra capacity for care provision.
Paul Truswell, Labour MP for Pudsey, welcomed the extra resources but asked the health secretary why he had 'taken it upon himself to introduce this punitive legislation before thoroughly evaluating the use and impact of that money'.
Mr Milburn said the legislation was not at all punitive.
Desmond Turner, Labour MP for Brighton and Hove, said his council had done exactly what the minister had asked through close working partnerships with the local health bodies, but there was a serious problem with bed blocking which was outside its control. Under the Bill, said Dr Turner, it was quite possible that the extra resources could be used to pay punitive fines for bed blocking outside its control.
Mr Milburn insisted: 'My intention is not, and never has been, to punish local government but to pursue a real and sustained reduction in delayed discharge from hospital. Frankly, there can now be no excuse for social services not to fulfil their obligations to older people'.
Shadow health secretary Liam Fox said the Bill would be divisive and undermine successful working relationships between the NHS and social services departments. It tried to blame local authorities for something beyond their control, and placed new burdens and costs on them.
Dr Fox said the Association of London Government estimated that the cost to its authorities would be£25m a year. Buckinghamshire estimates it would cost£2m; Essex,£3m; Cambridgeshire,£1.4m; Surrey, between£6m and£7m; and Kent,£5.5m.
Former Labour minister Glenda Jackson said her authority, Camden LBC, was not only Council of the Year but a beacon authority for the social service provision, and the first local authority to create an integrated mental health and social services trust. It had increased domiciliary care and aids and adaptions - yet there was still some bed blocking.
'There seems to me to be gross inequity in the government's proposals', she added.
David Hinchliffe, Labour chairman of the commons health select committee, said he fundamentally disagreed with the principles of the Bill. He thought it flawed and would ultimately be damaging to many positive policies promoted by the government.
Social services had been treated as a poor relation, and now the government was putting the boot into that poor relation.
'The supposed logic behind the Bill is based on thinking that is completely outdated, because it is rooted in the social services environment of at least 20 years ago, when social services were direct providers of care and could offere care home places and accomodation under Part III of the National Assistance Act 1948', said Mr Hinchliffe.
'That is no longer the case. The previous regime rapidly got rid of local authority direct care provision, and in answer to the [commons] health committee, the government now describe the role of local authority social services as managing the private care market'.
Mr Hinchliffe asked why not fine nurses for failure to arrange home care packages; or the ambulance service for transport delays; or housing authorities to arrange appropriate accomodation for patients who could not return to their homes because they needed ground floor accommodation or some form of sheltered housing; and why not fine relatives who said: 'She's not coming out because, in our view, she's not fit to do so'.