I beg to move,
That this House
believes that the underfunding of social care by successive Governments has led to bottlenecks and delays in the NHS, reducing health care capacity and increasing waiting times;
further believes that it is the most vulnerable elderly who suffer the consequences of inadequate care;
regrets that the piecemeal approach of the Government to hospital delayed discharge simply shifts the pressures from one part of the care system to another;
condemns the Government for its mishandling and misunderstanding of the care home sector and the consequent loss of homes and beds;
regrets that the failure to adequately fund social care has produced serious staff shortages and reduced choice and quality for those in need of care;
and calls on the Government to undertake a whole system review of funding for social care to tackle staff shortages, increase capacity, promote choice and ensure that people get the right care at the right time.
I am pleased that my hon. Friends and others are staying for this important debate on the state of the care system and the crisis in it. The national health service is always in the news, but the Government often overclaim for it and for their delivery. In fact, it frequently under-performs. As with the railways, they have been too timid and from day one they failed to invest in our health care and our health systems.
The results of that are there for all too see: long waits in our accident and emergency departments, more people waiting for treatment, more people waiting to get out of hospital after being treated. The NHS is short-staffed and struggling to deliver, but it is only part of the picture. Step back and take a look at the bigger picture—the care system outside our hospitals. The Cinderella status given to social care and the failure to invest in the care system are fuelling the pressures on accident and emergency departments and hospital wards.
There are countless victims of this Government's failure to invest in the care system—every year, 700,000 elderly people find themselves stuck in hospital and unable to leave because there is not enough care provision outside. Grotesquely, elderly people are left in hospital waiting for someone to die in a care home before the council will fund their care home place. In parts of the country, two people have to die before one new care place is funded. People are labelled bed blockers as if it is their fault that they are stuck in hospital. It is the Government's fault, but those 700,000 are just the tip of the iceberg.
My hon. Friend refers to "bed blockers" and suggests that the Government blame elderly people for being in those beds. Should not we use the expression "bed lockers", because it is the lack of Government funding that ties elderly people to beds?
My hon. Friend makes a fair point. As a consequence of the Government's failure to invest in social care and the care system outside our hospitals, there is increasing gridlock in the care system. As a consequence of that, people are suffering and receiving bad care.
What is happening to people waiting for treatment? We know that in the five years since the Government came to power at least 5,000 years of bed time have been lost to the NHS as a result of delayed discharges. Who pays the price for that incompetence—5,000 years of time wasted? In the first quarter of this year alone, 22,000 more people could have been treated if the care system did not leave people stuck in bed once they are well. If we managed to treat those people in the health service and get them out quicker, we would be able to reduce or perhaps remove the need for them to fly abroad or rely on private health care for treatment.
Madam Speaker, looking at the figures for the first quarter—
I have listened carefully to the hon. Gentleman's argument. Although the Government are open to criticism for the way in which they fund social services authorities, does he not agree that some authorities hardly assist in ending bed blocking? For example, the Rev. David Barker of Nettlestone in my constituency is concerned that the Isle of Wight council, which is of course led by the Liberal Democrats, is not providing the necessary support for people who are sent home, so they are left in beds.
It is a great pity that the hon. Gentleman is not backing his council to make sure that it has the resources to do the job. It will be noted in the Isle of Wight that he is not standing up for the Isle of Wight to ensure that it has the resources; many of his hon. Friends do defend their social services departments.
I am afraid that the hon. Gentleman may not have liked the answer, but that is the answer he is going to get.
There is a chronic shortage of staff and a substantial loss of care home beds, and care increasingly is being rationed. These are the hallmarks of a Government who have neglected the care system. Last year the King's Fund report "Future Imperfect" warned the Government of the increasing difficulty in recruiting and retaining staff, with vacancy rates in excess of 20 per cent. and turnover rates in excess of 16 per cent. It is no wonder that some home care agencies have hit crisis point and have gone out of business.
Before my hon. Friend leaves the causes of bed blocking and the subject of social services departments, does he agree that there has been a gross neglect of district nursing services by all health authorities in recent years? District nurses are getting older and unable to cope. People are not going into the profession, because of the pay and conditions. However, they are crucial to relieving bed blocking from hospitals.
District nurses are an essential part of the team that is needed in the community to facilitate appropriate and prompt discharge from hospital. In too many places, as my hon. Friend has rightly said, they are not there in the numbers needed to do the job.
Added to that is the issue of the new standards for domiciliary care and the fact that a high proportion of home care workers are not far off retirement. As a result, things are set to get worse before they get better in that sector. The same difficulties beset the care home sector.
My hon. Friend is being extremely generous in giving way. Before he leaves the subject of the domiciliary sector, is there not now a real problem in recruiting domiciliary assistants not only in the public sector, but in the private and voluntary sectors? Is it not the case that the standard spending assessment for personal social services across the country fails to deal adequately with that problem this year, which means that the situation can only get worse?
My hon. Friend is right, and I wish to refer to the social services SSAs in due course.
I was about to say that the same difficulties beset the care homes sector. The Association of Residential Care said recently:
"With some supermarkets offering £8 per hour to stock shelves overnight it is hard to attract staff to a complex and often stressful job for much less money. In some parts of the country the only people applying for vacancies are those that Mcdonald's and Tesco have already rejected."
It is a frightening thought that our care homes are so dependent on the rejects from McDonald's.
Staff shortages are no excuse for a minority of care homes that resort to the restraint and chemical management of residents instead of offering decent care. The Local Government Association has warned the Government about staff shortages: in particular, the vacancies of about 10 per cent. in management posts which have led to a cycle of heavy workloads, low morale, long hours and high staff turnover.
Care staff are voting with their feet. As many as one in five care staff, social services staff and others are actively seeking new jobs. No wonder two out of three social services departments are reporting recruitment difficulties. We are faced with the real prospect of importing staff from abroad, only to export elderly people to the continent to be cared for.
In the care homes sector, there is no escaping the fact that a combination of falling incomes and rising costs has resulted in a substantial loss of beds. In the last three years alone, 35,000 beds have been lost and the number of new registrations has dropped dramatically.
Probably for the same reason I gave to Mr. Turner: the council in question was not properly funded in terms of social services. Yet again the hon. Gentleman plays into the hands of the Government by dividing councils and accusing them of failing to deliver, when in fact they have not been given the resources to do the job in the first place.
As a result, care home fees have been driven down so far that we are in a situation where it is impossible to be certain that continuity of provision can be maintained. With figures as low as £225 per week for residential care and £336 for nursing care, how are owners supposed to comply with the new standards, let alone staff their homes and care for the residents?
I have some sympathy with the points that the hon. Gentleman is making. But how does he reconcile the difficulty that he describes, of new care standards—which he criticises—and of staff whom he describes as McDonald's rejects? Surely if we want the right staff in place, we must have the standards to encourage them.
The hon. Gentleman is quite right to say that standards must be appropriate and that there is a need for extra training. But training is not cost free; it requires money. The problem is that the Government have not recognised that and they appear to be in denial when it comes to the extra costs that are a consequence of compliance with the standards. That is where the problem lies and that is why we are bringing the matter to the House tonight.
On issues of funding, we see that private payers and so-called preserved rights residents are subsidising the shortfalls in state-paid fees. In the case of preserved rights residents, this was in excess of £50 million last year alone. Charities that run care homes are using as much as £185 million of their own funds to plug the gap in state funding for care. That is 19 per cent. up on last year and it is still rising. Money given by the public for charitable purposes is used to prop up state-funded care that is inadequate because it is not properly funded.
On top of that funding shortfall and the staffing crisis in care homes, care homes are also faced with the new care standards coming in this April. Higher standards will mean fewer residents and even less income. Try selling that to a bank manager: "We want to make adaptations and changes to our care home and we need extra capital to pay for that. But we will have less income once we have made the changes". I do not see many bank managers signing up to that.
It is no wonder that, faced with mounting difficulties, care homes are often realising a better rate of return on their capital by selling the property. The victims of this are the frail and vulnerable elderly who are forced to pack their bags and move to another home. The trauma can and does kill. Despite mounting evidence of the extra costs of complying with the new standards, Ministers seem to remain in denial.
Earlier today I was briefed by Leonard Cheshire Homes, which had done some calculations on the costs of complying with the standards for young adults. It found that the weekly cost per resident in one of its homes for disabled adults will rise from £680 to £1,092, a 62 per cent. increase to comply with the training and other standards laid out by the Government. In addition it has estimated that it will need to find an extra 237 nurses to deliver the standards. Where are 237 extra nurses coming from? The NHS? I do not think so. The Government need to spell out where the extra resources are coming from.
Home care fares no better. Under the Government, there has been a 19 per cent. reduction in the number of people receiving home care—93,000 fewer people a year receiving home care in just four years. The Government amendment says that more people are living independently. Perhaps that is what it means—93,000 extra people not being supported in their own homes.
The rules have been rewritten so that only the most frail and dependent are looked after and the rest have to fend for themselves. To make money stretch a little further, care is increasingly being rationed. It is being rationed by denying help to those with moderate care needs or with a carer at home. It is being rationed for those who have high care needs by having them wait in hospital beds or, more likely, having them wait unseen in their own home. It is also being rationed by setting limits either on how much the council is prepared to pay or on the quantity or quality of care to be provided.
According to the LGA, six out of 10 councils have tightened or proposed to tighten the way in which they ration care, as a way of controlling their spending. All we are talking about tonight are things that are not luxuries—help with getting in and out of bed, getting dressed, keeping clean, eating a reasonably balanced diet, having nails cut, using the toilet, having clean laundry, living in a decent environment. We are talking about a person's basic dignity. That is why Liberal Democrats remain committed to the principle that personal care should be free, on the basis of a person's need.
Increasingly, personal care involves services that would have been seen in the past as nursing care, such as changing catheters and dressings, preventing or treating pressure sores and managing medication. That is why Liberal Democrats say that nursing care should be free on the basis of need, not according to who provides it.
The Government's answer to the crisis in the care system is to treat the symptoms and not the causes. The £200 million initiative to tackle bed blocking that was announced last year falls well short of what is needed to tackle the staff shortages, capacity constraints and rationing of the care system that are causing delayed discharges. The £200 million has to be set against a long history of underfunding.
Year by year, the gap between what councils spend and what the Government think needs to be spent on social care has widened. The gap has increased from 3 per cent. in the early 1990s to 8 per cent. in the mid-1990s; in the past three years, it has widened to a gulf of 12 per cent. More than £1 billion has to be found by local councils through council tax to meet statutory duties and respond to yet more Government initiatives and priorities. As a direct consequence, over the past two years three out of four social services departments have overspent their budgets. How much worse would the problems in the NHS be if councils spent down to the level the Government think is necessary and clamped down on overspending?
Against that backdrop, the absence of any extra cash for social care in this year's local government settlement is mind boggling. Social care has been short-changed to the tune of £113 million in the coming year—money that was pencilled in by Ministers in the spending assessment in 2000, but not actually delivered this year. As a consequence, overspending will continue to rise.
Health and social care are two sides of the same coin: underfund one and the other is undermined. It is for that reason that the Government must undertake a whole system review of funding social care. Such a review must go beyond the Government's sticking-plaster solution of cash to tackle delayed discharges. What is needed is long-term, sustained investment in social care, informed by a realistic assessment of what is needed to deliver real improvements.
Social care is stuck in crisis management mode. Those with less acute needs drop off the queue, only for the vicious circle of lack of support, leading to increased dependency and greater calls on high intensity care, to start all over again. That is a false economy that is doing great harm. The true cost of running the system in that way is measured in two ways—in ministerial failure and in human misery.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"welcomes the Government's strategy for modernising social care services through unprecedented real terms increases in resources, which enables and promotes better joint working between the NHS, social services, and the independent care sectors, develops a national framework for standards and quality and ensures a greater emphasis on users and patients in the design and delivery of services;
notes that this has led to more independence for older people, fairer funding of long term care, reduced levels of delayed discharge and greater choice for users;
and condemns the Liberal Democrats for their obsession with producer interests over those of users and patients and their failure to recognise that investment must be matched by reform."
The care system plays a vital role in ensuring that vulnerable people of all ages receive the care that they need, and I should like to start by commending the efforts of those social workers and care staff in both the public and independent sectors who, every day of the week, provide support and opportunity to people in need. Incidentally, those staff will not have been impressed by their description by the hon. Gentleman as rejects from McDonald's. That reference might have been noted outside the House.
The hon. Gentleman has not apologised, but he has attempted to pass the buck.
However, it is clear that we can all do more to ensure that the care system provides the right care at the right time and in the right place, that it promotes independence and choice and that it puts the user and the carer at the centre of services.
The hon. Gentleman made much of delayed discharges and we are all agreed that we need to make sure that people do not have to wait in acute hospital beds when they could be better cared for elsewhere. That is, of course, not a new problem and, in fact, the proportion of older people who have to wait while their discharge is arranged has fallen steadily over the past four years. It is true, however, that we need to consider the issue seriously.
A serious consideration of this issue must start with an honest look at the figures. Today we have heard ludicrous claims about the number of people who have their discharge delayed. This evening, the figure went up to 700,000. Throughout the day, the figure has varied by about 200,000, depending on which edition of the press release is being referred to. The hon. Gentleman's calculator may have been red-hot today, but I am afraid that taking a figure from a parliamentary answer and then multiplying it by the number he first thought of might make for good stories, but it does not get us any further in the important task of ensuring that everybody gets the care they need when they need it and where they need it.
We have all learned to disbelieve figures quoted by the Liberal Democrats, but will the Minister comment on the figures published on Friday by Eastbourne district general hospital that show that, despite the extra money that has been invested recently by the Government, the number of beds blocked has risen since June—when it stood at 46—by so much that the acting chief executive said that the hospital had 75 beds blocked and a consistent flow of patients who need them?
I do not have the figures for Eastbourne at my fingertips, but I know that like other areas it will have benefited from the extra investment and will be subject to the targets for reducing delayed discharges. Of course we need to tackle delayed transfers in order to make sure that the whole system works effectively, but I have to point out to hon. Members that, contrary to what the hon. Member for Sutton and Cheam suggested, more operations are now being done in the NHS and waiting lists are down.
We know that there is more to be done. That is why, in October, we announced an additional £300 million—not £200 million—during this year and next for councils to work with their health and independent sector partners to tackle the delays and the causes of delay.
The Minister mentioned a figure of £300 million, but the directors of social services estimate that £1 billion is required. What will fill the gap between the £300 million that the Government are providing and the £1 billion that the experts in the field say that they need?
That is not the first example, and I am sure that it will not be the last, of the Liberal Democrats calling for more money regardless of how we change the system. I will say more about the extra resources that the Government are putting in to personal social services over and above the £300 million, but the point remains that we have been willing to invest that sum in order to ensure that we can tackle delays.
I thank my right hon. Friend for that intervention and I know of the good work that he has done in Birmingham on the problem of delayed discharges. As I will explain later, the investment in social services, and that £300 million in particular, has to deal with all the problems in the system, including funding projects that will ensure that people do not end up having to go into hospital, perhaps by providing better support in their homes, as well as ensuring that we have the capacity and the necessary services to get them out of hospital in a timely manner.
Everything that the Minister says shows that my hon. Friend Mr. Burstow is right to say that the Government are in denial. For example, is it not the fact that in Somerset the extra money that has been provided to deal with bed blocking is almost exactly matched by reductions in grants for other parts of social services? That means that no improvement is possible.
No, it does not mean that, as I shall explain later. I monitor carefully the figures for delayed discharges and can assure hon. Members not only that the trend is down but that since last September there are fewer blocked beds and fewer people wait more than 28 days. The investment and the new services that it has brought are working, and the health service and its social care partners deserve congratulations on the progress that is being made.
The hon. Member for Sutton and Cheam made some points about care home capacity. The Government are well aware of those issues. Once again, however, the truth has been misrepresented. Figures show that the loss of beds during the past few years is nowhere near as high as the figure of 35,000 cited today, or the figure of 50,000 that has often been cited. Indeed, residential care and nursing home capacity is roughly the same today as it was four years ago.
It is nonsense to consider closures in isolation. Laing and Buisson's figures, for example, show that more than 33,500 beds were created between 1996–97 and 2000 as a result of new registrations. The net loss of care home beds during that period, according to Laing and Buisson, which has no axe to grind in the matter, was about 19,000. To claim a higher figure is both mischievous and misleading. After this debate, I hope that figure will not be used again.
What must we do to maintain that capacity and to ensure that standards are what we would expect for our constituents who use those services?
I am listening to the Minister's comments with interest, but let us put the dispute over the historical figures to one side for a moment. When I visit care homes in my constituency, I am told that the wholly erroneous standards specified in the Care Standards Act 2000 are forcing them to make real decisions about the future. They have to decide whether they can afford to make those so-called improvements even though their homes already function perfectly. The owners are all drawing up plans to sell their large old houses for flats. What impact will the Act have on the number of future places in homes? Has the Minister made an assessment?
I thank the hon. Lady for her intervention. We are witnessing a certain amount of confusion among Liberal Democrats this evening—certainly as regards their historical position. The hon. Lady seems to be suggesting that we should oppose the whole idea of setting up national standards, while the hon. Member for Sutton and Cheam supported it. I take the impact of standards extremely seriously, as I shall explain later.
Does my hon. Friend share my concern that the Liberal Democrats seem to be denying the need for care standards to protect elderly people who desperately need them? Is she aware that, when the Government held their widespread consultations on care standards, most care home owners in Lancashire told me that the standards were, by and large, examples of good practice. Those owners were already implementing such standards. If they had a concern, it was about building regulations. The Government responded to that concern by extending the period needed to convert the buildings to the new standards.
It is also worth pointing out that the Liberal Democrats have turned their fire on domiciliary care. Those services have never been regulated. I am interested to know whether the Liberal Democrat approach is that there should be no regulation of the whole sector that deals with care services provided to people in their own homes.
I am more than happy to make it clear, as we did throughout the passage of the care standards legislation, that we support the introduction of national minimum standards but, as we pointed out, higher quality comes at a cost. The problem is that the Government are not prepared to write the cheque.
I am glad that I gave the hon. Gentleman the chance to correct the impression that he gave in his original comments.
It is important to remember why national standards are being developed—that relates to the point made by my hon. Friend Mrs. Humble. The old regulatory system for care homes is riddled with gaps and anomalies. Existing standards for care homes are set and administered in different ways by different authorities, and some homes are not regulated at all. I am sure that hon. Members will have heard—as I have—the complaints of care homes and users about the current inconsistencies.
The introduction of national minimum standards will mean that providers will be clear about the standards that they have to meet, and users and their carers will know what they can expect as a minimum. It is right to provide that protection and assurance for the vulnerable people who use our care system.
The fundamental point is that, although we welcome the introduction both of care standards and of the increase in the minimum wage, there is an increasing mismatch with the money provided to social services. The Minister knows that, next week, I shall be meeting her with a delegation of representatives from health authorities, social services and the independent sector to raise the issue of that increasing gap between the cost of meeting the welcome standards and improvements in the residential sector and the money provided for social services. That problem affects not only Cornwall but many parts of the country. The Minister must address that gap.
I thank the hon. Gentleman for making that point. I have lost count of the number of Liberal Democrat demands for extra money but I shall deal with his point.
The way that we implement the standards is crucial. In particular, the focus of the National Care Standards Commission, when it takes over regulation and inspection in April, will be to work with providers to help them to meet national minimum standards. In practice, that means that if standards were not being met in a few respects the commission would note that in its inspection report and would write to the home owner giving reasonable time in which to make the changes.
Of course, the point of national standards is to ensure consistent high standards throughout the country, not to close good homes. That is why, when we heard the results of the consultation, we made changes to the standards, putting off the environmental space standards until 2007 and ensuring that space could be used flexibly. However, I am determined that the standards will be introduced in a way that will safeguard users and maintain good homes. I will be discussing with industry representatives and with the National Care Standards Commission the details of the environmental standards, and how we can ensure that they are introduced in a way that promotes higher standards for users but does not drive high-quality care homes out of business.
Local authorities are rightly responsible for decisions about the fee levels that they pay. It was interesting to hear Liberal Democrat Members speak about the failure of some Liberal Democrat councils to live up to the enthusiasm of their Members of Parliament. However, fee levels should reflect the quality of care that we expect from care homes for our older people. That is why I welcome the fact that local authorities are using funding from the £300 million building capacity grant to buy additional places in care homes.
A number of councils have drawn up new agreements—which include increased funding—with the independent sector, to stabilise the sector and ensure that standards of care are maintained. That will help to ensure that capacity is maintained locally, so that the right range of care services can continue to be provided to older people in the future.
The debate about care goes wider than care homes alone. The Government have also introduced a range of reforms to the long-term care system. Free nursing care in nursing homes was introduced on
It is important to maintain capacity and make the system fairer, but more of the same just will not do if we want to provide real choices and independence for our older people. I am encouraged by the figures that show that 5 per cent. more households were receiving intensive home care packages in 2000 than in 1999. About 1.5 million people now receive care packages of all types in their own homes.
In addition, the national service framework for older people, published in March last year, focuses on raising standards and promoting independence in services for older people.
Is not the Minister concerned that the 5 per cent. more people receiving intensive care packages at home might have come at the expense of the 93,000 fewer people who receive all types of care packages at home? Stealing from one group of vulnerable people to provide for another such group is a cynical tactic, not something of which she should be proud.
I am sure that Liberal Democrat councils around the country will be interested to hear that Liberal Democrat MPs think that they are stealing when they make local decisions about resources. The important point is that local authorities and their health partners are using the extra resources that have been made available to find new and different ways to support old people's independence. That is to be welcomed.
Central to raising standards in the national service framework is the increased development of intermediate care services to provide rehabilitation, to support independence, to prevent people from going into hospital into the first place, and to help them back into their own homes after a spell in hospital. The extra investment in these services has already led to more beds, more places and more people receiving these services.
A new advice and information line, Care Direct, went live in the south-west from
The Minister is generous in giving way again. She is good at blaming Liberal Democrat councils for what they do or do not do, as if we controlled the world. No party is in overall control of Devon county council, but the leaders of all the four political groups in that county—Liberal Democrat, Conservative, independent and Labour—came to lobby Devon MPs last week. They had but one message: that funding for Devon is inadequate, and that there is insufficient money for the SSA for services for the elderly or for children. Devon's problem is that it cannot deliver enough money to the independent care homes. It recognises that, as do the independent care homes. How can the council improve the care standards—
I had started to speak about the extra resources going into local authorities. Some of those extra resources are, rightly, finding their way into new services and into increases in fees.
The hon. Member for Sutton and Cheam called the Government's policies quick fixes, or words to that effect.
The hon. Gentleman called the policies sticking plasters, but not one of them is a quick fix. The accusation is ironic, coming as it does from Liberal Democrat Members, who think that the only fix is more money, more quickly.
Of course we need to reform the system further: we need new services, new choices and new ways for health, social care and their independent partners to work together. That is why my predecessor established a high-level strategic commissioning group to give greater direction to the commissioning of care services for adults.
The agreement published by the group, which brings together representatives from a variety of organisations, sets out responsibilities and expectations for central Government, local government, the NHS and independent providers. It stresses the need for councils and the independent sector to enter into long-term agreements on placing people into care homes or giving them other forms of support. It will lead to improvements in the commissioning of services and therefore more choice and security for older people.
The Government have broken down the legislative barriers that prevented health and social services from working together, so that services are now beginning to be designed around what older people actually need and want rather than what fits administrative boundaries. We need to see even more of that type of working. Of course, that needs more investment and resources and, yes, social services have been underfunded. That is why the Government have increased social services funding by more than 20 per cent. in real terms since 1996–97—an average annual real terms increase of 3.2 per cent.
Incidentally, before we hear from the Conservative Opposition spokesman, I should say that that increase stands in contrast to an average annual real-terms increase of 0.1 per cent. in the last five years of the previous Government and no promise to match our social services spending at the last election.
We are working with the Local Government Association to ensure that, as I have said, we continue to put extra resources into social services. In fact, the gap has narrowed in the past year. We are working to attract more staff through a recruitment campaign that we launched last year, and it has already attracted at least 14,000 responses. We are investing in training support to ensure that our care workers have the skills that they need.
Today, Liberal Democrat Members have been big on calls for more money and short on vision or ideas for reform. The Tories will be big on complaint and low on investment. What people will get from a Labour Government is more investment, higher standards, more services, more choice, more independence and more hope for the most vulnerable people in our society. I commend the amendment to the House.
I certainly welcome this debate, but I must say that listening to the increasingly bitter exchanges between the Minister and Mr. Burstow, I began to feel that I was intruding on private grief—it seems that the love affair between the Labour party and the Liberal Democrats is well and truly over if the early stages of the debate are anything to go by. It is amazing to think, Madam Deputy Speaker—and even you can think about it—that there was a great cosy love affair only 18 months ago. Lord Ashdown, Mr. Beith and Mr. Campbell were all involved in a Cabinet Sub-Committee—the first time that that has happened since the time of Lloyd George. Tonight, we can well and truly see that that love affair is over. The bitterness of both sides is more than apparent, given the way they were at each other's throat.
Just yesterday, it was widely reported that the elderly in Britain are being penalised by the NHS because of widespread health care bias and discrimination. Although that is deeply alarming, such discrimination is not a wholly new revelation. Indeed, such prejudice towards the elderly has increasingly manifested itself in another aspect of Government policy since 1997—long-term care for the elderly. Between 1998 and 2001, the number of general nursing homes in England fell by 13 per cent. During that relatively short period, nearly 22,000 nursing homes beds were lost and about the same number of hospital patients had their discharges delayed because there were no places available to look after them properly in the community.
Less than one year ago, there were 525,900 places in residential settings for long-stay care for elderly and physically disabled people across all sectors.
I am a little concerned by the fact that the debate seems to be concentrating on beds when community care should be about preventing people needing beds. How do countries such as Denmark, with a similar proportion of elderly and very elderly people, manage without any care homes whatever?
The hon. Gentleman raises an important issue concerning domiciliary care, and I will refer to it in my speech. The simple answer to his question is that the debate has revolved around beds because it is about the crisis in care. Unfortunately, the Government's record on what has happened to the number of beds over the past few years has helped to contribute significantly to the crisis. That is why the issue will be an integral part of the debate. I know that the Government do not like to hear bad news or, in many cases, the truth when it is unpalatable, but they will have to listen to it this evening without the fantasy, the spin or the denial of Ministers.
I will give way when I have made some progress.
As I was saying, less than one year ago there were 525,900 places in residential settings for long-term care for the elderly and for physically disabled people across all sectors. That is a drop in capacity of almost 50,000 places since 1996–97. Indeed, 760 care homes were closed in 1999 alone, resulting in the loss of more than 15,000 beds. In anyone's mind—except that of the Minister, who does not seem to think that it is happening—that is an extremely alarming situation.
I do not know about the Minister's constituency, but in mine two care homes have closed in the past 12 months. I suspect that most hon. Members—certainly those on the Opposition Benches —will probably have experienced the same tragic situation. For some reason, it is not obvious to Ministers, who want to perpetuate the myth that everything is fine and that any fact or statistic that suggests otherwise is not true.
I remind the hon. Gentleman that his Government introduced the National Health Service and Community Care Act 1990. When the then Secretary of State for Health announced its introduction, he agreed with Sir Roy Griffiths who had been commissioned by the then Government to produce a report and who said that 25 per cent. of care home beds would be lost as a result of that legislation because it was deliberately designed to move people out of residential care and into a home care setting.
The hon. Lady must understand that one of the fundamental principles of community care was to examine where it was possible to allow people to remain in the familiarity and security of their own homes with domiciliary care packages. If there were a static population, that would lead to the loss of some beds because they would not be needed. The hon. Lady is talking about what happened 10 or 11 years ago and the elderly population has increased significantly since then. For a variety of clinical and funding reasons, many people have not been to able to remain in their homes. In recent years, care homes have closed and beds have been lost not because there is no demand for them, but because it is not viable for a variety of reasons—some financial and some bureaucratic and administrative—for them to be retained.
The other problem is that the closure of homes is not taking place where there is spare capacity. More often that not, it is happening in the south-east, the south-west and the eastern region, where there is the greatest demand, and that creates a greater problem. The situation is critical. A survey in May 2001 showed that more than 70,000 pensioners were forced to sell their homes in 1999 to pay for the cost of residential nursing care. That represented a near doubling of the 40,000 pensioners in the same circumstances when a similar survey was carried out in 1995.
Even more worrying is the survey of 104 councils which showed that
"potentially more than a quarter of a million" pensioners have been forced to sell their homes to pay for care costs since Labour came to power. Is that what Labour meant when it claimed that things can only get better? That is not how most elderly people who have gone through that tragic process or who are fearful that it might happen to them would define getting better.
I want to make some progress first.
The Government have failed to address the problem for far too long. The average age of this country's population is increasing. Some demographic projections indicate that the provision of nursing home beds needs to expand by around 65 per cent. by 2031 if the population is to be adequately cared for. Yet with the number of beds falling, an even greater expansion—possibly as much as 100 per cent. over the next 30 years—will be needed to meet the target.
No, I am going to make progress.
The Government can continue to spin the situation, to fiddle the figures and to call it what they like, but the stark fact is that there is a crisis in long-term care. They may refuse to recognise that, but Opposition Members are not the only people who live in the real world and understand what is going on. Frank Ursell, the chief executive of the Registered Nursing Home Association, has commented:
"The Government can rightly be accused of fiddling while a vitally important part of the health care sector declines before its very eyes. Inaction by the Government, coupled with chronic underfunding of services for older people, could mean that there will be insufficient long-term beds available in the years ahead."
The National Assistance Act 1948 is long out of date. Fortunately, the provision and the policy of caring for old people has moved on from the undignified and sole-destroying placement of the elderly in long-stay hospitals, where they had little comfort and little self-respect or dignity. That has gone, and I suspect that no one would object to that.
We have to ensure that community care is developed—I strongly support this policy—so that it provides the back-up and the freedom from fear that the elderly deserve in the 21st century. I am afraid that despite some welcome strides forward, such as the raising of standards, more has to be done to address the problem. The knock-on effect of the loss of nursing homes and beds is causing a critical problem with delayed discharge, or bed blocking. A vicious circle is emerging. The increasing number of residential home closures has led to further delays in discharging older people from acute hospital wards. Not only does that prevent them from leaving hospital, but it lengthens the waiting times for patients who want hospital treatment.
The situation is ridiculous. On
Although the Minister says that the article was wrong, after the Daily Mail had pointed out that the Government's figures were wrong, the Government admitted that they were wrong: they had referred only to those beds blocked in NHS hospitals on any one day, leaving out the other 364 days in the year. There is no point in the Minister repeating like a parrot, "It's wrong." It is not wrong. The Daily Mail also revealed that Department of Health statistics showed that over the course of the year, there were more than 680,000 elderly bed blockers. The Government insult the country by systematically refusing to accept what is happening. How are we to believe Ministers if whenever they are given information they do not like, they say it is not true?
Last year in inner London, 11 per cent. of acute beds were blocked. In December, in response to a written question tabled by my hon. Friend Dr. Fox, the Minister acknowledged that 36 per cent. of patients subject to delayed discharge were delayed in hospital for more than 28 days. That equates to almost 245,000 patients. How many patients could have received acute treatment had those beds been available and not blocked by people who had nothing wrong with them but had nowhere else to go?
The Government's policy and the knock-on effect of delayed discharge is having a profound effect throughout health care provision. Insufficient care facilities in the community mean that elderly people are being kept inappropriately in hospital, which in turn prevents those who need hospital treatment getting a bed.
We recognise that hospital is not always the most appropriate environment in which to care for elderly people. Wards tend to be noisy and overcrowded, with individuals afforded little privacy. The Government have failed to meet their deadline for ending the use of mixed-sex wards. Even more disturbing is the high risk of elderly people in hospital acquiring infections: almost one in 10 of all hospital patients contract an infection during their stay.
Although I welcome last October's announcement by the Government that they would release £300 million over two years to tackle delayed discharge, I agree with Sheila Scott of the National Care Homes Association, who described the sum as a "sticking plaster". With 680,000 bed blockers last year, 1,000 extra beds will do little to alleviate the problem that the money is intended to tackle. The vicious circle will continue to revolve until the problem of bed blocking and delayed discharge is brought under control. In the meantime, all care suffers. Under new Labour, we have been put in the ridiculous position whereby one is put on a waiting list both to get into hospital and to get out of hospital.
The Government have failed on another key aspect of health care: free nursing care. Before the last general election—under new Labour, these things always happen just before a general election—the Prime Minister and the Secretary of State promised that there would be free nursing care in England as soon as its introduction was viable. Since then, the implementation of the policy from
Many people feel betrayed because they took the Government's words at face value and believed that everyone would receive free nursing care. They failed to realise that it was the Government who would define nursing care and personal care. Now, a significant number of people who thought they would be entitled to receive free nursing care have been told that they will not get it, because the care they need has been categorised as personal care. Some sufferers from Alzheimer's disease or dementia, for example, may not receive nursing care because it is judged that their care is personal care, and under the new policy personal care is not paid for by the system.
I seek clarification. Is the hon. Gentleman advancing the view that personal care, like nursing care, should be free? Can he explain why his Front-Bench team, who in opposition took that measure through in the last Parliament, did not pick it up and did not deal with the complications of the Government's free nursing care scheme?
No, free nursing care. Like the Government, we also said at the last general election that we would not give a commitment to free personal care. We fought the last election on that policy, and so did the Government. I know the Liberal Democrats had a different view, but I am stating the policy on which we fought the last general election.
Far too many people feel that they have been let down over the free nursing care promise, which has not lived up to expectations. The Government wring their hands and will not accept evidence that any constituency MP is more than familiar with, especially if they live in the south-west, the south-east or the eastern region. They see homes closing down and being sold off for other endeavours. Homes are under tremendous financial, bureaucratic and administrative pressures. They are desperately trying to provide the highest standards of care for their residents.
We all support the idea of more provision of domiciliary care for people for whom it is a viable and rational option, so that they can remain in the security and familiarity of their own homes. However, there is a crisis, as the title of the debate on the Order Paper shows. It would be far better for the elderly of this country if the Government recognised the arguments and did more to help alleviate the problem, rather than pretend that it does not exist or that it will merely fade away.
I welcome the debate. I shall probably break the consensus that has existed so far. I do not subscribe to the view that the success of community care policies can be evaluated on the basis of the number of beds in private care homes. I worked in the care sector for many years, including in care homes. My mother ended up in a care home, and that was the worst experience of my life. I do not want to end up in a care home. I think that we can do a damn sight better for our elderly people than sticking them in institutional care. As the Minister implied, it is about time that we showed vision and courage by moving in a more radical direction.
I felt depressed when I listened to the criticisms of the Government, which were almost wholly based on the decline in the number of care beds. If community care is working, of course there will be a decline in the number of care beds. Reference has been made to people such as Sheila Scott, the chairman of the National Care Homes Association, and others whom I have known for a long time. I probably know more private care home owners than most hon. Members, and I have never known any who have been poor. Someone somewhere is making money out of the sector. I have not seen them walking away from the private care sector.
I want to explore key areas that have not been touched on so far. I was surprised that Mr. Burstow did not mention the structural problems that have occurred as a result of the split between health and social care since the 1940s, which is a major area. I understood that Liberal Democrat policy was to do something radical about that, but perhaps they have moved away from that position.
Somebody mentioned the National Assistance Act 1948, which set out local government services that were to be means-tested. There was also the National Health Service Act 1946, under which care was to be free. Since then, we have had difficulties in matching up the two parallel systems. In 1974, the Conservative Government moved more elements of local government health care into the health service, complicating matters even further. I worked in social services at that time, so I am aware of the difficulties involved in getting the two elements of the care system to work closely together.
We have talked about the royal commission on long-term care, which was proposed by the Labour party when I was a Front-Bench spokesman on community care policy. I claim no credit for the proposal, because it was the idea of my right hon. Friend the present Home Secretary, who is a good friend. It was right to try to develop a consensus on the direction that the long-term care of the elderly should take. Personally, I believe that the conclusion in the majority report was correct. The split between nursing and social care is unsustainable, and nobody has managed to define the two types of care. At the moment, the definition of nursing care is anything that a nurse does. What absolute nonsense. I think that the definition will be challenged in law; it is impractical and it will not last very long.
My Government have made tremendous progress on community care, and I concur with much of what the Minister has said. I fully and actively support many of the Government's reforms, but I do not believe that we yet have the right policy to tackle the divide between personal and nursing care. We will have to revisit that matter. I would go further and tackle the separate structures for health care and for social care. I do not want to rehearse arguments that I have been making for many years about having a common system delivering health and social care, but until we get that we will have problems.
The hon. Gentleman and I have worked together over the years and I know of and share his concern. However, I must enter a caveat. In Northern Ireland, health and social services work together, but we still have the same problems with the availability of beds. We must deal with the financial structures so that one section is not holding back from another.
I have the greatest respect for the hon. Gentleman, whom I have known a long time. He has had a passionate concern about health and social issues for all the years I have known him. Obviously, he knows the Northern Ireland system far better than I do, but I understand that the problems there arise from the fact that although there is one common organisation, there are still separate budgets.
That brings me to my next point, which relates to the figures on delayed discharges which were given to the Health Committee. In October, we were told that 6,000 beds are blocked on any one day. That was the Government's figure. I do not know whether it is correct, but I have not seen a revised figure. We were also told that the cost of an acute bed averaged out at £120,000 a year, so a quick calculation tells us that blocked beds cost £720 million a year.
I would bet my bottom dollar that for a small proportion of that sum, we could have got those people out into the community and cared for them more cheaply, more effectively and, from their point of view, more happily and in a more settled environment if we had a coherent organisation running the whole show. I make a plea for a common health and personal care organisation—a plea that I have been making in the House for the past 15 years. I hope that by the time my career in this place ends, I will have got somewhere on this issue. I look forward to the Minister tackling that point in her winding-up speech; my hon. Friend is really suffering this week.
I turn now to a point that was not dealt with in great detail by the Liberal Democrats. The difference between the marked and welcome increases in NHS funding under this Government and the less positive developments in personal and social services funding is having a serious effect on our ability to unblock beds and tackle difficulties in the community. The Government told the Health Committee that the total gross expenditure on the NHS had increased by 8 per cent. in the last financial year. That is an impressive increase, and I welcome it. The budgeted personal social services expenditure for the same year went up by only 1.4 per cent. That is a big difference, and I am sure that the Minister understands the consequences.
I was reminded of the consequences at my surgery only last Friday night, when a lady came to see me about her mother, an elderly lady who had been in hospital for a hip operation. She was on an orthopaedic ward and was told, to the surprise of her daughter, that she was fit to be discharged into a private care home. The daughter was told that she had to get on with getting her mother out because she was blocking a bed. The daughter felt that her mother ought to be transferred to a geriatric ward or into intermediate care, but she was told that her mother had to go into a private care home.
The daughter obtained a private care home place for her mother. Interestingly, she was told by the ward sister that because her mother had private resources she could fund her care and there was more pressure on her to leave than there would be on someone who would be funded in that care home by the local authority. I do not know whether that is true or not. If after making local investigations I find that that is happening, I may well draw it to the Minister's attention because I will be concerned; I am certain that she will share my concern.
I differ from Conservative and Liberal Democrat Members on the use of the private market. In a week in which the Government have talked about making more use of the private market, it is important to look at the implications of relying on the private market in care provision. Mr. Burns appeared to accept no responsibility for the current situation in the care home sector. However, he knows full well that his Government decided in 1981 to allow supplementary benefit payments to top up private care home fees. That unpublicised decision led directly to a massive explosion in private institutional care. As a result, huge numbers of nursing homes and care homes sprung up across the country. Mrs. Thatcher believed in stimulating the market; consequently, we are bogged down in the community care system and locked into the kind of debate that we are having tonight in which we worry about the number of beds that we have.
The huge explosion in private institutional care arises directly from the market's involvement. Figures that I obtained from the Library show that, between 1981 when that decision was taken and 1993 when community care changes were introduced, the Conservative Government spent £10 billion subsidising private care homes. How much could a proportion of that money have done to keep people in their own homes? There was money to put people in institutional care, but not to keep them out.
Will the hon. Gentleman help me? Is it not the policy of his Government and the Secretary State to use the private sector in the provision of acute health care as well?
I am still trying to explore what has happened this week; it has been an interesting experience for one or two of us. I referred to the use of the private sector in care because I fear the consequences of its use in the NHS, as the hon. Gentleman knows full well; he knows my feelings in great detail.
Following that point, does my hon. Friend agree that as a result of the Griffiths report the previous Government wrongly decided to demand that 85 per cent. of all moneys be spent in the so-called independent sector? They spoke about a mixed economy of health and social care provision, but it was nothing of the sort.
I did quite a bit of research while advising the Labour Front-Bench spokesmen on community care for a number of years. In a sense, the problem in East Sussex arises from the use of the market. We found from my research that the market had gone for areas where there were large houses and where, in some but not all cases, there were larger elderly populations. We found that people were being moved out of inner London to places such as Sussex and Surrey, where there were more private care homes. The investment was not in the areas where they were living.
My concern is that the Conservative Government allowed the market to provide what was in the interests of the care home owners, not what was in the interests of the people who ended up having to occupy those homes. The solutions that those people got were not what they wanted. They wanted care in their own homes, or at least near to where they lived. Precisely the opposite happened.
My main concern about the use of the private sector is the way in which it invested in wholly outdated models of institutional care. There was no recognition that most old people do not want to go into a care home. Our country is unique in our reliance on institutional care. In Denmark, which is the obvious example, care homes were made illegal in 1988. Other models of care exist there, because care homes are deemed to be a humiliating form of care.
The models developed by the private sector in this country until recently were based on our old workhouse institution. Some of the care homes are not much better than some of the workhouse institutions of many years ago. I am sad to say that, and I am sorry that there have been attacks on the care standards legislation from the Liberal Democrats. [Interruption.] There certainly seemed to be attacks. I shall check the record. I was actively involved in exposing standards in the private care sector, where people were genuinely suffering.
When he checks the record, the hon. Gentleman will see that our concerns have been about care standards that have not been funded and are therefore threatened. When he criticises care homes that are doing their best with the resources and staff that they have, he should reflect on the implications for the care home staff. Are they workhouse staff?
Of course not. I am speaking of the model of institutional care, which is a direct consequence of the workhouse system. It is its historical successor, whether the hon. Gentleman likes it or not. In 2002, it is about time that we moved away from a system set up in the 1600s. None of us here wants to end up in an institutional setting, but the debate assumes that we all want to end up there and that we all want to see more care home beds. I, for one, do not. I should like to see a gradual reduction in institutional models and a move towards the models that exist in other countries—
No. I have given way enough.
I should like to see a move towards models such as care link schemes and housing with care schemes. There are many in the private sector, as well as in the public and voluntary sectors, where intensive care packages are available so that people are not permanently institutionalised in their old age. The key challenge is to move away from costly, outdated institutional care and to develop alternative models of care within the community. That is what people want and it is about time we delivered it.
I have studied the Liberal Democrat motion. As the Government amendment states, it relates more to the producer interest than to the consumer. The motion refers to the
"loss of homes and beds" and is rooted in grossly outdated thinking. The Government amendment more accurately reflects my personal concerns and contains some vision of future developments. I am happy to support the Government this evening.
I am delighted to have the opportunity of taking part in the debate, and I am particularly pleased to follow Mr. Hinchliffe. We all feel for him in his personal voyage of discovery, as he finds out what modern Labour party policy is towards our health care system.
It is breathtaking to witness the sheer opportunism and cynicism of our Liberal Democrat friends in some of the matters that they choose to bring before the House, especially in view of the experience of some of us in East Sussex. For eight long, painful years the Liberal Democrats ran East Sussex county council. As I mentioned in an intervention, in every year they succeeded in hitting the bottom of the national league table as the lowest payers to the private sector of any council in the entire country. Interestingly, Sedgefield council was at the top of the table, but that is another matter. There was a combination of incompetence and political dogma. The Liberal Democrats were getting a bit excited about the remarks of the hon. Member for Wakefield, who speaks with great authority and knowledge on these matters. I do not want to upset him, but I must say that they are philosophically very close on these issues. I am convinced that the attitude of the Liberal Democrats in East Sussex during the eight years to which I have referred was based on dogma and the notion that people should not be able to make a profit out of running private care homes. I am sure that that is what drove their attitude to private care homes in my county. Other people's experiences may differ and I am sure that we will hear more about that.
I hope that the hon. Gentleman will say that to the people running private care homes in East Sussex—especially those that have gone out of business in recent years.
As I said, several different pressures were faced. First, the area was the worst paid of any in the country. Secondly, there was the dogmatic insistence of the Liberal Democrat-controlled county council on keeping open its county council-operated homes. My hon. Friend Mr. Burns, who is gracing the Front Bench, may not remember an Adjournment debate on
"When a local authority is complaining that it does not have enough money, I cannot understand how it can justify spending about £152 a person a week extra just by placing them in its own homes."—[Hansard, 19 February 1997; Vol. 290, c. 898.]
He calculated that the total amount that was being wasted from the social services budget in that way was £5 million.
More recently, in July 1999, I secured a debate on a similar subject. By that time, East Sussex was paying the private sector £209 a week, but it was paying for its own homes the equivalent of £401 a week. That is a difference of almost £200 for every single person in its homes. I am sure that that figure is now even bigger. In those days, it was difficult as a local Member of Parliament—I anticipate the points that the Liberal Democrats might make—to lobby the Government, whether Conservative or Labour, for more resources when the existing ones were being squandered by the county council.
The third factor that has been hitting care homes in my area very hard is the new standards that will be introduced in April this year. In principle, we are all in favour of better standards. It is right that there should be constant pressure to improve standards and make life better for people in care homes throughout the country. We have no problem with that, but the reality on the ground is that many homes have rooms that are the wrong size and do not have the facilities or the area of land that is necessary to expand their resources in the way the rules demand.
The details of the regulations were made available extremely late in the day. We should bear in mind the fact that this is a question not only of care home owners and operators, but of their bankers. For some time, banks that have previously been heavily committed in the care homes sector have stepped back and decided to wait and see how the new regulations impact on their existing and potential customers. That, too, has had a major impact on care homes in my constituency,
It is worth considering the figures that were provided in answer to a parliamentary question that my hon. Friend Mr. Hendry tabled on
We could face circumstances similar to those in Australia, where Government neglect over many years meant that the private care sector died, went out of business and had to be reinvented by the Government at vast expense—many billions of dollars—because there was clearly a need for it. East Sussex is not unusual in having such a high proportion—more than 90 per cent.—of care beds provided by the private sector.
More and more of our older people will need such facilities and they will have to rely increasingly on the private sector. As I said, East Sussex county council kept its homes open for several years. Some of them are simply not up to the task in the 21st century. Recently, I revisited such a home, Parker house, in my constituency. It was built in the early to mid-1960s, and its fabric is crumbling. The facilities do not fulfil existing requirements, and will certainly not fulfil the new requirements that come into force in April.
The now Conservative-controlled county council has consulted on whether Parker house should be closed. I do not want to pre-empt the process or suggest that I have any inside knowledge. However, I should be surprised if the consultation did not conclude that the home should be closed. However, in the run-up to the local elections in May, some prominent local Liberal Democrats will be beating their breasts and claiming that closing the home would be outrageous, and that old people would be thrown on the streets. We should tackle such cynicism head on, and I intend to do that. Liberal Democrats would be saying, in effect, that some of our older people should be consigned to third-rate facilities and care. That is a reflection not on the dedicated and caring staff but on facilities that do not meet existing standards, let alone new ones.
I thought that I had expressed my view, but I repeat that I suspect that a decision to close the home will have to be made. I surmise that it could be refurbished, but at inordinate expense. If I had a magic wand, I would start again on the site and build something more modern and in tune with the needs of local older people, such as a resource centre that would meet many needs that are currently not satisfied. Again, that is not to due to the staff. I shall be interested to read "Focus" on the issue. I hope that Liberal Democrats are forewarned that their actions will be met with the force of the argument that I have just presented. I am sure that there are similar facilities around the country in which similar arguments apply.
I want briefly to move on to the question of bed blocking, or delayed discharge, as I think it is more fashionable to call it nowadays. I have laid as much blame as I think appropriate at the door of the Liberal Democrats for the chaos in which they left the social services budget, and for their dogma over paying for the private care homes sector. However, the Government cannot escape blame, for two reasons. First, immediately on taking office, they changed the calculation formula for standard spending assessments so that the number of old people resident in East Sussex is no longer properly and fully taken into account by the formula.
Secondly, we have this issue of bed blocking. We keep being told that it is being solved by extra inputs of cash from the Government. At one time, bed blocking seemed to be a phenomenon that occurred in the winter months. Nowadays—at least if Eastbourne district general hospital is anything to go by—it is a phenomenon that starts in the summer and gets worse in the winter. Indeed, it is an all-year-round phenomenon.
The hospital had a major problem with bed blocking before the last election, and—lo and behold—under pressure from myself and others, the Government put in extra cash to tide it over during the election period. Last summer, there was also a major problem. Speaking from memory, I think that 45 beds were blocked in June. That is the equivalent of a couple of wards, if we want to look at it in that way. More recently, the Government have put in some extra funding. But last Friday, the district general hospital commented that the number of blocked beds not only matched but was now rising above the figure for last June, despite the extra funding. The acting chief executive, Glen Douglas, said:
"Bed blocking is causing a considerable problem at the DGH. We currently have 75 beds blocked and a consistent flow of patients who need them."
I have to tell the Minister that, whatever extra funds the Government have put into this problem, it simply is not working. We still have a major bed blocking problem.
I am grateful to the hon. Gentleman for giving way, especially as I missed the first few minutes of his speech. I share his concern about bed blocking, which affects my constituency too. Is he aware that the money provided by the Government has been allocated first and foremost to Hastings, despite promises by the county council? One of the reasons the problem of bed blocking in Eastbourne district general hospital has not been solved is that allocation by the county council.
It would have been helpful if the hon. Gentleman had been here for the first hour and 45 minutes of this debate, but it is nice to have his company none the less. I am not in the business of making knockabout party political points, and I would have hoped that he would agree with me that the extra funds that the Government have produced are not doing the job. Whether the money is allocated to Hastings or Eastbourne is neither here nor there, particularly as a merger of the two hospitals is on the cards in any event.
Will the Minister please promise to look again at the situation in Eastbourne? I appreciate that there are hospitals up and down the country that always have a story to tell about a lack of resources, but here we seem to have a genuine problem. I do not know whether the problem is administrative or endemic, or whether the money is not being disbursed properly, as Norman Baker might have been suggesting. Whatever the practical reason for the problem, this extra money is not doing the trick. Far from bringing the figures down, we are heading towards them being twice the level they were at last summer, when they were already severe grounds for concern.
To echo my hon. Friend Mr. Burns, the Government have created a situation in which we still have significant waiting lists not only to get into hospital, but to get out.
The state system for providing medical or social care is crucial and I welcome the Liberal Democrats' choice of topic for this Opposition day debate. However, I was taken aback by the language used by Mr. Burstow. I neither recognise the situation that he described nor believe that the elderly or the great majority of my constituents in Stockton would describe the care that they receive in similar terms. They most certainly do not see social services as Cinderella services. They see them as historically underfunded, but they also recognise the professionalism of the staff who run them, so they would object most strongly to the use of such language and the notion that they must wait for someone to die before they get a place.
Let me explain to the Liberal Democrats. We have too many places and too many homes, not insufficient capacity. There is over-provision, so my constituents would find your argument untypical of the situation that they face. It has been said that district nurses are getting older. We have young district nurses. Many are being trained and many are impacting on the community that I represent. Your use of language suggests to me that you are seeking press coverage.
I am appropriately corrected. The language used by the Opposition seems to court press coverage, but it does not reflect reality.
I shall not pepper my speech with statistics—an awful lot of those have been bandied around—because I want to talk about the reality that my constituency faces. Our health and social provision has developed into a health and social services partnership that has been awarded beacon status. It is innovative and it has high standards. There is a clear, professional and qualitative relationship between health and social security professionals. I hope that the Minister has time to acknowledge the value of the partnership's innovative capability. It is one of only five such partnerships to achieve beacon status and I say to Stockton, "Well done." However, I would not say that everything is fine.
The partnership's policies are often innovative and they challenge a culture in which elderly and old people's residences are seen as coincidental. We do not see things that way and it is clear that my authority does not see things that way. I do not suggest to the House that the partnership is working to maximum effect. I am very realistic. I know that it needs time and that more, serious money is required. It needs space to accommodate individual needs, but my realism is appropriate. A dose of realism would stand Opposition Members in good stead.
Inevitably there are problems and some are historical. We do not need to be told what the Conservative Government did for 18 years. We all know what they did. We know that there are demographic problems and that there is an ageing population to accommodate. There are undoubted problems because we are challenging a culture. The remark of my hon. Friend Mr. Hinchliffe was so appropriate—the elderly do not always want to go into homes and residences. I talked to elderly people when I worked in Sunderland and I talk to them in Stockton. Often they would choose to stay at home.
I am not saying that there are no problems, because problems are inevitable when we propose change. I am especially conscious of the fact that stand-offs always arise when we change a policy relating to vulnerable people. People say, "We would rather things stay as they are because we are not too sure of the quality that you will provide." We understand that and I am not saying that the partnership in Stockton is achieving all. I simply say that it is innovative, achieving change, responding to higher expectations and delivering better services. It is responding in such a way that individuals feel that they are prized in the community.
A lot more has to be done, but a lot is being done. By speaking about my local authority and its relationship with the Government, I am speaking the truth. I am neither exaggerating nor underestimating the problems and opportunities.
It is difficult to see new policies delivering appropriate services, so it is valuable for all of us to hear the language used by professionals in my constituency on the Government's approach. The language of local policy- makers is invariably positive. Members might say that I would not quote them were it not. They would be wrong. It may be difficult but, as a policy-making Government, we have to face up to the problems as well as the opportunities.
The language used shows that partnership is valuable, as is supporting a fundamental change in culture. Establishing relationships between different professionals that are based on co-operation and support is valuable. Many of us in the House have professional backgrounds, and we are here because we want to deliver a policy or create a new approach. The partnership arrangements lead to co-operation. The days of ambivalence are becoming fewer and there is less indecision about whose responsibility a person is. Although all the problems have certainly not been solved, they are withering on the vine. Health and social needs are being handled holistically by partnerships such as mine, and we are achieving a much higher quality of care and support.
The director of social services for Stockton has said:
"Labour has done a lot", adding that local flexibility was liked. The Secretary of State's remarks about freedom for local hospitals and local social services will provide the opportunity to develop services that respond to local needs. Stockton's social services director warmly welcomed that, and believed that it showed that his staff's professionalism was being recognised. The director said that they believed that a relationship of trust was beginning to develop.
This is not pie in the sky; it is something that we hope to achieve. We have to start somewhere, and my local authority is starting a positive relationship with the Government because the Government have given them the opportunity.
My local authority has adopted a principled approach to helping the health and social needs of the elderly in a care package known as homes for life. There is determination to establish a service that encompasses the needs of all older, vulnerable people within the broader community, and in which the richness of being part of a community remains. The elderly and the vulnerable have rights and they must have easy access to family and friends. Independence must be a fact of life. This well-rounded and well-thought-out policy maintains the individual's connections with the community. It should not require two bus journeys for a family to visit an elderly person, or a difficult journey for an elderly person to visit their family.
There are problems, and it is early days. We are in a period of transition, but at least we are in that period. Homes for life is a clear and principled approach, and a policy that will support independence.
I wish to respond to the arguments about the private care sector and to refute categorically the challenge in the motion that Government policy has mishandled, and misunderstood, the home care sector, causing a loss of homes and beds. In Stockton, we have not lost any beds. I am the first to acknowledge that the relationship between the local authority and the private sector is not always easy, but no beds have been lost. Concern has been expressed about the amount of money that the local authority is prepared to pay for care and support of the elderly, but those concerns are now being resolved. Private owners are saying that that is because the Government have carefully organised the funding of social services in Stockton to allow private owners to pay appropriately. There has been disagreement, but it has been resolved and negotiations have taken place. Therefore, people in Teesside will wonder what on earth the Liberal Democrats have been talking about.
We do not have bed blocking either. We have two elderly people who have to be placed carefully in residential care.
The hon. Gentleman thinks that this is funny. Good for him. The reality is that local people do not laugh about it. They are very grateful. As I was saying we do not have a bed blocking problem, but we have two people who need places. Where is the crisis? From the perspective of my constituency, my council and local private homes, the Government have achieved an innovative care system that is significantly better financed. It has a structure based on a partnership of equals between the public and private sector. It is a service based on the principle that people's individual needs, not profit, come first. It is also accommodating high standards. The local people know that it will take time for all those characteristics to become evident, but they know that we will persist until they do.
There is little evidence in Stockton of shortage of beds or bed blocking. In fact, there is much evidence that our policies are competent and achieving a much better service. There is no crisis. Unfortunately, in tonight's debate, the Liberal Democrats have been playing to the gallery. The language they have used is also used by my Liberal Democrat colleagues—and they are colleagues—on Stockton council. During a council debate, when the homes for life policy was introduced, it was warmly welcomed by the leader of the Liberal Democrats. However, when public opinion began to question the policy and the debate became a little bumpy, the Liberal Democrats immediately decided that a change of mind was the most appropriate response that they could make. I suggest that opportunism is the last thing required when a policy is being developed to respond to the needs of the old, the ill and the vulnerable in our society.
Stockton's approach—"Homes for life, a life in your own home"—is appropriate. That policy came about because the Government have allowed us to innovate and to challenge a culture; they have allowed us to say not only that we want quality, but that independent, individual lives should be accommodated in the social and health care system.
If only the whole country were like Stockton—it sounds like a paradise. I have never thought of Stockton in that way, but I learned much tonight.
The test of a civilised society is surely the way that it cares for its older people. Although I agree with the hon. Members for Stockton, South (Ms Taylor) and for Wakefield (Mr. Hinchliffe) that we should facilitate independent living wherever possible, it is not appropriate for everybody. Ideally, there will always be a place for residential care in a mix of provision.
At present, the vast majority of people who go into residential care go into the private independent sector, so the state of that sector should be of concern to us all. Despite the paradise in Stockton, that sector is in a state of developing crisis and I shall explain why.
The sector has suffered underfunding for many years. In Norfolk, year-on-year fee increases are below the rate of inflation. Last year, the Labour-Liberal Democrat council budgeted for social services spending of £13 million above the standard spending assessment, but it still overspent by £1 million.
The competing demands faced by social services departments put those departments in an impossible position—for example, as regards their child protection work. In Norfolk, we experienced the awful and desperately sad death of Lauren Wright. Part of the problem is that there are insufficient social workers. I pay tribute to the work they do, but there are not enough of them. Furthermore, there is not enough money to pay for an adequate number as well as providing sufficient funds for the care of elderly people.
In addition to the underfunding in fees from social services, the costs incurred by care homes over the years have continued to rise. They have had to cope with the minimum wage and the introduction of holiday pay. I fully support both those things, but they must be funded. The increases have not been enough to fund those extra costs.
On top of that, there are the new care standards. I repeat the comments already made by my colleagues on the Liberal Democrat Benches. We support national care standards. They are important, but it is essential that they do not act as a straitjacket that makes it impossible for inadequately financed care homes to meet them, with the result that the homes become unviable and have to close.
The effect of all those measures is that a substantial number of homes have already closed—35,000 beds have been lost nationally during the past three years—and there has been a dramatic drop in the number of new registrations. We have also heard about the knock-on effect for the NHS where blocked beds inevitably result in cancelled operations—despite the situation in Stockton—and longer waiting lists.
The homes that are most affected are those that rely on social services-funded residents, so the most disadvantaged residents lose out most as a result of the current inadequate funding. Furthermore, those residents also lose out owing to the problems in the underfunded NHS—problems such as cancelled operations. They are unable to opt out as people with more money are able to do.
Finally, I shall comment on the situation facing care homes for younger adults—residents with learning difficulties. That sector is the real Cinderella service. Recently, I visited an impressive home called Abbottswood lodge, which is situated in Swanton Abbott in north Norfolk. It is highly regarded locally and has received very good reports from social services inspection teams, but staff there are very worried about the impact of the new care standards on the home. They are especially concerned about the limits on the size of units and rooms in the home. They feel that the overly prescriptive approach will have a severe impact on their ability to continue to operate as a care home for younger adults.
The home is wonderful, an old vicarage with delightful grounds. However, the extent of the grounds cannot be taken into account in the prescriptive rules of the new care standards. The introduction of the national care standards requires sensitivity and flexibility.
It is time for some joined-up Government thinking, to quote a new Labour phrase. There needs to be a whole-systems review, so that we can judge the impact on the health service and on the care sector. It is time too that the whole system received proper and sustained funding.
I shall be brief, but various points remain to be highlighted.
The problem with the debate is that it is stuck in the past, whereas we should be looking to the future. However, I am not going to live in denial: there are problems in Gloucestershire. Recently, I met care home representatives from my constituency. Homes have closed there for a whole range of reasons, some of which have been noted already.
Yesterday, Lord Sutherland, Baroness Greengross and Ian Philp from the national service framework for older people addressed different meetings. Their various perspectives on the matter allowed hon. Members who attended the meetings to see the good things that are happening, as well as some of the problems with which we are all familiar.
My main aim in this debate is to make it clear that I think the mistakes that have been made are not necessarily the fault of this Government, or even of their predecessors. Although we could do some things better, the problem is that many previous Governments have failed to overcome the barrier between social care and health care. My hon. Friend Mr. Hinchliffe made that point very clearly.
The Conservative Government may not have been responsible for that mistake but, as I noted in an intervention, it was made worse by the way in which they tried to reallocate funds to personal social services as a result of the Griffiths report. As a result, the NHS was removed from the equation to too great an extent, and there was a failure to understand that it was not a mixed economy of care.
Moreover, that period saw the beginning of the end of county-led provision, certainly in my county. I believe that that was wrong. There was also a failure to realise the opportunities for the mutual sector. I hope that that matter will be looked at again. There is a role for mutuality in this sector, as it overcomes some of the distrust that people feel for the private sector.
I do not want to belittle the private sector. Some of my friends run care homes, and they are open about the fact that they want to make a profit. However, the private sector is not the only solution. We must give credence to mutuality, which is something from which we could gain considerable benefit.
The debate has already touched on various geographical and historical problems. Interestingly, the latest figures from Laing and Bouisson show that demand has not continued to rise exponentially, but has been capped. Perhaps that is a result of the way the funding mechanism operates, but alternatives are already being sought. Demand may grow as the population increases, but we must take demand into account as well as supply. The problem is not merely one of capacity: we must take account of what people want and where they want to go.
There is also a difference in expenditure. Again, I understand from House of Commons figures, drawing on Laing and Buisson's work, that approximately £9 billion is spent in the residential nursing sector, compared with just over £1 billion in the domiciliary care sector. Is that the right balance? Many hon. Members would argue that it is not, and we need to find a difference balance.
In trying to find some solutions, I would argue that the NHS has already moved too far out of the personal care sector. The NHS is invaluable precisely because it is the most trusted of organisations. Despite its various problems, it has a notion of how to deal with people, and we must ensure that that is carried into the personal care sector.
As I have said before in the Chamber and in Westminster Hall, there are different ways in which we can ensure that people are properly accounted for when they enter the system. In the United States, systems called minimum data sets provide a much better understanding of how people in the system can be moved more effectively. I hope that the Government will consider some of the pilot work that has been done in the Bristol area and try to roll it forward towards a national system. That involves using information technology effectively, but if that can be done people will not be lost but will be funded appropriately and they will feel that they are being listened to much more.
Another concept worthy of mention is that of supporting people, which has not been mentioned at all in this debate. It is important because for the first time it genuinely locks housing into social care and health provision. People often want to go home when they leave hospital—they do not want or need to go into the residential or nursing home sector—but perhaps cannot do so for the simple reason that their homes have not been adapted, and we must highlight that problem. I have done a lot of work locally and nationally with Care and Repair, and through other home improvement agencies it can lock into that exciting debate.
A final issue is that of intermediate care. I shall not try to define it here tonight; the Government have much cleverer people than me working on that, but we could consider the way in which the NHS and others can provide the appropriate facilities for older people and the other groups mentioned—the vulnerable people—by pursuing intermediate care.
To give it a quick plug, Standish hospital will no longer be used for acute provision after 2004, so it could be considered for use as an intermediate care centre. In the years to come, I shall write to Ministers to advocate that solution, but that much-loved institution should be considered properly. If such things happen in the NHS, some of the pressure will be taken off the care sector, and we shall ensure that we do not view the solution as lying entirely in private provision. That would be neither fair nor realistic to the private sector; nor would it represent an appropriate use of state resources—people's resources—and we could have a much better system accordingly.
I shall be very brief. I am one of those hon. Members who still has not decided which way to vote this evening or, indeed, whether to abstain, but I have found all the contributions extraordinarily interesting and very helpful.
I am delighted that we have been reminded of the importance of care in the community, yet I am pleased that Norman Lamb reminded us that care homes are essential. One of my constituent's comments about his father were published in the Daily Mail. My constituent said:
"He spent two weeks in residence and enjoyed it so much that he decided to continue to live there."
So care homes are right for some people.
I welcome the opportunity to expose the enormity of the task that the Government face. I agree with them absolutely that investment alone is not enough unless it is matched by reform, but the enormity remains. If the £300 million investment announced in October is broken down into counties, Worcestershire received £713,000. If all that money had been spent on residential care, it would have been enough to provide less than one extra place a week. I am not criticising the amount, but merely pointing out the enormity of the task.
The cost of care is not met by social services in my county. I would almost like to arrange a visit to Stockton to see how it does that. Care homes in my constituency hope to take large numbers of fee-paying patients because they subsidise those who are paid for by social services.
"In 2001/2 Worcestershire receives £53 million in respect of payments for Residential and Nursing Care and Domiciliary Care. However, due to political decisions in the Council Chamber, only £33 million is used for the purpose intended".
Will the Minister investigate that claim? If it is correct and if it applies to other parts of the country, will she take action?
I enjoyed the news from God's own county. It is very much a contrast to life in Surrey. My father is 80 and lives in Yorkshire and I have told him. "Don't come south. Stay in Yorkshire." [Hon. Members: "Go to Stockton."] I am not going as far as Stockton.
Many Members have spoken about what is almost crisis management and the problem is not that we resent it if care homes make a profit. Any business can stay in business only if it makes a return on its investment. The cost of living and the price of property is so high in Surrey that investing in care homes involves a bad return on investment. That is the problem.
We still want good-quality care homes and we support high standards in them. However, we recognise the need to fund the provision of that care. Those of us who have constituents who have been bedridden for more than a year as a result of poor care have plenty of reason to desire improvements to the standard of nursing in some care homes.
We are in crisis, but the Minister would be hurt if I did not recognise the contribution that "cash for change" has made to bed blocking in Surrey. Even though, as in other areas, there have been massive queues in accident and emergency departments and even though people have been virtually imprisoned in wards in the Royal Surrey hospital, some improvements have been made. Notwithstanding that, we need ongoing planning so that care homes can plan. Furthermore, we need the money to train and pay care workers to look after people in their homes. Without that funding and without the recognition that counties cannot pay with money that they do not have, we will make no progress.
Some care workers in Surrey work for 10 hours a day, unpaid for some of the time. They do not have enough time in the day to look after people, and that is not good enough. We need to treat people with decency. One of the problems is that there are not enough care workers in Surrey because they cannot afford to live there. However, we cannot bring them in from overseas, as we can nurses, because they are not at national vocational qualification level 3. People advertise throughout the country, but no one responds and we cannot bring people in from elsewhere. Consideration must be given to that point.
We have not touched on care for those who care for others. Although we have considered the revolving-door syndrome and bed blocking, a report commissioned by Help the Aged shows that one third of all carers over the age of 75 provide 50 hours of care a week. Three quarters of older people who live with the person for whom they care receive no regular visits from health or social services. One in 10 older carers who live with the person whom they look after receive home care themselves. Carers over 75 are more likely to be providing intensive care than those between 60 and 74. By 2031, nearly one in three of the population will be over 60.
We all want people to lead happy and healthier lives, but we have to recognise that we not only have to meet the current crisis but have to plan for the long-term needs of the population. We need long-term, consistent planned growth, based on realistic costs of providing social care of a quality that not only meets Government objectives, but provides plain and common decency for our older people.
The Government amendment implies that all is improving in care for the elderly. The simple truth is that it is not. Every word of the Liberal Democrat motion will ring true with social services departments, the health service and, more important, users of the services and their carers up and down the land—perhaps with the exception of Stockton.
The Government are not doing enough in the round and the problems start with local government finance. I speak as a past chair of social services in Stockport, where we welcomed many of the social care modernisation reforms demanded by the Government. We are proud of working jointly with the health service and the voluntary sector, and we improved our management and record keeping. Basically, we did our best and the social services department in Stockport continues to do its best against both a backdrop of structural problems associated with local government funding of social services departments and a general backdrop of underfunding of local authorities in many parts of the country.
I wish to explore two issues. The first is the structural problem caused in budgets by the chronic underfunding of children's services. In Stockport, crude standard spending assessment measures do not reflect the levels of need of children within our community. The knock-on effect of meeting the needs of children's services is to steal money from older people's services, with the resultant increases in gatekeeping. That reduces social services departments' ability to provide the right service at the right time for the elderly. All too often, money has to be spent on firefighting instead of ensuring a dignified and supported older age for the infirm. The lack of funding in older people's services leads to bed blocking and to entry to residential care, two outcomes that the vast majority of older people and their carers do not want.
The second issue that I wish to explore is the shortsighted way in which the Government tackle the problems. By the time someone becomes infirm, it is almost too late to engage in issues to do with lifestyle and diet. All the evidence indicates that as our young people get older, their sedentary lifestyle and poor diet, which we know is causing obesity, will lead to greater dependency when they reach an older age. The Government are engaged in pilot schemes such as the school fruits initiative, but they need to do much more to counteract the insidious effect of junk food and drinks machines in school corridors and sports centres throughout the country. Young people used to engage in more vigorous activity in schools, and more needs to be done to establish a better balance between activity and academic work in their lives.
In addition, more attention needs to be paid to the difference that local authority leisure services can make. France, for example, spends eight times as much on sport per head as we do. Leisure services are also often starved of cash because of the needs of other departments, like social services, that are busy firefighting.
I am disappointed that four and a half years on, a Government with a big majority have not come up with proposals to replace the discredited local government finance system. Until they do, SSAs will continue to fail to meet people's needs and the improvements demanded by the Government cannot be implemented.
We have had a good debate, started by my hon. Friend Mr. Burstow, who stated the position clearly and backed up his remarks with evidence. It is important to provide data as well as solutions to the problems we see.
Using House of Commons Library figures derived from Government answers, my hon. Friend demonstrated that there are bottlenecks and delays in the health service. In the last year, 1,400 years of elderly people's time has been spent waiting to get out of hospital. The Minister may dispute those figures—perhaps she thinks it is only 1,300 years. However, the facts are clear and the Government must acknowledge them before they can claim that they are starting to solve the problem.
My hon. Friend demonstrated the loss of beds and homes in the care sector. He pointed out the cash shortages affecting many social services authorities, leading to a macabre game of musical beds wherein people who require funding can be placed only when one or more care home residents who are funded die. What a sad game to which to subject the elderly people of this country.
My hon. Friend further demonstrated the diminishing eligibility criteria caused by cash shortages, which lead to ever fewer people qualifying for any help from social services, as well as the staff shortages, vacancies and high turnover. Sensibly, he called for a review of the social care sector. In a thoughtful contribution, Mr. Drew pointed out how much thinking is needed in that respect. An independent review of how to get best practice across the country, new thinking and the funding required is long overdue.
Not only have the Liberal Democrats come up with that proposal, but we are prepared to state that we would put in extra investment and to say where that funding would come from. We have talked about extra investment to tackle delayed discharges. According to figures given by the Chairman of the Select Committee on Health, tackling delayed discharges in one year would release £720 million. In addition, we would free councils to raise revenues, as voters elected them to, to meet the needs of local people.
Unlike the Labour party, the Liberal Democrats said at the last election that we would be prepared to increase taxation, including setting a new top rate of 50p in the pound for incomes exceeding £100,000. According to Government figures, that would yield an additional £3.7 billion to spend on elderly people, including those in health care settings.
Ministers may disagree with asking better-off people to pay more to help the most vulnerable in society. I think that to do so is wrong, unreasonable and a betrayal of their principles. They cannot deny that we went into the election with a costed manifesto to deliver whatever cash the Labour Government had to spend plus £3.7 billion derived from having the courage to ask the better-off to help to protect the most vulnerable people in our society.
Ministers and their yes men and women on the Back Benches should be ashamed of having lacked the courage to say before—not after—the election that taxes would have to rise. They ruled out the only fair way to raise those funds, which is progressive direct taxation rather than stealth taxes. I suspect that many Labour Members wish that their Government's policy was different.
The Minister's response was astonishing, but nothing we have not heard before: "Crisis? What crisis?" She was eloquently and loyally—I hope it is worth it—supported by her hon. Friend Ms Taylor, who claimed that there was no problem of elderly people requiring earlier discharge or better services. The hon. Lady was prepared to say that there was a "demographic problem" but added that these are the early days of the Labour Government. If these are the early days, lord help those who need help when the Government have got into the swing of things. She said that there were no lost care homes and no problems, and only two elderly people were suffering from delayed discharge. The Government's new policy to modernise the health care system will be to tell people who want to be discharged from hospital to go to Stockton.
By contrast, we heard testimony from my hon. Friend Norman Lamb about the problems in Norfolk, from my hon. Friend Mrs. Calton about the problems in Stockport, from Dr. Taylor about the problems in his constituency, and from my hon. Friend Sue Doughty about the problems that still exist in Surrey. In my own constituency, care homes that had survived years of Tory cuts had to close under a Labour Government, and now there is a shortage of beds and a huge increase in the number of delayed discharges in my local hospital.
It is remarkable that the Government refused to acknowledge those problems. The Minister admitted that there was a need to stabilise the private care home sector. If it needs stabilisation, that implies that there is already a problem. What does stabilisation mean? It means rescuing the situation, and she should admit that her limited funding is designed to do that.
The Minister's response was clever but unfair. She chose to centralise praise for the Government every time new money was announced, but decentralise blame to local councils when underfunding led to cuts in provision. She was supported in her tactic of blaming local councils—a few of them Liberal Democrat, but most of them not—and attacking the Labour-led Local Government Association by Mr. Waterson and Mr. Turner, who did not even remain in the Chamber to hear the rebuttal of his weakly put point.
The Minister talked about £300 million to tackle delayed discharge and to stabilise the private care home sector. That is not £300 million a year: it is £100 million in the first year and £200 million in the second. We are used to such double counting, but social services departments despair of it. We do not even know whether that will be recurrent. We certainly know that it is not the £700 million that the independent King's Fund has established is required, and we would provide at least as much by releasing those acute beds, as Mr. Hinchliffe said.
The Minister does not put enough money in, but claims praise for the money that she does provide. She blames hospitals for delayed discharges by naming and shaming them, and by giving them zero rating when they are unable to discharge patients and do not have the capacity to admit others.
Ministers stand at the Dispatch Box and praise staff in the care home sector, but when care homes cannot afford to pay staff adequately they blame the employers. The Minister claimed that 5 per cent. more people receive intensive domiciliary care, and praised the Government for that. She blamed local councils for the fact that 19 per cent.—93,000 people—receive less care. She probably thinks that it is a triumph that people who do not qualify for care under the tightened eligibility criteria are happily living independent lives, but they are heading more quickly towards high-level care because of the failure of early intervention.
The Minister claimed to have tackled the problem through the establishment of the high-level, strategic commissioning group. Bully for her! That group has come up with fantastic ideas such as long-term contracts. Of course long-term contracts are a good idea, but long-term funding to go with them would be helpful.
The contribution of the hon. Member for Wakefield was interesting. At least he accepted that there was a capacity problem. Like us, he accepted that the ideal would be independent living and less institutional care. Although care homes are suitable for some people, we should not assume that they are suitable for everyone.
The hon. Gentleman said that he disapproved, as he has always done, of the structural divide between health and social care: what the Government describe as a Berlin wall, and what my local trust and social services department describe as a Berlin trench, as they are digging to find the funds to fulfil the extra duties imposed on them by Government. We agree with the hon. Gentleman on that point. He accepted that 6,000 people suffer delayed discharge on any one day, and he pointed out that it would save £720 million if that problem were tackled. Again, he agrees with us and our motion.
The hon. Gentleman said that social services were underfunded compared with the health service, and that the real-terms increase in social services was not keeping pace. Again, he agrees with our point of view. He criticised the Government for their non-evidence-based love affair with private sector provision of social care. He supports us in almost everything, but then announces that he will support the Government in the Lobby tonight. Wheels within wheels. If the hon. Gentleman disagrees with the Government but will vote for them when the crunch comes, it is not scrutiny but tribalism. I say with the greatest respect, because the hon. Gentleman is bigger than me, that those who agree with our criticisms ought to follow the logic of their position.
Mr. Burns, one of the few Conservative Members in the Chamber tonight, confirmed in an honest speech that his party in opposition is committed to funding only nursing care, not personal care. [Interruption.]
I am not going to change my mind. I shall state my position clearly so that there can be no misunderstanding by Liberal Democrats, because we all know what Liberal Democrats do in our constituencies. I said that, like the Government, the Conservative party fought the last general election on a policy of free nursing care, but we did not have a policy of free residential care.
I am glad that the hon. Gentleman repeated his position; I just wish that he had done so a bit more quickly. The hon. Gentleman does not understand, or perhaps he does, that such a policy discriminates against elderly people. It subjects them to the degrading assessment of whether bowel care, catheter care and stoma care is nursing care—that is, a requirement of their health needs—or personal care. What a way to treat elderly people. The Government are saying to them, "If that care need is delivered by a nurse, we'll pay for it, but if it is not, you'll pay for it. Having saved and paid taxes all your life, you will pay for care that you were told would be free from the cradle to the grave."
Absolutely. We know that people who suffer from dementia will have a mixture of personal care needs and nursing care needs, and it is degrading, discriminatory and invidious to try to make a distinction between them. We are prepared to say that we would fund personal care, and we have said where the money would come from. I know that there are Labour Members who know, in their heart of hearts, that that is the right policy.
The hon. Member for West Chelmsford did us the favour of quoting Liberal Democrat research, the aim of which, as I think he accepts, was to show that people still have to sell their home to fund their personal care even though the Labour party, in opposition, used to claim that that was a scandal. Very little has changed.
The charges that the Minister must answer are clear. Discharges are delayed, beds are blocked and elderly people have to wait to receive suitable care in an unsuitable setting, which means that other elderly people who require that care have to wait to get into a hospital bed. Indeed, in many places, they have to wait in corridors, with the resulting lack of privacy. Who would have thought that five years into a Labour regime we would see wards made up in corridors, with no screens, no privacy and no dignity, and health care staff struggling to provide the care that patients need?
The Government stand charged with presiding over a system in which 19 per cent. fewer people are receiving social care because of the shortage of cash. They stand accused of under-resourcing that threatens the quality standards that Liberal Democrat and Labour Members want to see. The Government are committed to more tax cuts for the better-off at the expense of services for the less well-off. They are denying elderly people the free provision of personal care on the NHS and subjecting them to degrading and invidious assessments. They are overseeing the tightening of eligibility criteria by local councils, which they are making the scapegoats.
We want to hear the Minister accept that there is a problem, that funding as well as reform is needed and that the Government have the courage to say where that funding will come from. We believe that the better-off who have done well under this Government should help to provide care for the vulnerable elderly who are getting a raw deal from the Government.
The Government believe strongly in giving people the right treatment at the right time in the right setting. We have had a wide-ranging debate, but I was particularly disappointed by the contributions of Mr. Burstow, who opened the debate, and Dr. Harris, who closed it for the Liberal Democrats.
There were good contributions in between, but it was extremely disappointing that the hon. Member for Sutton and Cheam used incredible and unbelievable figures, from which he extrapolated beyond the bounds of comprehension to talk about 5,000 years and 88,000 operations. Where would he get the surgeons to do those 88,000 operations? He was utterly unreasonable and went on to insult care home staff in the most appalling manner that I have witnessed in the Chamber for a long time. To talk about them as rejects from Tesco and McDonald's, when they are putting in time and energy and showing commitment to looking after people in care homes, is dreadful.
I am disappointed that Liberal Democrat Members spoke almost exclusively on behalf of care home providers. That is nothing new. When the hon. Member for Oxford, West and Abingdon moved a motion at his party conference last year, he spoke 26 times about doctors, nurses and staff, but only once about patients; they are important, but he spoke about them only once.
I know that the hon. Lady follows the Liberal Democrat conference carefully; I just wish that she would take note of the fact that the motion was about staff in the NHS. When we talk about staff in the NHS, we talk about staff, not stabilisers or modernisers.
When we talk about partnership, we talk about a partnership of staff and patients working together to shape services; that is the difference between the Liberal Democrats and the Labour party.
We appreciate that the independent care home sector is facing a number of challenges; we are certainly not in denial about the issue. However, the position is nothing like the one represented by Opposition Members. Let us have a bit of honesty in the debate—it would make a refreshing change for the Liberal Democrats. Figures have been bandied about; the loss of care home places was said to amount to 50,000 beds. It went down to 35,000 beds, but the true figure is 19,000 beds. Those figures are ludicrous. I am glad that Liberal Democrat Members reduced their first figure by about half; perhaps by the end of the debate we shall have the proper figures. They did not take into account the fact that 33,500 beds were created between 1997 and 2000 by new registrations. They should be clear about the figures that they submitted.
Our policy is to allow people to remain as independent as possible and be supported at home, which is why 1.5 million people are receiving care packages of various types in their own homes. Last September, the number of people receiving intensive home care packages was 3,500 higher than it was the previous year. My hon. Friends the Members for Wakefield (Mr. Hinchliffe), for Stroud (Mr. Drew) and for Stockton, South (Ms Taylor) spoke imaginatively and creatively—[Laughter.] I am sorry, it appears that Liberal Democrat Members do not recognise imagination and creativity when it stares them in the face. My hon. Friend the Member for Stockton, South spoke passionately about the local partnership in her community that is beginning to design facilities around the needs of patients. My hon. Friend the Member for Wakefield said correctly that we must not judge our success in community care by a simple number-crunching exercise involving the number of beds. We must look at the kind of services that we provide to support people in the community.
My hon. Friend the Member for Stroud mentioned, extremely importantly, the role of the mutual sector in drawing up new solutions to those problems. The Secretary of State in his speech yesterday talked about new models of care. The mutual sector has a role to play. I have recently been made aware of a project in St. Helens in which the co-operative movement is looking at providing a range of services—not just residential care, but supported housing with care services in place. When someone begins to become frail, they can get day care; when they are a little more frail, they can get sheltered housing; when they need residential care, they move into that; when they need nursing care, they move into that. They do all of that within the same village community in which their carers and families are involved. That is the kind of new model of care that local people want, and which the Government, with their creativity and imagination, will begin to put in place. The Liberal Democrats have simply spoken about more money for business as usual and the same old system. That simply will not wash.
Solving delayed discharges is important to us and we have made tremendous progress. Since last September there has been a 10 per cent. drop in the national number of delays. We are keen that the figure should fall even further, which is why we announced the investment of £300 million. I am pleased to tell the House that by
I thank the Minister for graciously giving way. She makes the situation sound rosy, but can she explain the following statement from all 15 local authorities in the south-west, including Labour-run local authorities? They state:
"Local Authorities are placed in an impossible situation with no recourse other than to hold back spending on older people in order to provide marginally safe and adequate services for children and other adults."
Is that the rosy garden that the Minister is painting?
I was not painting a rosy picture. I acknowledge that there are problems. The Government are not in denial. We are dealing realistically with problems in the community. If local authorities are taking that position, after they have received extra resources from the cash for change programme, it is outrageous that they are not putting in place services for older people. We will look into the matter.
About 2,500 more people will be able to leave hospital at the appropriate time as a result of the extra funds that we have allocated. Mr. Waterson stressed the need to ensure that that happens in his area. I shall examine the distribution of the allocation of those funds in his area, but I understand that the Conservative-controlled county council there has cut grants to carers, leaving them without respite care. That is a serious matter, which will not help the situation.
Before the hon. Lady hands out brickbats, she should bear in mind that a few short months ago, the Conservatives took over a social services budget in chaos, brought about by the Liberal Democrats. I hope that she will also address the point that I made—that the Government changed the SSA calculation for East Sussex to disadvantage central Government funding for older people.
If the hon. Gentleman wants to argue with the Liberal Democrats, I shall not intrude.
The agreement last year, "Building Capacity and Partnership in Care", set out a new way of providing long-term care for older people. It envisages long-term partnership, joint commissioning, new forms of service and the development of new models. It will give us the sustainable system that we need. Mrs. Calton spoke of the need for long-term planning. That is the aim of the agreement.
Several hon. Members mentioned free nursing care. On 1 Oct 2001 we delivered on our commitment to provide free nursing care for everyone in England. Some 42,000 people will save money on their nursing home costs. We are moving away from a means-tested system of nursing care to one based on clinical need.
We have been much maligned for failing to follow the Scottish Executive and offer free personal care to all, but to implement free personal care for everyone in England would cost approximately £1.5 billion a year. I know that my hon. Friend the Member for Wakefield takes a different view, but we decided in the NHS plan to make £1.4 billion available per annum to improve services and standards for older people. Spending a vast amount of public money on free personal care would not guarantee improvements for older people. We firmly believe that we have targeted resources so that those most in need will receive high-quality care at no cost. It is important to decide the right priorities. It is right for a Labour Government to target funds on those in most need.
The Minister defended her refusal to follow up the recommendations of the majority of the long-term care commission by saying that the funding required would have to come from other vulnerable groups. What about the proposal to raise the funding from the better-off in society through fair, progressive, open taxation?
As usual, the Liberal Democrats want to face both ways at once. One could say that they want to have their cake and eat it. They want to ask the better-off to pay and to implement free personal care that will, in many cases, benefit those who are better off rather than those who are in most need. There is a fundamental contradiction in their policies.
It is all too easy to spread a mood of doom, gloom and crisis. I challenge Opposition Members to do some hard thinking. I know that that is not easy for them. It is much easier merely to complain and sit on the outside carping and criticising than to come up with constructive new ideas. I am asking them to propose new models to put people at the centre of the service and to design facilities around their needs, rather than to force them into ideas and traditional care that can sometimes rob them of their dignity and independence.
This debate has highlighted some very real differences between the Labour Government and the Liberal Democrats. We put patients and the public first; they put providers first. We want creative and imaginative solutions; they want more places in nursing homes. We want to promote people's independence; they want them to be passive. We want a partnership between the national health service, local government, the voluntary sector and the private sector; they simply want to concentrate on care home numbers. We are forward looking; they are stuck in the past. We are creative and positive; they are negative. We are committed to reform; they have the same old ideas.
There is a lot more for us to do, but we are putting in the investment and reforming the services. The two must go hand in hand if we are to deliver the top-quality care to which people are entitled in this day and age. As ever, the Liberal Democrats are guilty of political opportunism of the worst kind. They just want more money, as usual—the same old record—but they do not want any reform; they just want the same old system.
The Tories are just as bad, but they are not even prepared to put the money in. The only thing that Mr. Burns could find to talk about was age discrimination. I am delighted to tell him that the Government's national service framework addresses for the very first time the rooting out of age discrimination throughout the national health service.
Norman Lamb again raised the very sad case of Lauren Wright. I spoke in the Adjournment debate on the case and, as I recall it, the director of social services in the area was honest and open, and recognised that his problems stemmed not from a lack of funding, but from the systems that were in place and the difficulties of joining up the different parts of the care system. The hon. Gentleman needs to be very careful about putting the blame on that individual.
Dr. Taylor said that he had not yet made up his mind about how he was going to vote at the end of the debate. He now has precisely two minutes in which to do so, so I hope that he can make the decision fairly soon. It is right that his local council will set its priorities. I am afraid that political decisions are made about priorities—that is what we are all here to do and that is what will happen.
Sue Doughty said that we were in crisis, but then recognised that lots of improvements were being made because of the cash for change money. I do not know whether she thinks that we are in crisis or not. She seemed very confused about that, but I am pleased that she has welcomed the improvements in her area that have resulted from the Government's action.
It is this Labour Government who have the courage to invest in better services and to challenge all our partners in local government, the national health service and the independent sector to work together in new ways to deliver for the people whom we represent. The Liberal Democrats said in their manifesto for last year's general election:
"Three simple words. Freedom, justice, honesty. These sum up what the Liberal Democrats stand for."
We have certainly seen tonight just what they stand for. Three simple words sum them up: cynicism, confusion and opportunism. I ask the House to reject the motion.
Question accordingly agreed to.
Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the Government's strategy for modernising social care services through unprecedented real terms increases in resources, which enables and promotes better joint working between the NHS, social services, and the independent care sectors, develops a national framework for standards and quality and ensures a greater emphasis on users and patients in the design and delivery of services; notes that this has led to more independence for older people, fairer funding of long term care, reduced levels of delayed discharge and greater choice for users; and condemns the Liberal Democrats for their obsession with producer interests over those of users and patients and their failure to recognise that investment must be matched by reform.
Order. It is the convention of the House that the official Opposition occupy the Benches above the Opposition Gangway. Liberal Democrat Members are not Members of the official Opposition. As no Members of the official Opposition are in the Chamber at present, it does not matter that Liberal Democrat Members are seated on the Benches that are normally occupied by the official Opposition, but tomorrow Liberal Democrat Members will be in their usual place. They have only a short loan of the Benches in question.