Care System

Part of the debate – in the House of Commons at 9:29 pm on 16 January 2002.

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Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 9:29, 16 January 2002

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.]