I beg to move,
That this House
expresses its profound concern at the continuing crisis in care for elderly people;
deplores the Government's over-prescriptive, expensive and bureaucratic regulation of the care home sector, which has greatly exacerbated the crisis in care and has led to many care home closures;
condemns the loss of over 70,000 long term care places since 1997 and is gravely concerned that the number of people receiving domiciliary care has fallen by 100,000 since 1997; is further concerned that the implementation of the Community Care (Delayed Discharges etc.) Act 2003 will merely place an unfair financial burden on Social Services departments, and could lead to patients being discharged prematurely from hospital into inappropriate care, resulting in an increase in emergency readmissions;
and calls on the Government to recognise the crisis in the provision of long term care for elderly people, to take action to reduce the current rate of care home closures and to combat the decline in the availability of domiciliary care, rather than simply disregard the crisis.
Despite the protestations of Ministers, there is clearly a crisis in long-term care for elderly people. That is not solely my view; it is also the view of many who work in, and provide care in, the long-term care sector. Only last month, the Independent Healthcare Association said the following:
"As a nation we are facing a crisis".
The Registered Nursing Homes Association has echoed that view, and the National Pensioners Association has declared that
"there is clearly a crisis in care and older people are suffering".
Ironically, the only person who seems oblivious to the crisis is the Minister with responsibility for long-term care, Dr. Ladyman, who declared the following in an article in "This Caring Business" last November:
"There is no national crisis in the sector".
Frankly, the hon. Gentleman must be in denial if he is unaware of the crisis that is so apparent to everyone else. It is time that he began to listen to the concerns of those working tirelessly and selflessly to care for some of the most frail and vulnerable in our society, and to pay attention to those elderly people who are entrusted into such care.
Far from the Minister being complacent, should he not be losing sleep and worrying greatly about the state of social services in Birmingham? Is my hon. Friend aware of the recent Audit Commission report, which singled out social services there as absolutely appalling and deeply letting down local people? What does he think that the Minister should be doing about that?
I am extremely grateful to my hon. Friend for that intervention, and I shall indeed refer to Birmingham at a later stage. He will be as aware as I am that in the year to the middle of 2003, 96 homes closed in Birmingham. Social services have been forcing down prices to a level at which it is not feasible to run homes. They are prepared to pay only £265 per client, whereas in respect of their own homes they are prepared to pay £525. I agree with my hon. Friend that it would be more reassuring for the elderly and their families in Birmingham if Ministers—including the Minister and his predecessor—were prepared to spend more time and be more concerned about examining what is causing so much distress in relation to care problems in the city of Birmingham.
My hon. Friend has just dealt with problems in Birmingham. Does he acknowledge that one problem that greatly annoys people who run private care homes is that the local authorities pay much more to their own care homes than they are prepared to pay to the private sector? That is one of the big problems often put to me by private care home owners.
My hon. Friend raises an important and valid point. The fact that that is happening all over the country is not only unfair, but anti-competitive. If my hon. Friend will allow me, I shall deal with that point again later in my speech.
I believe that the Government can pursue two options: either the dangerous one of remaining in denial and doing nothing, or the positive one of seizing the opportunity to end the current confusion and crisis surrounding the care of some of the most frail and dependent members of our society. Because the Under-Secretary seems so oblivious to them, it might help if I explain the problems facing the care of elderly people in this country.
The first problem is the collapse in the provision of homes and beds throughout the country. The most recent data published by Laing and Buisson in July shows that long-term care capacity across all sectors is now some 74,000 places lower than its peak in 1996. Indeed, some 13,400 elderly care places were lost in the 15 months to April 2003 alone, yet demand for elderly care is growing. We estimate that between 2005 and 2020, 130,000 more people each year will require care than currently receive it—an increase of 25 per cent.
What would the hon. Gentleman say to my constituent, Mr. Watson, who is currently waiting to be discharged from hospital? He wants to go home and be cared for by his family, not to go into a nursing care home. Is it not the case that most people want to stay at home and do not want to go into nursing care homes? Is that not the real issue?
The hon. Lady makes a good point and is, in many ways, quite right. I would say to her constituent that he should not remain in hospital any longer than is clinically necessary, and that he should receive the most appropriate care for his needs. If the hon. Lady will bear with me, I shall discuss the issue in greater detail in a few moments.
I am glad that the hon. Gentleman has clarified that point in response to my hon. Friend Ms Munn. As a Minister responsible for community care in the previous Conservative Government, does he feel that his Government bear any responsibility for the current difficulties in the care sector? In particular, in the 10-year period before community care changed in 1993, there was a 4.7 per cent. increase in the number of elderly people, but the Conservative Government increased care and nursing home places by 500 per cent.? Is that not a factor in our current difficulties?
No, it is not a factor. As the hon. Gentleman will recall, when community care was introduced with the support of his party in the early 90s, we had to deal with circumstances that needed to be controlled because of excessive—and I choose that word carefully—growth. The growth was due to demand and was not stimulated by Government. I shall return to that point later, as the portion of my speech that concerns domiciliary care was written with the hon. Gentleman in mind. I know his views, which he has made clear in the Health Committee.
In the 15 months to April 2003, about 13,400 elderly care places were lost, yet demand for elderly care is growing. We estimate that, between 2005 and 2020, more than 130,000 more people each year will require care than currently receive it—an increase of over 25 per cent. New analysis shows that, as a result of that projected growth in demand, and of the rate of decline of availability of care, overall demand for care home places will outstrip supply by 2005—that is, in just 12 or 24 months.
The human consequences are potentially dire. I know that the Government—and the Minister, who has done it often before—will claim that the problem is not as great as it seems, because there are about 10,000 spare beds in the country. However, what the Minister sadly fails to understand is that that spare capacity is not located where the demand is. Too often, areas where there is a shortage of beds are also those areas where demand for beds is greatest. The unfortunate result is that, too often, elderly people have to be placed further and further away from where they have lived all their lives, and from where their families and friends live. That is deeply distressing to elderly people, and to their families and friends. They feel that they are becoming increasingly isolated, in unfamiliar surroundings.
However appalling the problem is, we must not forget that residential care is only one element of care for the elderly. It is important to remember that the guiding principle for the provision of long-term care must be that the elderly receive the most appropriate care suitable to their needs. That care may be provided in a residential home but, equally importantly, it could also be domiciliary care provided in the familiarity of an elderly person's own home. Unfortunately, however, the number of people receiving domiciliary care has fallen by almost 100,000 since 1997.
No, I want to make some progress. That is a fall of more than 20 per cent., and it came about even though the 1997 royal commission on long-term care emphasised the need for increased levels of domiciliary care to allow people to retain their independence for as long as possible—something about which all hon. Members are, I am sure, united. It is all very well for Ministers to state that the provision of domiciliary care rose between 1997 and 2002, but that is disingenuous spin.
I am not surprised by the figures that my hon. Friend has quoted. I have done a lot of case work in this area and I know that the system involves people filling in endless tick boxes. The aim seems to be to stop people receiving anything, and not to make available the small amounts of care that would help them to maintain their independence. It is another example of bureaucracy gone mad.
The hon. Gentleman may be aware that I have worked in this area for some considerable time. I was involved in the process of consolidating domiciliary care for those in need of intensive care. The aim was to give people like the constituent to whom I referred earlier the option to go home. That means that much greater care must be devoted to fewer people.
I disagree with the last part of the hon. Lady's statement. I fully recognise, as will anyone familiar with domicillary care, that many clients need highly intensive and time-consuming care. The fact is, however, that if, because it is considered more appropriate, we want more people to remain in their own homes rather than going into residential care, we need more domicillary care. Ministers repeat the mantra, "We have increased domicillary care". Yes, their figures show that the number of contact hours has increased, but not the number of people who need the care. That is the nub of the problem.
No, I am going to make progress.
The question is why there has been such a contraction in care capacity. Part of the reason has been the policy of social services departments to use their bulk purchasing power to force down the price that they are prepared to pay for beds, as my hon. Friend Mr. Mitchell said. Nowhere, as I told my hon. Friend, has that been more apparent than in Birmingham, where the price paid in the private sector has been forced down to £260 per resident while the price paid in the local authority homes is £525. That has resulted in 96 care homes closing down in the two years to 2002.
In addition, the introduction of more and more bureaucratic regulations, many of which were minimal in raising care standards, has contributed to home closures. Before any Minister tries to misinterpret what I am saying, let me make it quite clear that no Conservative Member opposes in any way the raising of standards so that frail and elderly people can have the highest possible care. What we object to is unnecessary and over-prescriptive regulation. While the Secretary of State continues to mutter from his sedentary position, he should recognise what I am saying. His own Government, before he became Secretary of State, did a U-turn on regulations, recognising the problems that there were.
No, I will not.
In addition, since 1997 we have experienced the Government's over-prescriptive, centrally driven approach, which I believe has contributed to the current crisis in care. In the last two years, we witnessed the Government's ridiculous and unnecessarily prescriptive implementation of some of the national minimum environmental standards. Then the Government had to do a U-turn. We saw the over-zealous and complicated implementation of Criminal Records Bureau checks for care home staff. Then the Government had to climb down. The Government vigorously imposed regulations but then said that they would use a lighter touch, because even they came to understand that their approach had been too officious.
What we have not seen is consistency and a level of regulation that is reasonable to ensure that standards are raised to the levels that we all wish to see. Just last week, we saw the implementation of the Community Care (Delayed Discharges etc.) Act 2003, under which it is intended to fine local authority social services on a daily basis for delayed discharge payments. As I highlighted during the Bill's passage, we remain implacably opposed to what I consider to be a nasty and vindictive piece of legislation that will simply exacerbate a difficult situation and unfairly impose fines on local authorities that are unable, often through no fault of their own, to find places in homes or provide domicillary care packages because of the crisis in long-term care brought about by the Government's indifference.
My hon. Friend has not so far mentioned the cost of regulation. Care homes in Somerset are complaining about a 20 per cent. increase in the regulatory cost from the National Care Standards Commission on top of a similar increase from the Criminal Records Bureau, which my hon. Friend mentioned. Will he comment on how the squeeze between low fees and rising regulatory costs simply means that fewer people can be cared for? Perhaps that is the root cause of the problem that he is addressing.
My right hon. Friend is right. It is, of course, a double whammy in terms of costs. In addition to the significant increase in the costs that care homes have to pay to comply with many standards are the costs of the fees to ensure that they are complying. For example, registrations fees to use the Criminal Records Bureau have increased by 147 per cent. in 18 months, which has a significant impact not only on the larger homes that employ more people, but on small homes, for which it is a disproportionate amount of their costs. As he no doubt finds in Somerset, many of them—especially, although not exclusively, the smaller ones—have thrown in the towel because financially they cannot continue to provide care. They have either sold up or converted the homes into domestic dwellings and left the market. That has contributed to the problems we face.
How does the hon. Gentleman justify the actions of his political colleagues in Leicestershire who took control of the authority for the first time for more than 20 years on general election day? They immediately decided to flog off the remaining 14 residential homes that were operated by the county, which had achieved the highest standards of physical and care provision. Is it not disgraceful that the residents of those homes were not even treated as sentient beings, but just as objects to be moved around?
I do not share the hon. Gentleman's final analysis. I have no doubt that Leicestershire social services did not treat the clients in their homes as objects.
On the general principle of whether it was wrong for the homes to be sold, it is up to any social service department and local authority to decide whether to continue to provide in-house care or to sell their homes. One reason why I have not opposed local authorities selling their care homes is that for many years those homes were not under the same inspection regime as the private sector. As they did not invest in their homes, for whatever reason, the quality and the fabric of the buildings—not the quality of care—deteriorated. The money was not available to invest in the homes to make them comply with the Government's minimum standards. It would have benefited the people living in those homes if the person who ran and owned them had the money to invest to improve and enhance the buildings and to maintain the highest standards of quality of care.
The Community Care (Delayed Discharges etc.) Act 2003, which came into force on
No, I will not.
The fines will lead to an increase in red tape, damage relationships between local authorities and the NHS, and increase the likelihood of inappropriate discharge decisions. The 2003 Act is a knee-jerk reaction to the serious problem of delayed discharges and is incredibly short-sighted, endeavouring to reduce the levels of delayed discharges by imposing perverse incentives in the form of fines rather than positive long-term solutions.
I have been extremely generous in giving way and I want to make progress.
The Government have missed a golden opportunity. If they were to legislate, they should have come up with a positive system of reducing the number of delayed discharges in our hospitals rather than the negative approach of introducing a fines system. These measures will also undo the excellent work that has been established over the last 15 years in fostering good working relationships and partnerships between the NHS and social services departments. That work was long overdue and it has led to a more seamless provision of service. It will—[Interruption.] The Secretary of State says that we were in power, but if he had been listening carefully he would know that I said "over the last 15 years". If he looks through his history books, he will notice that a Conservative Government as well as a Labour Government were involved in that work.
That is precisely the point that I was making. The hon. Gentleman talks of the lack of money provided by Governments over the last decade—[Interruption.] He mentioned money about four minutes ago. Earlier, he also mentioned the lack of Government support during the past 15 years, so will he at least accept that a significant proportion of the alleged deficiencies must have come from the Government whom he supported? Indeed, as far as I can recall he was a member of that Government for a prolonged period.
I do not think that the Secretary of State was listening carefully so I shall repeat what I said so that he can fully understand me—[Interruption.] The right hon. Gentleman obviously did not hear me because his intervention bore no relation to what I said. I said that the measures would undo the excellent work that has been established over the last 15 years in fostering good working relationships and partnerships between the NHS and social services departments. I still believe that. Tremendous work was done in the 1990s and also, to be fair, under the Labour Government who have taken it to a logical conclusion, to ensure that the barriers—the them-and-us culture—between the NHS and social services were broken down and that the organisations worked seamlessly to provide a better service.
I applaud the Government for doing that, just as I applaud the last Conservative Government for laying the foundations and starting the work. It is a good step forward and it must be continued. My concern, however, is that the Act that came into force last week will set back that good work, because it could reintroduce a blame culture when decisions are taken about when and how to discharge patients.
Another consequence of the enforcement of the Act is that the number of emergency readmissions will rise further as patients are discharged prematurely from hospital so that local authorities can avoid hefty fines for delayed discharges. There will be a costly, time-consuming, bureaucratic shambles, which could result in the opposite of what the Government intended.
How could that possibly be the case when the delayed discharge reimbursement system will not apply until a clinician has said that the patient is ready for discharge?
The clinician may say that, but it may not be physically possible for the local authority to find a place for the patient in a home or to provide a domiciliary care package. We shall see arguments between the NHS and social services about whether a patient should be discharged, although I accept that the whip hand in the decision-making process rests with the NHS.
Have Ministers considered how the burden of the fines could affect their constituencies? Of course, the Secretary of State must be delighted. This health policy, like all the Government's other health policies for England, will not impact on his constituency one iota. He is in a unique position in the ministerial team in that he is the only member of it whose local social services department will not face the possibility of paying out tens of thousands of pounds in delayed discharge fines every month, as his constituency is in Scotland and thus immune from this rather nasty measure.
How will the measure affect other health Ministers? Let us consider the social services department in the county of the Under-Secretary of State for Health, the hon. Member for South Thanet. My hon. Friends may not remember that Kent is implacably opposed to the Minister's policy. Anyway, it originally estimated the cost of fines as potentially some £5.2 million a year.
I would like to make a little progress.
As the Minister of State, Department of Health, Ms Winterton will undoubtedly know, her local social services department will receive £315,000 for the remainder of the current financial year and £600,000 for next year. Although the department hopes that that will be enough to cope with the fines, it is not yet sure how much it will have left to invest in mechanisms to reduce the number of delayed discharges in the future.
In any event, this is a case of robbing Peter to pay Paul. Rather than being spent actively and positively in toto on mechanisms to reduce the number of delayed discharges, central Government money is being given to social services departments with one hand and taken away with the other, in fines. That is a cockeyed system. The net result is that the money, often a significant amount, is not being used constructively.
The Under-Secretary of State for Health, Miss Johnson—who, unfortunately, is not present—will find that her local social services department expects fines in the region of £25,000 a week. We have to ask whether that considerable sum could not be spent more positively and productively. As for the department in the constituency of the other Minister of State, Mr. Hutton, it originally estimated that its fines would cost about £2.74 million in the first year of implementation. Again, exorbitant amounts are being used in fines rather than being spent positively and meaningfully to tackle a problem.
I believe it is time the Government acknowledged the urgent need to give more security and confidence both to our vulnerable elderly people and to those who care for them. That is why I urge my right hon. and hon. Friends to support the motion.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"welcomes the real terms increase in social services funding of 20 per cent. between 1997 and 2003, and the commitment to continue these increases by an annual 6 per cent. in real terms from this financial year to 2005–06; notes that councils are able to use these resources to increase fees they pay to care homes where they think necessary, with 2002–03 figures showing 56 per cent. of local councils in England and Wales increasing the fees they pay by at least 5 per cent;
notes that the Laing &
Buisson Care of Elderly People Market Survey published in July 2003 puts bed capacity in care homes from all sectors at 470,000 with demand estimated to be around 460,000; further notes that over 80 per cent. of older people say they want to live independently in their own homes for as long as possible;
supports the Government's policy of improving choice by providing alternatives to residential care with 20,900 more households since 1998 receiving intensive home care packages, 143,200 additional people receiving intermediate care services since 1999, and a cash injection of £87 million to be spent on creating 1,500 new extra care housing places by 2006; and further supports the Government's policy of driving up care standards where the care is delivered and ensuring that older people are not held unnecessarily in acute hospital beds when their care needs can be better met elsewhere.'."
Fond as I am becoming of these exchanges with Mr. Burns and the jousts in which we are increasingly engaging, on this occasion I can offer him no comfort—there seems to be no common ground between us. The voice of the care industry speaks loudly to him and his party, but the voice of older people speaks more loudly to the Government. The Conservatives seem determined to champion the providers of care; my hon. Friends and I know of the importance of the people who provide care, but we put the needs of those who use it first.
I will establish my thesis first.
The Conservatives seem wedded to a model of care for older people that could have been plucked from the 1980s. To them it seems that dependency and a care home place are the inevitable result of old age. We take a different approach. We want to put the individual at the centre of care. We want to offer a spectrum of care choices, and we will go the extra mile to help people maintain their independence and stay in their own homes for as long as possible.
Our vision is a million miles from the service that we inherited in 1997. Although we are much closer to it today than we were then, we are not there yet. We inherited a low-quality, dependency-based care system that was imposed on people because it was all that was on offer to them. In its place, we are building a high-quality, well-regulated system that makes independence a real option and gives individuals control of their care.
As we make that transition, however, the care industry and the market in which it operates will have to adapt. It will be a challenge for the industry and for care users, but it is not a challenge that we can duck. It saddens me, therefore, that rather than helping the industry to adapt the Conservatives have decided to set their face against change and to swallow every myth that the care home sector wants to throw out.
No. Let me establish my thesis, and then I will certainly give way.
Let us start with some of those myths: first, the notion that older people want to end up in care homes. They do not. More than 80 per cent. of them tell us that they want to remain independent and to live at home for as long as possible. The second myth is the so-called care home crisis. Yes, the number of care home places is falling year on year, but when will the Opposition understand that demand for those places is falling at an even faster rate?
The Minister says that 80 per cent. of old people want to remain in their homes, so 20 per cent. presumably do not want to do so. Given that only 4.6 per cent. of people between the ages of 75 and 84 live in residential homes, what happens to the other 15.4 per cent.?
If the hon. Gentleman is seriously telling me that he believes that older people want to end up in care homes and do not want to maintain their independence for as long as possible, he is, frankly, barking mad.
I will give way to the hon. Gentleman in a moment.
I do not dispute that the number of care home places is falling, but by no stretch of the imagination is that a crisis; it is an inevitable contraction of market capacity, following a reduction in demand. People simply do not want to be in care homes any longer, and the Government are giving them a real opportunity to stay in their own homes instead.
I thank the Minister for giving way, but he is absolutely out of touch with the realities in care homes. Does he not recognise that there are very many people suffering from the chronic conditions of old age—Parkinson's and Alzheimer's—for whom a place in a care home is not just an option, but a necessity? Many of those people are stuck in hospital beds, unable to get the care that they need. What the Minister describes is absolute poppycock. Those people need places; they need help and support; and the Government are letting them down.
The hon. Gentleman should not ask questions that he does not want to know the answer to. My mother has severe Parkinson's, and I can tell the House that she will do everything in her power to stay out of a care home. I believe that everyone else—the people that the Parkinson's Disease Society and the Alzheimer's Society represent—are all in the same position. Of course I accept that, eventually, some people will have to go into care homes, and the care home sector will remain an important part of the spectrum of choice that we want to offer.
I will make a little progress before giving way to all those hon. Members who want to intervene.
We want to offer real choice. The Government no longer collect care home figures, so the best figures that we currently have available are those collected by Laing and Buisson—a respected and independent health care consultancy. As the hon. Member for West Chelmsford said, it says that 470,000 places are available in the United Kingdom today and that there is demand for just 460,000 of them. Of course, I acknowledge that there are more difficulties in some parts of the country than in others. Those local problems need to be addressed locally, but even the Tories ought to accept that that is in no way a national crisis. In a minute, I shall describe some of the ways that we are giving resources to local people to deal with local issues.
I thank the hon. Gentleman for giving way. Does he accept that the very report that he has just cited states that demand for care home places is expected to expand again from 2005 because of population ageing?
If the hon. Gentleman will bear with me, I will give some alternative views from other respected consultancies on that very figure, but I accept that Laing and Buisson believes that a further expansion in demand might take place. However, I remind the hon. Gentleman that the same report said that occupancy levels in care homes have only reached 91.3 per cent. and pointed out that that is still a relatively healthy proportion of capacity that is full.
If there is a crisis in the sector, why did Richard Nunn, director of surveyors, valuers and agents at Christie and Co., write in Caring Times last November:
"We have noted the activity of private equity companies keen to find rising markets in which to invest their capital. Their burgeoning confidence in the care home sector emphasises the opportunities available to the astute investor. We are also encouraged by the number of existing operators who are looking to extend their portfolios"?
Mr. Nunn is not the only person to say that. Another article says:
"The improvement in profits for the six months ended March 2003 reflects both better occupancy levels at the company's homes and improved margins".
Its author describes the improved margins as being
"in line with the rest of the industry".
Later in the article the author says:
"The financial position continues to strengthen and the company is well placed to take advantage of opportunities for expansion. These continue to be sought".
Those are the words of the chairman of Univent plc, which is a nursing home and domiciliary care company. The chairman of the company is none other than Mr. Yeo, the shadow Secretary of State for Health.
The Minister told us that his main concern was with the elderly recipients of care rather than the industry. As a fellow Kentish Member, does he really think that it is fair that when bidding for places in Kent's overcrowded care homes sector, people from London receive funding rates that are more than twice the rates that Kent county council can afford for our elderly, especially given that he knows that our social services in Kent are overburdened in other ways, not least in the children's sector due to unaccompanied asylum seekers?
The hon. Gentleman and I clearly have different conversations with officers from Kent county council. They tell me that there is huge capacity in the care home market in Kent. Yes, they constantly tell me that they think that it is unfair that London councils receive more funding and can therefore afford to pay better prices in the north of the county, but I do not believe that there is anyone from London with a care home place in the hon. Gentleman's constituency—certainly very few people are placed in care homes in my constituency by London authorities. The situation about which he talks is simply not a factor.
In this House, the hon. Member for South Suffolk is keen to promote the idea of a care home crisis, but when he writes for the stock market and his investors, he is keen to promote the idea of a booming sector in which money can be made. The truth is that the number of care home places reached a peak in 1995–96, as the hon. Member for West Chelmsford said, and began to contract as the National Health Service and Community Care Act 1990 started to bite. The number of places has been falling continuously since, but demand is falling faster still. Supply and demand are now starting to come into balance in many areas, which is why the hon. Member for South Suffolk and other industry spokesmen see a strong future for providers. Laing and Buisson, for example, believes that the rate of closures has slowed down significantly over the past two years, but I do not believe that we are at the end of the process yet.
Let me make this point because it relates to an earlier intervention.
The personal social services research unit at London school of economics recently observed that if dependency rates fell by 1 per cent. per year, which is by no means unlikely, the number of older people cared for in care homes could remain roughly constant between 2000 and 2020 despite the rising numbers of older people. If that is combined with increasing choices and changing patterns of care, I believe that it is likely that the number of people requiring care home places could fall even further.
When I asked the Prime Minister whether he was the only person in the country who could see no connection between the 25 per cent. decline in care home places offered in the south of my county and the ratio of delayed discharges, which was reported at column 299 Hansard on
That is why we have made a building capacity grant to local councils and have put substantial sums into the reimbursement scheme in the Community Care (Delayed Discharges Etc) Act 2003. We want to enable councils to make preparations for the requirements of that measure, and I shall deal with that in more detail later.
The Minister has just cited research by the personal social services research unit, which found that a 1 per cent. reduction in dependency rates would stabilise the number of people going into care homes. Does he nevertheless accept that people receiving care at home are becoming increasingly dependent and are receiving more hours of care? Consequently, fewer people are receiving care at home, so the aim of reducing dependency is hampered by the fact that the Government are not providing sufficient support for home care for people with lower-level needs.
I thought that the hon. Gentleman was about to make a sensible intervention, but at the end of his question he lost the plot. We are increasing the number of hours available for home care and are targeting them on more intensive packages that enable people to remain at home. We are giving huge amounts of extra resources to local councils so that they can continue to build capacity for intensive home care. However, I agree with the hon. Gentleman's sensible suggestion that, as there is an increase in the elderly population and life expectancy, and as we want to keep people out of care homes—the LSE figures suggest that we might be able to do so—we must maintain many more people at home through intensive care packages. It is the Government's policy to provide resources to achieve that.
My hon. Friend is making a coherent case, but he has not touched on the fact that when we talk about market forces and the effect of home closures, we must recognise that the residents of those homes are clearly involved in the delivery of that market force effect. We should consider using a methodology to regulate that effect better. My hon. Friend commended research by Laing and Buisson, which has suggested a methodology for negotiating a proper rate for home care. Has he considered whether it is appropriate?
I congratulate my hon. Friend on his constructive approach—I only wish that Opposition Members were equally constructive. I am considering the possibility of developing a model to allow the fair negotiation of price, and I shall discuss that later. Mr. Turner is not in the Chamber today, but there was recently a strike by care home operators on the Isle of Wight because they did not like the price that the local council was offering them. That price was calculated using the Laing and Buisson model, so it does not always meet people's needs. We must take that issue into account.
Loss of care home capacity in areas where there is a significant over-supply is not a problem, provided that closures are managed sensitively. There is a greater problem when losses occur in an unplanned way in areas where there are few other alternatives or where supply and demand have not yet reached a balance. When that happens, it is important that action is taken by local authorities to rebalance provision. That might mean increasing fees, either to attract homes to expand or to encourage new homes to open. It might mean working with social landlords to create new care choices, or it might mean the local authority stepping into the market and providing council-owned homes. Those are all valid options for local decision, and cannot possibly be controlled successfully from the centre, which is why I have resisted calls for a national review of care home fees or demands that I try to impose particular solutions from Whitehall.
To tackle the problem, we have given local authorities substantial extra funding, together with the responsibility to manage care home capacity in their own areas. We have given resources dramatically above the level of inflation since 1997. We gave local authorities 20 per cent. more funding in real terms for personal social services between 1997 and 2003. We gave them a 6.3 per cent. real-terms increase on top of that this year, and we have promised them a 6 per cent. real-terms increase next year and the year after, as well. Compare that with a 0.1 per cent. annual increase between 1992 and 1997.
This year councils have just over £13 billion to spend on personal social services; by 2005–06 they will have around £15 billion. That will be close to double the amount available when this Government came to power. Before anyone argues with these figures, the percentages I have used have been calculated on a like-for-like basis and adjusted to take account of additional responsibilities.
Birmingham social services has serious challenges to meet; there is no question about that. One of the things that that department has decided to do, as the hon. Gentleman says, is to maintain its own care homes, because it believes that that is necessary to rebalance provision in its area. It has taken exactly the sort of decision that we are encouraging councils everywhere to take—to look at their local area and ask themselves, "What do we need to do locally to make sure we provide for our older people?" I realise that the hon. Gentleman has a problem because the social services department pays more to those homes than to the private sector. My advice to him—I think I have given him the advice before, but if not, I give it to him now—is that the department can do that only if it has carried out a best-value review and can justify the extra cost on the basis of increased services or quality. He and his constituents just need to get hold of that best-value review and they can find out why Birmingham chooses to pay a differential in rates between the two types of care home.
The money that we have given to councils is money that they can use in any way they want. As I said, they can increase fees locally, if that is what they need to do; they can invest in new capacity locally, if that is what they want to do; they can make their eligibility criteria for social care more generous, if that is what they want to do; and they can cut the charges that they seek to impose on people who have to contribute to the cost of care at home, if that is what they want to do.
Some councils have reacted to local challenges with increased fees. Fees paid by councils to independent care operators have increased by an estimated 8 per cent. on 2002–03 figures, well ahead of wages. If anyone is in any remaining doubt of that, again I refer them to the annual reports of the chairman of Univent plc and his boast of increased margins. The key, of course, is to establish a fair market process. Falling demand has created a buyers market, and we expect care home owners to take on board what the market throws at them. But they are entitled to ask that councils also respect the market and do their share to create a level playing field on which businesses can compete to provide services. It is not acceptable for councils to decide how much they want to pay and to tell home owners to take it or leave it, knowing that most home owners will be unwilling to evict council-supported residents.
Services must be commissioned fairly, using a process that allows the market to establish a fair price for the job and allows individual providers to bid the price they believe appropriate to their business. Once that is done, the council is entitled to take the best price on offer, but it must allow reasonable annual uplifts reflecting genuine annual cost increases. This type of best practice is fair to providers, fair to council tax payers and, most important, fair to service users, but too few councils follow such best practice.
That is why I have announced a national series of conferences to disseminate best practice commissioning. They start this month, and there is no excuse for any council not to send a representative to those conferences. I will speak at the first one, and my speech will be recorded for the regional conferences to ensure that everyone understands that the Government expect councils to use fair commissioning practice. The Government have done their part by making resources available, and will continue to do so, but local democratic accountability is important too. While the Tories continue to believe in imposing solutions from the centre, and the Liberal Democrats pay lip service to localism, we believe in local solutions for local problems, and we have given councils the power and resources to address them.
On local choice, does my hon. Friend agree that it is regrettable that the motion does not refer to the option of delivering in partnership with registered social landlords the sort of sheltered housing schemes that deliver extra care, offer people choice, meet modern standards and provide continuity of care as older people's needs change? Such schemes also give older people their own front door and the level of dignity in later years in which we, as a party of choice, believe. The only thing I ask him to do is continue his dialogue with the Office of the Deputy Prime Minister about the availability of local authority social housing grant funds to local authorities to enable more such schemes to be brought on stream.
Order. Interventions are getting longer, which is taking away valuable time from Back Benchers who wish to contribute to the debate later.
My hon. Friend is absolutely right—extra care is a model of older people's care for the future that we must promote. We must do so in all sectors, including the private and social sectors. We must do a lot more in that regard, and I shall say a few words about that later.
The motion's reference to regulation is another example of the Opposition speaking for providers and not older people. When I speak to pensioner groups around the country, they tell me that they want more regulation, not less. They tell me that regulation and inspection should be thorough and rigorously enforced. Did any Member of this House not receive a letter from someone in his or her constituency following the recent "Panorama" programme on care workers, which made that very point? When the Tories were in power, regulation and inspection were at best inconsistent and were non-existent in many places. Every council carried out its own inspections and used its own criteria and decided how hard to push them. The results were poor standards in many areas, bad practice in many homes and abuse and misery for many older people. So we introduced national minimum standards and a consistent national inspection regime. That was the right decision, and it is driving up standards to the discomfort of those who cannot meet them.
I thank my hon. Friend for giving way. I congratulate him on highlighting the fact that the bulk of the care standards introduced in the Care Standards Act 2000 apply to good social care practice, which providers welcome. Is he aware that providers also welcome the additional investment that he and his colleagues have given through Topss England for training their staff? They want to deliver the best quality of care and they will do that by having well-trained staff. Government investment is helping them with that.
My hon. Friend is absolutely right. We introduced the national minimum standards and have consulted about them continuously since. As the hon. Member for West Chelmsford acknowledged in an underhand way, we have shown that we are prepared to listen to what is said in those consultations and change the standards where necessary. My hon. Friend is right that we have put huge investment into training people involved in social care and into attracting people into the social care work force.
Caring for older people is not only about long-term care, however, but about wider choices. That is why we have invested so much in intermediate care—a type of care provision that many developed nations do not even provide, but which we see as a valuable new tool to ensure that older people get the right care at the right time in the right environment and that there is a real alternative to an acute hospital bed. Compared with 1999–2000, by June last year there were approximately 3,600 additional intermediate care beds and about 12,800 additional non-residential intermediate care places. In 2002–03, that meant that 143,200 additional people received intermediate care services compared with 1999–2002. That is a fantastic achievement, which meant that a significant number of people avoided entering an acute hospital, that even more were able to get out of an acute hospital more quickly and that many avoided entering a care home unnecessarily. Would it not be nice if the Conservatives occasionally congratulated us on the success of that initiative?
Over the past two years, we have made good progress in tackling the problem of delayed discharges. Older people do not want to be stuck in a hospital bed when they are ready to leave, becoming more dependent and less motivated. We have positively managed a reduction of almost 50 per cent. in the number of people over 75 experiencing a delay since 2001, and that progress is continuing as a result of people preparing for the Community Care (Delayed Discharges etc.) Act 2003. By September last year, there were only 2,988 people aged over 75 whose discharge was held up—a reduction of considerably more than half—and informal feedback from October to January suggests, contrary to the claims of the hon. Member for West Chelmsford, that delayed discharges are continuing to fall without any adverse impact on quality whatsoever.
Councils have been given £50m for the period since last October, and £100m for the financial year to come, to pay reimbursement charges. I invite the hon. Member for West Chelmsford to do some simple arithmetic, although I know that he was not in school when the numeracy hour was introduced. If he multiplies the number of delayed discharges in September last year by the number of days in the year by £100 for each day, it is clear that even if councils did nothing to make the system better, they have been given a sufficiently large reimbursement to ensure that they are no worse off. In fact, if they put a bit of effort into helping with delayed discharges, they would make a profit under the 2003 Act—that is the positive incentive for which the hon. Member for West Chelmsford was calling. I was disappointed by the sloppy thinking in the article in the British Medical Journal that appeared over the new year. Its authors seemed not to realise that we have already consulted on changes to the direction of choice regulations or that we have put in place a single assessment process that means that prior to people's discharge we will have better information about them than ever before. I believe that the 2003 Act will prove to be one of the great successes of this Government, and I look forward to debating it with the hon. Member for West Chelmsford in a year's time when it has finally and incontrovertibly proved itself.
Our vision is about meeting the genuine hopes and aspirations of older people—for most, that means care in their own homes. To deliver on our vision requires a range of high quality support services and good partnership between all partners. For example, a simple housing adaptation installed in good time can sometimes help someone to stay at home. That is why we have made housing adaptations that cost less than £1,000 free. Home care, especially intensive home care, has an increasingly central role in our plans. Mr. Burstow mentioned that, but he did not say that 81,500 people now receive intensive home care as a result of what the Government have done. Since 1998, we have increased the proportion of people receiving intensive home care by almost 30 per cent. The total amount of hours of home care that we are delivering is 16 per cent. up on the amount that was delivered under the previous Government. We are targeting home care on where it can do most good in keeping people in their own homes, because that is what they want.
We are targeting our resources at everyone, not at free personal care for the elderly—which the Liberal Democrats mention in their amendment, which was not selected. Those resources became available only because of the tough choice that the Government made in putting £1 billion towards making those choices available for everybody, not giving it to the better off. One of the things that we have been able to do with that money is to make £87 million available from the Department of Health to improve the amount of extra care facilities, which act as seed corn in starting people thinking about how they can increase extra care provision.
It is a tragedy that too many Conservative and Liberal Democrat spokesmen do not appreciate the importance of the extra care model of housing. I wish that they would go around the country to see some of the people with severe conditions—dementia, Parkinson's or physical conditions—who will be able to stay in their own home because of the extra care model that we are going to roll out. Those are choices that we are making available. It is sad that the Conservatives do not understand that older people want to make those choices and do not see a care home as an inevitable consequence of old age. It is sad that the Liberal Democrats stick with the nonsense of free personal care for the better off when the resources that such a policy would consume would be better spent on making choices available to everybody. If older people cannot hope that the Conservatives and the Liberal Democrats will hear their voices, they can at least be confident that the Government are listening to them and know that they want independence. They want to be respected, given the choice of planning their care, and being at the centre of it. They want dignity in old age, and high quality and well-regulated services. The Government are proud to be delivering that to older people everywhere.
The debate is important and Liberal Democrat Members welcome it. Such is its importance that I was disappointed that the shadow Secretary of State for Health apparently did not feel able to put his name to the motion. However, the previous speech more than covered that issue. I wish to consider a more interesting subject: long-term care for the elderly. It is fair to say that neither of the two larger parties has much about which to be proud, but this is no time to comment on the Tory record, because the Government have also provided a lot of material.
I believe that it is in fact time to comment on the Conservative party's record in power. I come from Gloucestershire, where the county council was capped year after year in the early 1990s so that it could not provide the sort of services that we are considering for elderly people. Who was in charge of that damage and distress? The answer is Mr. Howard.
I dare say there are countless other examples, but today's debate is not about that. [Interruption.] The Tories say, "Let's not bother." That is because they know that the record does not stand up to scrutiny.
Despite the words of the Government's amendment, they are in no position to rest on their laurels. Before the 1997 election, they promised to set up a royal commission to consider long-term care for the elderly. To give them their due, in December 1997, soon after the election, the then Secretary of State for Health, Mr. Dobson said:
"As people approach old age, many become anxious about how they will be looked after, how much it will cost and who will pay. At the general election, we promised that we would establish a royal commission to work out a fair system of funding long-term care for the elderly."
He announced the commission and proudly trumpeted:
"The new Government are keeping yet another of their election promises."
He described the terms of reference and said that the commission had 12 months in which to report. He continued:
"The task of this royal commission is neither simple nor easy, but it is important. The present situation cannot go on much longer. People are entitled to security and dignity in their old age"—
I seem to have heard those words in the past few minutes—
"so we must find a way in which to fund long-term care which is fair and affordable both for the individual and for the taxpayer. With the independent advice of the royal commission, I hope that we shall be able to establish a consensus from which we can fashion a sustainable system of long-term care that will meet the needs of elderly people well into the new century."—[Hansard, 4 December 1997; Vol. 302, c. 489–90.]
At the time, the Conservative's big idea was to fund long-term care through an insurance scheme. The royal commission readily dismissed it. However, the Government, having established the royal commission with their usual fanfare, decided to ignore one of its key findings, which was:
"Personal Care should be available after an assessment, according to need and paid for out of general taxation."
The Government's response to that recommendation was to declare that they were making unprecedented new investment in older people's services, which would more than fund the cost of the royal commission's proposals. However, they subsequently stated:
"The Government does not believe that making personal care universally free was the best use of these resources."
In some ways, I can accept that, but I have heard some worrying rhetoric today. For example, it has been asked, "Shouldn't the rich pay?" The fact is that it is not the rich but people on modest savings who pay. They still have to sell their houses and break into their savings to provide funding in a way that they never expected to have to do. I believe that the Government would admit that that is unfair to many people.
Seven out of 10 people already get some help with the cost of their personal care. Those who still live in their home do not have to have the value of it taken into account when their contribution to personal care is being assessed. The hon. Lady is talking about making personal care free to the better-off. If we had another £1 billion or so, which would be necessary to do that, could she honestly say that it would be better to give the money to people who already have resources than to spend it on enabling more and more people to stay in their homes for longer?
The Minister is merely reinforcing the inverse snobbery that is so prevalent in the Government. Seven out of 10 people may receive some help, but the other three out of 10 are not necessarily wealthy. We shall shortly have the same debate on tuition fees.
What is the point of setting up a royal commission if its advice is to be so roundly ignored? The Government will probably claim that they accepted the bulk of its recommendations, and that it would be wrong to place too much emphasis on this particular one. It might therefore be useful to turn to the statement made by the royal commission on long-term care, which was published in September 2003 and whose purpose was to review the extent to which the long-standing problems in long-term care and its funding had been resolved since the commission reported. The statement points out that the debate about long-term care and its funding is very much alive, that little has been resolved, that Governments in most of the UK still decline to act, and that there is widespread concern. That is the view of the commissioners. The statement also reminds us that this is an important issue not only for older people and their families but for the wider public.
The statement was damning, and highlighted other areas in which the Government's response had been disappointing. The first related to the setting up of a national care commission. The Government will point out that they have set up the National Care Standards Commission, but the remit of that body is much narrower than that envisaged by the royal commission, as its role is merely regulatory and falls far short of the wide-ranging role proposed by the royal commission. The reality is that the establishment of the new Commission for Social Care Inspection will result in a further erosion of the principles originally envisaged by the royal commission.
My vision is that increasing numbers of elderly people will not need to go into long-term residential care and that they will be able to stay at home, sometimes at a greater cost than would be incurred by their going into a nursing home. How will anything that the hon. Lady is describing help to achieve that goal?
I cannot argue with the hon. Lady's long-term vision, but if she will wait for me to develop my argument, she will see that, while her vision is worthy, it is not being fulfilled by the Government or the party that she supports.
The hon. Lady has talked extensively about the recommendations of the royal commission. Has she made an estimate of the proportion of a typical nursing home fee of £500 a week that is taken up by personal care, and that she is arguing should be funded? What proportion of such a typical fee does she believe should be paid for?
I am sorry that I do not have detailed figures; I only have the overall costs. I do not know if the hon. Gentleman is referring to our manifesto pledge, but I can assure him that it is fully costed.
The bulk of the report consisted of condemnation of the Government's refusal to adopt free personal care for the elderly. Tempting as it is to concentrate on that aspect of policy, however, it is not the only issue in this very crowded field, and I want to spend a little time examining the Government's record. It is difficult to argue with the assertion that people would prefer to stay at home. Many people would agree with that, but is it actually happening? Is that what the Government are achieving?
It is difficult to get to the bottom of this issue. The latest figures show that, in 2001–02, some 1.4 million people were helped to live independently at home through the provision of a variety of community-based social services. This was an improvement on the 2000–01 figure. A response to a parliamentary question revealed that no figures were available for the years prior to 2000–01. Strangely, however, I came across some figures provided to the Health Committee in the public expenditure memorandum of 2001, which showed that an estimated 1.5 million service users were then receiving community-based care. The reality is, therefore, that 100,000 fewer people are now receiving such care. As Mr. Burns pointed out, that seems completely contrary to what the Government are trying to suggest.
Although more money is being provided, it is reaching a smaller number of people. I have noted the carefully worded ministerial replies that refer to intensive home care packages. Those have increased, but a definition of "intensive" has been difficult to obtain. The reality is that the number of households generally receiving any sort of care has been reduced. I cannot square that with helping more people to stay at home. Many cases can be cited from around the country in which an older person who lives at home needs a small adaptation but cannot get it until they fall over, end up in hospital and social services come to the rescue. It seems that the system is skewed and is reactive rather than proactive.
The Minister said earlier that people can have home improvements, but in many cases those will take six months to happen, and those six months can be six months of misery. A constituent of mine told me about her husband whose situation meant that they had to have a downstairs toilet. In the interim before it was built, the only way in which they could cope was to have a commode in the main downstairs room. This lady felt that she could not invite any friends home. Is the Minister happy to preside over a situation in which people must wait months to receive the help and care that can help them get on with their lives? I think not. He will surely admit, however, that his priorities are skewed.
We should move on from the question mark over the figures, because that is a relatively small matter. What is of paramount importance is whether people who receive domiciliary care packages are receiving the service that they require and that they deserve. A report called "Nothing Personal" by Help the Aged, highlighted certain worrying findings. It found that levels of care often fell short of the hopes and expectations of those interviewed, and staffing pressures meant that the number of care hours that could be provided often met only the bare minimum of needs and sometimes did not adequately cover that. There was a particular problem with low-level users, unreliability and poor time-keeping of care staff left users in substandard living conditions and sometimes even in danger, and a common complaint was that management allowed workers insufficient time to travel between appointments so that they often arrived 10 to 20 minutes later than expected. That problem was exacerbated when users did not receive a single carer regularly, especially if the user's residence was remote or difficult to find. The report also found that the quality of care varied significantly within authorities, some agency workers simply could not cope with the tasks that they were asked to perform, care was particularly unpredictable at bank holidays, and all too often users were let down, especially by agency staff. Some Members will have watched the chilling "Panorama" programme that covered the same subject area. Evidence from Age Concern seems to indicate that that programme did not have to try hard to obtain material and that, sadly, the situations portrayed are commonplace.
I do not want a glib response from the Government saying that the matter is in hand and that all will be well because the National Care Standards Commission now has responsibility for this important area. In theory that is right, because the commission theoretically took over responsibility in April last year. All domiciliary care agencies operating before
The Government made arrangements so that existing domiciliary care agencies can continue operating until their application is determined—granted or refused—and no inspections would take place in the first year. At first glance, that is all very sensible. I draw the House's attention, however, to the reply to a parliamentary question that was tabled on
This morning, I rang the commission, but it could not tell me how many domiciliary care providers had failed the assessments. I hope that the Minister has that information at her fingertips when she sums up. I also searched the commission's website to try to establish the date by which all applications must be processed. The search proved fruitless, but when the question was put directly to commission staff, I was told, "There is no date." I am sure that the Government will admit that this endless procedure is completely unacceptable. Can the Minister explain why no date has been set, and what plans there are to rectify the situation?
Perhaps I can help the hon. Lady with one or two of her questions. The phrase "validated and being processed" means that the forms have been filled in, all the documentation has been received and the matter can be properly investigated; that is different from such people's having been assessed and met the criteria, as she perhaps realises. Frankly, it is a serious problem and at the moment I doubt whether many, if any at all, will meet the standard and be capable of full registration. That is one reason why we introduced the standards and regulations—to drive up the quality of care that such people are providing, and the standards that they are working to—and why we are trying to push them through as rapidly as possible. The hon. Lady and I should be on the same side, fighting the Conservatives, who want to take away all that regulation and checking and return to the old, laissez-faire attitude.
The Minister's answer, although honest, is fairly chilling. He has set great store by this approach. He has admitted that the existing system is failing completely, yet he seems happy to move more and more people into it before the standards are in place. Basically, he has just admitted that an increasing number of old people are being allowed to be subjected to a substandard system. That is totally perverse.
It would seem that the focus on bed blocking and care home places has taken the Government's eye off the ball. We often denigrate targets in this place, but the Government appear, as we heard in a previous debate, to be inordinately fond of them. Is the lack of domiciliary care targets evidence that the Government are paying only lip service to this aspect of care, or do they know the chosen solution has not been thought through and is ultimately bound to fail if nothing is done?
People are staying at home longer, but in some cases an individual's care would continue for longer still were it not for the fact that the carer reaches the end of their tether. Written evidence to the Sutherland report highlighted the fact that respite care has emerged as a main priority, and the report itself also admitted that such care is expensive. The way forward would appear to be to extend respite care not necessarily as a right, but by making it available to those most in need. I concur with that, because I regularly come across constituents who are providing care services, but for whom respite is simply unavailable. Where it is available, it is the occasional hard-won week, with no prospect of anything else to come. One elderly carer told me that if she could have a week off every six to eight weeks, she could cope indefinitely. It is the unremitting nature of such care that is affecting her physically and mentally, and in terms of her attitude to her husband.
Hampshire county council pooh-poohed the idea because of a shortage of beds, but a similar scheme is operating on the Isle of Wight. There are regular respite beds, people are on a rota, the home in question gets to know the patients and the system seems to be working well. It is too early to say how cost-effective it is, but the Government should be looking creatively at such a solution. We need more of these places in order to establish a solution.
All the evidence shows that these days when people do enter a nursing home—if they can find one locally—their general state of health is worse than it might have been some years ago. I am not saying that that is necessarily a problem if they have been allowed to stay at home, but it does mean that for many, a nursing care assessment is made and the individual is placed into one of three bands of care. That approach was the Government's alternative to that recommended by the royal commission, and it has been fraught with problems from start to finish. The first problem was the delay in getting through all the assessments. Okay, that is history, but it was a fiasco. The second problem was that this period seemed mysteriously to coincide with many nursing home owners putting up their prices. That may well also be history, but we are still stuck with a system that is bureaucratic, inconsistent and often downright unfair. It is not just me that thinks so, and I quote the royal commissioners again. In a recent statement they cited the general inadequacy of nursing care support levels in comparison to nursing home charges. They described the system as "arbitrary and inconsistent", when people with equal nursing needs receive different financial support rates.
One study showed that in Shropshire 48 per cent. of residents were assessed in the top band whereas in neighbouring Worcestershire it was 12 per cent. That is bad enough, but the overall figures show that the vast majority of patients are placed in the middle band. If that is to continue, it would seem far more sensible to scrap the expense of the assessments—it lies in human resources and high administration costs—and redistribute the money on a flat-rate basis, as in Scotland and Wales. The lack of a proper appeals process is another problem.
There are still further pitfalls. I make no apology for citing a recent constituency case. When a financial package is worked out, the assessment is usually that the patient will be in the middle band for nursing care. That is a fair assumption because, as we have already said, that is the reality for 90 per cent. of people. However, families often have to decide how much they can really afford to top up and then seek a nursing home that will fit those price criteria. In my neck of the woods, nearly everyone has to top up.
In my constituent's case, the home did such a good job that her health improved, so by the time that she was assessed, she was in the lowest banding. That meant that her family had to find the difference of £35 a week in home fees, which was impossible because they had already worked out the maximum that they could afford. It also placed the home owner in a difficult position. No other home placement was available in the area and the family was convinced that moving to another home would have made it difficult to visit the mother so often. The mother's health would decline, so she might then be eligible for the middle range of nursing care assistance again. The home owner wrote to me and described the system as providing a perverse disincentive to making sure that a patient's health improved. I am sure that other hon. Members will have similar stories to recount—
I do not believe that the Government will take any notice.
The hon. Member for West Chelmsford is being unfair. I have been speaking for a fraction of the time that he was on his feet. [Interruption.]
I have alluded to the difficulty of finding care places and the motion before us today stresses that aspect of the long-term care system. That is why I have concentrated my efforts on other aspects.
There are only so many times that the House can be expected to listen to the Laing and Buisson figures, so I shall spare the Minister a repetition of them. However, I query his selective take on those figures. I am pleased that, for once, he admitted that the number of hotspots was causing problems. As he knows, the report states that that is behind the drive to force local authorities to pay higher fees. The Minister may be complacent because he knows that hard-pressed social services departments throughout the land do not pay the going rate because they cannot pay the going rate. In many areas, top-up fees are the norm.
Rukba, a charity championing independence for older people, highlighted that problem and spent £448,000 in making good the deficit in running its homes. Its assessment is that the funding gap is distorting the balance of supply and demand within the private care sector, and it predicts a major crisis in care provision. It also points out that when care packages are provided, they are retrospective and there is insufficient emphasis on preventing problems. That view is shared by the Association of Directors of Social Services in "All Our Tomorrows", which calls for a broadening approach to prevention and the development of universal services to support it. The Government's approach is far too top-down, and the most recent example is the introduction of a £100 bed-blocking fine, which will be levied—
The hon. Lady is, I believe, the Liberal Democrat spokesman on long-term care for elderly people. Is she not aware that elderly people and those who live and work in the long-term care sector find the term "bed blocking" deeply offensive?
Before the hon. Lady moves away from the issue of delayed discharge, is she aware that the Liberal Democrat local authority in my area has said that, to avoid fines, it is best to invest in rehabilitation? That is what that authority is doing, so should she not encourage other authorities to do the same?
I find that slightly confusing. I have said that I think that preventive care and rehabilitation are the goals towards which we should be moving. In some cases, I have no doubt that the money will be spent wisely, but a recent report by Allyson Pollock stated that, if elderly patients were not moved within two days, local authorities might decide to put them in any home rather than in the home of their choice. That would be at odds with the Government's supposed aim of providing choice in health care. It seems that old people will not be allowed to have that choice, and that is a clear case of discrimination.
If that is the outcome, it would be very disappointing. We will have to wait and see, but there is a growing feeling of disappointment outside the House. A society can be judged by the way in which it treats its old and infirm. At the next election, the Government will be judged accordingly.
I have long been saddened by the cosy consensus between the three major parties in this House that the way forward for the care of the elderly is to shut up more and more people in care homes. Today, for the first time, I heard a Minister challenge that consensus and say that progress lies in another direction. I have been a Member of Parliament for nearly 17 years, and the speech by my hon. Friend the Under-Secretary of State for Health was the best that I have heard any Minister make in a debate on community care.
I believe in being even-handed in these matters. I shall refer to the Tory motion in some detail, but there is one element with which I agree—its criticism of the Community Care (Delayed Discharges etc.) Act 2003. The Select Committee considered that legislation in some detail. I do not think that it is an appropriate measure, as it addresses the symptoms and not the cause of the problem. If I have time at the end of my contribution, I shall say more about that.
I think that the Tories have displayed what we in the north of England call brass neck in tabling this motion. The previous Conservative Government created the supposed crisis in care. I want to look at that Government's record in this matter, as the problems that everyone accepts now exist are entirely the result of the policies that the Tories pursued when in office—and that includes the time when Mr. Burns was a Minister.
The background to the current position must be examined so that we can understand where we need to go now. The Tories locked us into a hugely expensive, and outdated, institutional model of care, and they did so in a big way. The previous Conservative Government were right to move children out of children's homes and mentally ill people out of long-stay institutions. Why, then, did they do exactly the opposite in respect of elderly people?
In an intervention earlier, I referred to figures from the House of Commons Library that I received in 1991. They showed that, in the 10 years between 1981 and 1991—when the Tories were in power—this country's elderly population increased by less than 5 per cent. and that the number of NHS elderly care beds fell by 17 per cent., but that the number of private care and nursing home beds rose by 500 per cent. There was a deliberate stimulation of the institutional care sector. Until the Treasury forced the Tory Government to address the Budget implications of that stimulation, the cost came to more than £10 billion. That money was spent on subsidising private care and nursing homes.
What alternatives to the institutional care sector and to care homes could have been developed with that money? Vast numbers of people who did not need to be there were being sent to care homes without being assessed in any way. The Tories introduced the profit motive into the care of vulnerable and elderly people, and they did so big style. I find that offensive. I find offensive the wholesale privatisation and marketisation that took place under the Thatcher and Major Governments.
The Tory motion deplores closures, but why do most care homes close? They close for the simple reason that owners know they can make more profit through selling them for something else. The property market has moved in a way that lets them make more money. The whole problem, which the Tories harp on about constantly, relates to their own policy of introducing a market into the care of elderly people.
I am appalled that the Tory motion has the cheek to criticise regulation of the care home sector. The Tories' record was to draw into the care of elderly people some profoundly unsuitable people motivated solely by the opportunity to make big money. I was shadow Minister for community care between 1992 and 1995. I met people running care homes—a minority, I admit: I am not over-egging the pudding—whom I would not trust to care for a dog, never mind a vulnerable elderly person. Those were the kind of people attracted into the care home market under the Tory Government. I recall speaking at a care homes conference as shadow Minister, and my right hon. Friend the Minister without Portfolio was present. He applauded something that I said, and he was assaulted by one of the people attending the conference. Those are the kind of people whom the Tory Government attracted into the care home market.
I recall raising in speeches here practices that were being undertaken in care homes. One example that I remember vividly was of 16-year-old youth training scheme students being used to catheterise elderly people in private care homes. That is on the record: it happened in Liverpool. That was the record of the Conservative Government when it came to care of the elderly. Mr. Yeo talked about low politics earlier: low politics is the motion before us, which does not address the quite disgraceful record of the Tory Government on care of the elderly. They resisted—the hon. Member for South Suffolk was responsible for community care—my attempts on several occasions to introduce a Bill regulating domicilliary care to ensure that people who care for folks in their own homes were properly checked on for criminal records and so on. The Tory Government resisted pleas from the social work profession to introduce regulation, but thanks to the present Government we now have the General Social Care Council to ensure that people working with the vulnerable and elderly are properly checked. That is right.
The Select Committee on Health is currently looking into elder abuse, which is highly relevant to the debate. We were told a couple of weeks ago that 500,000 or more elderly people are being abused in this country at any one time. The question for the Tories on their proposed deregulation is whether it means the repeal of the Care Standards Act 2000, and the scrapping of the Commission for Social Care Inspection, the General Social Care Council and the national service framework for older people. If it does not mean that, what does it mean? Glib comments about deregulation and over-regulation are unacceptable against a background of serious problems with the care of elderly people.
The Tory motion is clear evidence, as the Minister said, that the Tory party is entirely provider led. It has been hijacked, lock, stock and barrel, by the care home owners. Those owners are writing Tory policy, which is why Tory Back Benchers seem unable to see any possible alternative to care of old people other than sticking them in institutional care.
I have one or two points on which I hope that the Government will reflect. I have made them before and will continue to make them. At some point, I hope, I will succeed in getting across their merits. First, I make a plea for a more radical longer-term agenda for care of the elderly. In both the Ministers present, particularly the Under-Secretary of State for Health, my hon. Friend Dr. Ladyman, we have people who are prepared to listen and who understand the need to move in a very different direction.
I may be the only person in the House who is attracted to those countries that have got rid of care homes. My long-term objective, as someone who is 55, is that in 20 years, when I may need some form of care, it will not involve sitting wall to wall with and looking at other, similarly demented, gaga people. Frankly, we can do better than that. My mother ended up in that situation, and I swore that I would do all in my power in politics to ensure that we secure a very different future for elderly people. We are slowly but surely improving the quality of that care. We need to get away from the nonsensical outdated models of institutional care that, frankly, belong not in the 20th century, but with the workhouse in the 19th century.
I want a planned policy of reducing dependence on institutional care with the development of positive alternatives. The Government are moving in the right direction on housing with care and on extra care. We need to follow the model established in other countries, such as Denmark, which have got rid of institutional care. The private, independent and voluntary sectors are gradually going in that direction. The obsession with old people's homes takes us away from the real agenda. Let us get into intensive home care packages and telecare, the type of facilities that we know we can provide to ensure that people remain in their homes.
I end by making my usual plea that the way forward in the longer term is to merge health and social care within common budgets. If that were to happen, we would not need arrangements for fining social services when people are stuck in hospital beds.
I pay respect to the passion with which Mr. Hinchliffe stated his case. He is long experienced in the subject, which I have appreciated for many years, and he put his case well, although obviously I disagree about the history of the Conservative party.
I also disagree with the Minister about the so-called myth that the Conservative party is in the hands of the providers and that it can talk only about nursing homes and residential homes. We all know that our elderly relatives wish to stay in their own homes as long as possible. I have an aunt who is 97. She gave up driving her car only recently, largely because she could not back it into her garage. She was insistent on staying in her home. Only very recently, in the past month or so, did she take the voluntary decision to go into a residential care home because she could not cope any longer. Most people wish to stay in their homes. If that is the Minister's vision, we share it. I have no doubt about that. Keeping people in their own homes is the vision of Mr. Burns. There is no disagreement on that.
I agree with the hon. Member for Wakefield that there are problems across the board. We all accept that there are severe problems. I am privileged to be a parliamentary representative on the Greater London forum for the elderly. We recently held a seminar in the Jubilee Room of the House of Commons. It was attended by a large number of representatives—or at least as many as we could squeeze in—from all over London.
The Minister may be interested to know that we did not simply discuss home care and care homes; a range of issues was raised. The representatives decided that the issue was the erosion of community care in the London area. We discussed chiropody services, the closure of local pharmacies, domiciliary care, NHS dentists and adaptations. I welcome what the Minister said about adaptations, and the representatives were concerned about how quickly they could be provided and whether people could get what they required. That range of issues forms part of the community care package as it is seen by the elderly. My hon. Friends were right to initiate the debate as an across-the-board issue, not just one that relates to care homes.
On care homes—we must not be frightened of talking about them just because the Government say that we are in favour of care homes and nothing else—the Minister said there was a huge surplus of places in Kent. That is not the case in Bromley, which is not far from Kent, as he is well aware. The primary care trust recently had to convert beds in the local community hospital into 44 intermediate care beds. I know that intermediate care is only for six weeks, but it did that because of the great difficulty of finding suitable homes for people who were unable to leave hospital as a consequence of the homes and packages not being available to them. So there is a problem.
The Minister also rightly said—I praise him for this—that he hoped to tour the country, pointing out best practice to local authorities and fixing fees for local care home places. I welcome that, but he must be aware that exhortation from Ministers does not always produce results in the detailed way that he would want. The fact is that there is a marketplace, as he acknowledged, and market solutions are determined by local supply and demand. However much Ministers may wish it otherwise, fair and suitable conclusions are not always reached.
Furthermore, local authorities use their muscle-power with adverse effects for local care homes. They drive down prices and, as a consequence, individuals who pay for themselves have to pay much more. There is often a difference of several hundred pounds between what a self-payer pays in a care home and the payment for a person whose local authority is funding their care. People who have provided for themselves for their whole life see that local authority support as highly unfair to them. That is one of the factors that has arisen due to the shortage of supply in places such as Bromley.
Even with the private sector subsidising local authority clients, homes are still closing down, as the Minister acknowledged. They are closing down throughout England but especially in London where the costs and difficulties are greater and where the possibility for making a financial killing is much greater from property development than it is from running a care home. There is no doubt that that is a huge problem in the London area and the Minister must not ignore it. I hope that he will spend some time in London, as well as in the rest of the country, and point out that there are difficulties in the capital, too.
I hope that we all agree about domiciliary care. However, there is a problem that seems to have escaped the Government's attention. I recently received a letter from a lady in my constituency, which states:
"I started a small business 2 years ago, providing support services for the elderly, in order to keep them independent in their own homes. This involves shopping, meal preparation, prescription runs and domestic help etc. Quite often, we are the only people our clients see in any week and we become good friends. This year the Government introduced the National Care Standards Commission. Although I comply with all the standards as set, I am not in a position to pay the £2,500 registration fee, nor the £300 for registering each of my staff."
That lady has a staff of 16.
I had not realised that the fees for registration with the commission were so high. As the lady cannot afford to register her staff, she has to pay VAT. She serves some of the poorest people in our society, many of whom are on income support, and is competing with larger organisations that do not pay VAT and can make economies of scale. I raised the matter with Age Concern, which replied:
"The issue of VAT on homecare is one that has been raised a number of times over the years and Age Concern has been very active in trying to ensure that older people who need care services because of their disability do not pay VAT.
Your enquirer does raise an interesting point . . . We had hoped that the problem of VAT and home care had been resolved but your enquiry makes us realise that there are still some further outstanding issues."
I have only just received that reply from Age Concern, and I shall write to the Minister about the matter as it affects people in our communities who are most in need and I should like him to address the problem. Although those people receive domiciliary services, some providers have to compete against larger organisations that are VAT-exempt.
We can all agree about the sort of vision that the Minister outlined, but it is not being delivered. There are many, many problems and the Minister and the Government have still to address them and acknowledge their importance.
It is a pleasure to follow Mr. Horam, who clearly has a great interest in care of the elderly—as I do. When I qualified as a nurse, I decided to concentrate on that specialism and I have always remained interested in the care and treatment of the elderly and in new innovations for older people in our community.
Sandra Gidley referred at length to the royal commission on long-term care for the elderly. In 2001, we held a fantastic conference on that issue in Crawley. Many people, especially the families and friends of people who had to remain in hospital, told us that they could not get access to residential care and that there seemed to be a huge problem. I thought that the best way to deal with the matter was to get everybody around a table at the House of Commons and to have a meeting of all the stakeholders, including the care home sector, so that we could discuss things at length and come to a conclusion about why we believed there was a problem.
Since December 2001 there has been a huge improvement in Crawley, especially in terms of delayed discharges and lack of access to the care home sector. There are many reasons for that. The motion made me cross because it devalued and debased something important by making the spurious assumption that regulation is the main problem for long-term care of the elderly.
I want to say a little about what is being done in my constituency to give older people the care that they deserve. Of course we cannot yet rest on our laurels, but enormous changes have been made. What struck me when I got everyone together—members of social services departments, GPs, people in the care home sector, housing representatives and many other stakeholders—was that few of those people had met before or had an opportunity to discuss how things could be improved. The crucial element that had galvanised them was Government regulation. It was no longer acceptable for 70 out of 400 beds to be inaccessible because of delayed discharges, for instance.
We thought that there was a capacity problem in Crawley. We thought that there were difficulties related to funding, housing and a rapidly growing elderly population. When we began to discuss solutions, however, no one mentioned regulation; it was not an issue for all those who were trying to ensure that care of the elderly was the number one priority. What emerged were issues such as improved joint health and social services activity, and that is where improvement has been particularly evident.
We managed to reduce the 70 delayed discharges to something in the teens, and the number has fallen even more since then. I know that my hon. Friend Mr. Hinchliffe—whose work on the Select Committee I respect enormously—is concerned about the Community Care (Delayed Discharges etc.) Act 2003, but I firmly believe that it has provided the extra lever that was necessary to get people round the table to stop the disgrace of patients being stuck in acute settings inappropriately.
We found that when people met regularly to discuss individual cases, it was possible to get the figures down. What struck us most forcefully was that the capacity issue in the care home sector was, in fact, about inappropriate placement. Everyone seemed to think that because elderly people were not well supported at home—because they were having falls, taking drugs for a long time and not being checked often enough— they could not cope any more. Since then, however, there has been a massive intervention by Crawley primary care trust, which now watches older people much more closely. It ensures that they are checked properly to make sure that they are not being poisoned by the drugs they are taking, and are able to support themselves at home.
We also found that it was a good idea to use care homes for intermediate and respite care rather than long-term care, and to set aside six beds to prevent older people from having to go into hospital in the first place. That has proved a tremendous success.
Unlike my hon. Friend the Member for Wakefield, I see a future for the highest-quality residential care; but those who are not prepared to provide such care should not be in business. Therefore, the regulation issues are a complete red herring. If that is making people decide to leave the care home sector, so be it.
We have an extra problem locally. As the hon. Member for Orpington suggested, land prices are incredibly high, particularly in the south-east, so it is very hard to persuade people, especially those who are getting older and have been in the business for a long time, to continue in the business if they are offered perhaps £1.5 million for a piece of land for redevelopment. So we have a difficulty delivering in that sector, especially in the south-east.
None the less, with all the new proposals in place, we are making true headway on ensuring that people have proper choice. To walk into the extra care home in Crawley is an absolute delight for me. More than 90 per cent. of the people who went into that home five years ago are still there. That is a testament to having all sorts of care and not concentrating just on the care home sector, but providing real choice and making it available to all the people about whom we care.
It is pleasure to follow Laura Moffatt, who sought to introduce an element of balance in the debate on what is an extremely important subject for almost all hon. Members.
I begin by declaring my wife's interest as a non-remunerated trustee of Brackley cottage hospital, which is a charitable trust and was formerly in the NHS, but now provides services both as a registered home and as an agent for the NHS. Perhaps another debate would be an appropriate occasion to piece together the history of that organisation's attempts to position itself in the right place to deliver intermediate care in the face of constant, serial reorganisation by the NHS. I am now personally involved in a stakeholder group convened by the local PCT to try to find a way forward. I have become very familiar with the situation that the hon. Lady has described in relation to step up, step down, intermediate, terminal and palliative care, as part of the range of provision that may operate and is certainly required.
I have been most disappointed by the fact that the Minister tried to characterise the debate as one in which the Government say, "We are in favour of the widest possible range of care at home, and the Tories want to see only residential care." I can assure him that that is not our view. In any case, such care is not always appropriate at any given moment. I am thinking of my elderly mother, who died in July at the age of 93. She had to have spells in hospital and spells of respite care. In fact, she died at home, and we were pleased that she was able to be at home when she died.
There is no simple solution to a complex problem, but I wish to draw on one statistic that came to me as part of the working studies for the local review. It relates to Oxfordshire because Brackley, although part of my constituency, is treated as part of the Oxfordshire health authority for this purpose, as my hon. Friend Tony Baldry, whose constituency neighbours mine, will know. It was reported that 45 per cent. of beds in acute hospitals in the county of Oxfordshire on any one day were inappropriately occupied. I say to the Minister in all seriousness that that shows the extent of the current problem. His intentions to resolve it may be real, but he has not yet been able to discharge that problem.
Does the hon. Gentleman accept that the number of people going into hospital inappropriately and interventions such as avoiding slips, trips and falls are needed to address delayed care transfers and that they must be considered as much as the output side of the equation?
I entirely agree—perhaps we are moving into a more constructive discussion. I tell the Minister that the Laing and Buisson study, the figures that have been cited and all my business experience suggests that if capacity is only 102 per cent. of demand, it is difficult to deliver a proper service. Long-term demographics suggest that the numbers will expand anyway. If we are in a situation, as the Minister conceded, in which some people will require residential care—albeit not for the whole time—or step-up, step-down or intermediate care, there will be a need for residential places, although they might evolve over time.
However much the Minister tries to explain things away, there is still a strong element of complacency and wishful thinking in the Government's approach. I referred in an intervention to a study carried out by my local community health council—the situation therefore relates to Northamptonshire—that reported that there had been a 25 per cent. reduction in capacity over 30 months, which might reflect several of the pressures that exist. It is difficult to move to an ideal pattern of care if what is available is reduced at such a rate.
Fining local authorities will do nothing to increase capacity. It was put to me recently that one of the interesting elements of the legislation that could apply is that the number of beds that are defined as finable because they are subject to the analysis for delayed discharge, might be refined down by agreement so that the real coverage of the total number of beds in Northampton general hospital, for example, would not come into the equation and thus there would be further massaging of NHS figures—we are perhaps not unfamiliar with that. The Minister might like to reflect or comment on that.
The reality of our local situation is that our local authority's fee offer for the provision of care is unlikely to increase by more than 2 to 3 per cent. due to the state of its budget, yet costs in the sector are ratcheting up. It is inadequate for the Government to take no account of the pressures imposed by bureaucracy. One of my local medium-sized care homes that briefed me for the debate referred to the 20 per cent. increase in registration fees, which means that it is likely to pay some £3,000 in registration fees, let alone compliance requirements. Criminal Records Bureau checks will cost it an additional £1,000. It faces many other pressures because although it pays above the minimum wage, its wages will reflect changes to that rate. It also faces other general pressures from the economy.
It is difficult to envisage even the best care homes keeping in step with the cost pressures that they face, and my experience suggests that it is equally difficult to find immediately available alternatives. I single out for the Minister another local case in which the local authority was unprepared to offer fees at the level that a care home required. The alternative provision suggested was in Wellingborough, but it would not have been fair to move an elderly person some 30 miles because of a row between two public authorities.
The situation is worrying and it is insufficient for Ministers to say that it is not. It would be more sensible for them to say that they need a palette of different provisions, for things to evolve and to work in partnership with providers, but pretending that there is not a problem to start with will not help. Most of us know how the situation works for our constituents.
It will be possible to solve the problem if sufficient resources are made available, but the solution is certainly not more bureaucracy. The danger is that the Government's present attitude might evolve in an unplanned way to address the problem. If what we do is insufficient and what is outlined in the press release on the new piece of eye-catching legislation with no substance is not delivered, there will be evolution—or regression—into a two-tier system. Those who can afford to pay the fees required in the market will continue to use the residential sector at high cost, although they will probably erode their capital or become unable to provide an inheritance for their descendents. People who cannot afford such care will simply fail to find a place, because their only recourse is to social services and it will be uneconomic to offer them one. They will end up bouncing back into hospital, at ruinous cost to us all, or into inadequately supported community care. That is light years away from a rational and objective discussion of care requirements which, I hope, we all believe should be our starting point. It is sad that the Government have programmed themselves to fail. I do not believe that they can avoid that, but I would be delighted if they do. The burden is on Conservative Front Benchers to introduce the realistic proposals that we all want on the delivery of appropriate care for elderly people.
It would not be right, as has been said many times in our debate, to assert that there are no problems in the system. However, to assert that there is a crisis is going much too far. It not only inflicts stress on people who are in the system, as well as their families and other people who are waiting for care, but skews the debate and stops us taking a sensible view of the situation. However, there have been signs of consensus among Members on both sides of the House, especially on domiciliary care. I was pleased to hear from Mr. Horam that the Conservative party is not denouncing domiciliary care, as appeared to be the case at the beginning of our debate. I hope that I understood him correctly, because domiciliary care is a valuable part of the package that is required.
Domiciliary care is one aspect of care where we certainly cannot say that one size fits all. We all know people in their 90s who are still digging their gardens, sweeping their paths and looking after themselves perfectly well. We also know people in their 60s who are in the early stages of Alzheimer's or dementia. The range of care must therefore fit people's circumstances and respond to their problems. We must consider how we got to where we are now, whether the arrangements work, what we learning and where we are going. I do not want to dwell too long on the Tory years, as they do not bear too much examination. However, I remind the House of Ray Griffiths' report on the care sector, which was commissioned by Lady Thatcher. The report appeared after the privatisation of care homes and examined care in the community. It said that the system was chaotic and more planning and investment were required for care in the community.
The Government are dealing with those requirements. In my own area, people have told me that the measures that we are debating this afternoon were a stimulus for change. All the care in our area has been reviewed and the results have been encouraging, as people believe that the fines for delayed discharges will never apply to them because, in response to the Community Care (Delayed Discharges etc.) Act 2003, they have changed what they do. They invested quite a lot in rehabilitation so that elderly people did not have to go into hospital or, if they did, that there was appropriate care for them on discharge. However, they realised that much more needed to be done and there is now a huge amount of investment enabling that to happen.
People in my constituency have looked at the range of care that needs to be provided. That is a distinctive feature of the mixed market of care homes, and makes it different from other markets. We must plan that market. We cannot wait for market drift to determine how many homes of a particular type are needed in any one area. We must look ahead and see how many types of provision are required for people with different needs. A pure market model clearly could not work in this sector. I am pleased to hear that that has not been suggested by anyone. Such a model would be mad.
I would not be happy with any model that excluded any form of help that could be made available. To assume that any model could be taken out, on the assumption that we all want to be in our homes for ever and a day, would be wrong. It would say to people that even if their family felt that they could not support them properly in their own home with the package of care available, people could not make that choice. That would be wrong.
If the package of care is to be available, it should be properly scrutinised. My own local authority is concerned about the level of scrutiny. It feels not that it is over-regulated, but that the inspections are stringent and sometimes difficult. I have thought carefully about what the local authority says, and I have also looked at the case histories of people who have been to see me. I want to see the evidence for the local authority's view that it is over-inspected. If it is over-inspected, why do I have cases in my surgery where people have had bedsores while they have been in care, where people have not had any stimulation during the day, where they have not received the proper food, or where the water in their water jug has not been changed properly?
Such things, on a day-to-day basis, month in, month out, can change a person's life significantly. A jug of water may not seem much to us, but to an individual who does not have access to the proper drink during the day, it means an awful lot. It means a lot if someone is given milk when they have a milk allergy and the notes have not been checked. It means a lot if staff have not been trained in the proper use of hoists, when they can be used and when they should not be used, so that a person is left dangling uncomfortably, and in one case left dangling uncomfortably as a punishment, because she had been "a very naughty girl". A patient who is suffering from dementia is not a very naughty girl, but someone who needs the highest standard of care.
When such cases are reported to me, that tells me that inspections are necessary and should take place ad hoc, without warning. I have heard from people working in homes that they sometimes have quite a lot of notice and they make sure that the place is spick and span. They make sure that all the proper cleaning equipment, which they often cannot be bothered to use, is used on that day. They make sure that the entrance to and egress from the building are clear, which they do not always bother to do as it is a lot of bother to move trolleys.
I find such features of the system abhorrent. That is not historic information; it comes from people working in the system now. That tells me that we might not yet have the inspection system right, or such things would not happen. We should not loosen the inspection regime. We should work harder and make sure that the standards in our homes are the very best that we can provide.
I shall be brief so that my hon. Friend Bob Spink can get in.
Only time will tell whether Professor Pollock's concerns about the Community Care (Delayed Discharges etc.) Act 2003 leading to elderly people being put into inappropriate care come true. My concerns about the Act are different. It creates a blame culture and sets social services against health authorities, when they should be working collaboratively together.
In Oxfordshire at present there are 55 people subject to delayed transfers. Only four of those come into the statutory category. The other 51 are waiting to be moved to other NHS facilities—by far the most common problem—or there are disputes with relatives about where they should best be placed. It seems daft to set social services against health providers. I agree with the Chairman of the Select Committee. I do not see why we have two separate budgets. We have five primary care trusts in Oxfordshire, a couple of acute NHS trusts and a huge social services department. I do not think that that involves anything about democratic accountability. To be honest, I do not think that any Members of Parliament or county councillors could say with their hands on their hearts that they knew where all the income streams were coming from and going to. If we are going to tackle delayed discharges and ensure that people get appropriate care, why on earth do we not have a simplified single budget and stop the blame culture in which health authorities and social services blame each other for what is happening?
No, as I have very little time.
Next month, to try to get to grips with the problem, rather as Crawley had to do, we in Oxfordshire are having a conference including all the Members of Parliament in the area and county councillors and officials, simply because we need to have everyone in the same room at the same time to discover what on earth is happening. That should not be necessary, and we should have a collaborative approach.
In addition to those who are delayed transfers in acute hospitals, I understand that there are about 46 delayed transfers in community hospitals. Of course we believe in domiciliary provision, but there is also a need for nursing home and residential care provision. Ministers must accept that that provision is not growing, but contracting. Whatever they say at the Dispatch Box, one of the reasons why it is contracting is over-regulation, and one cannot get away from that. In Oxfordshire, we are not seeing new provision coming forward from the private sector, and the public sector seemingly cannot afford to make it either.
We have had a lot of Punch and Judy-style debate this afternoon, but I do not think that that helps anyone at all. Can we not try to ensure that more collaborative work is done? I do not think that the Community Care (Delayed Discharges etc.) Act 2003 will help to achieve that aim. I do not think that attacking nursing home proprietors as profiteers, as Labour Members have done, is helpful. Nursing home proprietors whom I have met in my patch are often concerned clinicians who have been doing a lot of detailed work over many years in dealing with patients with serious Alzheimer's and dementia problems. They are not the sort of Dickensian rapacious profiteers that some people have suggested they are. That is a complete caricature.
I ask the Minister to please see whether we can try to achieve a more collaborative approach. He talked about best practice conferences. I should like to give him an invitation. If he feels that the Oxfordshire health economy or social services are failing in any way, will he please let Oxfordshire Members of Parliament know? Otherwise, can we get away from blame and recognise that all of us have to work together to deal with what will become an increasing problem as we have a larger ageing population, as we will need better care and greater amounts of it? Simply fining or blaming authorities will not miraculously resolve the situation overnight, as the facts clearly demonstrate. We require a collaborative approach, not a confrontational one.
The long-term care of the elderly is clearly a complicated and very important issue for us all. Many excellent points have been made by colleagues, especially on the Opposition Benches, but also on the Labour Benches. I shall not repeat those points, as I wish to refer to a single example and a specific case study to show how wrong the Minister was to say in his opening remarks that residential care was somehow optional for some people. There is nothing party political in what I am going to say. I shall simply speak honestly for vulnerable people in society, as we must in this place.
First, I should like to pay tribute to the many care home providers. I congratulate their staff at all levels, including the managers and owners, on their care and dedication in an often difficult area of work. Society is indebted to them and they generally do a most excellent caring job.
I wish to raise a specific case in order to illustrate a major problem. Mr. Curran is a constituent of mine whom I have visited several times over the past year in Goldenley care home. It is a very well-run home with excellent, dedicated staff and management—a credit to its community. Mr. Curran is a delightful, dignified gentleman for whom I have the greatest respect, and he is singularly fortunate to have a wonderful, caring wife, Doreen, who has fought to ensure that he gets the very best possible care for his medical conditions.
Sadly, Mr. Curran is very ill—indeed, I have seen him becoming increasingly so over the past six months. He has suffered a number of strokes and the ravages of neuro-degenerative disease. On
"considerable health needs which are:
Irreversible brain damage due to many strokes
Parkinsonism and just recently arthritis has been diagnosed.
My husband has deteriorated considerably within the last three months and is now mostly in a semi-vegetative state. There is very little response from him now. He cannot communicate; he is unable to move. He is bedridden most of the time. All food, including medication, is now liquid and there is difficulty in feeding as his mouth is rigid and he cannot open his mouth, necessitating the removal of dentures to access his mouth more easily. His body is rigid and he cannot move or straighten his legs. His hands are very swollen and it is impossible for him to move them too."
"From the outline of my husband's condition you will see that the care he receives is more than social."
Mrs. Curran believes that her husband should qualify for health care funding for the care on which he so obviously depends for his life. I agree with her when she says, as she did in a further letter to me, also dated
"it is grossly unfair for my husband to be forced to pay for care in view of the fact that he is such a very sick and disabled man."
I am pleased to report some recent improvement in Mr. Curran's condition. He is now able to speak a few words—that took place over the Christmas period. I am sure that the whole House will send its very best wishes to Mr. and Mrs. Curran and to everyone at the Goldenley home.
Having set out the background, let me read out the decision reached by the authorities on the funding of Mr. Curran's medical care. In a letter dated
"As a result of the hearing the Panel reached the conclusion that the Castle Point and Rochford PCT had acted in accordance with the published eligibility criteria of the Strategic Health Authority in that Mr. Curran's needs for nursing and other clinical care are not more than incidental and ancillary to the accommodation provided."
It seems that the published eligibility criteria of the SHA dictates that Mr. Curran's
"needs for nursing and other clinical care" are "incidental and ancillary" to the accommodation provided. That is perverse and wrong. If the panel's decision was valid, I suggest that the criteria that it used are wrong. I therefore ask the Minister to look into those criteria and to make any changes that are necessary to reflect what should be a civilised society's response to providing medical care for the elderly.
Home care is not an option for Mr. and Mrs. Curran. He could, of course, be transferred to hospital, where he would get his care completely free of charge, but that would be against his best interests and would reduce his personal quality of life at this time. That would not only be wrong, but against the public interest, because it would be more costly than his residential care home and would block a hospital bed, thereby denying care to other people. The Government clearly need to finesse their policy to prevent that kind of nonsense from taking place and to ensure that appropriate care, and the funding of that care, is provided for people like Mr. Curran, of whom there are many thousands at the moment and will be many more thousands in years to come. I see that the Minister is listening to me carefully, and I thank him for that.
Will the Minister ensure that private residential care providers are encouraged by fair funding to supply what we expect to be an increasing demand on their services from 2005 onwards? Does the Minister also agree that we must break down the rigid barriers between health and social care and integrate funding streams for the NHS and social services? Above all, we must drop the political correctness in social care and become more person or patient committed.
There is a sense of déjà vu about this debate. Yet again, we are debating long-term care and the crisis in care for the elderly, whether at home or in residential care, about which we have held numerous debates. Each of those debates has been initiatied not by the Government in Government time, but by the Conservatives in Opposition time.
There were some interesting contributions from Back-Bench Members. Mr. Hinchliffe congratulated the Minister excessively on the best speech he had heard in 17 years. It was not the best speech that I had heard from the hon. Gentleman. If anyone has brass neck, it is he, for laying all the blame for the current problems in care at the door of the previous Conservative Government. We were not criticising all regulation but excessive regulation. Frank Ursell, chairman of the Registered Nursing Home Association, said that the regulations make important what is measured, rather than measuring what is important. No one ever died from a small room, but elderly people have died from poor care standards. It does no one a service to rubbish the whole care home sector, as the hon. Gentleman did.
No, I want to make progress. The hon. Gentleman suggested that the scandals and misdemeanours of a few in the past represented the whole sector. That is deeply offensive to many people who run good care homes, and to the people who pay good money to stay in them.
On a point of order, Madam Deputy Speaker. I appreciate that the hon. Gentleman will not give way, but I should like to ask your advice about one point. According to the Order Paper, the debate is about the long-term care of elderly people, yet the monitors state that it is about care homes. That is an important point of procedure, and I would welcome your advice, Madam Deputy Speaker, on who is responsible for saying that the debate is about care homes. Perhaps the hon. Gentleman's comments will simply be about care homes, not long-term care for the elderly.
I am surprised that the hon. Gentleman did not blame us for the monitor problem. However, other hon. Members made more measured and positive contributions.
My hon. Friend Mr. Horam said that homes were suitable for some people and care at home was suitable for others. Laura Moffatt made positive comments. I am sure she would have paid tribute to West Sussex social services—an excellent authority—for many of the improvements that they have brought about in the north of the county that we represent. My hon. Friend Mr. Boswell referred to the use of step-up and step-down roles for care homes. Kali Mountford emphasised that we favour domiciliary care. Of course, most people want to stay in their homes for as long as possible, but that is possible only if we provide the care to support them there. My hon. Friend the Member for Banbury made an important point about the blame culture in the Community Care (Delayed Discharges etc.) Act 2003, which causes so many problems. My hon. Friend Bob Spink took up that point.
There is a crisis, which is not improving. There was a crisis when we raised the loss of 40,000 care home beds; there was a crisis when we raised the loss of 61,000 beds, and there is a crisis now, when we have lost 74,000 care home beds since 1996. There is also the crisis caused by the decline in the number of care home packages for vulnerable elderly people, the increasingly high thresholds that have to be achieved to qualify for them and the potentially counter-productive implications of the newly up-and-running delayed discharges measure.
My hon. Friend Mr. Burns has presented all the stark figures concerning the number of lost beds, including the 13,400 lost beds that account for 745 independent homes that have gone out of business in the 15 months to April 2003. Decline continues in new registration for new homes, and hotspots with acute shortages of supply increase. That applies not only to the south-east and the south-west. The problems place greater strain on GPs and the army of 7 million carers who are increasingly exploited by the Government through stealth.
The demographics over that time are also worsening. I know about demographics; I represent Worthing, where we have some of the oldest people in the country. For the first time, there are now more over-60-year-olds in the country than under-16-year-olds. It is predicted that, by 2015, nearly a quarter of the population will be over 60—an increase of 9 per cent.—and that the number of over-85s, of whom we have the greatest number in Worthing, who need and deserve extra care, will increase from 1.1 million to 1.4 million over that time. Three times as many people over the age of 100 will be living by 2015.
Throughout all this time, the Government's response has been one of denial, confusion, incompetence and caricature. There have been limited U-turns on the over-prescriptive implementation of care standards acts, climb-downs on Criminal Records Bureau checks, claims of using lighter-touch regulation, and a rubbishing of care homes across the board as "banging up" elderly people, as the former Secretary of State put it. Today we have again heard the Minister claim that there is no national crisis in the care sector. He is the "Crisis? What crisis?" Minister, and he spent 33 minutes today rubbishing the care home sector and accusing it of peddling myths, yet he was perfectly happy to quote a report from Christie's—of all people—about what was going on in the care home sector. He also made a disgraceful criticism of the British Medical Journal for being sloppy in some of its reporting of this matter.
We have heard some interesting innovations, including the claim that the Community Care (Delayed Discharges etc.) Act 2003 was actually a money-spinner for local authorities, and a profit-making exercise. Is this a new turn in Government policy? Are we now going to see an early discharge of pupils Bill to introduce truancy fines, so that education departments can benefit from truancy? Perhaps we could have a Bill to introduce fines on late-running buses to fund local authority transport. This is fantasy island in the extreme. Ministers may come and go, but this problem is set to stay and to get worse. It affects some of the most vulnerable people in our community, and they are being failed by the Government.
The Minister complacently states that we must accept that the sector is contracting, and that that process will go on. He justifies that by saying that more people want to live in their own homes for longer. I am sure that that is right, but this is a matter of horses for courses, and what is needed is real choice: available, quality, serviceable choice. Of course staying at home is an ideal, but only if people are given the support to do so. We are increasingly seeing elderly people living at home, growing older and frailer, while the level of their care package diminishes or, in some cases, is withdrawn altogether. In some cases, there is no package available in the first place. Living at home is not a real choice if a person's quality of life diminishes unreasonably by doing so.
There is an added problem of the shortage—particularly in the south-east of England—of skilled social workers, leading to the greater use of agency staff to service home care packages, often changing quickly and going in and out of homes quickly without building up a relationship with the clients they are looking after. If the clients cannot cope, they then become emergency readmissions to hospital, of which we have seen an enormous increase in numbers. As the Royal United Kingdom Beneficent Association put it, people need independence without isolation in order to have a real choice about remaining at home. That is not happening, despite the best endeavours of social services departments, which are facing a crisis in funding.
Despite all the Minister's bluster, the vast majority of increases to local authorities have been passported to education. West Sussex, my local authority, has left just £400,000 to service social services, transport, highways, the environment and all the other services. We also got another £6,000 recently thanks to the generosity of the Chancellor. This is in a county in which the formula grant per head gives £503 to my constituents, compared with £810 per head in an outer-London borough. It is also in a county in which social services budgets are being stretched between elderly care, child protection and the implications of the Laming report and the forthcoming Children's Bill; these all constitute demands on a dwindling budget.
The pips have long since given up squeaking, and it is the elderly and vulnerable people who are being squeezed the most, whether in three-star, two-star or no-star authorities. This is a double whammy, because increasingly frustrated and abused care home managers are being over-regulated, under-recompensed, generally put upon and abused constantly by the Minister and his colleagues. As one care home owner put it recently,
"Everyone is running my business except me."
There is little correlation between the quality of care in a home and the level of inspections and the hoops that it is put through. One doctor who was recently inspected by the National Care Standards Commission said,
"I am perfectly happy to be assessed, provided that I feel we are working on the same side, trying to improve the care of patients."
Far from pursuing a policy of being on the side of those looking after care of the elderly, however, the Government have set themselves on a course of confrontation and bullying with their response in the Community Care (Delayed Discharges Etc.) Act 2003. They are robbing Peter to pay Paul—the antithesis of partnership—undermining years of good work on bringing social services and health care closer together in the interests of patients. Because of the delayed discharges Act, if a patient's first choice of care home is not available, older patients will be offered an interim placement that may be far away from their families and not necessarily appropriate to their care needs. Allyson Pollock, who has been much quoted this evening, has said that that contradicts the Government's pledge to "give genuine individual choices" and that this legislation
"is targeting really vulnerable people and placing them at greater risk."
As with so much in new Labour's health service, far too many of the vulnerable among our communities' sick and elderly people are paying the price of a system dominated by bureaucrats not patients. We make no apology for raising this issue again. We do so not as a mouthpiece for care home owners but as a mouthpiece for many elderly constituents who are suffering from the Government's squeeze on social services departments and their obsession with constantly rubbishing care home owners and treating decent care homes on a par with the Lubyanka from whose clutches people must be saved at all costs. That is why we need this debate today. I urge all Members living in the real world, who recognise the problems that we have set out today, to support the motion in the interests of their elderly constituents before they join their ranks.
As Tim Loughton said, this has been a good debate. As the Under-Secretary of State for Health, my hon. Friend Dr. Ladyman said in his opening remarks, however, the Opposition, in calling the debate, have started from completely the wrong assumption. As ever, they are living in the past. They assume that the way in which services to old people have been delivered previously is exactly the way in which they should be delivered in the future. That is not what older people want. What older people want and need is a Government who are committed to increasing standards in all sectors for older people, and who are committed to making independence and choice for older people a reality.
That policy has not come out of thin air. This Government have consulted widely with older people and their representatives, and we know from our consultation—from hard evidence—that as people get older they still have the same aspirations. The vast majority want to stay in their own homes and neighbourhoods as long as possible, and our policy delivers that.
Let us be clear about the track record of the Conservative party. Under the previous Tory Government, funding to councils for social services rose by just 0.1 per cent. per year between 1992 and 1997. This Government have changed that. We have given councils a real terms increase of 20 per cent. over the last six years, and on average a further 6 per cent. real terms increase this year and until 2006. When the Conservative party left office in 1997, funding of social services was £7 billion. By 2006, that will have increased to £15 billion—a massive investment in services for older people.
What Labour Members found most shocking, as my hon. Friend Mr. Hinchliffe said, was the attitude taken by those on the Opposition Front Bench towards regulation. Thinking about it, however, perhaps we should not be surprised. They opposed the protection given by the national minimum wage, and they opposed the protection of people at work. Now they are opposing the protection of some of the most vulnerable people in our society. We completely reject their attitude towards regulation.
The speeches from the Opposition Front Bench were in contrast to the rather more thoughtful speeches by the hon. Members for Orpington (Mr. Horam), for Daventry (Mr. Boswell) and for Castle Point (Bob Spink). The hon. Members for Castle Point and for Orpington both raised issues about which they intend to write to my hon. Friend the Under-Secretary, and he has undertaken to examine those issues. I can also assure the hon. Member for Daventry that we will not be massaging figures in the way that he described.
Sandra Gidley referred to the royal commission and to free personal care. I should point out that we accepted every single one of the commission's recommendations, but we stressed in our response that personal care for everyone would not in itself guarantee service improvements. We could spend on free personal care the additional £1 billion that we are making available annually for improvements in service delivery, but we do not believe that that is the best use of finite resources. As was pointed out, seven out of 10 older care home residents already have some or all of their personal care costs paid by their local council.
My hon. Friend the Member for Wakefield made an excellent contribution; I say that not only because of his very perceptive comments about my hon. Friend the Member for South Thanet, but because of his devastating critique of the record of the previous Tory Government. I also congratulate my hon. Friends the Members for Crawley (Laura Moffatt) and for Colne Valley (Kali Mountford) on their contributions. They spoke very eloquently about the need for integration of health and social services, and about rehabilitation services. They showed that the fears that Tony Baldry expressed about delayed discharges were misplaced.
The motion before the House is stuck in a view of the past that does not correspond one iota to what older people tell us they want, or, indeed, to what younger people want to look forward to in older age. It is true that each generation expresses higher expectations. We expect an improved standard of living, more choice and better services; that is as true whether one is 35, 55 or 75. That means that we as a Government have to change and to expand the models of care to meet those aspirations.
This Government reject the concept of a model of care that creates dependency and is too often of low quality. We want high quality care that offers choice and independence. Meeting aspirations inevitably means changing services, and we fully recognise that change can be difficult. But what we have done is to set up a properly regulated system, so that councils and primary care trusts can work with providers to deliver high quality services to older people that meet local needs and reflect local circumstances. That is what local accountability and local democracy are all about.
Let me remind the House of some of what we have done to make such choice a practical reality. We have set up an £87 million fund for extra care housing. We have made community equipment and intermediate care available free to the individual. We have provided £170 million to enable more people to live at home. And we have committed £70 million to support training for social care staff, many of whom work with older people.
After years of stagnation and underinvestment under the previous Administration, change is challenging to those delivering services for older people. It is challenging to partnerships, and to those who want to keep on doing what they have always done, in the same way that they have always done it. It is challenging to poor standards of care and to limitations on choice. But the challenge is right and proper, and the Opposition motion does a disservice to older people by continuing to look backwards, rather than seeing the opportunities for the future. As ever, the Opposition have the wrong approach. They want to restrict choice to those who can pay, and to offer nothing to the majority. We believe in giving everyone choice.
Question accordingly negatived.
Question, That the proposed words be there added, put forthwith, pursuant to
Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the real terms increase in social services funding of 20 per cent. between 1997 and 2003, and the commitment to continue these increases by an annual 6 per cent. in real terms from this financial year to 2005–06; notes that councils are able to use these resources to increase fees they pay to care homes where they think necessary, with 2002–03 figures showing 56 per cent. of local councils in England and Wales increasing the fees they pay by at least 5 per cent; notes that the Laing & Buisson Care of Elderly People Market Survey published in July 2003 puts bed capacity in care homes from all sectors at 470,000 with demand estimated to be around 460,000; further notes that over 80 per cent. of older people say they want to live independently in their own homes for as long as possible; supports the Government's policy of improving choice by providing alternatives to residential care with 20,900 more households since 1998 receiving intensive home care packages, 143,200 additional people receiving intermediate care services since 1999, and a cash injection of £87 million to be spent on creating 1,500 new extra care housing places by 2006; and further supports the Government's policy of driving up care standards where the care is delivered and ensuring that older people are not held unnecessarily in acute hospital beds when their care needs can be better met elsewhere.