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Nursing and Residential Homes

Part of the debate – in Westminster Hall at 11:42 am on 3rd April 2001.

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Photo of Roger Gale Roger Gale Conservative, North Thanet 11:42 am, 3rd April 2001

Before injecting my usual note of discord, I start by agreeing with the hon. Members for Southwark, North and Bermondsey (Mr. Hughes), for Dumfries (Mr. Brown) and with the Minister. I have had the fortuitous opportunity of listening to him speak on the subject for many hours. The hon. Member for Southwark, North and Bermondsey is right to say that one could not put a cigarette paper between the objectives of all hon. Members on both sides of the House on the care of the elderly. We all want our elderly constituents to end their days in dignity and comfort and with a high standard of care.

When I was first elected in 1983, I represented a constituency with a large number of residential and nursing homes, many of which I visited very quickly after the election. I was appalled at the standards that I found. They stank of urine, the control over drugs was minimal, the so-called care staff had little or no training--they did not know how to make a bed, how to change an inco pad or how to lift the clients in their care, leading to back strain for the staff and bed sores for the elderly people. All in all, it was a very depressing picture and the standard of care was well below par.

With others, I began a campaign to change that situation. The Registered Homes Act 1984 went a long way towards improving conditions--even if it did not make us friends. I was assailed by many proprietors of what became revoltingly but appositely named granny farms, who felt that they were being forced into investing vast sums of money. However, the net result was that partition walls made of hardboard and chipboard, which were fire hazards, were taken down and standards of decoration, furnishing, cleanliness, general hygiene and nutrition improved. Most importantly of all, the self-respect of the people working in the homes rose dramatically. My local technical college--Thanet tech, as it then was--introduced a course to teach young people working in the homes, who tended to be between 18 and 22, how to carry out basic tasks. It does not take long to teach that, but it makes a great difference to the standard of care. We quickly found that, apart from anything else, the elderly people liked having bright young people around them who took a pride in their work, and the atmosphere changed dramatically.

The fees being paid increased. Some bad homes went out of business, but the good homes--those that invested--made more money. It is probably fair to say that, by the back end of the 1980s or the early 1990s, a reasonable balance had been struck in most cases between a fair return on investment and a fair price for a fair standard of care. It was the standard of care that was important--not the quality of form-filling, bean-counting or political correctness, but the manner in which people were looked after. They are generally elderly, but not exclusively; sadly, there are some younger people with premature senile dementia.

I do not pretend any more than any colleague in the House that I was entirely happy with everything. There were still bad homes, which were being winkled out by the inspection regimes and people such as us visiting them unannounced. I doubt whether any hon. Member who has residential or nursing homes in his or her constituency does not visit quite a few of them over Christmas, if at no other time.

The hon. Member for Southwark, North and Bermondsey made a point about the need for stimulation and an interest in the environment. At the time, that need was being met, because people had time to care. They would go round everyone regularly and ask them whether they wanted a cup of tea, whether their inco pad needed changing and whether they were all right. They had time to talk, help with crossword puzzles and do all the other little things that make the difference between real caring and "looking after" in its loosest sense.

Since that time, however, we have fallen into a downward spiral. It is fair to blame home owners only in part--if at all, in many cases--because if we want such care, it must be funded. It is all very well to say that we have a lot of homes, but there is a free and good market. The commissioning local authority and county council can go into the marketplace, drive down prices and get the best deal possible. For the council tax payer, that may, superficially, be a good thing. However, if we are to have the staffing levels and trained care staff that we need and if nursing homes are to have the nurses that they need and at the levels that the law requires, they must be paid for.

I am certain that most medium-sized residential and nursing homes, particularly the nursing homes in my constituency, make their profit on the last three beds. All the rest of the money that goes into the home is spent on running costs. We are no longer talking about a licence to print money and the bad old granny-farming days, but talking about marginal businesses. If those homes are denied their last three beds or clients, who make the difference between being viable and not viable, there can be only one outcome. Looking the Minister straight in the eye, I must tell him that the standard of care falls, because people start to cut corners on food, cleanliness and staff.

If, as in Kent, the local authority is then competing with London boroughs--which appear to us to have riches beyond the dreams of avarice when it comes to dumping their problems on someone else--we cannot win. The homes closer to London become stuffed full of those whom the London boroughs neither wish nor care to provide for. They are quite prepared to write out a cheque with someone else's money, but we are left picking up the pieces. We cannot and will not go on doing that. Indeed, residential and nursing home proprietors are not continuing to do that. They are burdened by bureaucracy, red tape and continual inspection--not of the care given to the elderly ladies and gentlemen, but of the form filling and whether there is another half a metre of floor space for someone who will never be able to get out of bed to use it. That is why those people are giving up and going out of business. During the past nine months or so, Kent has lost hundreds of residential and nursing home beds. The result was that, through the winter crisis, the hospitals were jammed full of people who should not have been in a hospital at all, but who had nowhere else to go.

So-called care in the community--in theory, a good idea--in practice, has turned into neglect in the community. Care assistants who would like to be able to care have half a dozen clients to visit first thing in the morning. They rush around, allowing about 20 minutes for each. They need to travel by Tardis--there is little time to get from one to another--get the old girl out of bed at half-past 6 or 7 o'clock, potty her, stick her in a chair, give her a boiled egg and say, "Bye-bye, dear, no time for conversation." Somebody else comes in at lunchtime and throws something into the microwave oven saying, "There you are, dear, there is your lunch, and at half-past 4 you go back to bed." The fact that one might not want to go to bed until 9.30 or 10 o'clock at night is neither here nor there. There is no choice but what is imposed by a system that is out of control.

The moment that such people become ill, they are faced with practice nurses and general practitioners who do not have the time, energy or inclination, in many cases, to look after them. Where do they go? They go straight into a hospital, where they clog up the beds that are needed for patients who need elective surgery. They used to go into good, caring, well-funded residential and nursing homes, but that no longer happens. It is a great sadness that, having gone so far forward--we now have a real prize within our grasp, notwithstanding the fact that we have an ageing population and more people who require care--we now deny choice and do not allow even those with a little money of their own to go into home B rather than home A. They are prepared to pay a top-up from their limited resources, but must pay all or nothing. When their money has dwindled to a level such that they can no longer pay, they go where the local authority tells them to go.

I have heard the Minister speak long and often about the subject, and I believe that he cares. He must impress upon his friends in the Treasury that money is required. Counties cannot take on more and more responsibility and statutory duties from Government: for trading standards; for inspection of this, that and the other; for dog wardens, traffic wardens, wardens for whatever and more parking schemes introduced by legislation. Counties cannot do all those things and, in the case of Kent, continue to pick up the tab for the fringe requirements that are not paid for by Government of all the asylum seekers who come into the county, and still be expected to have the money that is needed to provide care for the elderly.

East Kent has an inadequate supply of nursing care for the elderly and mentally infirm. My constituents have nowhere to go, other than a mental hospital--the very situation from which we tried to move away--because the homes have closed. They have closed because it now costs £500 a week to care for such a client, but the going rate is about £300 to £320 a week. In the middle of the winter crisis, the Government gave Kent £850,000. They said, "Here is more money, buy some care." The first problem was that the care was no longer available because the homes had closed. Secondly, what happens when the short-term money runs out?

I listened very carefully--I had the opportunity to do so--to the debate on the Care Standards Act 2000. I believe that there is much good in that, which hon. Members on both sides of the Chamber would wish to support. However, to echo Mr. Hammond and others, it will fail unless it is backed up by real, hard cash. If it fails, we shall be failing to ensure that our elderly constituents are provided with the care to which I, the Minister, and every other hon. Member aspires.