Care (Older People)

– in Westminster Hall at 10:59 am on 6th September 2011.

Alert me about debates like this

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford 10:59 am, 6th September 2011

Thank you very much, Mr Streeter, for calling me to speak. It is a pleasure to serve under your chairmanship for, I believe, the first time, which is an honour.

I am grateful for the opportunity to hold this important Adjournment debate on care and services for older people. As part of the younger generation of MPs, I am proud to initiate a debate on a subject that I hope will be of interest not only to those who are in their third phase of life but to the next generation and to the generation after that who will one day find themselves in need of care and services. The statistics show that those of us who are in our thirties will fuel the ticking time bomb that is the ageing population, so it is incumbent on us to try to provide solutions to meet this challenge.

My initial interest in care for the elderly stemmed from my late grandmother, who worked in community care for much of her life. She strongly believed, as I do, that people want to live in their own home and community for as long as they can physically do so, and that the delivery of certain services can prevent people from entering residential care, which benefits both them and the state. It was with that in mind that I chose such a wide-ranging title for this debate. It is very easy to focus entirely on the issue of funding care, but there is more to looking after our older generation than the issue of how to pay for their care. Services for older people, whether delivered by volunteers, charities or local authorities, also need our attention if they are to be developed and improved.

I want to start, however, by expressing my very strong support for the campaign to appoint an older people’s Minister. I believe that if that post had a cross-departmental remit, as there is for equalities or for women and equalities, it would be of huge value to the Government. Some of the issues to which I will refer do not fall within the portfolio of the Minister of State, Department of Health, Paul Burstow, and although I have the greatest respect and admiration for what he is doing to improve social care, he is not responsible or accountable for issues such as transport policy, local authority spending or the provision of financial products and education.

Having said that, if the Government maintain their opposition to the creation of another ministerial post, perhaps they would consider two other options. First, we could establish a new Cabinet Committee on older people’s issues that would effectively scrutinise emerging policies. Secondly, we could consider introducing a new test within regulatory impact assessments that would specifically examine the effect of proposals on the over-65s, as other tests do for other defined sectors of society. We need to pay much closer attention to the impact of national Government policies on the older generation, and I believe that a Minister for older people or a new Cabinet Committee would help to do that. However, there should also be a far greater assessment of the impact of policies at local level and I would welcome the Minister’s views on that matter when he responds to the debate.

The publication of the report of the Commission on Funding of Care and Support—the Dilnot report—was welcomed as a much-needed examination of how to fund care in the future. It is an accepted fact that we are all living longer and that our care needs are greater but that funding in social care has not increased by anywhere near enough to match our requirements. Significant demographic change is not something that should surprise us—it has been predicted for many years—yet the long-term care system has remained unreformed. Dilnot’s findings are very sensible, and hopefully they will achieve the better and fairer funding system that we need. However, there are some questions that arise from the report that I hope the Minister will address.

The Commission set out a reasonable timetable for the implementation of reforms. If we are to begin a new programme of funding, one that should perhaps be aligned to some of the other changes affecting future pensioners, we need to ensure that legislation is passed soon. It may be brazen for me to say so as a new MP, but Governments of all colours appear to be adept at pushing difficult issues into the long grass and waiting for the next Government to address them. We are seeing that at the moment on public sector pensions, which is another ticking time bomb issue that was ignored for decades; dealing with it now will cause more pain than if it had been dealt with sooner. We must not let the funding of social care become the next big but continuously ignored problem.

With that in mind, I should be grateful if the Minister provided us with an update on the public consultation on the Commission’s proposals and told us when he will publish the White Paper on social care. Does he expect a Bill on this issue to be included in the 2012 Queen’s Speech and will implementation of changes to funding begin in 2013, as per the Commission’s timetable? It would help all of those who are involved in delivering care and those people who are planning for their retirement if we received some clarification at the earliest opportunity about the timetable for implementing the Commission’s proposals.

The Dilnot report rightly focuses on the issue of financial advice, guidance and product availability. It is estimated that about 130,000 people enter residential care each year. Under the current system, around 41% of those people are self-funders—in other words those people who have assets exceeding £23,250. The increase in the threshold will raise that figure to £100,000, but given how much wealth is tied up in fixed assets such as housing, that will not necessarily change the numbers dramatically.

I am concerned that self-funders deplete their assets paying for care and end up becoming reliant on local authorities for future care funding. Earlier this year, the Local Government Information Unit estimated that a quarter of all self-funders fall back on the state, costing local authorities up to £1 billion per year. The unit’s own report indicates that key decision makers in councils are unaware of the problem or underestimate its cost by 50%. I was shocked to read that 61% of authorities did not know how many self-funders they have or how many self-funders fall back on state funding.

While we need to improve local authorities’ understanding of funding liabilities, it is also clear that those who are in a position to fund themselves need much better financial advice and planning to mitigate the premature exhaustion of funds. Dilnot mentions the variety of financial products that are available, and I should say at this point that although I entered Parliament after working for an insurance provider I have no registered interest in the sector. Nevertheless, from my time in the industry, I think that it is fair to say that there is an appetite for providing products in this area, but the market is not as wide or as competitive as it could be.

I recently met representatives of Partnership, a provider of immediate needs annuities, which is a product to which Dilnot refers to in his report. Like the Dilnot report, Partnership made it very clear that there is a need for improved advice and education. Raising awareness of long-term care needs is essential, not least because people’s expectation is that when they get old they will be looked after for free. I am not convinced that the Dilnot report changes that expectation. Although care costs will be covered, the so-called “hotel costs” of food and board will not be covered, so we need to improve individuals’ understanding of what they will be required to fund themselves.

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Communities and Local Government), Shadow DUP Spokesperson (Business, Innovation and Skills)

I thank the hon. Lady for giving way and I congratulate her on securing this very important debate. I have not read the Dilnot report, but I understand that it indicates that we may have to increase taxes or cut public spending to provide care for senior citizens. All right-thinking hon. Members will agree that it is paramount that we provide that care. I may have misunderstood the hon. Lady, but is she suggesting that we should consider having some form of insurance policy to provide for future care rather than increasing taxes or cutting public spending?

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

I am suggesting that we need to look at various ways to fund care in future. I believe that a market exists for this type of care insurance. There are people who can afford to take out such insurance, but they do not necessarily know that there are products out there that could prevent them from having to fall back on the state. For example, they could afford to take out a premium. It may be a hefty premium at the outset, but it could prevent them from draining all the assets from their home and then relying on state funding for residential care. Such insurance policies are certainly an option that we should look at, and indeed Dilnot himself looks at the financial services sector as one that could relieve some of the burden on state funding.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

I congratulate my hon. Friend on securing this debate. With regard to the use of resources, we have looked at taxation but we must also look at Medway council, which is the local authority that she and I share and which was rated “excellent” in its use of resources by the Department of Health. Rather than increasing taxation, local authorities have a key obligation to ensure that resources for the elderly are available and are funded. For example, in Medway there is free swimming for the over-60s, concessionary bus fares start at 9 am rather than 9.30 am, and home library services are available for the elderly, so this issue is not simply about increasing taxation; it is about making better use of resources. Medway has done so and it is rated “excellent” by the Department.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

Indeed. This issue is about using resources wisely. However, it is very well discussing how resources are used now, but the problem lies in the future. At the moment, one in six people are over 65, but by 2050 one in four people will be over 65, and resources will only be able to stretch so far.

We spend a lot of time—rightly so—talking about financial education for young people, but I am enormously sympathetic to the suggestion that we should consider providing free financial health checks for people in their 50s and early 60s, possibly funded by using unclaimed assets in banks and insurance companies, and possibly delivered by financial advisers, charities or through the new money advice service. The provision of good quality care is an emotive matter for all involved. Standards of care, and indeed of care homes, differ dramatically, not just across the country but across constituencies. I recently visited Amherst Court in Chatham, a purpose-built Avante Care and Support home that supports residents with dementia. I was really impressed with what it offered and could tell that a lot of thought had gone into the building and the care provision. Such quality, however, has to be paid for, and unfortunately not all residential homes offer the same standards. When homes close, sometimes because the buildings are no longer fit for purpose, there can be uncertainty for residents and their families. It is that postcode lottery of care that we need to mitigate as best we can through the consideration of our long-term care requirements, which is why one policy that we need to get absolutely right for the benefit of our elders is the one on building more homes.

We have a massive housing shortage in the UK, but it is the older generation who have the least choice as to where they live. If they decide to downsize from their family home, they find that there are few bungalows or smaller houses being built. There are not many purpose-built retirement complexes, whether flats or houses, and any new development with social housing rarely, in my view, considers the needs of the elderly.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport)

There is a great focus on residential homes, but does the hon. Lady feel, as I do, that there should be a greater focus on letting people stay in their own home? They feel more confident there, and it is cheaper. I think that if they had a choice, a great many people would rather be in their own home than in residential care.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

That is precisely my point, and I hope that it will be the key theme to emerge from my speech. Homes must provide good-quality care for people who have to go into residential care, but we need to try to keep people in their own home for as long as possible. My late grandmother certainly believed, as do I, that if good-quality services can be provided people will have to rely less on expensive residential care, and we should therefore provide a greater choice of available private homes. Not many bungalows are being built, because their capital value is not that of a seven-storey apartment block on the same land, which poses a problem for our older people, who then have the choice of staying in their family home, which is incredibly expensive to heat and often impractical, or of moving into residential care.

We want to rely less on the state to fund our residential care, and it seems logical to put greater emphasis on ensuring that new developments have as much of a duty to provide for older people as for other younger sectors of society. The issue of choice extends into the social housing sector too. In my constituency, a few areas of social housing are allocated to the over-55s, but there is a huge difference in the lifestyles of 55-year-olds and

75-year-olds, which often leads to antisocial behaviour problems. I doubt that many people would consider 55 to be old, and therefore we perhaps ought to consider revising the age allocation up, to the over-65s.

I am pleased to say that Kent Housing Group, which is a partnership of developers and local authorities across the county, is looking precisely at housing for older people, and I look forward to seeing the outcomes of that work soon. However, I fundamentally believe that there is a role for the new homes bonus, which could incentivise authorities to build bungalows or complexes for older people and lead to much more housing choice for those who wish to stay out of residential care. That could be one policy that would have a positive impact on the welfare of older people, and it would also benefit the Treasury by keeping people out of the more expensive residential system.

The funding of social care might be the hardest single problem to overcome in this policy area, but we often forget that the services side is equally, if not more, important. Good delivery of services can prevent people from needing to enter residential care, or from staying in hospital longer than the average patient. We have some excellent charities and volunteers who provide an essential community service, and they can be vital to the health and well-being of the people they look after. As brilliant as individual schemes are, however, our overall community service for the elderly needs to be much better. I heard a heartbreaking story from the WRVS about a lady whose light bulbs broke. She was unable to fix them herself, and so for a month she sat in the dark. As she used her television for light, the electricity company noticed that her bills were unusually high, contacted her and discovered what the problem was. A WRVS buddy was sorted out, and her light bulbs were changed, but it took a month and a concerned utility worker to alert others before she was helped. In these modern days of instant connectivity, I find such isolation utterly unforgivable.

Photo of Penny Mordaunt Penny Mordaunt Conservative, Portsmouth North

I congratulate my hon. Friend on securing this debate. Does she think that when we are considering Dilnot and the future funding of care, we need to look not just at the baseline and at our well-recognised ageing population, but at the unmet need to which she has just referred? In Portsmouth, for example, which is a fairly compact city, we have 1,000 people with dementia who have no access to services.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

We need to improve the services available for different people with different needs as they age. I am vice-chair of the all-party group on dementia, but I decided not to talk specifically about dementia today because I am hoping for a future opportunity to do so. There are, however, some very good services. They are very localised, but often people do not know about them. For example, the wife of a constituent of mine who happens to be a good friend, has just been diagnosed with dementia. He found out about the excellent Admiral Nurses service by word of mouth; there was no one there to signpost him to it. He could have been provided with a hugely valuable service at the outset of his wife’s diagnosis. We need fundamentally to improve services across the country.

The Centre for Social Justice has produced a report, which I highly commend and which is entitled “Age of Opportunity: Transforming the lives of older people in poverty”. The report states that more than 1 million people aged 65 and over feel lonely, and a similar number feel trapped in their home. Charities can do so much but, as the CSJ says, there is a fundamental role for the state in preventing such isolation. So many older people are already known to statutory bodies, so providing the link to charities is essential. The CSJ recommends a greater role for neighbourhood policing teams, in engaging with extremely isolated older people, and the extended use of the increasing number of health visitors. Those are sound recommendations, which would help to deliver a new relationship between the voluntary and public sectors, and also reduce social isolation.

The authorities and partnership organisations to which I speak are desperate to provide good services, but they are hampered by finances. Although we have to be realistic about the need to make efficiency savings across various services in the short term, that needs to be balanced by an understanding that good-quality services can benefit public finances in the long term. Keeping retired people active, for example, keeps them healthy and less in need of acute primary care. Helping those nearing retirement to plan financially prevents them from draining their assets before falling back on the state. Providing company for people in social isolation not only enriches their lives but improves mental and physical well-being. Good-quality housing designed for the older generation provides greater choice for people wishing to remain in their communities. All those areas are interlinked, and better delivery could save the state a significant amount of money in the long term, but for the people who need care we must ensure that it is of good quality and sustainable for our ageing population, but also fairly funded.

If we are to improve the standard and delivery of care and services for older people we need to deal with this issue today, and I urge the Minister not to let it get kicked into the medium or long grass, and to consult on and implement reform of the system as soon as possible, for the benefit of this and future generations of pensioners.

Photo of Jack Dromey Jack Dromey Shadow Minister (Housing) 11:19 am, 6th September 2011

It is a pleasure to serve under your chairmanship today, Mr Streeter. I congratulate Tracey Crouch, both on securing the debate and on the sincerity that shone through in her contribution. I strongly agree with a number of the points that she made.

During the summer, I addressed a meeting convened by the Birmingham branch of Carers UK—an outstanding organisation nationally and in Birmingham. What shone through was that there is no more noble cause than caring. At that meeting, 200 were present, including people who were cared for, carers and the organisations that support them. Deep concern was expressed on two fronts, the first of which relates to an issue that we are not here to debate: the cuts to benefits and the work being done by the Hardest Hit coalition, which includes the Royal National Institute of Blind People, Mencap and others. The second issue relates to the growing crisis in social care. In one sense, the crisis is the consequence of a good thing—people are living longer—but there are undoubtedly two major problems. One, I agree, is that successive Governments have failed to implement a long-term solution to the growing crisis in social care. The other is the impact being felt now of cuts in public expenditure. The Government are going too far too fast, and that is having an increasingly serious impact on the most vulnerable in our society.

Looking to the future, the Dilnot review offers a new dawn. Its recommendations have been widely welcomed across the political spectrum. As we move towards implementation, it is key that Dilnot is fully funded and that its recommendations in respect of eligibility are carried through, so that what happened in Birmingham—I will say more about that later—never happens again. I agree strongly with the hon. Member for Chatham and Aylesford that its recommendations must be acted on as soon as possible. She is right that there has been a propensity in the past to kick such issues into the long grass. That cannot be the case in future. I sense that, across the spectrum, there is a desire in the House for the Government to act as soon as possible. They will unquestionably have the full support of the Opposition if they do.

Photo of Margot James Margot James Conservative, Stourbridge

I share the hon. Gentleman’s enthusiasm for enacting the Dilnot report in law as soon as possible, but I have reservations about whether we should enact it in full as recommended. To give one example of my concern, does he agree that the £50,000 cap above which nobody should have to pay out of their own purse for long-term care or personal care at home might represent a large proportion of some people’s savings and assets, but that for home owners in the property-rich markets of the south-east, it might represent a small proportion? I am concerned on that and various other points. We should not rush but should subject Dilnot to proper critical investigation.

Photo of Jack Dromey Jack Dromey Shadow Minister (Housing)

I accept that some of the issues that Dilnot identified will have to be worked through, but I think that there is a broad welcome for Dilnot ending what has caused so much grief in the past. People have had to sell their homes. People who spent their lives hoping to pass on wealth to their children have found in the twilight of their years that that is not possible. We can have an intelligent debate about the detail of Dilnot, but the cap is welcome. The sooner we implement Dilnot, the better. The problem is that, even if everyone gets a move on, that might be some years away, in which case we must address the here and now during the next two to three years.

WRVS has done excellent work in the field, and has said rightly that the Government must both address the adequacy of the funding that they have made available and ensure that it is wisely spent and properly monitored. The inescapable reality is that the consequences of the cuts to public expenditure are devastating for the most vulnerable in our society. To use the city that I represent as an example, Birmingham city council has cut £212 million from its budget this year—the largest cut in local government history. It cut £51 million from the social care budget, rising to £118 million over three years, and consequently sought to remove substantial need provision for 4,100 people. The council was prevented from going down that path only by a judicial review taken by four brave families, whose cases were heart-breaking.

I have seen some of the consequences in my own experience. One example is an absolutely wonderful couple, Faith and Frank Bailey. Faith Bailey is terminally ill. She left hospital some months ago, so that she could spend the remainder of her time on earth with her husband. They are a devoted couple; it is wonderful to see them holding hands at the age of pushing 80. The problem was that when she left hospital, her night-time care was restricted to two nights a week. She struggled as a consequence, and the impact on her husband was devastating. He was becoming increasingly exhausted, and neither of them could cope. The situation was causing them great distress. I am pleased to say that they are now in the admirable New Oscott village, where they will be cared for properly. However, those decent people who built Birmingham and Britain looked forward, in the twilight of their years, to being together for the remainder of her time, and to see them suffer in such a way was heart-breaking.

This is not just about the human consequences. As the hon. Member for Chatham and Aylesford was right to highlight, it is also about the financial folly of failing to recognise that not investing might cost more in the medium to long term. The King’s Fund report charts what happens in social care as a result: the number of people admitted to hospital rises. I am sure that we have all seen that in our respective constituencies. I remember one example in the constituency next door to mine in Birmingham. A fine young man who was seriously assaulted spent 18 months in hospital as the consequence of a failure to provide a social care package. After he had spent just over 12 months in hospital, he was told that he could leave if an adequate social care package were provided for him, but because it was not, he stayed in hospital. He was desperate to go home and his family wanted him back, and it was costing the national health service £2,400 a week in net additional costs to support him. That cannot be right. The impact on the national health service is an issue.

To give another example from Birmingham, all parties supported building 10 centres, such as the admirable Perry Tree centre, across Birmingham to provide intermediate care as a bridge between leaving hospital and going back home or into a home. Perry Tree is outstanding, and the atmosphere is wonderful. However, sadly, no more centres will be built. That will mean bed blocking on a massive scale in the national health service.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

Is the hon. Gentleman aware of the report by the all-party group on dementia that highlights that issue specifically? Dementia patients are extending their stays on hospital wards because they cannot go straight back to their residential care homes, and it is costing the NHS about £20 billion a year. It is a massive issue. Intermediate provision must be considered more closely to alleviate that financial pressure on the NHS.

Photo of Gary Streeter Gary Streeter Conservative, South West Devon

Order. Before the hon. Gentleman responds to that point, I would like to say that five other colleagues are seeking to catch my eye and the wind-ups will begin at 12.10 pm. If colleagues can moderate their speeches, I would be most grateful.

Photo of Jack Dromey Jack Dromey Shadow Minister (Housing)

Thank you, Mr Streeter.

The work that the hon. Member for Chatham and Aylesford has done, together with the all-party group, is admirable. She is absolutely right to highlight the dilemma. Before I conclude, I will give one other example of the impact of what is happening in Birmingham. It is a combination of the cuts to big society organisations on the one hand and the impact on carers on the other. On big society organisations, the budget of Age Concern Kingstanding—my constituency is one of the 10 poorest in Britain, and Kingstanding is the poorest area in Erdington—is being cut. A particularly heart-breaking case concerns a group called Elders with Attitude. It has one co-ordinator and a range of volunteers. I remember the first time that I met them. They are inspirational. People were brought together around a table and told their story. One individual—another Frank—said he had had a terrible stroke and had thought that his life was over. The group meets twice a week and, in his words, it brought him back to life. His granddaughter, who was sitting alongside him, burst into tears and said, “My granddad used to just sit at home, looking at the wall. This has given him fresh lease of life.” This is essentially a voluntary initiative and initiatives of that kind should be supported, not least because, as the hon. Lady has said, stimulating people is of the highest importance to their quality of life and, ultimately, to their not having to go back into a hospital.

I want to give one other example of the impact on carers. In Birmingham, thousands of carers are employed directly by the council. I remember meeting a group of 20 of them in July. They were women who had worked for 10, 15, 20 or 25 years. They were the kind of women who go the extra mile in the job that they do. I remember meeting one of them coming out of Sainsbury’s in Castle Vale the Easter before last. She had a bag of Easter eggs. I asked, “Who are those for?” She said, “Half a dozen people I care for.” I asked, “Who’s paying for it?” She said, “Oh, I am of course.” She was buying Easter eggs for people who would not otherwise get them. Such was her bond of love and affection for the people for whom she cared. Sadly, she and all the people like her are now going to see cuts. They earn, typically, £14,000 a year. They will see, under the proposed Birmingham contract, a cut of £4,000. That is absolutely devastating.

What I hope unites us here is the focus on the need for the new dawn to be realised and for all parties to work together to put in place Dilnot’s recommendations, and to do so as quickly as we possibly can. Crucially, however, it is about what happens in the meantime, because the hallmark of a civilised society is whether we care for the most vulnerable in our ranks.

Photo of Anne Marie Morris Anne Marie Morris Conservative, Newton Abbot 11:33 am, 6th September 2011

This is an important issue and probably one of the most important topics that we as a Government and a Parliament will need to consider. On current estimates, the number of 85-year-olds will double by 2026, so it is a serious issue and I congratulate my hon. Friend Tracey Crouch on securing this timely debate.

Dilnot focused on the financial issues and found that the current system is not fit for purpose. I think that there is another issue in relation to quality. The Government clearly want to ensure that we have a system that, ultimately, is fair, affordable and sustainable. They want to invest in a system that will ensure that we have more care and support in the community, so that we can keep people in their own homes rather than force them into residential care as the only option. However, if we want that quality, we need to ensure that there is proper monitoring and proper regulation. Although I am not a great fan of over-regulation, we have to bear in mind in this particular argument that we are dealing with consumers who are often not very vocal or not able to be very vocal. Therefore, it cannot necessarily be assumed that the way in which a market would normally self-regulate will be the way in which this market will regulate itself.

My comments are based on conversations I have had with the Care Quality Commission, a number of local authorities and private providers. I have a long-term interest in the issue. I was a county councillor and chairman of the health overview and scrutiny committee, and in Devon we currently have the largest number of retired individuals in the country. I will turn first to residential care, then to domiciliary care, look at how they are regulated and monitored, and raise some concerns that need to be addressed by the Minister.

Residential care is commissioned by the local authority. Although provision is monitored by the CQC, the commissioners, per se, are not. I have a concern about that, because it is the local authorities that are determining whether to commission in their own homes—where one might argue that they have a conflict of interest—or in the private sector. What I have found particularly disturbing is the price that is paid for each of these contracts. I hear that local authorities—I give this by way of an example—are paying £700 in the public sector, compared with £350 for a private provider. Whatever the savings might be, there is no way that, for half the price, the same quality of care can be provided.

There is no standardisation of contract in the current system. Although choice is clearly important, I think that, for a consumer who has a difficult time getting their voice heard, it is difficult to ensure that they get consistently good quality. If we are to ensure that there is real choice, genuine quality and fair pricing, we need to look seriously at how the commissioning bodies—the local authorities—might be monitored and regulated in future. I believe that the Government have looked at HealthWatch as a possible source. My concern about HealthWatch is that, first, it does not yet exist and, secondly, it seems to have been conceived as a reactive rather than proactive body.

The provider of residential care is, principally, either the local authority or the private home, and here CQC does monitor. Although the intention was to set out a new framework that, rightly, was more outcome-focused than process-focused, the challenge for the care homes is to comply with this new care quality regulation. I have talked to a number of homes and the majority have indicated that they expected a light touch from Government. They expected that they would be able to provide evidence of compliance and that there would not be many onerous visits. I hear that there are many visits, which surprises them and surprises me. They are saying that it is taking up an awful lot of administrative time. Given that, as a Government, we are committed to cutting red tape, something is clearly not working somewhere. The position needs to be reviewed. Clearly, it is important, because we need to guarantee quality, but let us find a way of doing it better. The other concern that homes have expressed to me is that, with the new outcome framework, there is no guidance as to how to meet the new requirements. In the old days, the CQC used to provide guidance, but now it does not see it as within its remit.

Domiciliary care is, perhaps, one of the most tragic and most important areas of concern. Commissioning of domiciliary care is done by local authorities. Here, again, there is no monitoring and, I understand, no regulator; I would love to hear the Minister tell me that I am wrong. I cannot therefore see how we can ensure that our local authorities are really making sensible, informed choices about how they award contracts for domiciliary care. Indeed, I have heard stories of local authorities trying to take out costs and to sub-contract their role to lead providers, who then take on the role of sub-contracting further to find individuals and more providers of domiciliary care. In all that process, the quality control and the quality test seem to be lacking. I have talked to providers in the private sector who have seen some of what goes on, and the stories are horrifying.

Let me give one example. A provider indicated to me that she had gone into the home of an elderly person who was having to be put on to the toilet. The lady was literally sitting in her chair eating her sandwich lunch and the providers came in and lifted her up in a way that is apparently not appropriate or correct from a nursing perspective. They put her on the toilet, went out, smoked a cigarette and came back in. The sandwich was still in that poor old lady’s mouth. They then took her and stuck her back in her chair. That does nothing for the dignity of the older person.

The provider of domiciliary care is sometimes the local authority but, increasingly, it is the private sector. Unlike the residential end of care, there is no Care Quality Commission monitoring domiciliary care and I understand that there are also no spot checks. Although there is an obligation on local authorities to have a watching brief, what I am hearing anecdotally shows that very little of that is actually happening.

The concept of e-monitoring was introduced to try to assist with that. The idea behind e-monitoring is that, when someone goes in to provide care in a home, they pick up the phone in the individual’s residence and log in. When they have finished dealing with the client, they log in again through the telephone. However, the reality is that once someone has logged in, frankly, they can do almost anything. As in the case I mentioned, that could be putting a lady on the toilet and then disappearing outside and having a cigarette. Therefore, e-monitoring is not an effective way forward. The other thing happening is that, because there is no monitoring of quality, cost rules and consequently quality are going down.

I shall make this a very short contribution. In conclusion, the Minister should carefully consider having a regulator to deal with the monitoring process for commissioners both of residential and domiciliary care. In addition, certainly with regard to domiciliary care, some urgent and immediate action needs to be taken to examine current practice.

Photo of Alison McGovern Alison McGovern Labour, Wirral South 11:41 am, 6th September 2011

I congratulate all hon. Members who have spoken so far, especially Tracey Crouch.

I feel sure that her grandmother would be incredibly proud of her today. Her contribution was important and she made many points that I wholeheartedly support.

I want to follow on from the comments of Anne Marie Morris, who articulated part of the problem very well. Although we have focused on Dilnot, the review and funding, I argue alongside her that we cannot talk about money without talking about what people get for that money. What people are prepared to pay surely depends on the quality of care that they are going to get.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

The hon. Lady makes a point about resources. A crucial issue linked to resources is that of the principle and presumption of early intervention and prevention in improving the quality of care for the elderly.

Photo of Alison McGovern Alison McGovern Labour, Wirral South

I agree. In a moment, I will talk about some of the problems that local authorities are currently facing. They have had bigger cuts than any part of Government in Whitehall. Although I wholeheartedly agree with what the hon. Gentleman said, it is a challenge to all of us to support local authorities in that prevention role.

The hon. Member for Newton Abbot rightly made the point that quality matters above all else. Some of the examples given by her and others were compelling in terms of the moral requirement on us all to stand up for the dignity of older people. I firmly believe that, when we hear examples such as the one just given, we know what is happening is wrong. I have heard examples from my constituents: for example, older people are told that a “breakfast” visit to get them up can take place anytime between 6 am and 11.30 am, regardless of their personal preference. That is not good enough and is an offence to somebody who prior to needing care was independent and perfectly capable of looking after themselves. We all know that instinctively.

The question is: how do we get from where we are to where we would like to be? I want briefly to make two points on the subject. First, I shall mention enforcement and some of the professional development issues. Leading on from that, I shall talk about the market for care provision and why there is an interesting and difficult problem that the Government will have to tackle regarding the market for providing care. I agree with many of the points made by the hon. Member for Newton Abbot about some of the anomalies surrounding enforcement. I repeat that local authorities are having to struggle with the fact that, if they were a Government Department, they would be experiencing the biggest cuts in Whitehall. That makes the job of having responsibility for the care of older people, which is a fixed cost, very difficult.

Photo of Margot James Margot James Conservative, Stourbridge

Does the hon. Lady agree that, when we consider expenditure, part of the problem is that, over the past 10 years, the increase in local authority budgets for adult and social care has been minimal compared with the increase in many other local authority budgets, particularly that for children and younger people’s services, to name but one? With adult and social care, we are starting from a base that is already very low, which is one of the problems and is why local authorities are struggling so much.

Photo of Alison McGovern Alison McGovern Labour, Wirral South

I do not know the statistics on that, so I am hesitant to comment. If the hon. Lady says that that is the situation, of course, I believe her. However, I do not know off the top of my head whether that is the case comparatively. I will make some comparisons with children’s services because there are some interesting parallels. If, as she mentions, the budget for children’s services has increased, I can only think that that is a good thing given the importance of child protection and youth services. I live in hope that we can move towards having better funding for older people’s services in the near future.

I return to the point I was making on enforcement. We have all had cases—since I was elected, I have had many cases—of people coming to surgeries who feel that the care provided is not sufficient. There must be a clear, easy process to follow for relatives or those concerned about a poor standard of care. At the moment, the system is confused. I will not repeat what has already been said, but that is my conclusion. If someone feels that the quality of care they have received is poor, the process they have to go through is not easy.

Some of the issues raised by constituents at my surgery have stemmed from the absence of professional development for those providing care. I have seen extremely good quality examples of both residential accommodation for older people and care provided in people’s homes but, by and large, the work force who provide that care are underpaid and neglected. It has to be said that that work force are mainly women who often have not received much workplace training over many years and are some of the lowest paid people in our society. Frankly, it does not do much for the dignity of older people that the job of looking after them is one of the lowest paid and least respected in our society. It is about time that we put that right. We should make it clear that looking after older people and protecting the dignity of our society is an important job. We ought to pay those people a decent wage and give them the training and support that they deserve.

The example of e-monitoring has been mentioned. In my surgery, I have been given examples of that. People are given time to look after people but not enough time to travel between appointments, and they are for ever catching up after themselves. By and large, the whole system is set up to make a profit for the company concerned, rather than to think first about the quality of service for the person receiving care.

[Mrs Anne Main in the Chair]

On the profit issue, I am not an unreconstructed left-winger. [ Interruption. ] To the chagrin of some, I am not one who thinks that the profit motive has no place at all in public services. However, there is a structural issue here. We have a large amount of competition for the provision of care. Price competition, in an industry where greater profit cannot be extracted through the use of technology—this is a person-to-person service with a one-to-one relationship with the person, so we cannot invest in technology to make more profit—means that wages are the only expenditure that can be driven down. In an environment where the work of care is seen as low, wages have been driven down. There has to be a response from the Government on the structure of the industry, which effectively means that wages have been pushed down lower and lower, and people’s skills and time are not being invested in.

I draw an analogy with the child care industry. In the 1980s and early 1990s we had a similar situation. Frankly, those involved in child care were seen as the lowest of the low and were paid as little as humanly possible to look after children. Those days are over now. By and large, those who look after children are now paid a bit better and are likely to have qualifications. Can we not set ourselves the challenge of better wages and a better skill level for those working in care for older people? That would meet the aspirations of the hon. Members who have spoken so far and would do a great deal to improve the quality of care. That would help us to deal with some of the funding issues. People would feel that what they paid for was worth having and worth investing in. Hopefully, it would also meet the challenge set to me earlier and ensure that the case is made to local authorities to pay for quality.

In conclusion, I agree with the comments that have been made so far. There has to be attention to quality and to standards, and an ability to uphold those standards. There is a problem, however, in the market for care that is forcing a driving down of the quality, and it could be dealt with.

Photo of Tony Baldry Tony Baldry The Second Church Estates Commissioner 11:52 am, 6th September 2011

I am definitely going to send for a subscription to “Elders With-Attitude”. It sounds like a very commendable organisation.

An aspect of public policy that is far too little debated is the consequences of us all increasingly living with an ageing population. It was about two years after I was first elected that I heard the word “Alzheimer’s”, but if I go around a nursing home in my constituency now, pretty much everyone there is suffering from age-related dementia of some sort. In my brief comments, I shall relate that to the problem of delayed discharge, or what is known as bed blocking. That is where the system needs improving.

Money has tended to allocated to local authorities based on population and a multiplier of deprivation indexes, but I am not sure that those formulae take sufficient account of the ageing population. When a person is old, their requirements for care and support do not depend on their social background, but that is not sufficiently recognised in the formula. In medicine, at one end people stay ever-shorter periods of time in hospital—one can now do such things as hysterectomies by keyhole surgery, which was impossible a few years ago, so some people go into hospital and come out very quickly—but at the other end, some people go into hospital and stay longer; largely, they do not need to be there, but an appropriate place cannot be found for them.

I understood, for example in domiciliary care, that the introduction of individual budgets would give individuals more control over their care provision. One hoped that that would lead to more providers coming into the system, but I see no evidence of that in Oxfordshire. Likewise, I do not see, and would be very surprised to see, substantial, or indeed any, increase in nursing home provision on what there was 10 years ago.

If one thinks about it and visits nursing homes, one sees that the point about wages is a good one. In the past decade, most nursing homes in my patch have managed by employing—I mean this in no pejorative sense; it is just the reality—Filipinos and paying them the minimum wage. At the end of their training, they have then gone on to find work in the NHS, and even though, with the cap on non-EU migration, that has become increasingly difficult, nursing home providers find themselves squeezed. On the one hand, the amount of money they receive from local authorities for placements is getting ever tighter; on the other hand, their wage bills and regulatory costs are becoming ever greater. There is little incentive for existing nursing home providers to increase the size or the provision in their own nursing homes, and there is certainly very little incentive for any new providers to come into the market place. There is a certain amount that the NHS or primary care trusts can do to fund intermediate care beds, but there is a limit to that and the cost still falls on the NHS.

We need to take a much better grip. I am not entirely confident about who has a grip on domiciliary care and is trying to ensure that there are sufficient providers of day care for those who need it. If we are to avoid ever-increasing fractiousness between the NHS and the social service providers over the thorny issue of delayed discharge, we will have to give more thought to how to ensure that there are sufficient places in the nursing home and residential care sector.

I agree with the point made by Alison McGovern about enhancing the professionalism of care staff. Those who provide domiciliary care in residential care homes provide a very important personal service. We should look at ways to enhance their reputation and status and encourage more colleges to offer HNDs and other courses for care staff. We will require more people in care services in the future, so it needs to be seen as an honourable occupation to which people aspire and where there are the highest standards of professionalism. There are important questions that need to be answered about the funding for local authorities for social care and how, with that funding, they are able to support both sufficient nursing home places and sufficient domiciliary care places.

For some time, many nursing homes were able to cross-subsidise, using the fees from private residents to subsidise the fees from local authorities. What I see in my patch is, effectively, two types of nursing home provision. Some nursing homes are now almost entirely privately paid; they are very expensive and provide a very good service. That means, however, that the only source of income for those nursing homes that provide residential care for patients funded by local authorities is the money that they receive from local authorities. They are stretched extremely tight to deliver a good service and have little incentive to expand that service. If we do not get our policies right, all that will happen is that the NHS will spend significant sums of money keeping in hospital people who no longer need to be in hospital and who could be discharged if there were places to discharge them to safely and properly.

Photo of Gareth Johnson Gareth Johnson Conservative, Dartford 11:59 am, 6th September 2011

I congratulate my hon. Friend Tracey Crouch on securing the debate. She feels passionately about the subject and made a robust and fair-minded speech.

Care and services for older people are of increasing importance, and I agree with the sentiments already expressed about how we must deal with the issue sooner rather than later. It is a growing mushroom that must be dealt with fairly soon because the population in this country is getting older, which is placing strains on our systems. That is a good and positive thing—too often we hear about longevity in a negative way, but it is a marvellous tribute to medical science that we have people living longer than they previously did—but greater reliance is placed on our care home provision and local authorities have to adapt to the changes in pressure placed on them as a consequence. I have disagreed publicly with my local authority, Kent county council, on decisions it has made about care home provision in my constituency of Dartford.

I accept that the future lies in a public-private partnership in care provision throughout the country. The Government face a dilemma: they cannot afford indefinite free care home provision and they do not want to penalise those who have saved for their retirement. Free care home provision for all without tax rises is completely unaffordable—I agree with my hon. Friend Tony Baldry about that. Such rises, especially in the current climate, would have a huge negative impact on the finances of this country. Equally, we should not be punishing prudence and forcing the elderly to sell their homes to pay for care. Prudence should be rewarded by the state, not punished.

Health and safety legislation has often added to the cost of care provision. The apparent necessity for all rooms in a care home to have en suite facilities was used as part of a reason to close care homes in my constituency, yet residents in those care homes would say that what they want is their home preserved and not the health and safety considerations met. I recently visited Emily Court care home in Wilmington in my constituency. The residents echoed the sentiments I have heard in every care home I have ever gone to: they like the facilities, but what is most important to them is that it is their home. That drives the affinity they have for the place.

What has staggered me since the upheaval in my area with the closure of care homes is how easy it is in this country to close them. I find it incredible that no real security of tenure exists for residents in a care home. Travellers have some rights over land they settle on—that is obviously an argument for a different time—and squatters have rights over empty properties that they occupy, yet residents in care homes can be moved almost on a whim. That might need further investigation, because the consultation exercises before any care home closes concentrate a bit too much on the bricks and mortar involved and not enough on the people.

Photo of Alison McGovern Alison McGovern Labour, Wirral South

The hon. Gentleman says what a bugbear health and safety legislation was and then mentioned the lack of security of tenure for residents. I find it difficult to know whether he thinks we need more or less regulation, legislation or sub-legislative guidance. What mechanism does he think is best to improve some of the standards?

Photo of Gareth Johnson Gareth Johnson Conservative, Dartford

The two issues are separate. When Southern Cross went bankrupt, for example, it blamed in part the increase in health and safety legislation, some of which was sensible and some completely unnecessary. Ensuring that people who reside at care homes have some rights over the land that they are living on is a separate matter. I do not see that as placing increased burdens on those running the care homes; it simply gives the individual residents the same rights that we would have if we leased a flat. Those living in residential care homes, who are perhaps among the most vulnerable in society, should surely have that extra protection. The challenge for the Government is to find a solution that is both affordable and fair—affordable, so that the Government can cope with the ageing population and the increasing demand on care homes, and fair, so that the elderly are not forced to sell their homes and lose out because of their earlier, sensible financial decisions.

Photo of Esther McVey Esther McVey Conservative, Wirral West

I am delighted to take part in the debate, which echoes the conversation I had earlier in the week with the residents of Hoylebank in West Kirby about the diverse and huge issues involved. Those residents believe that they are part of an invisible generation. They would like to be visible and, like my hon. Friend the Member for Chatham and Aylesford, they are calling for a Minister for the elderly to go through everything thoroughly.

Photo of Gareth Johnson Gareth Johnson Conservative, Dartford

I am sure that the residents in Hoylebank have similar difficulties to many residents all around the country: they are often screaming loudly and not being heard by anyone. It is incumbent on Government to listen to the messages we hear from care homes and to see where we can make improvements to their rights to ensure that their homes are protected as best as possible. We need to find a more sensible balance than is currently in place. Care homes provide a vital link in the health chain. Jack Dromey, who is not now in the Chamber, made the important point that if we reduce the availability of care home provision, the amount of so-called bed blocking in hospitals will inevitably increase, with all the extra difficulties and costs arising.

We all want to facilitate elderly people remaining in their homes as much as possible, but the ideal should be about choice and not about forcing people who want to go into a care home to stay at home, or forcing people who want to remain in their own homes to go into care. Their individual choice should be paramount, and their opinion should count for a great deal. I therefore look forward to the spring, when the Government intend to announce their intentions regarding the Dilnot report and what happens thereafter. I look forward to finding a balance that works for the whole of the older generation.

Photo of Emily Thornberry Emily Thornberry Shadow Minister (Health) 12:07 pm, 6th September 2011

It is a great pleasure to serve under your chairmanship today, Mrs Main. I congratulate Tracey Crouch on securing this hugely important debate.

The terrible consequences of the massive spending cuts are becoming clearer and clearer. They focus in particular on underfunding in the social care system, which is getting to breaking point. Earlier I shared with the Minister my research on the effect of the cuts on local authorities and on adult social care. I am sure he is pleased to hear that I am doing further research.

My preliminary research, which I put together with the House of Commons Library and which is a clarification or an interpretation of data published by the Department for Communities and Local Government, shows £1.3 billion in real-terms cuts in local authority spending on social care in both 2010-11 and 2011-12. For the oldest and most vulnerable, the picture is especially dire, with real-terms spending on social care for the over-65s lower than in 2009-10 by £60 million in 2010-11 and £1.3 billion in 2011-12. The Association of Directors of Adult Social Services has indicated that demographic pressures from an ageing population, physical disabilities and learning disabilities have placed a £425 million squeeze on social care funding in 2010-11, with fewer than half of local authorities allocating the funds to cover the bill. I believe that the Department of Health continues not to be able to provide a borough-by-borough analysis of adult social care funding, so when I have my full report available next week, I assure the Minister that I will let him have a copy.

As a consequence, care packages and care services are being renegotiated, with new and increased charges being imposed. Others are being denied state-funded care altogether, because of changing eligibility criteria. A recent report from Age UK warned that of 2 million older people in England with care-related needs, 800,000 receive no formal support from public or private sector agencies. With spending cuts, that number is likely to top more than 1 million between 2012 and 2014. The evidence is piling up.

The Minister may have heard yesterday’s “You and Yours” programme on the BBC, in which the UK Homecare Association gave an analysis of its recent research that showed a pattern of care in the home being taken away from people. In the cases that it looked at, 82% of councils were reducing the amount of time that people have with carers in their home, there was a widespread increase in very short visits—for example, the notorious 15-minute visits—75% of councils were reducing the number of visits per week, and 50% were trying to reduce the money spent on an hour of care. Fewer safety checks were being made on older people at home, there was a widespread reduction in the time allowed for bathing and washing, and social services were being cut completely. They include a range of services that are not personal care, but help people to stay in their home—vital services such as help with laundry and shopping and decisions about finances. With the cutbacks in all those services, we are heading for crisis.

In making the changes, councils are often failing to consult. My hon. Friend Jack Dromey referred to legal challenges resulting from lack of consultation. I believe that the number of judicial review cases has increased by 45%. The renegotiation of fees for residential care provision by councils is also putting great pressure on the care home market. That was not the only reason for the collapse of Southern Cross, but it was certainly one of the reasons.

I welcome the Minister’s statement today on Southern Cross, and I will take the opportunity to ask him three questions arising from it. First, has he established who all the landlords are? Secondly, he said that there is an expectation of a formal transfer of the care homes, with the second wave by the end of October. That expectation sounds similar to aspiration. How confident is he that that will happen? The third and most important question relates to the reference Gareth Johnson made to residents’ rights, including their right to know what their future is and where they will live and not have their care home closed. Can the Minister help us by saying whether any Southern Cross homes are likely to be closed; if so, how many and at what stage will residents be told? My fear is that they will be the last to know.

Those are not the only continuing problems. There is a continuing and exacerbated postcode lottery for who gets what services. Tower Hamlets spends five times as much on each older resident as Cornwall, and such disparity leads to unfairness. Our social care system is definitely creaking at the seams.

The good news concerns the Dilnot commission. The Opposition have made it clear that we will work with the Government to find a solution to long-term funding of care based on the Dilnot recommendations, but funding is not the only matter dealt with in the recommendations of Dilnot and the Law Commission. They include less complex matters that may be less financially challenging, such as recommendations to improve available information, to support carers, and to enable portability of care. We want to ensure that that happens, and quickly. Will the Minister assure us that there will be legislation during the next session of Parliament to deal with the Dilnot recommendations? We all agree that we must get on with this.

We must also ensure that the present strains on the care system are dealt with. The concern is that even if we find a solution for the long-term funding of care, we may look at our care system in a few years, and wonder what is left. That is a genuine and continuing concern for all those involved in the sector. I understand that the business in the main Chamber includes an amendment to the Health and Social Care Bill which may help to regulate providers such as Southern Cross, but we have only 10 hours to discuss more than 1,000 amendments, so perhaps the Minister will take this opportunity to explain whether the Bill has been sufficiently changed to ensure that we will be able properly to regulate social care providers, particularly providers of residential care to elderly people, and whether the legislation will be able to help with that.

I welcome the partnership on dignity and care that has been established by the NHS Confederation, Age UK and the Local Government Group to look at standards of health and social care. I agree with many of the contributions that have been made today. There is concern not only about the funding of care, but about the standard of care. I listened to the passionate speeches by many hon. Members about the dreadful way in which some people have been treated. It is clearly hugely important to keep standards are high as possible. I look forward to the report of the Equality and Human Rights Commission, which I understand will be issued in the next few months.

That brings us back to the cuts. I do not want to sound like a broken record, but I take this opportunity again to warn the Minister that if the Government continue to cut local government funding as they are doing, the biggest area of discretionary spend, which is adult social care, will continue to be cut. The much-vaunted additional £2 billion that the Minister says is available for adult social care is simply not sufficient. He must not continue to close his eyes to the situation. I know that he feels passionately about the issue, as do we all, but we must be realistic and more must be done to protect the elderly. We must put more money and more investment into social care and ensure that it is not cut to the bone.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health 12:16 pm, 6th September 2011

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend Tracey Crouch on securing the debate. The speeches and interventions have demonstrated why we need Back Benchers such as my hon. Friend to raise such subjects, which Parliament has not debated enough over the past 10 or 15 years. That may be one reason why, as several hon. Members have said, social care has historically been the poor relation of the NHS and inadequately funded relative to the NHS.

We should not delude ourselves that many of the problems and pressures that have been amply and passionately described in our debate have emerged in the last 12 months. Indeed, if one takes a run through Hansard reports of the past 30 or 40 years, one sees that they have been raised previously. I do not say that to excuse the obligation that rests with the present Government to address the issues, but I ask hon. Members to bear in mind the fact that we should come to the debate with humility and recognition that past responsibilities were perhaps not fully met.

Attention was drawn to the fact that by 2033 almost a quarter of the population will be over 65. Indeed, some parts of the country have already reached that proportion—my hon. Friend Anne Marie Morris referred to the situation in Devon. I agree entirely with the point made by my hon. Friend Gareth Johnson that all too often in these debates we use the language of time bombs and consternation instead of celebrating not just the successes of our health and social care system in supporting vulnerable and frail people, but the contribution that, in turn, older people make in our society, often to their fellow citizens. We should do more of that and I want to make sure that we do.

It is worth saying that if the NHS and social care are to cope, some systems and processes need to change; I will say more about that shortly, but it is also necessary for older people themselves and their families and carers to call the shots about the decisions that affect their lives, so that the system can provide the care that people want, need and feel comfortable with. The whole agenda of personalising services so that people have the resources to be able to make choices and to be in control of those services is important, and the Government are determined to turn that ambition into reality.

Let me say something about the coalition’s commitment to see health and social care provided in ways that achieve better outcomes and deliver more personalised services. A thread running through the comments from hon. Members during the debate is the role of integration, which is a key element in realising better outcomes and better quality in the system. Integration is about care services working together in the interests of people and the local populations they serve, and about learning from one another’s experience and ending up with care and support that is of higher quality, safer, and more comforting than ever before.

We also need a sea change in the nature of the working relationships at local level, so that closer working relationships between local authorities and the NHS become the norm rather than the exception. That is one reason why we have made extra funding available. We can debate and will continue to debate in the House whether that funding is adequate, and I have no illusions about the challenges facing local authorities, but the Government have done much to ensure that local authorities have the resources to address them.

NHS funding that goes directly to local authorities for measures that support social care and benefit health will rise to £1 billion per year by 2014-2015. It is the first time that any Government have made such a significant transfer of resources. This year, £650 million has been allocated to PCTs and transferred to local authorities to invest in social care services. That will benefit health and have an overall impact on well-being. I am under no illusions about the interdependencies between health and social care services to which many hon. Members have alluded during the debate. One must look at both parts of the system to understand and mitigate the impact.

I look forward, as ever, to the next chapter of the report on social care by Emily Thornberry. From what I see, however, and from discussions I have had, I know that the picture is far from clear; it is mixed and different authorities are adopting different approaches to the challenges they face in meeting the Government’s deficit reduction targets. Some local authorities are being smart in the ways they confront those challenges and are looking at using telecare and telemedicine, investing in relevant services, and redirecting resources into earlier interventions that can make a big difference up stream. Other authorities—the ones we tend to hear about in debates such as this—are adopting more of a slash and burn approach and tightening eligibility without thinking through the consequences of such decisions and the impact on services. We need to challenge such actions not only in the Chamber but in our constituencies as constituency MPs. These pressures on the system are not new and we have seen such features for many years. Indeed, the vast majority of local authorities already used substantial need as a basis for eligibility and access to services before this Government came into office.

The £650 million that is being transferred to local authorities from the NHS is on top of the £530 million from the Department for Communities and Local Government that will go directly to social service departments.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

If the hon. Lady will forgive me, I want to ensure that I answer two or three of the key points raised by my hon. Friend the Member for Chatham and Aylesford. One key issue concerned the role of a Minister for older people. I certainly share my hon. Friend’s view that we must ensure cross-governmental dialogue and gain a much clearer understanding of the interdependencies between different policies and actions across the Government as they affect older people. The Government are not currently minded to appoint a Minister with specific responsibility for older people, but my hon. Friend has made a number of suggestions that could be a way to look at the issue. I undertake to take the point away and discuss with colleagues how we might join up services in a better way. A number of colleagues across Government have various responsibilities and we must find ways to ensure a clear articulation of the Government’s approach to ageing and an ageing society. We must ensure that that happens not only nationally but locally.

It would be remiss of me not to pick up on the comments about Southern Cross. I did not quite catch the second question, so the hon. Member for Islington South and Finsbury may wish to remind me of it so that I can answer. She asked about landlords, and the answer is that work to ensure that the transfers could take place required that measure to be concluded. As I understand, all landlords involved have now been identified, but if I am misinformed I will write to the hon. Lady and give her the details.

The hon. Lady also asked about home closures. In the past, I have said that when Southern Cross first made its proposals for restructuring the organisation, it suggested that the medium-term future—the next three or four years—would involve a limited closure programme. It did not specify a number and has not done so since. In some ways that programme is no longer the programme being followed; Southern Cross is effectively managing its own demise and passing homes on to new operators, which will have to make judgments about the economic efficiency of those businesses and the welfare of the people living in the homes, and decide whether they can carry on. We must have good advice and support to manage any closures that take place, which is why I have said on a number of occasions that I welcome the work done by the Association of Directors of Adult Social Services.

The hon. Member for Dartford raised an important point about the tenure to which we must give serious consideration. I do not want to make a policy announcement about that today because the issue is complicated. We do, however, need to look at how we can give people a greater sense of confidence in the place they consider their home, and ensure that in the future they cannot be lightly tipped out to find a new care home. I will write to the hon. Member for Islington South and Finsbury about the second question to ensure that she gets an answer.

I appreciate the warm words of support—broadly speaking—that have come from all parties about the Dilnot inquiry and the appetite to get on with action. I will ensure that that appetite is well understood across Government. We are clear that the report submitted by Dilnot in July makes an excellent contribution to providing a framework or scaffold around which we can take forward a wider reform of social care for the future. We will soon set out a further process of consultation not only about the details of implementing the Dilnot inquiry—he sets out a number of parameters in his report that are up for further discussion, not least the one mentioned earlier in an intervention—but about the wider issues of quality in social care that were referred to by the hon. Members for Wirral South

(Alison McGovern) and for Newton Abbot. We will approach all those issues in a combined way that will lead to a White Paper next April—that answers the question raised by the hon. Member for Chatham and Aylesford.

It is above my pay grade to announce what is in the Queen’s Speech; that has to be someone else’s job—probably Her Majesty, when she sets it out in detail, and the Prime Minister and the Cabinet who make those decisions. The Government remain committed to legislating at the earliest opportunity to bring in the Law Commission’s reforms and address the question of funding reform. I hope that answers the points of concern that have been raised.

The hon. Member for Chatham and Aylesford also mentioned housing, and she was right to talk about choice. That underscores the need for a cross-departmental approach to ageing and an ageing society, and I will raise her comments with my right hon. Friend the Minister for Housing and Local Government. Given his responsibilities for supporting people, it is important that I do that.

Prevention underlies many points that have been raised today and there is much we can do both to prevent admissions into hospital appropriately and to manage hospital discharges better. The increased roll-out and use of personal budgets will play a part in that, and will provide people with more control over the packages and nature of the care they receive.

The contribution made by the voluntary sector and charities has rightly been highlighted in this debate, in particular the role that such organisations can and do play in tackling social isolation. They also provide practical, low-level help—for example, helping to change a light bulb, which sometimes seems to take for ever. We must ensure that communities feel confident to give that help and are given support to provide mutual aid. Through our work on the big society we are determined to see that through. Local councils have an important role in improving health and well-being through commissioning those low-level services, and that has been well described in the debate.

The hon. Member for Newton Abbot expressed some concern about the role of the CQC. Like her, I met representatives from the care sector to discuss their views about what will soon be the first full year of operation for the CQC. The CQC was established in 2009 but has been fully operational only since October last year. Not all of what it does and will do has been explained to care providers as clearly as it should have been, but some of those defects are now being remedied. Just last week I had the opportunity to visit the CQC and see the work it is doing to establish a new, much simpler website. That website will provide a lot more information to providers about how issues of compliance with essential standards are being addressed.