House of Commons Hansard Debates for 13 Mar 1990

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many Conservative Members who first started to draw attention to the problem have come from areas where property is expensive.

Dame Elaine Kellett-Bowman (Lancaster) : Is my hon. Friend aware that even in the north-west it is extremely expensive for charities such as the Abbeyfield Society, in which I have a particular interest, to build extra care homes, service the debt and run them?

Miss Widdecombe : My hon. Friend is right and I was not suggesting that the problem did not exist in other parts of the country. While the problems in the south-east are extra acute, we must examine the issue on a nationwide basis.

I shall rehearse again the case of Florence Smith. She is aged 93 and until January 1989 was happy in a residential home, where she could afford the charges. Her income support more or less matched them and there was no problem. Then, like many elderly ladies--many of them much younger than 93- -she developed specific nursing needs and could not be accommodated in a residential home. She was transferred to the Poplars, a reasonably priced nursing home in my area. Having telephoned my constituency to check on average charges, I assure the House that the home's charges are most reasonable. It is well respected, well known and a much sought after home. In other words, it is not a ruthlessly profiteering establishment. Florence Smith was moved there and it immediately became apparent that the total benefits payable to her would not cover the costs involved. At that stage the gap was about £10 and was manageable by her daughter. But her daughter depends on a pension, so as the gap grew and the £10 became a larger sum, the pressures on the daughter increased. The Florence Smiths of this world remain in such homes largely because the homes subsidise them. There must be a limit on how long we can expect the better homes to go on doing that. Somebody entering a home at the age of 93 may have six or seven years left, and the relatives are faced with the problem of meeting the ever increasing gap in payments. That is bad enough. But for somebody aged 70 with nursing needs and with perhaps 20 years to spend in a home, the relatives face an extremely worrying prospect.

I could detail other cases, such as that of a professional, quite well-off couple who faced great problems. The wife developed Parkinson's disease, the husband could not look after her at home and there were no children able to help. Eventually she was moved into a nursing home. The husband took responsibility for that decision and he has run down his capital to the point where there is nothing left. What is to happen to that lady? The benefits available to her do not cover the charges.

Last Saturday a lady told me that her father was terminally ill. Generous income support is available to the terminally ill and that lady has put her father in a home where the charges are eminently reasonable. Indeed, they are on the low side for the area. Yet those charges are not covered and the gap is £50 a week, which is a lot of money. The lady in that case is of working age, and told me that she would be willing to go to work to keep her father in that home for the last two or three months of his life. Unfortunately, she must also care for a sick son, so she must stay at home and cannot go out to work.

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The new clause poses the basic question of who pays. There is no answer to that question in any of the provisions that the Government have suggested. They have acknowledged the problem and have taken many courageous decisions, and we are grateful for that, but all hon. Members have in their constituencies cases such as that of Florence Smith and they know that there will be more of them with the passage of time. In other words, the problem will grow in magnitude and certainly will not go away.

What happens if nobody pays? The Florence Smiths of this world fear what will happen to them if they are turned out of their homes. I do not paint a terrible picture of people being turned out of homes and wandering the streets with nowhere to go, but a sick elderly person in that situation, who either has no relatives or whose relatives cannot cope, will have to go into hospital. It is not even a cost-effective option to transfer people from homes to hospitals. The Government's policy of closing the larger mental hospitals with the aim of getting people cared for in the community is jeopardised by the situation I am describing. The sick elderly will be returning to hospital, from where nobody will be able to discharge them because there will be nowhere else for them to go. That will put an enormous strain on the Health Service and on the individuals.

6.45 pm

Mrs. Alice Mahon (Halifax) : Is the hon. Lady aware that we have lost from the NHS about 6,500 beds in which many of the elderly people about whom she is speaking used to be accommodated? It is not realistic to suggest that returning the sick elderly to hospital is an option because there are so few long-stay beds available. I worked on a geriatric ward in the early 1980s. At that time the Government encouraged the practice of lists of private homes being put up in wards so that relatives could read them and consider putting their elderly folk into homes. There are no beds available in the NHS to take people on a long-term basis.

Miss Widdecombe : I accept that the option is limited, but the fact remains that if someone is evicted from a home, that person must go somewhere, and if he or she is sick and has nursing needs, the inevitable end is a hospital. I accept that that will put immense pressure on the limited facilities that exist.

We must also consider the problem of unreasonable fees. The Government are right to say that, whatever system is created, we must not encourage homes to increase their fees by £20 the instant income support is increased by £20. The Government are right to fear that happening. That is why the proposal in the new clause--that an adjudication officer should be able to refuse to pay any part of fees that appear to him to be unreasonable-- should take care of the situation.

The problem of fees is bound to arise with new residents. Nobody is saying that a contracting authority, when taking a certain number of beds in a home, will say, "No matter what you charge, we will go on paying it." There must be a system by which authorities can negotiate reasonable charges. That process will establish what is a reasonable charge and, once established, it can be applied to existing establishments. So, because of the

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Government's proposals, the bogy of the unreasonable charge will be less real than it may have been in the past. That will certainly be the case after April 1991.

The new clause provides an adequate solution, and while the Government may complain about its wording, its aim is right. If we do nothing, the most vulnerable of our constituents will suffer greatly. Homes will have no incentive to build and expand when such developments should take place. Undue pressure will be placed on hospital services, which are already highly pressurised.

While I support the Government totally in their general aims in the matter, I urge hon. Members to support the new clause and thereby protect existing residents, whose situation, we are told, will remain the same. In other words, it will remain grossly unsatisfactory, a grievous worry to them in their declining years and a growing burden for their relatives.

Mr. Frank Field (Birkenhead) : I support the remarks of my hon. Friend the Member for Livingston (Mr. Cook) and the hon. Member for Maidstone (Miss Widdecombe). There are honourable reasons why many of our constituents find themselves in the land of limbo. I refer to our desire to offer our older citizens a better deal than they got in the geriatric wards of the past. Such a better deal appeared to be offered by many of the residential and nursing homes that sprung up. In the same spirit in which my hon. Friend the Member for Livingston moved the new clause, I do not wish to spend time drawing attention to the number of times that Opposition Members begged the Government not to go down that road--or, when they were going down it, not to have a gatekeeper to prevent expenditure from expanding, whether people needed to go into residential care or not. As the hon. Member for Maidstone said, we are now in that position, and must address ourselves to the question of what to do to protect some of our most vulnerable constituents.

It is important to underline that we are discussing this matter tonight because there was a genuine agreement on both sides of the House that the geriatric ward was not the most desirable place for people to end their days. Nevertheless, it is also important to remind the House, and people outside, that when we were offering the alternative there was never any question that families would have to foot bills, let alone large bills.

There has been a significant change in what I regard as the rights of citizenship. We are talking about people who may have been through two world wars ; many of them have never been unemployed, and they have paid all their rates and taxes. One of the benefits that they thought would result from the contract struck with the state was the certainty that, if they needed to go into hospital or have nursing care, they or their relatives would not be faced with a bill. Now we discover that, because we wanted to offer them a better deal and because hospitals thought that it was a way of cutting costs, they and their families will face the sort of charges that the hon. Members have mentioned.

Giving evidence to the Select Committee on Social Services last week, a witness from the Alzheimer's Disease Society said that families faced a deficit of £90 per week. As was pointed out by both the hon. Member for Maidstone and my hon. Friend the Member for Livingston, the deficits are growing. The Government must acknowledge that there are now pressures from the

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National Health Service, which will make the position worse. The Committee also heard evidence from clinicians who look after the Acton hospital in west London, which has a £1.5 million deficit. Some of those clinicians feel that the authorities are rushing into a scheme with the private sector in the hope of closing all the geriatric beds, because even under the current Government terms--which in the long run may prove unsatisfactory to the families of patients--as a result of closing its geriatric beds, the hospital will be able to halve its deficit. The picture painted by my hon. Friend the Member for Halifax (Mrs. Mahon), of those beds no longer being there when the ambulances bring people back, is a reality.

Mr. Ian McCartney (Makerfield) : A constituent of mine was informed that her aged mother had only three or four months to live, and that the consultant required the bed. She was not given a choice, and her mother was placed in an old people's home. Owing to nursing care and her own abilities, that old lady was still alive 18 months later. However, the fee in the home was more than £60 per week in excess of the family income.

My constituent must now work part time, and she is assisted at the weekend by her son. The doubly incontinent 87-year-old woman is now cared for at home because the old people's home could not continue to keep her : the family could not meet the £60 per week deficit. Their family life has been destroyed, and they are distraught. There is no possibility of their finding care or respite in the public or private sector, because that facility has been denied to them.

Mr. Field : I am always pleased to give way to my hon. Friend, especially when he takes me on to my next point.

We have now entered a new phase : there is no individual test of income on the recipient, but in respect of many families we have returned to the hated household means test. When Ministers appeared before the Select Committee, they made it plain that they would not tolerate that when the new scheme came into existence, and we applaud that. However, those who are already caught in limbo will continue to have a household means test applied to them.

The examples given by my hon. Friend the Member for Livingston and by the hon. Member for Maidstone show that even families that want to make up the difference often cannot, because they are pensioners themselves. What shall we do about them, and also to prevent the position from deteriorating? As my hon. Friend the Member for Livingston said, once the new scheme is in operation we know perfectly well what decent owners of nursing homes will do. They will arrange swaps : ambulances will move between homes, because once an ambulance touches down in a new home the person will be a new resident, and the fees will be paid in full. We can decide tonight whether that is desirable, and whether the Government should be building that into the Bill. The hon. Member for Maidstone asked what would happen between now and the time when the new reform is implemented--and beyond, for those who are caught in limbo. Those residents will face eviction when their families have been broken by the cost of trying to make up the shortfall in fees, or when the owners face bankruptcy because they can no longer continue cross- subsidising--either from other tenants or from their own reserves.

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Mr. Anthony Beaumont-Dark (Birmingham, Selly Oak) : I, too, am a sponsor of the new clause. Does the hon. Gentleman agree that one of the arguments of those opposing the new clause is that we are asking for a blank cheque--that anything goes, and that anything that is asked for should be granted? Does he further agree--given his very proper record-- that all that those who support the new clause are saying is that it should be costed out? Of course, the state should not be penalised, but for goodness sake let us not penalise those in the homes, and throw them on the scrap heap.

Mr. Field : I am pleased that I gave way to the hon. Gentleman, as his remarks take me on to my next point.

I recall a statement that was made by Ernest Bevin. He said, "When looking at a motion, do not bother to read the text ; see who is moving it." Let me point out to Conservative Members, who may be worried about the new clause giving a blank cheque, that the name of the hon. Member for Maidstone is on the motion. The hon. Lady would not be proposing any solution that was in the nature of a blank or open cheque. Both she and my hon. Friend the Member for Livingston have tackled that argument head-on. We are not pretending that, if we signed a blank cheque, all those who provide private residential or nursing care would behave honourably to the taxpayer : the sad fact is that they would not. Therefore, built into the new clause is the important proviso that the costs should be covered if they are reasonable. It is not for us to decide whether theyare reasonable ; that is for an adjudication officer appointed by the Department of Social Security.

The new clause does not create a blank cheque. We are not just throwing money at the problem. We are targeting it and we are discriminating in the help that is to be given. I hope that people will be mindful of the gains that have been made. We have moved away from the situation where many of our older constituents could expect care, freely given, in the hospital to a much better quality of care in many of the residential nursing homes in our constituencies. Our constituents went there thinking that their fees would be paid in full, but a growing number, almost half of those on income support, are not having their fees paid in full and, increasingly, families cannot meet those fees.

We have a chance tonight to ensure that that system does not continue and to deal some justice to some of our older citizens who have paid their rates and taxes during long and often distinguished lives in order to ensure that they do not face a summary eviction or a crude attempt to beat the Government at their own game by moving them around in ambulances. I hope that the House will agree with the arguments put so well by my hon. Friend the Member for Livingston and the hon. Member for Maidstone and will accept the new clause. 7 pm

Mr. Michael Brown (Brigg and Cleethorpes) : I apologise to the hon. Member for Livingston (Mr. Cook) for being unable to hear his opening remarks, but I was interested in the comments by the hon. Member for Birkenhead (Mr. Field). However, I am not convinced about the new clause. They, along with my hon. Friend the Member for Maidstone (Miss Widdecombe) and others who have signed the new clause, do not see the new clause

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as a blank cheque, but it would allow benefits for people in private old-age pensioner homes to be uprated to whatever a home charged.

We should be aware that a large variety of private nursing homes offer many different standards. There are those that offer poor standards and there are those that offer all sorts of luxurious standards. My family live in west Sussex, so I recently had the opportunity to visit one of the cream of the nursing homes on the south coast, the costa geriatrica. It was a wonderful home with superb standards. All its residents were offered a glass of sherry every morning. [Interruption.] I make no complaint about that. It is important that all private homes should aspire to the best service for the prices charged. But we must acknowledge that there will always be homes that will try to row in behind the standards set by the most expensive homes. Even the most expensive homes will have residents in receipt of the full benefits paid by the Department of Social Security.

It may not be obvious in the new clause, but we are in danger of writing a blank cheque. How on earth will the Secretary of State be able to provide the resources for the individual adjudication that the new clause invites?

Miss Widdecombe : I must ask my hon. Friend, with courtesy, not sarcasm, whether he understands what is being proposed. How will the Secretary of State determine between those variable charges for new residents? If he can do that for new residents, he can do it for existing residents.

Mr. Brown : I cannot accept what my hon. Friend says because the private sector offers a variety of services.

The Secretary of State for Health (Mr. Kenneth Clarke) : I am not sure which Secretary of State is being referred to, but I can assure my hon. Friend that this Secretary of State for Health has no intention of leaping in to try to decide what is a reasonable charge for each person under the new arrangements. We all accept that the new arrangements are a big improvement on the arrangements that we shall be glad to see the back of, as the hon. Member for Birkenhead (Mr. Field) said, but under them the local authority will have to assess an individual's needs for residential care and will then have to negotiate with a home that is acceptable to that client what the local authority is prepared to regard as a reasonable contract. That is not the same as addressing each existing resident in whatever home of whatever quality he or she might be in now. I share my hon. Friend's confusion, because that point has been slicked over in all the speeches so far.

The new clause cheerily says that there should be no payment beyond that which is reasonable, but how on earth is the Department of Social Security's adjudicating officer meant to decide what is reasonable? Does it mean reasonable for that resident, reasonable for that home or reasonable on the costs of a particular proprietor? My hon. Friend is being barracked, but he is making a good point. He should not give way to interventions that imply that my Department or the Department of Social Security is in any position to answer the questions posed by the new clause.

Mr. Brown : I am grateful to my right hon. and learned Friend. I share his view that there is an element of

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confusion within the new clause. There is an element of a blank cheque in it. I should be the first to acknowledge, as the tone of interventions from a sedentary position suggest, that there may well be within the arena of private nursing homes those who are unscrupulous. It is those very unscrupulous owners of old-age pensioners' private homes whom the new clause will aid and comfort. If we want to introduce some decent common standards--

Mr. Robin Cook : Since the hon. Gentleman is making a speech that hon. Members can use as a clothes-peg on which to hang our queries, let me put it to the Secretary of State through the hon. Gentleman that he is fearful that the new clause will make it difficult for the local adjudication officers to establish what is reasonable or unreasonable. But it is admitted that every local authority will have to establish that for its area under the new arrangements, so what is to prevent the Secretary of State for Social Security and his local officers at least meeting what the local authorities define as reasonable?

Mr. Brown : I would not envy any Department of Health or Department of Social Security officer in the task that is being suggested by the hon. Gentleman. I simply see a black hole or a bottomless pit that would ultimately prevent value for money being obtained for the taxpayer or the patient in private rented homes.

Mr. Frank Field rose--

Mr. Jerry Hayes (Harlow) rose--

Mr. Brown : I have given way generously to hon. Members on both sides of the House and I shall not give way any more because many hon. Members wish to speak.

Notwithstanding the assurances that have been given, the new clause creates a black hole. Much taxpayers' money will be wasted and that will not ultimately benefit residents in private homes. As has been acknowledged, some unscrupulous people run such homes and they will be the first to take advantage of the loopholes in the new clause.

Mrs. Mahon : I feel somewhat alarmed. I expected that tonight we might get all-party support for the new clause, because it is a very good clause. We are talking about large numbers of increasingly frail, elderly people. I should like the hon. Member for Brigg and Cleethorpes (Mr. Brown) or some of his hon. Friends who will be opposing the new clause to tell us what is to happen to these elderly, often very sick, people. What policy will the Government put forward to take care of them?

We referred in Committee--and I do not say this in any flippant sense but because the hon. Member for Maidstone (Miss Widdecombe) and others mentioned it--to the Florence Smith gap that applies to every constituency in the land, and increasing numbers slot into it. I have just looked at one or two statistics. In west Yorkshire, the average gap for a normal residential care home for the over-65s--not the very elderly--is £24.19. The gap for a nursing home is £19.59. That is the average, and I know that it is much higher in other areas. A constituent came to my surgery whose mother was in an ordinary residential home for elderly people. She was caught in this gap. The proprietor was not the decent kind of person that we would all wish to see in charge of such homes but was quite unscrupulous. When my constituent, who was the only daughter, went to see her mother, she

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was locked out because she had said that she could not meet the difference in cost. Eventually she had to be moved. The daughter was subjected not only to the worry of finding somewhere cheaper for her mother but also to harassment by the proprietor. I suggest that such treatment will increase, and that there will be evictions. What will the Minister do about these elderly people, because proprietors will not go on funding the gap? If we do not get evictions, will we experience the other kind of home that we have all heard about? Will we move back to the 10-bedroom situation, where neither the residents nor the people who see them in the home get any satisfaction?

I want to concentrate briefly on the Government's response to the problem so far. I hope that it will be different tonight. I am an eternal optimist.

The Government's response in Committee was to accept that there are problems. It was said in Committee that there were many bleeding hearts among Government Members, and that is true ; there was a lot of sympathy about these problems. The Government described the existing system as being not satisfactory and then proceeded to ignore it. If the hon. Member for Brigg and Cleethorpes is anything to go by--and he has taken the Government line--they intend to carry on ignoring the situation. Even worse, Social Security Ministers suggest that people who are unable to meet their fees should turn to the National Health Service. There will simply not be the beds available.

As my hon. Friend the Member for Birkenhead (Mr. Field) said, we tried to get rid of care in the geriatric hospitals because we thought that care in the community was better. Is it seriously suggested that we should go back to the philosophy of the very long stay bed? I hope not. I do not want to see any more geriatric beds closed down ; the British Geriatric Society says that that process has gone much too far and that we need more beds for geriatric patients, either long or short stay. To suggest that as an alternative, as Social Security Ministers have, is to fly in the face of the philosophy that we are all supposed to support.

Apart from anything else, there will not be any beds available. In fact, my own district health authority, because of the cuts imposed upon it as the cash allocated to it is not sufficient, is faced with the necessity of closing beds across the whole spectrum of disciplines, and one of the options is to take another 15 geriatric beds out of service. I think that that will become the norm. I return to the major question that Ministers must answer tonight. They must tell us what they intend to do with the large numbers of elderly people who will be very anxious indeed, the ones who are still mentally able to grasp what is happening. As for the others, their relatives and the people who care for them will be desperately anxious. The Minister must tell us tonight, if he will not support this new clause, exactly what message he has for the thousands and thousands of Florence Smiths. There is all-party support for this new clause, and I hope that the Minister will not let us down. 7.15 pm

Sir Dudley Smith : For some strange reason, Leamington Spa, which I represent, seems to be the mecca for old people. I believe that I have more residential homes in my constituency than even Bournemouth, and even more perhaps than my hon. Friend the Member for

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Brighton, Kemptown (Mr. Bowden). I suppose that it is because we are in the heart of England, but anyway the numbers have increased greatly in recent years.

I agree with every speech made in this debate so far, with the exception of that made by my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown). I congratulate the hon. Member for Livingston (Mr. Cook) on his moderation on this occasion, and the case that has been predicated is unassailable. I know that there are considerable difficulties in finding the right form of words to get this problem tackled by the Department of Social Security, but I have absolutely no doubt that it must be tackled. This is a modern phenomenon caused by the fact that people are living longer. As we approach the next century it will become a critical matter and one which will have to be tackled whichever party is in power. All of us who represent areas in which there are elderly people know only too well the sad and sorry stories of aged people, many of them incontinent and perhaps slightly deranged, who live on for 10 or even 20 years. Many of them have savings when they first go into a home, but gradually their savings dwindle because they have to pay for the growing gap between their income support and the cost charged by the homes.

I have seen many cases of families faced with an enormous moral dilema : should they try to help their mother or father to sustain what good quality of life there is in a residential home, or should they give up? These people are often of very modest means and may well be in early middle life, with young children. As every hon. Member knows, it is a very expensive time for families. Or they may be getting on themselves and perhaps reaching pensionable age, at which time every penny of their own savings will count for their own retirement. Are they to divest themselves of all their savings to help a mother or father, only to find that they finish up in a similar situation?

Therefore, this problem demands a very careful look by the Department of Social Security. Otherwise we shall end up, as I think the hon. Member for Birkenhead intimated, with large numbers of geriatric wards which will be very unpleasant compared with the residential homes which we have today and the numbers of which have expanded in recent years. Surely we cannot as a society face such a situation. We cannot allow old people to suffer the great indignity of being kicked out and moved around until a billet can be found for them. That would not be tolerated, and it would put an extra strain on the hospital system.

We must work out something far better than we have at present. I support the idea that we must be able to get the income support to cover the vast majority of the fees which are charged. At the same time we have to evolve a system whereby the homes concerned charge a reasonable sum for the people staying there. We must curb exploitation and sustain those who are managing, sometimes at a disadvantage to themselves, because they are able to cut corners. They are conscious that they need to support their inmates of whom they are quite fond ; for them it is not just a commercial proposition.

I hope that the Minister will give us some assurance, because we shall not be able to get the new clause carried-- [Hon. Members :-- "Why not?"] I am being realistic. We want an assurance that the Government have taken note of the concern of hon. Members on both sides of the

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House. I hope that he can satisfy us that the safety and well-being of thousands of old people will be safeguarded by the Administration, because it is a growing problem.

Mr. David Hinchliffe (Wakefield) : I find it difficult to be as charitable about the Government's record as some of my hon. Friends, including my hon. Friend the Member for Birkenhead (Mr. Field), whose work in the Select Committee on Social Services I respect very much. I also find it difficult to accept what I can only describe as the bleating from the Government side. The Government are directly responsible for the shambles because of the policies that they have pursued over the last 10 years. They need to be reminded of that. The Government have failed adequately to fund alternatives to institutional care. They have failed to take account of the demographic trends that have led to a huge increase in the number of people over the age of 85. They have cut back on the resourcing of domiciliary care, which is the alternative to institutional provision. At local authority level they have slashed the rate support grant which has had a direct impact on the provision of home helps, meals on wheels and other preventive services. They have also slashed Health Service preventive spending.

I give as an example a case with which the Secretary of State for Social Services is familiar. Recently he took part in a Yorkshire Television programme which featured the case of a constituent of mine, Mike Frobisher. That man is in care now, directly as a result of the fact that health services in Wakefield have been cut by the Government. Twice a week someone came along to help him bath ; that was cut to once a week. He was affected in many other ways. Respite care in the local hospital was reduced. Finally, his wife collapsed. As the Secretary of State is aware, Mr. Frobisher is now in a home where he has to manage on 5p per week. That is all that is left for him to live on when everything else is taken into account. He does not have any spending money apart from that.

Alongside the cuts there has been an explosion in free market care which has been generated deliberately by a Government committed to market forces. The result is that we have hundreds of thousands of cases such as that of Florence Smith. The floating of open-ended income support arrangements has led to an increase in private residential care. There has been talk of blank cheques, but we have had those already. That is why there has been a huge explosion in private residential care that is not appropriate to the vast numbers of elderly and disabled people. A total of £5 billion a year is involved. It is big business now. Some people are making vast amounts of money in the private sector out of elderly, dependent people. What concerns me most is the way in which the Government have created an institutional climate. There is an institutional vision of what is needed for old people. I do not believe that institutional care is the answer for elderly and handicapped people. There are alternatives, but the Government have slashed them and have forced people to enter institutional care, which is completely inappropriate.

The problems that people face in the community are horrendous. In many instances their problems are only beginning when they enter care because they cannot meet the fees. In Committee the Government said that existing

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residents will have a preserved right to income support. That is fine, but what about the future of non-assessed residents who end up in institutional care on the basis of their capital resources, who spend those resources and have to apply for income support? The Government have failed to consider that category. I understand that they may be covered by upratings in income support, inadequate as they are.

The Association of Metropolitan Authorities estimates on the basis of DSS figures that there is a £40 a week gap in residential care payments and about £60 a week in nursing home payments. What happens to people when they cannot pay the fees? In a recent report the Select Committee on Social Services said that many elderly persons will face eviction if the Government's policies are implemented as they stand. When I moved an amendment in Committee on security of tenure, contracts for residents and the prevention of eviction, it was resisted by the Government. So the Government are prepared to accept that because of the free market a proprietor may say, "I am sorry ; it is hard lines that you cannot meet what we are charging. You will have to leave. Get on your bike. We are not prepared to continue caring for you."

What are the options for such people when they cannot meet the fees? We all have such people in our constituencies. In most instances it is a matter of begging or borrowing. They may ask voluntary organisations for assistance. Many people are assisted by voluntary organisations which are in great difficulty because of the number of people whom they have to fund. Many elderly people are forced to go cap in hand to relations to ask for a supplement of £20 or £30 a week. That is not acceptable.

When I asked the Minister for Social Security about the problem in November he could see nothing offensive in relatives helping those in homes with fees. I find it offensive that people have to go out to earn money to supplement payments for relatives. That is simply not on, particularly when the elderly people have paid national insurance and taxes all their lives. Some of them are 90, 95 or even 100. We should also take into account the feelings of the elderly and handicapped people who have to beg and borrow from relatives to supplement their income. When they have saved up all their lives, how do they feel when they find they can no longer look after themselves financially? It is appalling that the Government are prepared to allow them to seek help from relatives. Many elderly people still have pride. We should respect it. We should say that it is inappropriate for them to be subsidised by their relatives. At my previous surgery a man was desperately concerned about his inability to meet the fees for his adult son in a private home. He and his wife were worried that the fees were increasing beyond what they could pay. His wife was seriously considering volunteering to work in the home to offset the increase in fees. These people are not young. They have a handicapped lad of about 29. They have gone through hard times. Even though their son is in care, they still have to worry about meeting the fees.

If people cannot afford the fees, they have the choice of going down market. They can go into a home which does not have sherry on offer. Surely the offer of a glass of sherry should not figure in the evaluation of care in a home. After I had spoken at a meeting last Friday night, a lady came up to me and said, "I am in the private sector. Come to my home. We have bone china." She told me that the residents got a drink of whisky, I think it was, before

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they went to bed. That was her advertisement of the care in her home. I suspect that description of care. That is not the care that I would want if I ended up in a residential home. That is not a way of evaluating the quality of care.

Age Concern has expressed anxiety about how the income support problem is forcing down standards in many homes. There are lower levels of care and people are having to move from single rooms to shared rooms simply because the resources are not available.

Mr. Peter Griffiths (Portsmouth, North) : Does the hon. Gentleman agree that one of the least acceptable solutions to the problem that he has described is that residents who cannot meet the costs in registered homes will be moved into unregistered homes with three or fewer guests where there is no inspection of the services on offer? 7.30 pm

Mr. Hinchliffe : I hope that Conservative Members were listening to that very valid point. The Opposition were concerned about that, which is why we pressed in Committee for the registration of smaller homes. What the hon. Gentleman described is happening now. I hope that the hon. Member for Portsmouth, North (Mr. Griffiths) will be in the Chamber later when we discuss the new clauses on the registration of smaller homes. I am sure that Conservative Members as well as Opposition Members are concerned about that.

Many of the people who can no longer pay private sector fees are now forced to look to local authorities to provide residential care. Clause 37 excludes local authority homes from the new funding arrangements and places them at a clear financial disadvantage. Local authorities are getting rid of direct provision because they can no longer afford to offer the provision by part III accommodation. As well as people being passed on to part III accommodation, that accommodation at local level is now disappearing.

The Government must address the problems that have been raised by hon. Members on both sides of the Chamber. New clause 1 attempts to deal with the consequences of what can be described only as the Government's free market experiment with care. If the Government see fit to leave the provision of welfare in the hands of market forces--as they clearly have done over the past 10 years--if they are not willing to develop clear alternatives to institutional care in terms of prevention and keeping people out of care, and if they believe that the institutional model is the only major response that society can give to the needs of handicapped and disabled people, the least that they can do is ensure that when people end up in institutional care or are forced into it because of the lack of alternatives, those people can live their lives in financial security and not worry daily and weekly where their fees will come from.

Mr. Andrew Rowe (Mid-Kent) : I will be astonished if the Government accept the new clause. With the best will in the world, there is no way of preventing charges rising universally to meet income support levels. It is perfectly clear that the supporters of the new clause have no desire to write a blank cheque. However, it will be impossible to avoid that consequence. If it happens, it will shrink other budgets which will be needed to care for the vulnerable. In

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the end, the effects will filter through the system so that the new community care system, which we are so anxious to see succeed, will be put at risk.

It would, however, be foolish and wrong to suggest that there is no problem. Therefore, what are we going to do about it? There are some strengths in the present position. The number of people in the category about which we are concerned is finite and known. After the Bill is passed there will be no increase in that number. The new customers under the new system will be covered by a contract that will not allow public services to renege on their responsibility to those people. We are concerned tonight with a number of people, many of whom did not have a serious contract except in so far as if they paid the bill, or it was paid, they would receive care. I can understand and applaud the desire of Health Ministers not to overload social service departments, which will already be heavily burdened, by giving them responsibility for that particular group of people. In parenthesis, I must state that homes are at great danger at the moment. We must consider the stock of places that exist at the moment. It is all very well for the hon. Member for Wakefield (Mr. Hinchliffe) to refer to the private sector for making vast amounts of money. With the exception of a tiny handful of fortunate, skilled or highly selective proprietors, the exact reverse is the case. The hon. Member for Livingston (Mr. Cook) and others have said that many homes are vulnerable. As my hon. Friend the Member for Maidstone (Miss Widdecombe) stressed, those homes have large debts to service. Proprietors have told me with great force that they are very worried about how long the new local authority assessment procedures take to supply them with replacement customers if their customers die or move out of their homes. There may be too big a gap to fund and proprietors will be vulnerable.

Mr. Hinchliffe : With regard to the hon. Gentleman's point about the profitability of the private sector not being very high, can he explain why, if that is the case, a great number of companies of national renown are moving into the private care sector? Such companies include Stakis plc, the amusement arcade business Kunick plc, Buckingham the international disco and leisure complex company, Vaux plc, Boddington's brewery and Ladbrokes. Are those companies moving into the sector because there are no profits to be made?

Mr. Rowe : It would be foolish to imagine that there are no profits to be made. However, I believe that where profits are to be made, they can be made only in most cases by companies large enough to weather the difficult periods as well as the relatively easy periods.

The hon. Gentleman is aware that many small and medium-sized homes have been started by people from the highest possible motives. Homes have been started by people who could not find appropriate care for their children so they decided to set up a home to cope with their children and with others as well. The impression that is sometimes given by Opposition Members that we are talking about a sector into which people move only because they can make profits by exploiting the vulnerable is wrong.

Mr. Frank Field : Will the hon. Gentleman answer his own question : what should the Government do?

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Mr. Rowe : I am sorry. I was distracted slightly by interventions. I had intended to discuss that now.

Central to any solution to the avowed problem must be a predictable budget which can be foreseeen and provided for. That is why I am completely against any suggestion of a blank cheque.

Mr. John Battle (Leeds, West) : Does the hon. Gentleman accept that the Government have already given a blank cheque in housing to the private landlords because they are committed to paying housing benefit at whatever level? If that is the case in housing, why can there not be funding in care as well?

Mr. Rowe : I do not want to pursue that avenue too far. The hon. Gentleman should be careful about suggesting to Treasury Ministers that there are blank cheques anywhere.

Given that there has to be a discernible, predictable and finite budget to deal with what is, after all, a predictable and finite number of people, Ministers might profitably consider two elements. First, perhaps there could be a regional differentiation in the amount of income support that is available for this purpose. That is a crude measure, but it is better than giving a United Kingdomwide level of support because there are discernible differences in different parts of the country. Like my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman), I am not suggesting that one can make a crude division between north and south or east and west, but it is possible to make a division between areas where prices are relatively low and areas where they are far higher, as in my area. Nor is it unreasonable to consider the debt burden relating to the age and capitalisation of such a home.

When it comes to assessing individuals, the Government have a precedent to hand. The independent living fund has been a substantial success at making a whole range of difficult and sensitive decisions. Perhaps providing an organisation at arm's length with a finite budget and saying, "You take over the difficult issue of assessing people for the additional support", may be a help.

Finally, the new clause as drafted is manifestly flawed because it cannot come into effect until next year which, for many of the people with whom we are concerned, will be too late. Therefore, although I am opposed to the new clause, I advise Ministers that they must come forward with some concrete suggestions about how we can meet the needs of the most vulnerable people in our community.

Mr. Alfred Morris (Manchester, Wythenshawe) : The speech made by the hon. Member for Maidstone (Miss Widdecombe) was a most powerful and, I hope in its effect, an influential contribution to this important debate. I am glad to note her return to the Chamber. Much of my parliamentary life has been spent trying, both as a private Member and as a Minister, to improve residential and community care for frail elderly and disabled people. If we are to ensure humane standards the essential principle is that, in every case of need, the right care should be available in the right place and at the right time. Otherwise people in special need are left in despair, as happens in so many cases now when residential care fees cannot be met. The relatives share that despair.

After a decade in which the financing of residential care was shifted, in an unplanned and officially unpredicted way, on to the social security budget, the Government are returning in this Bill to the old system of local authority

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sponsorship. Although there were always tough negotiations between local authorities and voluntary organisations, the old system is now acknowledged to have been the best method of ensuring both value for money and special provision for those with special needs. The new clause seeks to protect those who are trapped in the system that is now being discarded, which has proved to be a Procrustean bed. In the original format, which was introduced by the right hon. Member for Brent, North (Sir R. Boyson), payments were practically open-ended and costs expanded rapidly. A series of panic measures were introduced to cut the costs, but national yardsticks have proved just as insensitive as the old Greek bandit who either stretched his guests or cut off their limbs to fit the accommodation provided. The new clause is concerned with those whom our modern Procrustes in the Department of Social Security has maimed. Almost half the residents on income support do not have their full costs met, as my hon. Friend the Member for Birkenhead (Mr. Field) said in oral questions on 5 March. In response to my subsequent question, from the Opposition Front Bench, asking the Minister at least to

"ensure that income support payments keep pace with the charges agreed by local authorities for new residents"

the right hon. Member for Chelsea (Mr. Scott) appeared to misunderstand the question, which he failed to answer, and he referred to extra resources for community care. No extra resources are being provided for existing residents. Moreover, in Committee Ministers resisted the imposition of any duty on local authorities to assess current residents for a possible return to care in the community.

Later amendments are concerned with rights to residential community care, where it is needed and desired. In reply to my question on 5 March, the right hon. Member for Chelsea referred to the

"perverse incentive for people to go into residential care"--[ Official Report, 5 March 1990 ; Vol. 168, c.574.]

But the Government seem determined to swing the pendulum too far the other way, in that there is now often a perverse ministerial insistence on sweeping under the carpet the needs of people for whom such care is a vital necessity.

7.45 pm

Very old and frail people, who have been in residential care for several years and who have grown accustomed to the idea that this will be their last home, need the assurance that the Government will continue to meet their costs until the day they die. The attitude of Ministers is causing extreme distress, not only to residents, but to their relatives, who are often poor and disabled themselves, and who are approached to make up the difference between fees and benefits. That piles handicap upon handicap for the very needful people this new clause seeks to help.

The record shows that I was one of those who repeatedly warned the Government where the policy that they are now discarding would lead. In the spirit of the speech made by my hon. Friend the Member for Livingston (Mr. Cook), however, I am not concerned tonight to say "I told you so." Give or take the speech made by the hon. Member for Brigg and Cleethorpes (Mr. Brown), there has been scant controversy in the debate.

The new clause is eminently fair. It has strong all-party backing and the House should accept it. I sense deep and widespread unease on both sides of the House about the

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