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problem that the new clause seeks to resolve. The only proper way to give effective expression to that unease is in the Aye Lobby tonight.Mr. Bill Walker : I shall be brief, because many other hon. Members still want to speak. The Government would be unwise to accept the new clause as it stands. That is not to say that there are not problems, because it would be foolish to pretend otherwise. There may well be regional variations and differences that need to be considered positively, sympathetically and constructively, but that does not mean that we should put on the statute book legislation that may have an open-ended commitment.
When my right hon. Friend the Secretary of State replies to the debate, it would be interesting if he could give some idea of the likely envisaged costs of implementing the new clause, if that has been worked out. We are usually told that we should be prepared to understand the commitment that we are entering into. Being a canny Scot, I do not want us to enter into open-ended commitments for which the taxpayers will be required to pick up the tab. As I have said, I believe that we would be wise to look at the problem, bearing in mind the regional variations that may exist.
In that context, I must declare an interest because I have many such homes in my constituency. Obviously, therefore, lots of patients are my constituents. Many such homes have been opened recently and, as far as I can tell from the visits that I have made--and I still have quite a number to visit after already visiting a substantial number--the patients appear, in the main, to be well looked after. One must acknowledge that problems exist in some areas. It would be foolish to pretend otherwise. Another factor that must be considered is the variation in input costs. One thing that has struck me on my visits to different homes is that some homes are more expensive to run than others. The people who pay are those who pay for the patient, or inmate, depending on what one wishes to call them, but in any case those who are staying in the home and are not part of the team that operates the unit. People pay through taxpayer funding, whether partially or totally. The House and the Government must look carefully at the matter and deal with it positively and constructively. I am not prepared to vote for the new clause as it is drafted.
Mrs. Audrey Wise (Preston) : With one exception, everyone acknowledges that there is a problem. I even saw the Secretary of State for Social Security nod when his hon. Friend the Member for Tayside, North (Mr. Walker) said that there was a problem. So at least we have reached first base on the matter.
Some possible solutions which have asserted themselves among some Conservative Members would not be acceptable. The hon. Member for Mid-Kent (Mr. Rowe) acknowledged that there are problems. He seemed to finish up by suggesting that in some areas--such as his--more money was required. Any suggestion that a solution could be found by providing more money for the south-east would not find wide favour. The hon. Gentleman also suggested that we could take some comfort from the fact that the problem is finite and is not growing. But it will grow for a little while. I understand that the present system will operate until April 1991. All those entering homes before April 1991 will be in the position that we describe. The current number of people claiming income support and living in residential
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homes is 176,000, a considerable number. They do not all have relatives, but some do. If we add their relatives, that makes a large number of people who are exercised by and worried about this problem.Clearly cost is a pertinent question. Why are the Government so coy about it? They must be fixing their special income support level by reference to some calculation of costs, unless they simply pick it out with a pin. They must have some method of deciding how much they will give. Do they say, "We shall give 60 per cent. of the average", or "We shall give 90 per cent. of the average"? What do they regard as the average? What do they regard as the range? They are surprisingly coy on the matter.
In a parliamentary answer on 24 January, the Department said : "When taking decisions on increases, we took account of a wide range of information on costs and charges in homes. This primarily came from the Department's own local office returns, independent research and detailed representations from outside bodies,"--[ Official Report, 24 January 1990 ; Vol. 165, c. 1029.]
Outside bodies which have an opinion on and knowledge of the matter all say that the Government have got their figures wrong. The Government should look with kindness on the Select Committee's recommendation to
"immediately commission a rapid independent investigation of the costs of residential care and nursing homes. The results of this research should be published."
That is the key point. The Government should have the research done and should publish the results. Then we can all see whether the true picture is one of profiteering, we shall have a much better idea who the profiteers are, and we shall see the extent of the burden being tackled in examples such as that given by my hon. Friend the Member for Livingston (Mr. Cook). He referred to the problems faced by a group of Roman Catholic nuns in running their residential home. If independent research were carried out and published, the whole discussion would be on a much firmer footing.
No Opposition Member wants to make life easy for profiteers, in particular those who profit from the needs of the elderly. It is astonishing to us that some Conservative Members invoke profiteering as a reason for leaving elderly people without sufficient resources to meet bills which may well be legitimate. If people are profiteering, there are probably other things wrong with the home. Clearly such people are in the business for the wrong reasons. There should be a means of tackling that problem. Perhaps that could be explored later when the House considers matters of quality. In view of the representations made by the National Council for Voluntary Organisations and others, I am not willing to say that all homes overcharge. I do not believe that that is the case, nor do the Government make that case. They do not make any case on costs. They simply produce a figure and then upgrade it by £10 without publishing any groundwork or justification for it.
These are serious matters and they will have serious results. The Minister for Social Security believes that it is in order for relatives and charities to be a central part of funding care for the elderly. However, that has not been the intention of the House. Relatives may not be able to afford to contribute. There may be no relatives. Surely charities raise money for purposes other than to take on
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the burdens which should rightly belong to the state and to us all. It is unacceptable to say, "Let relatives and charities pay." If, despite their best efforts, an elderly person's relatives cannot pay, the result may be that he or she cannot have residential care even if it is the most appropriate type of care. Community care may become forced community care by relatives who cannot afford the extra fees to make up the income support. Relatives will be left to do the caring without proper back-up from the community.This is not a proper community care Bill. I do not wish to make too many waves in this all-party atmosphere, but to leave five days between the publication of a White Paper on community care and the tagging of clauses on to the Bill is fraught with dangers. I cannot understand why, after 15 months of blank silence between the publication of the Griffiths report and the Government's response, the Government went to the other, equally undesirable extreme of acting with precipitate haste and producing something which has not been properly thought out.
There will be other anomalies with regard to relatives, as the Select Committee pointed out. The relatives of people entering residential care after April 1991 will suddenly face fewer burdens. Suddenly it will be all right for them to say, "We cannot afford it." The Government will tell local authorities that it is their job to pay for care. Is that the difference? After April 1991 the local authorities will have the responsibility. Do the Government not mind giving local authorities extra tasks, however difficult they claim those tasks to be?
I am sure that you are aware, Madam Deputy Speaker, although Tory Members may not be, that the shortfall which is affecting individuals and their relatives will also affect local authorities. We shall have an opportunity under a later clause to explore the dangers and problems that will arise. At present we are looking at the effect of the shortfall on the unfortunate individuals who are termed "protected". One hon. Member, I am not sure on which side of the House, called them "excluded", and that is a much truer description. 8 pm
The possibilities range from eviction. The Select Committee on Social Services does not go in for extravagant language, yet we contemplate elderly people, some of whom are frail, facing eviction. They will not be protected against it.
Mr. Frank Field : When at the beginning of her speech my hon. Friend gave the figures, I calculated them on a constituency basis. She is right to say that not everyone will be evicted, but everyone risks eviction. There are about 160 residents per constituency in that category. In my constituency, that means two full streets. If we talked about two full streets of residents in every constituency risking eviction, the atmosphere of this debate would be even more tense than it is.
Mrs. Wise : I thank my hon. Friend for that apt picture. In case anybody thinks that we are trying to overstate the case, I point out that, according to the Government, not all the 176,000 are unable to meet the costs from their own resources. The Government say that a majority can meet the costs from their resources. That majority turns out to be 58 per cent. If, instead of my hon. Friend's two whole
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streets, I was terribly generous and suggested one whole street not just of people but of frail, elderly people who risked eviction, even on that modest evaluation, we and they still face a worrying situation.Mr. Michael Jack (Fylde) : The hon. Lady's remarks may be a little unnecessarily harsh, particularly on those who run private rest homes. I know from constituency experience of many elderly people whose condition has deteriorated and who need much better nursing care than the rest home can provide, yet the owners of the homes feel a deep obligation to them. They are caring people who look after their elderly residents. Although they need more money to do so, they keep them on the same premises and do not throw them on to the streets.
Mrs. Wise : The hon. Gentleman has misunderstood my point completely. I am not blaming the owners of the homes. From the beginning I have said that those who profiteer and are unsuitable should be dealt with in some other way. My concern is with the wide range of homes such as those described by my hon. Friend the Member for Livingston--for example, the homes of the Roman Catholic nuns. I fully agree with the hon. Gentleman that the owners may wish to provide care, but, however keen they are, they cannot do it on fresh air. Presumably they must pay wages and buy food, and many other costs are involved. I am not discussing the intentions of the owners or those who run these homes. For the purposes of this debate I am prepared to accept that they are all splendid. The fact is that they cannot run a home without money.
In a way the hon. Gentleman has reinforced my point, although he did not intend to do so. He has added a whole new category of desperately worried people--those who try honestly, legitimately and properly to care for elderly people and provide them with a home. Whether they are in the private sector or the voluntary sector, they cannot do so with the sort of shortfall which has been described by the National Council for Voluntary Organisations and which is regularly described by our constituents. It is not often that the hon. Member for Maidstone (Miss Widdecombe) and I are found on the same side, but, whether we like it or not, the inescapable facts of this issue drive us together. It is a remarkable cross-party experience.
Ms. Dawn Primarolo (Bristol, South) : The Government are taking us towards this disaster deliberately, and they know it. My hon. Friend mentioned a figure of 168,000 people. In a letter to me on 8 January the Under-Secretary of State for Social Security gave me the Government figure of 176,000 people in residential care or nursing homes claiming benefit. Therefore, although the Government expect the number of people who need income support to continue to grow, they deny them help.
Mrs. Wise : I thank my hon. Friend for that intervention. Indeed, the interventions have been extremely helpful to me.
The universality of our experience across different types of area is unusual. I can describe it in Preston where, generally speaking, people do not have much spare money with which to pay the shortfall on behalf of their elderly relatives, however much they desire to do so. We have heard of it in Kent where costs are higher, so although people may have more resources, they find it proportionately difficult. The Secretary of State for Social
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Security needs to do more than simply acknowledge the problem. He should accept this solution on offer to him or, failing that, outline an equally comprehensive and satisfactory one.There are other likely consequences. Homes, whether for good or bad reasons, may, in an attempt to cover the shortfall, pay wages to staff which are too low. That would have bad effects not only on the staff but on the people for whom they care. It may affect the quality of staff whom they can recruit. That is undesirable. We want our elderly people to be looked after by people who are properly paid.
Mr. Hinchliffe : My hon. Friend makes an important point about staffing arrangements. Last week I attended a meeting of the all-party personal social services committee when a representative from the British Association of Social Workers said that in Liverpool 16-year-old girls employed in old people's homes were changing catheters of men and women alike. They were untrained and were being paid about £1 an hour. I am sure that my hon. Friend will share my anxiety about what is going on in the private sector.
Mrs. Wise : I think that anxiety is too mild a word. The right word is horror. If that is the road down which people are travelling, it is a disgrace--a blot on the House--because the House bears the final responsibility for ensuring that there are adequate resources. When we have ensured that, we can follow it up by ensuring that there is adequate quality of care resulting from those resources. We cannot say care properly but do it without the proper resources ; that is impossible.
As has been graphically and dreadfully illustrated by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), there will be skimping and the use of unsuitable and unqualified staff--probably overworked staff as well. Overworked and underpaid is not a good recipe for proper care.
Sir Anthony Grant (Cambridgeshire, South-West) : If they can get the staff.
Mrs. Wise : That is a valuable point. Of course not everybody would be willing to undertake care in such an unsuitable way, and not everybody would be willing to be driven into jobs for which they were unsuited, despite the best efforts of the Conservative party.
Mr. Allan Rogers (Rhondda) : The hon. Member for Cambridgeshire, South-West (Sir A. Grant) asked whether one would be able to get people to work in such situations. There is no difficulty in getting people to work in the many regions of the country which still have high unemployment and where people--especially women--are forced into low-paid jobs because there are no other jobs available for them. Sir Anthony Grant rose --
Madam Deputy Speaker (Miss Betty Boothroyd) : Order.
Mrs. Wise : I had better acknowledge that intervention and then I shall give way to the hon. Member for Cambridgeshire, South-West (Sir A. Grant).
Sir Anthony Grant : In some areas--mine in particular--nursing homes have enormous difficulties in getting staff
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to help those poor old people. Much as they would like to do so, they cannot go down to Wales to recruit them. It is very sad.Mrs. Wise : That is another illustration of the universality of the experience. Although the emphasis is different in different areas, there is a problem. I think we are on common ground and without resources it is impossible to get properly trained staff who will give the proper quality of care. I do not want people who run residential and nursing homes to have the excuse of lack of resources. I want to be able to come down on them like a ton of bricks if their care is unsuitable, but I fear that the Government are putting us in a false position.
As hon. Members have pointed out, there will be two tiers of residential care. In fact, it seems that that already exists, as hon. Members have pointed out. I do not want people to be accused of dumping elderly relatives if they enter a residential home with that accusation being true because those homes are dumps. People will face bills that they cannot pay or tasks that they cannot undertake in their own home or they will have to dump relatives, and that is an intolerable choice.
Surely we can manage to get some cross-party support on the matter. I fear that some Conservative Members are shielding themselves from the arguments by not coming into the Chamber. I hope that those Conservative Members who are acquainted with the arguments, and who are here tonight, will pass on the message.
This issue could give the Government more problems. I shall give the Government a little advice, because if this works out well and our suggestions are accepted the Government will get the credit. The Government usually get the credit in the end for any extra payments or extra care that come from the state. Therefore, given the general context in which the Government are operating, I should have thought that, in self-defence, the Secretary of State for Social Security would positively welcome the new clause.
If he does not welcome it, and if it is rejected, I am driven to the conclusion that this is due to the extra burdens they intend to force on to local authorities. If more money is made available for the individual to meet the costs, more money will also have to be made available for local authorities to meet the costs. If the new clause is rejected against all the excellent advice given to the Secretary of State by his hon. Friends, I fear that that will be the reason, and it is a disreputable reason.
Sir George Young (Ealing, Acton) : My hon. Friend the Member for Maidstone (Miss Widdecombe) spoke for me and I suspect for a large number of my hon. Friends when she made a moving speech describing the problems that face Florence Smith, and the many others throughout the country like her. I am always amazed at the sacrifices that so many families make to keep an elderly relative in their home. Those sacrifices go way beyond what might be legitimately expected. 8.15 pm
I welcome two decisions that the Government have taken in this broad area. First, they are quite right to have a cut-off point on 1 April next year, and to say to local authorities that the new Griffiths regime for care in the community should apply to new residents and claimants only from 1 April. That strategic decision was justified
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because there was no way in which local authorities could have coped with existing residents if they were to get the new structure going.Secondly, the Government were right to prevent local authorities from topping up existing residents, because if they had done so it would have been a drain on the inevitably limited resources for getting the new care in the community package going.
We are all agreed that there is a residual problem of resourcing residents who are "protected" and who will continue to look to the DSS for income support to pay their bills. There will be new claimants, because anyone in a home at the moment who is not claiming because he has his own resources but who runs out of resources in the future will have to look to the existing DSS regime for help and not to the local authorities. It is not the case that the number of claimants is finite. There can and will be new claimants as existing residents run out of resources.
One issue has not been adequately raised--the pressure on housing associations, charities and organisations that run homes. Servite House in Ealing is an example. It recently closed an excellent home in Ealing simply because it had to make such huge inroads that it could not afford into its own reserves to keep it going. Hon. Members who have met housing associations and other charities know of the pressure on their resources caused by the present regime. It is a matter not simply of people digging into their own pockets to keep the structure going, but of private and voluntary organisations digging into limited reserves to keep things going. There is a limit to how long that can go on.
Another issue that has not so far been mentioned is that next year there will be a transfer of resources, in regard to income support, from the DSS to the local authorities. Under the new regime local authorities can buy contracts with homes. That transfer of resources will be based on existing income support levels. If that is the basis of transfer, local authorities will get inadequate compensation with which to get the Griffiths regime going. It would be disastrous to under-resource the new structure--in which I have great confidence. It is not simply a matter of getting it right for people who are in homes at the moment. The figure that will be used will reflect how much of the resources--ring-fenced or otherwise--will be transferred to social service departments to get the new package going. I hope that we can avoid the risk.
There will be some difficulties with the solution advocated in new clause 1. I am not wild about adjudication officers going round to decide whether a tariff is right. Nor am I particularly enamoured of the regional variation solution put forward by my hon. Friend the Member for Mid-Kent (Mr. Rowe). The solution that I like has been touched on in the debate, and lies in part III of the Bill. As from 1 April next year local authorities will be inviting all the organisations that we have been talking about to tender for contracts. When that happens, the organisations will have to put in a price. They will state the fee that they will charge if the local authority wants to continue to place people in a residential or nursing home. The local authority will either agree that that is a fair price and place a contract with them or it will reject it. That price could be used by the Department of Social Security to validate the payments that are made to those on income support. It is a price that the home believes to be fair ; it is a price that it will have used in the bid that it made to the
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local authority ; it is a price that the local authority believes to be fair because it will have agreed it when it placed the contract. Given that it is satisfactory both to the home and to the local authority, I see no reason why my right hon. Friend's Department cannot say, "We shall uprate income support for residents in that home to the agreed level."That would avoid the problem of having two classes of resident in one home : one resident on income support, who perhaps receives an inferior standard of service, and another resident who entered the home under a new contract that was negotiated by the local authority at a higher price and who is offered a higher standard of service. I feel that that problem will arise if we do not do something about it. It would be avoided if income support were uprated to the agreed contract price that had been negotiated between the local authority and the home.
If my right hon. Friend the Secretary of State were to say that he could not agree to new clause 1, for whatever reason, but that he was minded to go in the direction that I have outlined by validating prices that had been negotiated, I should be happy to vote against newclause 1.
Mrs. Rosie Barnes (Greenwich) : I shall try to speak briefly ; the argument was made--game, set and match--in the first three speeches. I pay credit to hon. Members on both sides of the House for sticking to the facts and making a convincing case.
We are talking about elderly people who, by definition, will die in the next few years. However, others will come along who need income support as their incomes decline. Much of the debate has focused on the blank cheque element of the proposals. We are talking about a finite number of people, but a dangerous blank cheque will be involved if we do nothing about them. Where will they go if, as we suspect, some are evicted from the homes in which they live? They will go into hospital. However, they will not go into geriatric beds, because there are not enough. They will go instead into acute beds. The National Health Service needs those beds. They are in heavy demand for all kinds of treatments.
Apart from the cost implications of elderly people occupying those beds for, perhaps, years, there is also a political implication in terms of waiting lists. Many hospitals could tackle their waiting list problem far more effectively if some of the beds that are now occupied by elderly people could be released. At the moment, however, there are no satisfactory alternative placements. If more of those beds are to be occupied on a long- term basis, the House ought to bear in mind the political implications of such a blank cheque. We should also consider the implications for those whom we should subsidise if the new clause were accepted. Some hon. Members have suggested that we are offering a golden opportunity to those who wish to make a quick buck out of the elderly. A few may do that. However, I have read carefully the representations that were made to me by the voluntary bodies and I am not convinced that the majority of the homes involved would do that. The National Care Homes Association told the Select Committee that seven out of 132 nursing homes and one third of residential homes charged fees that were in line with social security levels but that two thirds of the homes for the elderly could not cover their costs by means of income supplement. The National Federation of Housing Associations said that income support levels had not kept
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pace with the true cost of care. These are not the Rachmans or people who are making vast profits out of the elderly. They are trying to supply a genuine service at cost, but they find it increasingly difficult to achieve their objective.The new clause would redress the imbalance. Reference has been made to avoiding exploitation by the appointment of an adjudicator. I listened with interest to the suggestion that there may be a better method of assessing what is the fair rate for a particular home. However, I should have to consider the implications for residents who may be in homes which do not have contracts with local authorities and which would fall foul of that suggestion.
After 1991, new residents will not have to contend with the problem. Their full fees will be covered. However, we are referring to about 100,000 most vulnerable people whose needs will not be met. They have to turn to local authorities, charities and their families to make up the shortfall. We are referring to the very elderly, many of whose relatives are also elderly. The point was brought home to me recently when I visited a geriatric ward and was introduced to a very elderly man and then to his daughter who occupied a bed in the same ward. Those who are well into their 80s or 90s have children who are between 60 and 70 years of age. All that they can be expected to do is to cope with their own problems and to make financial provision for their own future without having to take responsibility for their elderly relatives.
To do nothing is not an option. If continuity of care for these people is to be assured and if they are to have peace of mind, the new clause must be passed. It will provide security for the most vulnerable members of our society. Without such a change, the omens are gloomy. The National Council for Voluntary Organisations conducted a number of in-depth interviews with a variety of organisations that revealed some of the highly unsatisfactory measures that already have to be taken. They include the closure of homes in order to cover losses, or a policy change so that only those who are able to pay the fees are admitted--inevitably at the expense of those who are in the greatest financial need--inability to attract staff because of low wages, development plans deferred or scrapped, inability to carry out maintenance, refurbishment or the upgrading of buildings so that there is a more appropriate environment for residents, and a general reduction in the quality of life for residents.
It is abundantly clear that such cuts and measures, at a time when the number of elderly people in our midst is increasing and will continue to increase, are highly undesirable. I shall not detain the House any longer ; other hon. Members are anxious to speak. The case for the new clause has been made convincingly.
Sir Anthony Grant : I, too, will be brief. Nearly all the arguments have already been deployed. Nearly all of them go against the Government, I regret to say, and in favour of the broad principle in the new clause. The hon. Member for Greenwich (Mrs. Barnes) summed it up admirably. I agree with nearly every word that she said. I put my name to the new clause not because I am wedded to every single detail or because I think that it is a perfect piece of drafting. Drafting is never perfect. We have all been around long enough to know that if the principle can be accepted the Government will find a way to meet that principle. I was moved to put my name to the
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new clause because of an experience in my constituency. It contains a number of excellent private nursing homes, and one of them highlights the problem. The Weald nursing home looks after a number of very elderly people whose elderly children come to see them. Those people are admirably cared for by the proprietors who have dedicated their lives to the problem. They have provided them with a wonderful service. That home was expanding. Indeed, I opened an extension for it a few years ago.The problem is quite simple : the elderly residents came in on the basis of income support, but that support has not kept pace with inflation. There is now a shortfall, and these people are unable to obtain a top-up to rectify the situation. As a result, unfortunate elderly and worthy people are in danger of being moved out. However, because the proprietors are very compassionate they go to great lengths to avoid that. They move residents into other accommodation. They squeeze them in. They make economies here, there and everywhere, and in some cases almost subsidise residents. In this day and age, that cannot possibly be right. It cannot be right that people who have lived honourable lives should find themselves in such an undignified, worrying and anxious position.
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The new clause may be defective in some way, but I do not accept the "blank cheque" argument. Nobody wants a blank cheque to be provided. As I understand the situation, however--and I am open to correction--it will be possible to have restraint in the case of new residents. If that is the case, why on earth can it not be applied to existing residents? If there is a problem, I cannot conceive of its being beyond the wit of the Government, with all their resources, to find ways to ensure that solving it does not involve signing a blank cheque.
I hope that the Secretary of State will say that he realises that there is a problem. Perhaps he will say that, for some reason, the new clause would be ineffective. Perhaps he thinks that the suggestion of my hon. Friend the Member for Ealing, Acton (Sir G. Young) is a better one. In any case, he should tell the House that he will deal with the problem. Perhaps he could urge withdrawal of the new clause, on the clear understanding that the Government will produce something along the lines of this principle. I am bound to tell my right hon. Friend that, if that is not done, I will find myself in a great dilemma. I have been a loyal supporter of the Government for many years.
Sir Anthony Grant : It would not be the first time I had rebelled, nor would it be the last. I do not like to vote against the Government. I believe that, in this Bill, they are, in general, doing the right thing, but if I do not receive a reasonable assurance from my right hon. Friend I shall feel inclined to vote against them. The Minister is a compassionate and sensible man. We often come across Ministers who are sensible but not compassionate, and Ministers who are compassionate but not sensible, but this Minister is both compassionate and sensible. I know that he will take on board, with all their weight, the arguments that have been put before him on behalf of very worthy, decent people, who have a right, in the twilight of their years, to live in reasonable peace and dignity, without anxiety.
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If we do not get a reasonable response, what shall I do? I suppose I could go home--that would be one solution--or I could abstain. Instead, I will listen very carefully, and with an open mind, to what I hope will be a reasonable, compassionate and sensible response from my right hon. Friend.Mr. McCartney : I am a member of the Select Committee that went into this matter on numerous occasions--since it was first brought to attention in 1987. What we are discussing tonight is a problem that has been building up for seven years. As a result of deliberate Government policy in 1983 to expand the private sector and to introduce market forces into the area of care of the elderly and of other specific groups, resources were unleashed in an unplanned way. That led to limits being set at local level for board and lodging, for residential care, and for nursing home care. In different areas the limits for residential care could vary between £51 and £215 per week, and for nursing homes between £80 and £290. In one financial year--1984--the effect was such that the Government tried to put limits on the activities of local social security offices. Indeed, by September 1984, they had restricted the ability of the Department to make decisions at local level. In those 12 months the Government unleashed forces with which, for the past seven years, they have been unable to cope. I refer both to the financial situation and to the unplanned and unstructured way in which the sector developed. In 1985 that system was scrapped. Over the next two years the Select Committee on Social Services received evidence--first in a trickle, and then in an avalanche--about the growing gap between the cost being met by the Department and what a resident or his family had to pay from his own resources. During the same period local authority provision grew by 4 per cent. annually, whereas in the private sector the rate of growth was 350 per cent. More than 40 per cent. of all residents in board and lodging, residential care or nursing homes are in the private sector. At a time of such massive explosion, although there was an average of 4 per cent. growth in local authority provision, in many areas there was actually an absolute loss of provision, by way of homes being taken into the private sector or as a result of closure, or by reason of local authorities' joint arrangements with health authorities to operate exclusively in the private sector.
During that period I was a member of the Social Services Committee and of the planning committee. The avalanche of planning applications was such that special arrangements had to be set up between the social services committee and the planning authority to monitor the quality and nature of applications. At the same time, the social services department, with the health authority, set up an allocation system to deal with bed allocation. Consultants at Billinge hospital refused to accept frail elderly patients both from the private sector and from the local authority. There was a tit- for-tat arrangement, and I believe that it continues. If someone in part III or part IV local authority accommodation--even at that intensive nursing level--was incapable of being sustained by the local authority, the health authority would accept him back into its care if the local authority could accept
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someone from an acute bed in return. Bearing in mind the reduction in the number of beds, that is not always possible.Some months ago I visited a local authority home where an elderly lady who had been refused admission to Billinge hospital was being cared for by staff who were on their day off. Those staff members worked in shifts. They were the only people who were prepared to accept responsibility for that frail elderly lady. That is the position in which we find ourselves because of the unplanned explosion of market forces in health care.
As my hon. Friend the Member for Preston (Mrs. Wise) said, irrespective of political views, what we have heard from both sides of the House today drives us to ask what we can do to extricate ourselves from this morass. The Minister, whether he accepts or rejects the new clause, owes it to the House and to all those involved in community care to state precisely what his intentions are. I pressed the Minister for Social Security many times to advise us what the Department would do to protect residents from the problem of eviction. He ignored those opportunities to clarify the Government's position.
This matter has been treated with cynicism. We are talking about a finite group, many of whom are elderly and frail. Some people believe that, if we wait four, five or six years, most of those elderly people will die, and the problem will die with them. If that is the conclusion of advisers to the Department, it is totally unacceptable. For every elderly frail person in a private residential home, there is at least one elderly frail person at home trying to cope financially or socially.
Many of the people who see me about their parents are themselves either pensioners or are coming up to pensionable age. Many people have mentally or physically handicapped relatives at home and have seen their parents die. The brothers and sisters are left to cope with the handicapped person. The problem is passed on from generation to generation. If we do not accept the new clause, we shall pass on the problem of caring financially and socially not only to parents but to grandchildren. That is unacceptable in social and economic terms.
Like other hon. Members, I could tell horror stories about what happens to our constituents. Families find themselves in serious financial problems, some needing £10 or £15 a week and others needing £60 or £70 a week. Unbelievable sacrifices are made by people individually and collectively to maintain the family in the home, but they are driven to suffering illness and to seeking expensive respite care or other assistance from a local authority or the NHS. The proposed system in the new clause is not only financially fair to those who will benefit from it but in the medium and longer term will be much more cost effective to the Government in terms of the votes of money to the local authority, the NHS or the Department of Social Security. Given the total votes to those three organisations involved in community care, it would seem far easier to provide, as the new clause does, a consistent means of maintaining financial assistance to those who will remain in residential or nursing home care. The new clause is a genuine attempt to find a way through a serious and increasing problem in the private sector.
I have been a Member for only a short time, but I know that hon. Members are usually in conflict and that some can take what I say or leave it. Whatever region we come from and whatever political party we represent, the same
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problem arises. We are driven inexorably to the same possible solution. Even if the Government will not say that they are wrong, we hope that they will accept, just as they did in evidence to the Select Committee, that a serious problem exists. I hope that, because of practical debate on an all-party basis, for the first time since I became a Member we have come up with a solution that is acceptable to our constituents and in terms of the Government's financial targets. 8.45 pmMany families look to this debate for not only a financial solution but a solution to the long-term care needs of those families. I should like the Minister to investigate one matter involving Springfield home in Wigan. It is a local authority home which, as a result of negotiation, last year moved into the voluntary sector because of an agreement between the local authority, the care organisation and residents. At the time of the transfer, there were negotiations as to which residents could apply for and receive attendance allowance at the higher or lower rates. In about September, agreements were reached on specific residents. I understand that, in the past few weeks, the Department decided that residents who came under the control of the local authority before last August were no longer eligible for the allowances, which have now been withdrawn. That is astonishing and unacceptable. I ask the Minister to investigate that as a matter of urgency.
Hon. Members have seen such transfers take place in their areas on the basis of additional allowances being made available to assist the people in those homes. If that is not to be Government policy, it will have serious effects in terms of the transfer arrangements and the financial requirements of the residents. For those reasons, I ask the Minister to accept the new clause.
Mr. Peter Griffiths : Some of my hon. Friends invited me to sign my name to the new clause. Although I said that I had considerable sympathy with it, I declined to append my name. I felt that it was desirable to have a debate on the subject and for my right hon. and learned Friend the Secretary of State to know that there were those who had not made up their mind about how to vote before hearing what was said.
The position that I should like to describe has been well rehearsed by hon. Members--including the hon. Member for Livingston (Mr. Cook) and my hon. Friend the Member for Maidstone (Miss Widdecombe)--who have said that the problem will exist not just between now and April 1991 but will continue for those who are either already in residential homes or who will need to turn to income support to meet their costs.
A city such as Portsmouth, which I represent with my hon. Friend the Member for Portsmouth, South (Mr. Martin), has particular problems. Portsmouth is the second, or perhaps third, most densely populated area in this country. Land and property are extremely expensive. Until a few years ago, it was a low-wage area, dependent on the Navy, the dockyard and the women's clothing industry. Many of the elderly who live in residential homes did not enjoy the high wages and salaries that younger people in Portsmouth can enjoy because of the high-tech industries. If they made savings, as many did, they did so out of pitifully low wages. They assumed that they would be able to look after themselves in their old age as far as possible, but they believed that if their savings fell short of
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the amount necessary to meet their needs-- they would, of course, be sorry if that happened--they could carry on living reasonably comfortably and in reasonable dignity. They did not have especially high demands. They have moved into residential care, often initially at their expense, and paid the costs, only to find later that they have had to turn to income support to meet the costs of their continued residence.The difficulty is that the costs are high in a city such as Portsmouth. As I have said, it is an extremely densely populated city and property is expensive. We now have the problem of high interest rates, which make it difficult for the owners of homes to expand and to carry out repairs. We also have higher wages than we had before, which means that to find the high quality of staff required is an expensive business. It is not the case that there is a one-off shortfall between the rates that are paid by income support and the charges in the residential homes, but that there is a growing shortfall. It has grown over recent years and shows no sign of ceasing. That problem must be addressed.
There are always hard cases, and the most extreme case may not be the most suitable to use in developing an argument. However, I want to mention briefly one case which, I should have thought, would commend itself to the Government. It is the case of a maiden lady who spent her lifetime caring for her parents and kept them out of care by looking after them. When she became too frail to look after herself living alone--she has no children, of course--she moved into residential care using her savings. She intended to look after herself and such self-reliance commends itself to the Government. I also find such self-reliance extremely commendable. That lady made proper provision. The trouble was that, as the years passed, her savings dwindled. In the end, her savings fell below the level at which she could turn to income support.
There is a gap between the income support payable and the fees. No one could say that the fees in that home are unreasonable. They are the fees that this lady chose and she was willing to spend her life savings on them. It is not likely that they are excessive or unreasonable. They are the fees necessary to maintain the service in that home. However, this lady can no longer pay. The owner of the home is allowing her to stay there. In fact, he is accepting that she pays less than others in the home, which means that his business is damaged. He could not do that for a steadily increasing number of people. The next stage is that those in the home who are paying their own way from their savings have to pay a little bit more to cover the costs of those who are drawing income support, which means that their savings are going down faster than they would have done otherwise. They are moving towards the same position that this lady is in at a rate that they did not anticipate.
That is a case in which there is need for a clear-cut approach to the problem. I asked the former Under-Secretary of State for Social Security, my hon. Friend the Member for Fareham (Mr. Lloyd), what was the position in this lady's case. He said that, unfortunately, income support did not meet the total cost of residential care. I wrote back and said, "I know that, but what is the old lady to do?" I am sorry to say that the answer was, "Are there no charities that could be found to help?" Was it suggested that the old lady should find a charity or that I should go round looking for charities to support my elderly constituent, who had made every effort after a lifetime of caring to look after herself? Such a solution will not do.
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That old lady may stay in that home until she dies. If the numbers of such people increase, they will have to be moved from one residential home to another. I hope that my right hon. Friend the Secretary of State for Social Security will answer me later. Is it reasonable that if someone has expended all his savings at a particular home in which he was prepared to meet the costs, assuming that his savings would last his lifetime, and if he lives rather longer, he should, in the twilight of his life, be moved out into less suitable accommodation, which he would not have chosen for himself? Is that what my right hon. Friend is suggesting? If it is, it will not do any more than the suggestion that I should look for a charity. We need something better than that.I do not suggest that the new clause is the only way to deal with the problem. There may be other and better solutions. I realise that there is a problem that if, in effect, we increased the resources available to the Department of Social Security clients in residential homes, charges might rise, which would place an unreasonable burden on those trying to pay for themselves. I can see that there is a difficulty, and I understand that it is not a simple matter, but a complex problem.
My right hon. Friend tonight does not have to accept the new clause, but he must accept the responsibility. I do not mind how he discharges that responsibility as long as he tells me tonight what I should say at the weekend to the proprietor of the residential home about the old lady. "You are to go on looking after her, come what may, out of your own pocket. You are to charge everyone else in the home a bit more. You are to put the old lady into cheaper and less satisfactory accommodation or go back to your Member of Parliament and tell him to look for anothercharity." Are those the solutions? If they are not, what is the Government's way of dealing with the problem? If it is convincing, I shall vote against the new clause tonight. However, unless there is an answer to those questions, I shall go into the Lobby in favour of the new clause, which will be the only thing that I can do in good conscience.
Mr. Kennedy : The speech of the hon. Member for Portsmouth, North (Mr. Griffiths) neatly, elegantly and beautifully encapsulated the practical and the moral dimensions of the problem. I hope that he will forgive me for not responding to his speech in particular. There have been three other contributions from Conservative Members that I found of particular interest.
Listening to the flow of this debate, only one or two rocks seem to have resisted the general current from hon. Members of all parties. I am reminded of a social security debate a few years ago. Some hon. Members will remember it and may have participated in it. The then Secretary of State was introducing a social security review. One controversial nugget was how child benefit would be dispensed--in the wage packet or directly to the mother.
There was an important debate that night in which every voice on the Government and Opposition Back Benches was of one view, and at the end of the debate the Secretary of State had to bow to pressure. He promised to re -examine the issue, and in due course, in another place, the proposals were amended. That was a sensible and welcome victory for Members in all parts of the House. I
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hope that much the same will happen tonight because the measured, reasonable and constructuve tones of the majority of speeches demand that a change be made.9 pm
The hon. Member for Cambridgeshire, South-West (Sir A. Grant) echoed my feelings when he fastened on to one of only three arguments that have been adduced against the new clause by Conservative Members. That argument is that we would be signing a blank cheque. Like the hon. Member for Cambridgeshire, South-West, I do not buy that idea--if one can buy a blank cheque--because, as the hon. Member for Maidstone (Miss Widdecombe) pointed out, if there can be a definition for one category of people, there is no reason why another category cannot be defined. The problem can be overcome.
The second argument was advanced by the hon. Member for Brigg and Cleethorpes (Mr. Brown), who thought that the clause would open the way for unscrupulous proprietors to ratchet up prices at the expense of the public purse. The few Conservative Members who support that argument are on thin ice because normally when we debate provision for the elderly there are exchanges between Labour Members, who are instinctively hostile to the private sector and would like to see social care provided in the public sector, and Conservative Members, who regard that as a pathological outlook and are critical of those on the Left who do not like private provision.
Perhaps I should make my position clear. I believe that it is inescapable, indeed essential, that we have a mixed economy in welfare, given the clear demographic trends in Britain. Conservative Members are on a hiding to nothing in saying that the new clause is defective because unscrupulous private profiteers would cause a strain on the public purse by trying to corrupt the system. The same Conservative Members, when debating in other contexts, accuse Labour Members of being hysterical in complaining about private provision. They can argue one way or the other. They cannot invoke one side of the argument for one set of conditions and appeal to the other side of the argument for a different set of conditions. While I would not seek to defend the Socialist outlook, because I do not concur with it--
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