| Previous Section | Home Page |
Mr. Campbell-Savours : The hon. Gentleman should join us.
Mr. Kennedy : The hon. Gentleman is older and greyer than I, but I suspect, from his choice of party, that he may not yet be wiser. We live in hope for him.
The third argument adduced by Conservative Members is always trotted out. It is that the drafting is indelicate and that technically the new clause would not meet the situation. I agree with the hon. Member for Cambridgeshire, South-West that where there is a will there is a way. We are not pushing the new clause in its present state. If the Minister accepts the spirit of it, and promises to introduce an amendment to achieve its purpose, we shall be satisfied. I hope that the Minister can pledge-- even if he cannot accept the new clause as drafted--that the spirit behind it can be incorporated into the legislation at a later stage. I also hope-- this refers to our initial discussions in Committee--that, when there is no legislation to be considered, a fresher, more detached, view
Column 237
will be given to social policy in terms of the split between the Department of Social Security and the Department of Health. There was much frustration in Committee because we felt that we were tilting at absent friends--the Ministers at the Department of Social Security. The Bill is being sponsored by the Department of Health. I am not sure that the split makes any sense any longer. I hope that, after the Bill is out of the way, fresh consideration will be given to which is the best all-encompassing sponsoring Department for a crucial and growing area of social provision and social policy.Mr. Roger Sims (Chislehurst) : The arguments on this vexed matter have been compellingly presented by Members on both sides of the House with remarkable unanimity. Because of that, and because I spoke on the matter in Committee, I do not intend to detail them again. However, I must express my surprise and disappointment at the Government's failure to deal with the problem.
The Government have accepted that there is a problem and have built it into the White Paper and the Bill so that those who enter the system from April 1991 will not be affected. It is extraordinary that they apparently propose to do nothing about those already on income support. I say "apparently" because that appeared to be the evidence that Ministers from both Departments gave to the Select Committee, and it is also what emerged in Standing Committee. It is not as if that is a new problem that has suddenly arisen ; it has existed for a year or more. I have corresponded with the Department about cases in my constituency for at least that long.
An important point was made by my hon. Friend the Member for Ealing, Acton (Sir G. Young). The money at present allocated to income support will--for new entrants after April--be allocated to local authorities to use as they think best. If that money is inadequate now, it will be inadequate then. Surely funding will be the basis of whether the proposals in the Bill succeed or fail.
The evidence is there in abundance. We all know the results of the research carried out by a variety of organisations, which have presented us with the facts and figures. It appears that the only place where research is thin on the ground is at the Department. It may have the material, but apparently it is reluctant to offer it to us. I invite Ministers to examine the Select Committee report, in which we have analysed the evidence and the inevitable conclusions. To those figures, I will add two from my constituency, which is part of the suburbia to which the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) referred. The limit for income support there is £163. The charges for homes in my constituency vary from the lowest shared rooms at £185 to others at £280. I am referring not to luxurious places, but to houses that offer people a reasonable, fairly basic standard of accommodation.
The other case to which I wish to draw attention involves the Cheshire home in my constituency. Its administrator says : "we are fortunate in that a few Local Authorities, in spite of the regulations, have agreed to top-up' This still leaves us with two residents for whom there is a shortfall of £84.86 per week (the difference between our current fee and the DSS maximum of £258)".
Column 238
That current fee is audited by the local authority. In any case, one would hardly expect a Cheshire home to overcharge. As a result, the home is losing nearly £9,000 a year in income, and that clearly cannot go on.Not all people in residential homes are in difficulty. Some have their own capital from which they can pay fees. Some find themselves on income support but the family can bridge the gap, and that may not be unreasonable if they are a family of some means. But, alas, some families simply do not have such means. As we have heard, they have to scrape round charities finding £10 here and £10 there to fill the gap. Yet others simply have no family and no other source of income. Therefore, as in the case of the Cheshire home to which I have just referred, they have to be subsidised.
Surely those are the poeple whom we should be trying to help. If we do not do so now, after April 1991 there will be two classes of resident in residential homes--those who have recently entered whose costs will be fully met by the local authority, and those who entered before April 1991 who will be subject to the social security rate of benefit as it is now and presumably will be then. That problem must be addressed not in April 1991 but now. The problem exists now and will continue to do so.
It is the Government's policy not to dish out resources willy-nilly but to target help where it is most needed. If the debate has done nothing else, it has demonstrated that those are just the people to whom the help should be targeted. I cannot believe that it is beyond the wit of man or woman to devise a scheme to ensure that that is done.
I have no doubt that when my right hon. Friend the Minister replies he will say, as others have, that for all sorts of reasons the clause is defective. But if all that he can offer us is that he will bear in mind what has been said at the next uprating, that will not be good enough. The next uprating will not be announced until October to take effect the following April. In telling us that the new clause is unacceptable, I hope that he will be able to tell us what the Government intend to do about the matter. If he cannot do so, I shall have no alternative but to support the new clause.
Ms. Primarolo : The quickest and simplest solution to the problem that we are debating would be for the Government to stop the move towards private homes and to provide such services within the NHS and the social services. We would not then need to work out a formula for a top-up payment for someone receiving income support.
On a number of occasions, I have written to the Department of Social Security and the Department of Health about the problem that we are debating and their answers would be amusing if it were not for the tragedies behind them. The first time I wrote was November 1989 in response to a letter that I received from Bristol Old People's Welfare Incorporated on the upgrading that had been announced. They were complaining about the increase of £10. They pointed out that out of 175 residents they had 80 who relied on income support, and that in 1987 their loss was £35,000, in 1988 it was £83,000, and in 1989 they expected it to be £100,000 ; and that as a charity they could not afford to continue to draw on their resources and therefore would have to close some of their places.
Column 239
9.15 pmThe Minister's reply was, first, that he was sorry to hear about the difficulties facing the charity. Secondly, he was sorry that it felt that the £10 was ungenerous. But then he went on to say of the £10 :
"This is an indication of our appreciation of the difficulties facing some people in homes and is a clear statement of our commitment towards helping those who need care and funding of community care."
He went on to say :
"It is our policy to target the available resources to where the need is greatest and where such targeting would prove most effective."
It comes back to the point that my hon. Friend the Member for Livingston (Mr. Cook) made in opening the debate. If these people are on income support, they have no other money. Therefore, how could targeting be any more effective than by giving it to the very people who have nothing? The Minister said :
"It was never the intention from the introduction of income support that it would meet the cost of all the fees".
He went on to say :
"other methods of topping up"--by relatives, charities and other sources--" --[ Official Report, 27 November 1989 ; Vol. 162, c. 422.] are essential to this part of the system.
We have heard about relatives and about the difficulties with charities. Perhaps the Minister will tell us what the "other sources" are, because those people on income support do not have any other resources ; that is why they are on income support.
Mrs. Mahon : I can assure my hon. Friend that when we had the first wave of elderly people being moved out of long-stay hospitals into the private sector there was no hint whatsoever that there would be any shortfall between the income of the elderly people and the cost of the home.
Ms. Primarolo : I agree with my hon. Friend. In fact, such a role for charities and relatives was never made explicit, either, at the beginning of the introduction of this policy.
I turn briefly to the case of the chronically sick, who also come within this clause. I shall use the example of a constituent because it demonstrates the utter disaster zone of the Bill. This woman--I will not name her, for personal reasons expressed by the family--is 48 years old and is suffering from Huntington's chorea, a tragic and unpleasant disease for anybody, let alone somebody so young. Her husband gave up work in 1986 in order to care for his wife and their 13-year-old daughter in the home rather than have his wife in hospital.
Unfortunately, the disease has progressed and even with respite care, which the family has had to use frequently, the husband is incapable of providing the intensive nursing care which his wife needs. Dearly as he loves her, there is no way he can afford to provide that care. His wife is currently in a hospital which is due for closure. She is in an acute bed which is not satisfactory for her treatment. In addition, the hospital is outside the district health authority region in which the woman resides. She is a resident of Bristol and Weston district health authority which is in the final stage of opting out as a district health authority.
The hospital's advice to the husband, who is unemployed, is to seek a suitable nursing home for his wife. There are no public sector nursing homes in Avon. She can go only to a private home. The husband has gone to 16 private nursing homes. Because of the intensity of the
Column 240
nursing that she requires, only one will accept her. She has to get out of hospital but she cannot go home and the only private nursing home which will accept her wants her to pay £320 per week. Her total entitlement to benefit is £235 a week, which leaves a shortfall of £85. The husband has been round an untold number of charities and has finally been able to reduce the deficit to £45. The family cannot get the woman into a nursing home because it cannot find the £45. What are we doing to the so-called care of the vulnerable chronically sick through the Bill?I wrote to the Department of Social Security and also to the Department of Health from who I got interesting replies. I was told again that the policy of the DSS was to direct available resources where they were most needed, that there was no provision in the National Health Service for providing nursing care and that it had never been the intention to fund all care from social security. The Department of Health told me that the National Health Service has a responsibility for providing continual nursing care and medical care for people in need of full-time care. However, it is for local health authorities to determine the level of care. Our district health authority is on its way out of the integrated NHS.
The Department of Health also told me that if the woman was in a private home she could not be moved, but she has not got into a home yet. The recommended course was to see the family general practitioner who is obliged to provide all the necessary medical evidence to patients, including referral to a hospital for care, if needed, and is medically responsible for that care. If necessary, the Department said that the woman should be admitted as an emergency case. That would mean that she would go straight back into an acute bed in the NHS simply because the Department will not make up the shortfall through income support. I cannot believe that the entire retinue of civil servants in the Department of Social Security and the Department of Health cannot work out a solution to this dreadful problem.
I have an offer to make to both the Secretary of State for Health and the Secretary of State for Social Security. If they feel unable to persuade their civil servants and to help them to reach a certain conclusion and so bridge the gap on income support, if my hon. Friend the Member for Livingston does not jump at the chance, I will help those civil servants to find a way of solving this disgusting and tragic problem. Anyone who claims that the problem cannot be solved is ignorant of people's ability to solve problems. Either Ministers have the political will to solve the problem or they have not. Voting in favour of the new clause is a solution to the problem.
Mr. Roger Gale (Thanet, North) : My right hon. Friend the Secretary of State for Social Security is aware that a need exists which must be met. The Government's provisions to meet the requirements of the Griffiths report and the Bill go a long way--and a brave way--towards meeting the needs for the future. I believe that the provisions will work. That leaves my right hon. Friend the Secretary of State to face the needs of today.
To some extent, I believe that we are the victims of our own success and that may be a happy circumstance. The residential care of the elderly has improved dramatically over the past 10 years. We inherited a shambles and a system in which the standard of care was bad in many cases. The facilities were poor and not infrequently the management of homes was greedy or corrupt.
Column 241
The Registered Homes Act 1984 did much to improve the position and the financial provisions made by the Government have solved many of the problems and cured much of the greed that existed earlier. Although the present system is by no means perfect--I speak from experience in my constituency--we have many residential and nursing homes in which the facilities are excellent and the standard of care is very good. In those homes the standard of training is also good and school leavers are no longer thrown straight into the deep end without training. In my constituency the Thanet technical college provides excellent care training.There have been many improvements, but they have all had to be paid for-- and they have all been paid for--by the proprietors of homes. Inevitably, the fees in those homes now reflect necessity and not avarice. As my hon. Friends have heard tonight, many residents in those homes cannot now meet the legitimate financial needs of the proprietors.
My hon. Friend the Member for Maidstone (Miss Widdecombe) in her excellent speech referred to many of the problems and I do not propose to repeat them. Many of us believe that it is right that children should make some provision for their elderly parents. However, in many of the cases about which we are concerned, the children are not 30, 40 or 50-year-old working people, but 60 and 70-year-old children keeping 80 or 90-year-old parents-- such is the level of care that is being provided. That is why in some respects we are victims of our own success. That gap must be met and my right hon. Friend the Secretary of State for Social Security must find a way of meeting it.
I listened with great care to my hon. Friend the Member for Mid-Kent (Mr. Rowe) and I agreed with a great deal of what he said. I believe that the new clause is flawed and I do not believe that it meets the needs that nearly every hon. Member who has spoken tonight agrees exists.
The awards should not be inconsistent with contracts awarded to new entrants under the new scheme. There are still homes that provide an inadequate standard of care and existing contracts may well be of a lower quality than that demanded for the award of new contracts. It would be bizarre if bad homes were protected at the expense of good ones.
My hon. Friends the Members for Mid-Kent and for Chislehurst (Mr. Sims) referred to the priority of need. We have a tremendous priority of need in Kent for the care of the physically handicapped and the mentally handicapped young. My hon. Friend the Member for Chislehurst referred to the problems that are faced by the Cheshire homes and to their inadequate resources. Given that I am told that young people in need of considerable care represent a cost to those homes of between £350 and £400 per week, it is clear that the Cheshire homes are running at a considerable cost, as is borne out by the Strode Park Foundation for the Disabled, which has a youth unit in my constituency.
9.30 pm
The funding is inadequate and that gap must be made up. However, I would not wish that gap to be made up from the funding that will be made available to local authorities in the next few years because inevitably the resources that are needed for other areas of care will be depleted to meet the needs of the present.
I also listened with great care to the speech of my hon. Friend the Member for Ealing, Acton (Sir G. Young). Of
Column 242
all the proposals that I have heard in three and a half hours in the Chamber, my hon. Friend's proposal struck me as the best. I repeat what I said at the beginning of my speech : the Secretary of State has taken on board and recognised the needs of the future. That is reflected in the Bill. It is essential that he now recognises the needs of the present. Therefore, I hope that he will pay particular attention to the suggestion of my hon. Friend the Member for Ealing, Acton.Mr. Jim Cousins (Newcastle upon Tyne, Central) : In every sense of the term, it is far too late for us to be trying to interest the Government in a whole range of possible solutions. The opportunities for that lie further back down the track. We are now faced with the start of a new and complicated system of which the matter that we are discussing forms an important part.
I do not identify myself with those hon. Members of all parties who have tried to entertain the Government with a range of possible solutions to this difficulty. Although it is teasing, I do not find it tempting to see the hon. Member for Ealing, Acton (Sir G. Young) in action because he is never a man to back up against a wall without first designing several different doorways. I identify myself much more strongly with the hon. Member for Chislehurst (Mr. Sims) who said clearly that now--tonight--when the Secretary of State replies to the debate is the time at which there can be an answer. We cannot go on debating a clear, obvious and substantial problem without having a definite answer on the table.
It is right and proper that the Government should find the answer themselves, because the problem with which we are wrestling is largely a creation of the Government's policies. The hon. Member for Thanet, North (Mr. Gale) referred to the position when the Government came into power, when there were 12,000 claimants on what was then supplementary benefit, but which is now residential care and nursing home support. In 1984, that figure had risen to only 40,000. However, the figure is now in excess of 180,000 and the number is rising rapidly. That has not happened by accident. It has happened as a result of a clear, conscious, definite and decided policy. In 1984 that policy substantially increased the levels of supplementary benefit--now income support--to encourage that trend and from then on rolled down the number of long-stay hospital provisions in which such people were then located.
The magical "perverse incentive" that has been mentioned as increasing those numbers does not exist. What has driven those numbers up is the Government's own policy of closing down long-stay hospitals and--more importantly--of preventing people from entering them because they were no longer there to be entered. That policy may well have had its good aspects, but tonight we are dealing with some of its unfortunate and bad consequences. What has happened has been as a result of the Government's clear policies and the Government must now find an answer to the difficulty that they have created. We are talking not only about the 180,000 people who are dependent now on income support for residential care and nursing home provision but the several tens of thousands of people who, by April 1991, will be in that position. Conservative Members and several of my hon. Friends, including my hon. Friend the Member for Bristol,
Column 243
South (Ms. Primarolo), spoke about the wave of transfers into dependency on income support as the shift out of the NHS sector gathers enormous speed.In my city at least five different schemes will transfer many hundreds of people from NHS care into dependence on income support by April 1991. We are talking about not only the 200,000 who are dependent now but the extra tens of thousands who will have been put in that position by April 1991.
I agree with the hon. Member for Ealing, Acton on one point. Residential care rates under income support will be the basic building blocks of the funding of the system after April 1991. All the difficulties of the present system that we have debated tonight will be exported into the new system. That is why the matter is urgent and why it is proper for the Government to come up with some definite answers to a problem that is massively important in human, financial and institutional terms and that they have created. An interesting factor lies behind the problem. We have seen the creation of a whole new industry of providing care to people who are dependent on income support. As little as five or six years ago it was a cottage industry but since then we have seen one of the most massive industrial rationalisation schemes that the Government have carried out. The voluntary sector mobilised itself to provide huge numbers of additional places to take advantage, as they thought, of residential care income support rates, only to be disappointed. We have heard tales of woe from Anchor Housing, Cheshire homes and other agencies. They are all true. Charities moved into the provision of such care thinking that the 1984 income support rates would be the basic building blocks of the new system only to find that in the years after 1984 the rates did not keep up with inflation. We now find ourselves in grave difficulty. The Minister must find an answer to the problem. When he replies, he must say clearly how he intends to pitch the new scales that will come into force in April 1991 for people who are dependent on income support now. That flow of funds will be the stream that carries us on to the system of community care after April 1991.
The matter is important and urgent. We have seen an enormous industrial rationalisation in human care and the generation of a big business out of a cottage industry. I doubt whether the provision of care should be big or business, but that is what we have come to. Tonight, not to start a new debate that will rattle on for the foreseeable future, but to close the existing debate, the Minister must be definite and talk specifics about levels of funding, not only for the 200,000 people who now depend on income support but the whole rafts of other people whose futures will depend on it.
The wave of stress and anxiety about the figures is enormous. In 1989 the range of scales under income support went from £140 to £255. Payments were pitched to the individual average claimant at £120. In other words, average claimants do not depend entirely on income support. They have not reached the crisis point, but their savings are being bled through the means testing of the income support system. They demand answers and want rescue The ocean of anxiety that they represent must be drained and that cannot be postponed any longer.
Column 244
Mr. Jack : I have been listening carefully to hours of this important debate. Nobody can ignore the issue which my right hon. Friend the Secretary of State needs to address in his remarks. New clause 1 is not precisely the solution to the problem, nor is a return of the whole private care machinery to the public sector, as Labour Members have suggested. I am encouraged in that view by the statistics for Lancashire. In the county council budget debate on the community charge, it was made clear that if the council's part III accommodation were offered to the private sector, 38 per cent. of it would not pass the county council's own care standards of inspection.
I reject new clause 1 because of a case in my constituency. A rest home was upgraded to nursing home status and went from an income support level base of fees to one geared to income support, because it knew that the people in the rest home could afford to pay those fees and no more. Down the road somebody thought that he could do better, so he upgraded an old rest and nursing home to a high quality one and put it on the market at £330 a week. It will not surprise hon. Members to hear that the market, if one can call it that, quickly made it clear that it would attract too few residents, so the price came down to £300 a week in an attempt to attract more people. We have heard about differentials. That is one of £60. I have visited both establishments and I am still left wondering which one--the former rest home providing an excellent standard of individual care for £240 a week or the new luxurious nursing home which charges £300 a week--is better and should be supported. Miss Widdecombe rose --
Mr. Jack : I reluctantly decline to give way because I want to finish in a few moments.
The matter is a deal more complex than simply needing additional money for the existing system of income support. In all sincerity I would not for a moment dispute that we need to consider the adequacy of some of those rates because costs vary. It is not just a case of tightening the system.
Labour Members who understand the income support system will realise that if elderly people adjust their financial circumstances in advance of going to a rest home, their family may be the beneficiary of a large sum and they may end up being able to claim income support. If we are to make the best use of the large sums rightly invested in income support, my right hon. Friend in reaching a conclusion must look further than simply the straightforward rate for the job. Income support anomalies create difficulties. If one of two elderly friends who bought a house together goes into a nursing home and seeks income support because as part-owner of the house his capital is tied up, he cannot get that much-needed benefit. I urge my right hon. Friend to encompass such cases when he comes to a conclusion.
Nobody would for a moment dispute the excellent job done by private rest and nursing homes, but already there is a big difference in the price charged. For example, one person in my constituency who runs a rest home has been innovative in order to improve business potential and has developed a domiciliary care service. That adds greatly to services and to his cash flow and it improves the work that he does. It means that he can maintain care for people in his rest home at a rate equal to what they can get on
Column 245
income support. I ask my right hon. Friend to reconsider the rate. To those hon. Members who are seduced by the simplicity of new clause 1, I say that the issue is not as straightforward as they imagine. 9.45 pmMr. Ieuan Wyn Jones (Ynys Mo n) : I have sat throughout most of the debate and have heard the almost unanimous view of hon. Members on both sides of the House that something must be done about a group of people who find themselves in great difficulty. Many hon. Members have said that they are a particularly vulnerable group of elderly people.
What has been remarkable about the debate is that there is no political divide in the House, as both sides agree that this is a major problem which the Government must resolve. The old adversarial system of politics in the Chamber has been put to one side in a remarkable way. We have been able to set aside that style of politics because we have an unanswerable case for the Government and they must come up with a solution. The case is unanswerable because no hon. Member from either side of the House has resorted to the safe haven of trading statistics. Whenever we have an empty case which we cannot support we seek refuge in statistics, but no hon. Member has done that tonight.
We have all had personal experience of constituents coming to us with problems, and we know that the Government must find a solution. Some Conservative Members have agreed with the principle behind new clause 1, but they are not happy about the wording, as it could lead to what some hon. Members have described as a blank cheque. Those Conservative Members have offered their own solution to the problem, and have suggested an answer different from that contained in new clause 1, but that clause has not been drafted to be perfect in every dot and comma. I accept that the clause could be amended. However, the House needs to give the Government a clear message tonight that something must be done. Unless the Government accept that, a group of elderly and vulnerable people will be devoid of assistance. The will of the House is clear. Conservative Members who agree about this issue, but do not agree with every dot and comma in new clause 1, should realise that the only way to keep pressure on the Government is to vote for new clause 1. I am convinced that the Government will have to bow to that pressure.
The Secretary of State for Social Security (Mr. Tony Newton) : Until recently, I had not expected to find myself once again confronting the hon. Member for Livingston (Mr. Cook). He was kind enough to say that it was a pleasure for him but, in the circumstances of the debate, I am not so sure that it is a pleasure for me.
We have certainly had an important and worthwhile debate, and I shall seek to respond in like fashion. I always look for common ground in an issue of this nature, and today the common ground is that the present system of income support limits is less than perfect, to put it mildly, for supporting the provision of residential and nursing care.
Since 1985, the system has sought to reflect variations in the needs of defined categories of people, but it has no mechanism or capacity to assess --in a medical or social work sense, as is often required--the needs and circumstances of an individual. As a consequence of that,
Column 246
and of the high level of such payments by comparison with what is often available in terms of other forms of support, for example, in the home, it is widely held to have been inconsistent with the drive towards care in the community to have created some scope--some people would say more than some scope--for exploitation and to have left very considerable room for doubt whether the resources involved were being used to best effect.The Government's clear acknowledgement of the unsatisfactory nature of the system--which in my case goes back many years to my earlier experience as a Social Security Minister--led to the proposal contained in the community care part of the Bill : that from April 1991, for new cases, the social security entitlement should be confined to the usual income support and housing benefit entitlement and that beyond that it should be the task of local authorities' social services departments or social work departments to assess an individual's care needs and to provide support for those needs in what is judged to be the most appropriate way, whether by paying for care in a residential care or nursing home or by paying for care in the person's own home. That approach is also, I believe, common ground.
The difficulty that we all face--particularly by me in the context of this debate--is the classic one for politicians on many political issues of getting from where we are to where we should like to be. The Government's judgment, which again is widely shared, is that it is not practicable to undertake a complete switch from one system to another at one particular point in time and that the change must be carried through in a phased and manageable way.
There are two main reasons for that judgment. The first is the one on which most stress has been placed : the huge burden that would be imposed on local authorities if the assessment process had to be undertaken not only for new cases but for nearly 200,000 existing cases, which could well make the whole thing unworkable. The second reason, which is certainly not to be dismissed or minimised, is that it was not thought right to withdraw existing entitlements to income support from those who are already in residential homes, with all the uncertainty that that could involve, especially in circumstances where it would be possible for local authorities to assess such people as not needing to be in a home at all. There is broad agreement that for those two reasons it was right not to attempt a wholesale switch at once.
Unless that basic judgment is challenged--which it has not been throughout the debate--there is an inescapable need to run the two systems side by side, despite the fact that that must entail some problems. What I and my right hon. and learned Friend the Secretary of State for Health intend to do is to ensure that, to the best of my ability, both systems operate effectively.
The new clause is directed towards one aspect of those problems--the future basis of income support payments under the existing system to those who will have preserved entitlements. I say at once, fairly and squarely to the House, that I cannot advise it to accept the new clause. It contains two main elements : first, that any gap between the income support limit and the actual charge should be measured and then met. I shall turn in a moment to the apparent safeguard. The second element is that the amount then defined should be increased according to an index of the average by which those charges are subsequently increased.
Column 247
There is an attempted safeguard. I acknowledge that my hon. Friend the Member for Maidstone (Miss Widdecombe) and other hon. Members have attached some weight to it : that payment could be withheld in respect of some part of the charge that is held by a social security adjudication officer to be "unreasonable", having regard to the nature of the premises and the services provided. That is a judgment which social security adjudication officers do not have, and could not sensibly acquire, the training or the knowledge to make. It involves social work skills and assessment skills of a kind that are outwith the ordinary operation of the social security system. Even attempting to make it work would entail imposing a burden on local authority social services departments. It would be essential to use their advice on a large scale, and that would multiply their problems in implementing the new system.Mr. Frank Field : Has not the hon. Member for Ealing, Acton (Sir G. Young) given the answer? Adjudication officers will not act in a vacuum. Running parallel to their decisions will be local authority market decisions about private homes. In deciding whether a rate is reasonable, it will be possible to look at all those decisions. The hon. Member for Maidstone (Miss Widdecombe) has provided a formula which, with that back- up, would work.
Mr. Newton : That is a helpful and entirely reasonable comment, as I should expect from the hon. Gentleman. Indeed, later in my remarks I shall come to the very constructive contribution of my hon. Friend the Member for Ealing, Acton (Sir G. Young). The very way in which the hon. Member for Birkenhead (Mr. Field) framed his remarks implies acceptance that, certainly as things stand, social security adjudication officers do not have the capacity to make judgments--
Mr. Field : But not in a vacuum.
Mr. Newton : I have told the hon. Gentleman that I will come to that point. He knows a great deal about how the social security system works and about the training and skills of adjudication officers. I do no more than make the point that, as things stand, they do not have the capacity to make the judgments that that apparent safeguard would entail.
Anybody who doubts that might look back at what happened when we had a system rather similar to that proposed in the new clause. I refer to the period before 1981 and running up to 1985, when adjudication officers were responsible for establishing what was a reasonable charge in each local office area. Let me take from the list two examples that are particularly striking. In the case of charges thought to be reasonable for nursing homes, there was a variation from £296 in Leytonstone to £140-- less than half--in Romford, which is just down the road.
In the case of residential care homes in East Anglia, there was a variation from £90 in Bury St. Edmunds to £177 in Colchester. Manifestly, that reflects the extent to which adjudication officers found it impossible to make judgments of the sort envisaged in this new clause.
Mr. Field : The figures that the Minister has just quoted are impressive, but they are irrelevant to this argument. We are not moving back to the system that pertained in the period up to 1985 ; we are moving to a system under which
Column 248
local authorities will have to negotiate care packages from the private sector. Adjudication officers, in deciding whether a rate is reasonable, will be able to consider what the market will bear.Mr. Newton : I should be grateful if the hon. Gentleman would let me do what I have already undertaken to do. I have said that I will come to that point later. In the context of the debate and of my response to it, it is sensible for me to comment on the new clause as it stands and to convey my clear sense--this view has been reflected in the speeches of at least five of my hon. Friends--of the substantial degree of open-ended commitment which would raise costs all round.
Perhaps it is simply an oversight on the part of the authors of the new clause--I have no wish to rest my case on technical drafting--but no provision is proposed to take account of whether it is reasonable for the accommodation, however elaborate and expensive, to be provided at public expense.
In my judgment, there would be three principal effects were the proposal, in the form that it takes in this new clause, to be carried into law. First, and most obviously, there would be an immediate transfer to the taxpayer of a large amount of expenditure that is currently undertaken privately. That would by no means be only the private expenditure undertaken in the circumstances that concern my hon. Friend the Member for Maidstone. The system that we operated until 1985 has been criticised by hon. Members and the Social Services Select Committee in earlier reports. At the time of the change to national limits specified by categories of home, it was specifically made clear that the Government did not think it right to set the limits at a level that would cover all charges in all homes. The package introduced unique provisions in relation to what was formerly supplementary benefit--
It being Ten o'clock, the debate stood adjourned.
Ordered,
That, at this day's sitting, the National Health Service and Community Care Bill may be proceeded with, though opposed, until any hour.-- [Mr. Greg Knight.]
Question again proposed, That the clause be read a Second time.
Mr. Newton : Those provisions which are unique to what was supplementary benefit and is now income support allow relatives to make payments in support of residents in such homes without the amounts being immediately knocked off their income support. In any other circumstances, a payment of, say, £50 a week would immediately reduce income support by £50 a week.
I do not want to place too much weight on this point, because I am conscious of the sort of cases that concern hon. Members. Those provisions were introduced specifically in recognition of the fact that there would be cases where either relatives or, perhaps even more often, charitable bodies would wish to make payments to support someone in care beyond what the state could be expected to provide. In recent weeks, that has been acknowledged by some people from charitable bodies in conversations with me. As I said, I do not want to place too much weight on it, but I need to make it clear to the House that part of the topping up does not have the character attributed to it by some hon. Members, although of course part does. I suspect that there would be almost universal agreement on my next point. Throughout the past 10 years, what the Department of Social Security pays has
Column 249
been a powerful influence on the prices charged. The immediate effect of the new clause would be to drive up prices all round, to the disadvantage not least of local authorities seeking to negotiate care packages under the new system. That risk cannot be dismissed, given the Laing and Buisson survey--to which little reference has been made, somewhat to my surprise--which shows a bunching of minimum charges in homes at, or just above, the level set by the DSS. That has been the tendency throughout the lifetime of these arrangements. The new clause would aggravate that position and would bid up prices, to the disadvantage of those paying privately in such homes--of whom there are more than 100,000--and of local authorities in bargaining under the new system.Dame Jill Knight (Birmingham, Edgbaston) : Does not the new clause put the power to judge in the hands of the Secretary of State?
Mr. Newton : No, it does not. It puts the power to judge in the hands of adjudication officers--
Mr. Frank Field : The power is in the hands of the Secretary of State.
Mr. Newton : The hon. Member for Birkenhead (Mr. Field) knows that the entire social security system has been set up to protect adjudication officers from being told what to do by the Secretary of State, and the hon. Member for Oldham, West (Mr. Meacher) knows that, too. That is the essential safeguard of the independence--if one likes, the judicial role-- of those making decisions in the social security system.
Thirdly, I have little doubt that the new clause, as it stands, would greatly reinforce, especially in the latter part of this year, all the so- called "perverse incentive" effects of income support arrangements, notably attracting into homes people who might be better cared for in the community. I also suspect--I direct this point to Opposition Members, including the hon. Member for Wakefield (Mr. Hinchliffe)--that the new clause would tend to aggravate still further the extent to which some local authorities seek to shed some of their existing responsibilities on to the social security system. I suspect that such an outcome would not be welcomed universally by the Opposition, although there might be two views about it in some other quarters.
As I said earlier, anyone who doubts such risks need only look at the experience in the early 1980s, when we had a system of local office limits set by adjudication officers, varying as I have described. Between 1979 and 1984--the hon. Member for Newcastle upon Tyne, Central used the figures to make a slightly different point--expenditure on supplementary benefit in this respect rose 20 times, from £10 million to £200 million, while the number of people being helped rose little more than three times, from 12,000 to 40, 000. There has been widespread criticism of exploitation of the system by home owners, which was echoed by the Select Committee on Social Services in the 1986 report. I do not believe that any hon. Member wants to go back down that path, which is the risk with the new clause as it stands.
Mr. Field rose --
| Next Section
| Home Page |