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Mrs. Peacock : I listened carefully to what my right hon. Friend the Minister said. Two weeks ago, like many of my colleagues, I went into the Opposition Lobby on an amendment. I greatly appreciate what my right hon. Friend said. Obviously, he listened carefully to many of his Back-Bench colleagues on that occasion.
I have one or two worries. Some hon. Members may have never seen anyone suffering from Alzheimer's disease. I think that it is the most frightening thing that could happen to an individual. Sufferers need special care and their families cannot cope. It is not a matter of them putting Grannie or Grandpa away. It is impossible to cope with someone in that state.
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In Yorkshire there are some specialised homes that can care for such people. Nursing homes send people out and say, "We can't cope," and we know that there have been examples of that. The specialised homes are residential care homes, not nursing homes. Because they provide 24-hour specialised care, their costs are high. A young family living in my constituency have such a problem. The husband, who is a bus driver, is working all the hours God sends to raise an extra £35 per week to pay for his mother-in-law, who needs to be cared for, and they have three young children. We spend so much money on benefits that it cannot be right that such a family should be excluded and have to find the amount somehow or another. Will the Minister consider that carefully? I fear that that old lady will end up out on the street when her family cannot provide £35 or that they will have to make their children do without shoes to provide it. Residential care and nursing homes do not incur such huge costs.Column 600
There is also a problem when pensioners, who are often in their early 60s, and on their own, have to try to provide for one or two parents who are in their 90s and live in residential care homes. Those pensioners do not have the money to pay. One lady brought her bank statement to me, and she had 22p left in the bank. She needs to find £45 to pay for her father, who is 92.There must be provision in the system to help such people this week and next week, but we have not found it yet. I appreciate that the increases in August were a tremendous help, and that the rules that come into effect next April will help, but the families that I have described are at their wits' end. That may result in nervous breakdowns caused by worry about their parents.
Given the amount of money that we spend, we should be able to help such people in the interim period. I plead with the Minister to consider specific cases or to give an idea of what hon. Members could do to help those who are waiting to see what he says tonight.
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Mr. Brian Wilson (Cunninghame, North) : I appreciate the announcement tonight, and I think that it is a major step forward. I cannot imagine why Conservative Members, who came into the Opposition Lobby to vote a couple of weeks ago and who find that they have something to be thankful for tonight, do not come into our Lobby more often. It seems to have been a worthwhile exercise.
Like other hon. Members who represent coastal constituencies, I became aware a few years ago of the extraordinary proliferation of nursing homes. Out of curiosity, I tabled a written question 18 months ago asking how levels of income support had increased. As far as I know, that was the first time that it emerged that residential care had become a billion-pound industry--it had gone from £82 million in 1979 to £1 billion 10 years later. That spiral cannot simply go on indefinitely. We must bear in mind that it was public policy to create that new industry--private residential homes--and to concentrate so many resources in that kind of accommodation, and into income support payments for people in them.
The tragedy was that, having created that huge expenditure, the Government took fright. The pace of increase in income support has not been sufficient to keep up with the costs of the homes which were created during the great boom period. The Minister has to live with that reality now, as future Ministers will have to.
The Minister would do well to listen to his hon. Friend the Member for Eastleigh (Sir D. Price), who seemed to speak a lot of sense on the subject. The new clause still has a blanket approach, although it is now within local authority areas. The problem is that we are talking not about problems arising out of what is charged in a town or a district health board area, but about individuals and specific homes. I am sure that Conservative Members will find out as they go along that the wonder of the poll tax is that one discovers that one is not dealing with categories of 1 million people or 100,000 people ; every case throws up different circumstances and different individual problems to be dealt with.
10.30 pm
Let me describe the kind of problems that I have come across in my constituency. An elderly person is living quite happily in a home until it is taken over by another company, which decides that it does not want to operate a run-of-the-mill home on basic charges but, rather, an up-market de luxe nursing home. The prices go shooting up. The elderly person, who has previously been able to meet the cost of his care, suddenly finds that there has been a large increase in the amount for which he is being asked. Would the new clause meet that happenstance? The new cost of the home might be out of the normal order of things in that particular area and the general rate that the local authority applied in the area might not cover the case of a person caught by such a change of ownership.
Similarly, as the hon. Member for Batley and Spen (Mrs. Peacock) said, there are exceptional cases in which costs are higher because the level of nursing care is higher. Within one area--whether it is a local authority area or a district health authority area--a great range of circumstances may pertain.
That takes us back to what my hon. Friend the Member for Oldham, West (Mr. Meacher) said. The owners of the homes identify an average shortfall of about £40 per
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person per week. At the most generous estimate, what the Minister proposes will go perhaps halfway towards meeting that shortfall. But everything is relative. For a poor person--a person who does not have extraneous income--it does not really matter whether the figure is £20 or £40 a week. It is a substantial shortfall, and if the person has no means to fill the gap, the problem remains the same.I welcome the proposals that the Minister has announced--I am not being churlish about them--but the problem remains that people will set a level of charge and many of the clients will not be able to meet it. On the other hand, a blanket approach does not meet the problem either. It takes us back to the initial dilemma to which I referred--that the global sum just goes on increasing and in some cases all that one is doing is encouraging homes to increase charges, for a quality of service that is not necessarily provided. Putting those two arguments together, it seems to me that there is a case for the flexibility for which the hon. Member for Eastleigh argued. That may be a big task ; such a system may be difficult to administer. But it will mean that there will be an officer in each area looking at specific cases and the genuine human problems and trying to solve them case by case.
I am grateful for the money that has been awarded, which will come as a relief to many people. The new clause is a step in the right direction and a response to what the whole House voted for a fortnight ago. But the Minister will have to go further--and future Ministers will have to go further--to meet the specific cases to which the problem gives rise.
Sir George Young (Ealing, Acton) : I shall be brief, because there are other Conservative Members who deserve to be heard--not least my hon. Friend the Member for Maidstone (Miss Widdecombe), who spoke with such emotion on the subject only two weeks ago. Like other Conservative Members, two weeks ago I voted against the Government and for the all-party amendment. I did so reluctantly, although I make no apology for it, because unless we used the most powerful means available to Back Benchers--voting-- there could be no guarantee that we should get a response.
Having said that, I am delighted that my right hon. Friend the Secretary of State has listened to the arguments and responded to the debate. In two weeks, which is a very short time scale for Whitehall, he has responded with the new clause before us today. He had to do that against a very difficult economic background. We have had a restrictive Budget, with the downward pressure on expenditure to which my right hon. Friend the Chancellor referred. Against such an economic background, to negotiate this sum of money from the Treasury in such a short time was a genuine achievement, for which my right hon. Friend deserves full credit.
I am delighted with new clause 26, because it embraces the principle for which many of us spoke two weeks ago--using local authority contracts as the basis for income support. The new clause gives the Department the power to validate the price negotiated between the local authority and the home as the basis for income support, which is the right long-term solution.
There is no advantage in Opposition new clause 14, which is wholly bureaucratic--involving tribunals and adjudicating officers--by comparison with the Government's solution. My right hon. Friend mentioned
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the time scale. If a local authority makes good progress this year and negotiates a series of contracts to come into effect in 1991, will my right hon. Friend's Department be able to use those contracts in setting the income support level in that local authority's area--or does he propose waiting until the system is nationally tested before allowing progress at a local level?In the debate of two weeks ago, it was no part of the proposed new clause to insist on extra help being provided this year. Certainly I did not make that demand in my own speech. I regard as a bonus the additional assistance that my right hon. Friend announced tonight for nursing and residential care homes from August, which will help in cases where the shoe is pinching.
New clause 26 is an honourable response from an honourable man, and I hope that the House will support it.
Mr. Allen McKay (Barnsley, West and Penistone) : I ask the Secretary of State a straight question, and I hope that he will give a straight answer. Who pays? Although we are grateful for the right hon. Gentleman's announcement tonight, it must be seen as an exercise in damage limitation, being the minimum action required to satisfy the Secretary of State's right hon. and hon. Friends.
The problem remains this year, as it will next year, that there is a gap between the amount charged and what can be claimed. Who will pay the difference? In some cases, it will be the relatives of the individual concerned--but often they themselves will be pensioners. Increasing life expectancy means that many residents of nursing and residential homes are aged 85 or 90, and have relatives who are themselves pensioners and unable to meet any additional costs. In other cases, relatives have moved from the area--which may be the reason why an individual was placed in a home in the first place. In both the Local Government and Housing Bill and the National Health Service and Community Care Bill, responsibility is ultimately placed in the hands of the local authority, which will have to undertake a case study and determine, through the officer concerned, what form of care is to be provided--care in the community or care in the home. So in many cases the local authority will have to pay the difference if the Department refuses to do so. I hope that Conservative Members will think about that when they vote tonight. There is little use taking a local authority to task or placing limitations on its level of poll tax if at the same time the Government deliberately load it with the responsibility for meeting the gap between charges and the money available from central Government. Will the Secretary of State or the Minister for Social Security undertake to hold consultations with local authorities, and confirm that funding will be available for them to make up any difference?
The Government have brought the problem upon themselves. When they came to power, they decided to encourage private nursing and residential care homes, which was fair enough. But the bill has to be paid, and instead of ducking, weaving, dodging and bobbing we should be honest and above board. Let us ensure that payment stops finally with the Government of the day.
We must care for those who find themselves in homes, so let us eradicate the problems, worries and concerns that
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face those who are in homes and their relatives. So many families are bending over backwards to try to find the charges. I believe that we can pull together within a proper system. It is right and proper that responsibility should rest with local government, but central Government should ensure that adequate funding is available.Miss Ann Widdecombe (Maidstone) : The new clause comes as a great reassurance and considerable relief to those who have been campaigning for such a provision for the past year. The question asked by hon. Members on both sides of the House is, "What happens to the existing shortfall?" I was concerned that strong pressure to evict would be the prospect if action were not taken. If those who run the homes had been faced with a long-term problem and had felt that no endeavour was being made to match the level of benefits to the level of reasonable charges, they would have had every incentive to evict quickly. Immediate relief means that they are receiving more money than hitherto, and that should help.
The homes that face the difficult problem of servicing a large capital investment will be assisted if, in addition to the generous interim measures, there is a fall in interest rates. I feel that there is some hope for home owners. I feel also that proprietors will be much less pushed to evict than they would have been if the measures in the new clause had not been brought forward. The shortfall is of less significance than it was. A perpetual bleakness has been removed.
Does the new clause provide a sufficient guarantee? I am reassured, first, because account is taken of both nursing and residential homes. There was much speculation that we would be confronted with action only in the nursing home sector. Secondly, the new clause provides that the Secretary of State shall, not may, take into account reasonable levels of charges. There is now, or will be, a clear obligation on the Secretary of State.
Two questions remain, however, for my right hon. Friend the Secretary of State. Does he accept that the new clause will be a cause for future action and that it is not merely an adornment of the statute book? Secondly, does he accept that future action must commence as quickly as possible after April 1991 if we are not to find, once more, that there is pressure to evict?
I find new clause 14 unacceptable because it places emphasis on adjudication officers. My right hon. Friend has persuaded me that that is not the right approach. As for the manuscript amendment, of which I have had sound if not sight, it provides the blank cheque that we have tried to aviod. If my right hon. Friend will give the assurance that he regards the new clause as a programme for action and not merely a reassuring sop, I think that we may trust him. I urge my right hon. and hon. Friends to go with him tonight. 10.45 pm
Mr. Merlyn Rees (Morley and Leeds, South) : I welcome what the Government have done. My concern about shortfall and future action was expressed clearly by the hon. Member for Maidstone (Miss Widdecombe).
I do not believe that the new clause is sufficient to deal with the problems that have been brought to my notice. Half the constituency of the hon. Member for Batley and Spen (Mrs. Peacock) was joined with half of my constituency for a long time--Batley and Morley--and,
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therefore, we share the problems with former mill towns in the west riding. I should like to express the concern of my constituents. The new clause refers to "prescribed" bodies. I declare an interest because I am on the governing board of a Salvation Army home not far from the House. My mother was there for a long time. She was a war widow and received war widows' pension and attendance allowance but not income support.Over the years, I have learned about the expertise of the Salvation Army. It does marvellous work for down and outs--it will do such work tonight in London--and it has built homes and altered old buildings. Before being on the governing board, I was not aware of the expertise and professionalism of its staff.
Whatever information the Department of Social Security receives from local authorities, the Salvation Army could provide, within weeks, a detailed report on the problems experienced in its homes. Such a report would cover a good cross-section, because the people in its homes come from a variety of backgrounds.
The letters that I have received and the people who have come to see me cause me to worry that the sums being offered by the Government are not sufficient. I have received letters from people on low incomes whose aged parents are in homes. They are concerned that their parents will be evicted because they cannot afford to make the payments. I want to check in the next few weeks what difference the money the Government have offered will make to them. Will there still be a problem of eviction because my constituents cannot afford to pay?
I have a constituent--a former nurse--who runs an old people's home with her husband. They are devoted to their patients and make only enough money to cover their incomes. I want to check that next year they will not lose money.
As my hon. Friend the Member for Bristol, South (Ms. Primarolo) said, we are debating not structures or statistics but the dignity of people living in old people's homes. If in the next few weeks the Minister is told by hon. Members or the Salvation Army that his figures are wrong, will he be able to act on that information in advance of 1991?
I suspect that we are all in for a surprise. Hon. Members will receive letters and their constituents will say to them, "Thank you for what you have done. We are not looking a gift horse in the mouth, but frankly it is not enough."
Mr. Peter Griffiths (Portsmouth, North) : I shall be extremely brief.
I welcome new clause 26 and the comments made by my right hon. Friend the Secretary of State, but I suggest that the success of the arrangements between now and April 1991 will depend not only on the generosity of the Department but on the restraint and tolerance of the owners of residential care homes. It would be helpful if my right hon. Friend said that we can look forward to such success. The advantage of new clause 26 is that after April 1991 it will not leave the cost of residential care open ended. Although two weeks ago and tonight our attention has been directed to residents who depend on income support, those who manage to pay their own fees must meet the increased costs that inevitably follow when income support is raised.
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New clause 26 meets the objections that I raised two weeks ago. We should be grateful for the tolerance of home owners who will now have a better opportunity to care for our constituents.Mr. Newton : I wish to make two crisp points. First, I am grateful to hon. Members for their response to my proposals. Secondly, such is my mellow frame of mind that I shall even co-operate with the Opposition, who wish me to sit down a little early so that they may vote on their amendment rather than on the new clause. I shall respond as best I can to some of the points raised during the debate.
I say to all hon. Members, but especially to the hon. Members for Oldham, West (Mr. Meacher) and for Bristol, South (Ms. Primarolo), that I do not think that the complexities of the position have been fully recognised in the debate. I want to explain the difficulty that I or any other Minister would face in coming forward with what would be regarded as a complete solution. As I said in our previous debate on this matter, there are two categories of shortfall with these homes. One is involuntary--where people cannot meet the charge being levied. That is the case that concerns my hon. Friend the Member for Maidstone (Miss Widdecombe) and others. The other category--there was a case in my constituency only last week--is where relatives use their freedom to top up what income support will buy because they wish to pay for more than the state can be expected to provide.
Indeed, many of the charitable bodies have said that they do not expect the full difference between income support and their costs to be met. It is important that that is understood. I am not suggesting that they have expressed satisfaction with the present limits, but they do not demand that the full gap should be met because it is specifically part of their policy to provide a standard of amenity and the like higher than they think it reasonable for the state to be expected to pay for. They view that as a legitimate use of their charitable funds.
I make that point only to illustrate the difficulties of pitching the figures at the right level. I am not in any way discounting the anxiety felt about the present level, to which I have sought to respond. Indeed, the increases are substantial. The debate has focused on what I shall do in August, but that should be linked with what I have already done, which will take effect next month--that is, £20 on nursing homes, £15 on residential care homes and, at the extreme, £25 for terminal illness limits.
The right hon. Member for Morley and Leeds, South (Mr. Rees) mentioned the Salvation Army. I am prepared to take into account evidence from that body or any other reputable source, as I sought to do in making my judgments today. I shall be looking for more and better evidence when I have to make a judgment next October about the uprating from next April.
I can tell my hon. Friend the Member for Ealing, Acton (Sir G. Young) that, even when not on the scale envisaged by the new clause, when information is available in advance of April 1991, I shall use it in making my judgments at that time.
The only point that I need to make in response to my hon. Friend the Member for Maidstone is that it will be some time--I cannot give an exact time-- after April 1991 before we have comprehensive information covering a range of local authorities and a range of homes and circumstances that would make it possible to activate the new clause. I assure her that I tabled it not as a cosmetic
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adornment, but as a sign of the way in which I hope to move in the future when the information is available to enable me to act in that way.Mr. Meacher : The Secretary of State says that his new clause is not intended to be cosmetic. What guarantee can he give us that as a result of his new clause there will be no evictions after April 1991? What action does he propose to take to prevent evictions before April 1991? He has not answered either of those questions.
Mr. Newton : The answer was given in the sensible remarks by my hon. Friend the Member for Maidstone when she referred to the background to some of the anxieties about the future and about the present limits. As my hon. Friend acknowledged very fairly, on both those fronts my actions respond to the concerns expressed by the hon. Member for Oldham, West.
I owe it to the hon. Member for Leeds, West (Mr. Battle) to respond to his comment about pocket money. I have undertaken to eschew the phrase "pocket money". It is really personal expenses allowance. The point about pocket money is not widely understood. The Department of Social Security cannot dictate how people use their pocket money. There is no question of the DSS allocating the personal expenses allowance to pay for residential home or nursing home charges. Some home owners set their charges at the expenses level above the income support rate. If I raised the income support rate, some owners--perhaps not many--would raise their charges to the same amount above the new income support rate. If I set it at £200 and the personal expenses element was £10, some owners would set the charge at £210. I cannot prevent that without controlling charges for homes or taking away an individual's right to spend personal expenses money as he or she wishes.
My colleagues who organise the business of the House have told me that, in order to fulfil my undertaking about voting that I gave at the outset of my speech, I should curtail my remarks now. I shall do that after expressing my gratitude for the support that my hon. Friends and some Opposition Members have expressed in a very reasonable and constructive way and for the outcome that we have achieved.
Question put and agreed to.
Clause read a Second time.
Amendment proposed to the new clause : to leave out "take into account" and insert
"determine the amounts required to meet the costs of providing such accommodation of a suitable standard by reference to".-- [Mr. Meacher.]
Question put, That the amendment be made :--
The House divided : Ayes 221, Noes 326.
Division No. 145] [10.57 pm
AYES
Abbott, Ms Diane
Adams, Allen (Paisley N)
Allen, Graham
Alton, David
Anderson, Donald
Archer, Rt Hon Peter
Armstrong, Hilary
Ashdown, Rt Hon Paddy
Ashley, Rt Hon Jack
Ashton, Joe
Banks, Tony (Newham NW)
Barnes, Harry (Derbyshire NE)
Barnes, Mrs Rosie (Greenwich)
Barron, Kevin
Battle, John
Beckett, Margaret
Beggs, Roy
Beith, A. J.
Bell, Stuart
Benn, Rt Hon Tony
Column 608
Bennett, A. F. (D'nt'n & R'dish)Bermingham, Gerald
Blair, Tony
Blunkett, David
Boyes, Roland
Bradley, Keith
Bray, Dr Jeremy
Brown, Gordon (D'mline E)
Brown, Nicholas (Newcastle E)
Brown, Ron (Edinburgh Leith)
Buckley, George J.
Caborn, Richard
Callaghan, Jim
Campbell, Menzies (Fife NE)
Campbell, Ron (Blyth Valley)
Campbell-Savours, D. N.
Carlile, Alex (Mont'g)
Cartwright, John
Clark, Dr David (S Shields)
Clarke, Tom (Monklands W)
Clay, Bob
Clelland, David
Clwyd, Mrs Ann
Cohen, Harry
Cook, Frank (Stockton N)
Cook, Robin (Livingston)
Corbett, Robin
Corbyn, Jeremy
Cousins, Jim
Crowther, Stan
Cryer, Bob
Cummings, John
Cunliffe, Lawrence
Cunningham, Dr John
Dalyell, Tam
Darling, Alistair
Davies, Rt Hon Denzil (Llanelli)
Davies, Ron (Caerphilly)
Davis, Terry (B'ham Hodge H'l)
Dewar, Donald
Dixon, Don
Dobson, Frank
Doran, Frank
Duffy, A. E. P.
Dunnachie, Jimmy
Dunwoody, Hon Mrs Gwyneth
Eadie, Alexander
Eastham, Ken
Evans, John (St Helens N)
Ewing, Mrs Margaret (Moray)
Fatchett, Derek
Faulds, Andrew
Field, Frank (Birkenhead)
Fields, Terry (L'pool B G'n)
Fisher, Mark
Flannery, Martin
Flynn, Paul
Foot, Rt Hon Michael
Forsythe, Clifford (Antrim S)
Foster, Derek
Fraser, John
Fyfe, Maria
Galloway, George
Garrett, John (Norwich South)
George, Bruce
Godman, Dr Norman A.
Gordon, Mildred
Gould, Bryan
Grant, Bernie (Tottenham)
Griffiths, Nigel (Edinburgh S)
Griffiths, Win (Bridgend)
Grocott, Bruce
Harman, Ms Harriet
Haynes, Frank
Heal, Mrs Sylvia
Healey, Rt Hon Denis
Henderson, Doug
Hinchliffe, David
Hoey, Ms Kate (Vauxhall)
Hogg, N. (C'nauld & Kilsyth)
Home Robertson, John
Hood, Jimmy
Howell, Rt Hon D. (S'heath)
Hoyle, Doug
Hughes, John (Coventry NE)
Hughes, Robert (Aberdeen N)
Hughes, Roy (Newport E)
Hughes, Simon (Southwark)
Hume, John
Illsley, Eric
Janner, Greville
Jones, Barry (Alyn & Deeside)
Jones, Martyn (Clwyd S W)
Kaufman, Rt Hon Gerald
Kennedy, Charles
Kilfedder, James
Kirkwood, Archy
Lamond, James
Leighton, Ron
Lestor, Joan (Eccles)
Lewis, Terry
Litherland, Robert
Livingstone, Ken
Livsey, Richard
Lloyd, Tony (Stretford)
Lofthouse, Geoffrey
Loyden, Eddie
McAllion, John
McAvoy, Thomas
McCartney, Ian
Macdonald, Calum A.
McFall, John
McGrady, Eddie
McKay, Allen (Barnsley West)
McKelvey, William
Maclennan, Robert
McNamara, Kevin
McWilliam, John
Madden, Max
Mahon, Mrs Alice
Marek, Dr John
Marshall, Jim (Leicester S)
Martin, Michael J. (Springburn)
Martlew, Eric
Maxton, John
Meacher, Michael
Meale, Alan
Michie, Bill (Sheffield Heeley)
Michie, Mrs Ray (Arg'l & Bute)
Molyneaux, Rt Hon James
Moonie, Dr Lewis
Morgan, Rhodri
Morley, Elliot
Morris, Rt Hon A. (W'shawe)
Morris, Rt Hon J. (Aberavon)
Mowlam, Marjorie
Mullin, Chris
Murphy, Paul
Oakes, Rt Hon Gordon
O'Brien, William
Orme, Rt Hon Stanley
Owen, Rt Hon Dr David
Patchett, Terry
Pendry, Tom
Pike, Peter L.
Prescott, John
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