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"This delightful lady is frail and confused, requiring a lot of care and attention. At night her bed linen is changed 6 times to keep her warm, dry and comfortable. her bedroom carpet has been shampooed daily for the past 2 years. Yet Jennie is charming, retaining dignity and pride, and is loved by all of us.Not one of our residents could live on their own now. Many have spent years in their own homes, coping with frailty, loneliness, poor diets, falls, fear, burns and hypothermia."
Perhaps the most serious of those is loneliness. Sadly today, the extended family is not as caring and is perhaps too extended to enable them to take care of their elderly relatives.
The gentleman who runs the home advises me that the only alternative environment for the residents would be a hospital. Of course, that would not be so homely or comfortable and it would go entirely against the policy of successive Governments, which is to have these people looked after in a much more caring way, hopefully within the community. In addition, the cost of a hospital bed is extremely high.
The proprietor of the home in Chesterfield says that they cannot reduce costs. He thinks that the Government's regulations are reasonable, but says that they demand only minimum standards, while he seeks to establish standards which are higher than the minimum. He says that his charges are well below those of local hotels which "do not offer skills to reduce the pain, or reassurance and a cuddle when you are afraid."
He continues :
"Recently I spoke to a chairman of a health authority, who confirmed that substantial economies are being made by closing Grannie beds' and transferring patients to private nursing homes." We all know that that is happening. I am making no announcement that is not well known to the Government. If the Minister of State and the Parliamentary Under-Secretary are determined that community care should work and that the more vulnerable groups within society should have a better life in their declining years, they will ensure that the level of income support for those who need to rely upon it is as high as is necessary to enable them to be looked after in a private residential or nursing home which can provide the proper quality of care that the House would wish them to receive. Those examples are not untypical of what is happening throughout the country. I have not mentioned Southfield Manor, just outside my constituency, which I brought up during our deliberations in Committee, where Mr. McCabe looks after 94 infirm, confused, mentally ill and mentally handicapped patients with serious behavioural problems. That nursing home requires a high level of qualified staffing. He may have to close at the end of the year unless many of the patients, most of whom rely upon income support, have an increase in their benefit.
I take the examples of top-up and housing benefit recommended in the report by the hon. Member for Birkenhead. If something like that is done, we can stagger through to 1 April 1993, but a very serious position will develop then. I hope that the Government of the day--my own Government, I trust-- will pay serious attention to the matter and make better plans.
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5.4 pmMr. Clifford Forsythe (Antrim, South) : In 1982, as mayor of Newtownabbey, I took the opportunity to visit all the residential and nursing homes, in addition to the hospitals, in the borough. Since then, I have visited many homes in the rest of my constituency. But it was the visits that I made as mayor in 1982 that gave me my first insight into the running of such establishments. I saw at first hand the facilities which were being offered to the disabled and elderly residents.
I should explain to the House that most of the homes were under the control of the Department of Health and Social Services, because in Northern Ireland the local government set-up means that district councils have no function in the delivery of social services to their ratepayers. The position remains the same today for the public provision of care, and many private residential and nursing homes now exist in the Province.
Returning to 1982, I was generally pleased with the lay-out and surroundings of most of the homes ; unfortunately, some fell far short of the standards of comfort and homeliness that many people, including the residents, would have liked. What impressed me greatly in all the homes was the dedication, hard work and helpfulness of all the staff, each working to overcome, in a minority of homes, adverse conditions of overcrowding and unsuitable, ancient buildings, in order to ensure that the residents were kept comfortable and contented.
I was made aware by those in charge of the homes that, because of better health provision and the demographic trend, a large rise in demand for places in residential and nursing homes was inevitable and that major changes would occur as a result. I am sure that those staff members, like me, have been startled by the huge increase, not only in the number of residents in the homes but in the vastly increased number of homes, particularly private homes.
It is revealing to compare the figures for 1982 and 1990. In 1982, residential homes in Northern Ireland totalled 246 ; in 1990, the number was 337, a rise of 37 per cent. In 1982, there were 12 nursing homes ; in 1990, the number was 164, a rise of 1,250 per cent. Recently, I asked the Secretary of State for Northern Ireland to supply me with up-to-date figures for residents. The total number of residents in all homes in 1987 was 2,382 ; in 1990, it had grown to 4,489, a rise of 85 per cent. in just three years.
The figures for different categories are interesting. Residential homes had 85 mentally ill and 1,321 other residents over 60 years of age ; 41 mentally ill and 203 other residents were under 60. The nursing homes had 80 mentally ill residents and 2,533 other residents over the age of 60, seven mentally ill residents and 219 other residents under the age of 60.
All those residents received income support. That means that, according to the 1991 benefit rates, approximately £1 million per week is paid in Northern Ireland for those in residential homes and nursing homes. That figure does not reveal how many of those residents are supported by their relatives, who cover the real cost of the residential care in many homes.
The principal demographic change in the 1990s will be a rapid expansion in the number of pensioners over the age of 85. By 2001, the proportion of elderly folk living alone in the United Kingdom will have increased by 600,000 over the number living alone in 1986. We are already
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aware that living alone is the second greatest demographic risk factor, other than age, that necessitates admission to hospital or to residential or nursing care homes.Those figures put into context the conclusions and recommendations contained in the report of the Select Committee on Social Security. They reinforce the vital importance of agreeing on an effective policy for such specialist care.
I support the report, and commend it to the House. I am not a member of either major political party, and I was impressed by all my Committee colleagues, under the excellent chairmanship of the hon. Member for Birkenhead (Mr. Field). I have been impressed by their industry and obvious concern when investigating this important subject. I was also impressed by the manner in which they laid aside party preferences--except on one occasion--to arrive at conclusions aimed to be beneficial to residents and fair to people who have taken on the task of caring for those who are no longer able to manage in their own homes. We must not forget those who undertake that work. I welcome the extra finance that will be provided by the Secretary of State for Social Security next April. However, I wonder whether various hidden expenses in running a home have been taken into account. In Northern Ireland, it appears that the Rates Amendment (Northern Ireland) Order could lead to some residential and nursing homes being rated by the valuation department. It also appears that, as a result of the new council tax, some of those homes will have to pay that tax. I do not believe that that hidden expense has been taken into account when deciding on the finance to be provided next April.
I sympathise with, and understand, the argument of those asking for a general uprating. However, I also sincerely believe that that would create a situation in which fees could be raised to absorb that extra cash. I am also concerned that, on occasions, a resident's personal allowance is used to top up their care home fees. The personal allowance belongs to the individual, and it must remain his property.
Recommendation (x) in the report asks that residents' homes should be exempt
"from consideration as capital assets in connection with Income Support claims in those cases where a carer remains living in the home or where there may be a reasonable possibility of the resident returning to live at home."
It also states that, should the resident's spouse sell the home to raise extra money, that money should be excluded from the calculations of income support entitlement.
I should like that concession extended to family smallholdings or farms where a similar problem can arise, with the result that land that has been in a family's hands for centuries is sold to pay for the former owner's residential or nursing home fees. That deprives his spouse not only of her home, but her livelihood. Such a sale places the land and the house in the hands of speculators who care nothing for history, tradition, or, indeed, farming.
In the future, we face the prospect of more and more pensioners taking on the responsibility of looking after their even older parents, as well as themselves, on a fixed and, in many cases, inadequate income. Therefore, it is obvious that we have a short time only in which to resolve the problem. It is up to us to ensure that those who created the wealth of the nation in the past are properly looked after without the pressures, tensions and worry to which many are unfortunately subject now.
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5.16 pmMr. Roger Sims (Chislehurst) : The House is indebted, not for the first time, to the hon. Member for Birkenhead (Mr. Field) for the manner in which he chairs the Select Committee on Social Security and for the way in which he introduced the debate today. The report from the Select Committee is a valuable one on an important subject. As the hon. Member for Birkenhead mentioned, the report also creates a precedent by being as near as possible a joint report of two Committees, the Select Committee on Social Security and the Select Committee on Health, of which I am a member.
Government is divided into different Departments, but life is not. There are bound to be overlaps in the work of different Departments, and therefore of different Select Committees. There are circumstances in which it is useful to conduct joint inquiries. I hope that it will be possible to amend the Standing Orders to produce joint reports, instead of having to follow the rather odd procedures which we did. People are expected, not unreasonably, to try to make some provision for their old age, but some are better able to do so than others. Some are able to live in their own homes and look after themselves, with or without help from relatives, literally until their dying day. Others--none of us know what the future holds--need to go into residential homes or nursing homes to receive care. In both cases, the costs can be substantial, but they are especially great in the case of nursing homes. Where such costs can be met from a person's resources, it is right that that should be done. When that is difficult or impossible, the state, through the payment of social security benefits, should step in.
I recall a case in my constituency of a lady who had to go into a home. Her son wrote to me from an address that suggested that he was not too badly placed. He protested that his mother's application for income support had been refused because she owned a home. He said that that meant that he would have to sell that home and therefore deprive himself of his inheritance. I am afraid that he got a rather dusty answer from me, because I did not see why the taxpayer should pay to support his mother when there was such a property in the family.
Any benefit system involves rules and regulations which are almost bound to produce anomalies. Some people will be covered, others not. Some will get benefit who perhaps should not have it. We must try to build in some flexibility and consider cases on their merits. That, without going into a detailed argument, is a feature of the social fund.
Income support for people in homes is not flexible. The rules specify the circumstances in which it shall be allowed, and the sums are fixed. On the Minister's admission, income support is not intended to meet the full cost of fees of residential and nursing homes. So how is the gap to be filled between the fees charged and the income support provided? Sometimes it is met by relatives, and that is not unreasonable if they are people of means. Sometimes charities are asked for assistance to fill the gap. But some people do not have relatives, while others have relatives who do not have the means to help.
Many examples were quoted to the Committee and are recorded in the evidence. They include a letter which I received about a 102-year-old lady in a modest residential home in my constituency for whom the difference between income support and fees is met by her son, aged 80, from
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his pension. That cannot be right. Similarly, there is the case of a lady in a nursing home in my constituency who receives retirement pension, war widow's pension, attendance allowance and a grant from the Soldiers, Sailors and Airmen's Families Association, her husband having fought in two world wars, plus income support. But that is still not sufficient to pay the nursing home fees. The difference must be paid by her son, an ex-POW pensioner turned 70.I urge the Minister seriously to consider the recommendations in our report, which would enable local offices to top up in individual cases, thus providing the flexibility that I have advocated. The arguments against a general increase in income support levels are rehearsed in the report, but I suggest that the alternative, of individual top-ups, would be less costly and a far more effective use of resources.
Reference has been made to carers. I cite the case of a lady in my constituency who, since her father died in 1975, has lived with her mother, sharing household costs and maintenance, and latterly has combined a full- time job with looking after the mother in failing health. The mother is now 82, her Alzheimer's disease has reached the stage where she needs 24-hour care, and she has moved into a nursing home. The daughter's entire net salary, plus the mother's pension, are insufficient to meet the nursing home fees, so an application has been made for income support. That benefit will be issued for six months, but not for longer, because the house was in the names of the father and mother and since the death of the father has been in the name of the mother only. So she is not eligible for income support after six months, the period which is given to enable her to dispose of the house.
That means that the daughter, now aged 52--she does not fall within the bracket of being either disabled or over 60--will be obliged to sell the roof over her own head. She is, in effect, being penalised for spending those years caring for her mother by having to sell her home of 20 years, on the proceeds of which she will apparently have no claim. The irony is that if, on the father's death, the home had been transferred not to the mother but to the daughter, there would have been no problem for the mother or daughter.
I urge the Minister sympathetically to consider our recommendation that in those circumstances the Government should exempt homes from consideration as a capital asset. I invite the Minister to look at the practicability of the ingenious solution mentioned by the Chairman of the Committee, by which social security might have a claim at a subsequent date on the estate or on the estate of the carer.
Some of those problems will cease to arise when the new community care schemes are introduced in 1993, and I emphasise the importance of the Government transferring sufficient funds to local authorities to enable needs to be met in full. We recommend that some research be undertaken to ascertain what the figure is likely to be. I suspect that, when assessment gets under way, we shall find much of what might be described as hidden need.
While, as I say, the problems should cease to arise, the existing problems will remain, because those at present on income support, and on support in April 1993, will continue under that system and at the rates then applying.
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We could therefore find after 1993 that in the same home will be people receiving income support because they were there before April and others who were put in the home at a later date by the local authority having their costs met in full.The impact on residential and nursing homes of the new council tax is causing concern. It seems clear from the Local Government Finance Bill that a person will be exempt from the council tax if "his/her sole or main residence is in a residential care home, nursing home, mental nursing home in England and Wales, and is receiving care or treatment in the home."
Miss Sheila Scott, secretary of the National Care Homes Association, sought clarification from the Department of the Environment, which said in a recent letter to her :
"The Government proposes that the landlord or the owner of a residential care home should be liable to pay the council tax. It will be for that person to decide whether to seek a contribution from residents through fees and charges as he would with any other overhead".
Rather confusingly, the letter went on
"Occupants of residential care homes will give rise to a discount. A maximum of two discounts will apply if there are no liable adults resident in the home."
While people on income support will not be liable, in any event, to the council tax, there is concern about what the implications will be for owners of residential and nursing homes, for if those charges are substantial--and in the past the rates did not apply--and if now a substantial, council tax is to be imposed, the tax will have to be passed on to the residents and will increase fees even more. I hope that the Minister, either when replying to the debate or by letter, will clarify the misunderstanding, if it is a
misunderstanding, because it would be unfortunate if life were made unnecessarily more difficult for people in residential and nursing homes whose position our report endeavours to assist.
5.29 pm
Mr. David Hinchliffe (Wakefield) : Having served on the Select Committee on Health and been involved in the joint inquiry, I endorse the report's conclusions and recommendations. I pay tribute to my hon. Friend the Member for Birkenhead (Mr. Field) for his role in engineering the joint working of the Social Security Select Committee and the Health Select Committee, and to the Chairman of the Health Select Committee, the hon. Member for Macclesfield (Mr. Winterton), for his role in the process. It was a useful exercise and we all have a right to feel proud of the end result--the content of the report. There has been a broad consensus in the debate so far, but I hope that I can break it as I take a different view from some of those that have been expressed. Some would say that my view is more politically partisan. I apologise for the fact that my argument may be familiar to most hon. Members present. The two Ministers present have certainly heard me take this line before, and my hon. Friends and most Back Benchers have heard it on a number of occasions. Furthermore, any similarity between the speech that I made to the Doncaster trades and Labour club a couple of weeks ago, when you, Mr. Deputy Speaker, were in the Chair, and the speech that I shall make tonight, is purely coincidental.
We have heard comments about the Government's community care programme and have debated the matter in the House on numerous occasions. None of us would
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argue with the broad political consensus that community care is desirable, and we all support the processes in which successive Governments have been engaged in the past 20 or more years. We all support the break-up of the large old lunatic asylums and the movement of people from geriatric wards into the community, but we may raise questions about how those changes were handled. The number of children who have been introduced into institutional care has also been reduced, and community schools have been broken up. Anyone who knows people who have lived in such institutions will support such measures. Alongside that process, however, there has been an alarming growth in the movement towards private institutional care. We have now reached a stage where community care is in a horrific mess and we have to unravel it. The report that we are discussing tonight is one contribution toward unravelling the mess that --let there be no mistake--has arisen because of the Government's policies alone. The hon. Member for Antrim, South (Mr. Forsythe) spoke of the huge explosion in the number of care homes in his part of the world. The official figures provided by the Library show that, in the past decade or so, the number of places in local authority care homes have been reduced by some 4 per cent., while the number of private residential care beds has been increased by 316 per cent. It is not possible to obtain reliable estimates of the number of private nursing home beds, but I am reliably informed that, in my area of Yorkshire, the increase in the past decade has been some 1,000 per cent. That is a massive increase in the number of people in private nursing home care.It may be argued that the reason for that is the explosion in the number of elderly people, but the figures provided by the Library show that that simply does not justify the explosion in the number of people in private nursing home care. The increase in the number of elderly in the same period is 9.5 per cent., and the increase in the number of very elderly who might be expected to end up in care is only some 20 per cent. Therefore, the actual increase in the number of elderly people in society in no way justifies the increase in the number of private care beds in the nursing home and residential care sectors.
The Government's policies have pushed into residential care people who do not need to be in such care. I say that not just because of what I see when I visit care homes in the public and private sectors in my constituency, as I frequently do. The Audit Commission said recently that 25 per cent. of the people whom it saw in care homes could have been cared for in the community and had no need to be in institutional care. That point was picked up by the previous Social Services Select Committee.
The Health Select Committee recently took evidence from directors of social services who said that their registered care homes officers reported that 50 per cent. of the people whom they saw in private care homes in their areas need not have been in those homes but could have been accommodated in the community. That is an indictment of the Government's policy in the past decade, and we must do something about it. Because of the Government's policy, people who do not need to be in institutional care are being placed in it. Whatever Government are in power, that is wrong, and I hope that the report will be a starting point for a change in direction.
The reasons for a revival in the institutional model of care are clear. The Government have pursued policies that have directly led to people being forced into accepting--
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they have no doubt had a resigned attitude-- the need to enter care because the preventive services have sometimes been pulled from under their feet.We can argue all day whether the Government have funded the national health service properly. There is plenty of objective evidence that there has been large-scale cumulative underfunding since the Government have been in power. However, I have seen cases in my area--I have mentioned them in the Chamber before--of people who have had basic services such as bath nurses withdrawn, resulting in their having to be forced to leave their homes, to give up the ghost, and to enter care. If the Minister wants details, I can name cases in my area where that has happened.
The Government are committed to a reduction in public spending, which has affected the availability of preventive, caring services--alternatives to institutional care. It is ironic that, although the Government are committed to reducing public spending, huge amounts of money--some £1.7 billion in the current financial year--have been thrown willy- nilly at the private care sector. If one looks at that in detail, one finds that it is a gross and highly irresponsible misuse of huge amounts of public money, which could be used far more effectively elsewhere.
My local authority has experienced major difficulties in attempting to provide the basic services that are required by people who did not want to enter care but wanted to remain independent and who had carers prepared to support them, with a little help from outside and from local authorities. Yesterday, I received a note from the deputy director of my local authority about its present financial position. I asked about the position of the local authority with regard to its standard spending assessment in the next financial year. He said that the local authority had experienced problems in the past few years and added :
"For 1992-93 the Standard Spending Assessment for Wakefield District Social Services, excluding specific grants is £26.3m. Current expenditure plus inflation, if carried forward into 1992-93, will be £28.6m. The SSA is therefore £2.3m less than we need to maintain current expenditure plus inflation.
However, the letter from the Department of Health dated 26.11.91 giving details of the Standard Spending Assessments for the personal Social Services states that In setting the 1992-93 figure the Government has taken account of demography and inflation and has allowed for the implications of Community Care and the Children Act 1989. Also included are the revenue consequences of the specific grants'."
Mr. Cullinan, the deputy director, then said :
"In round terms I would estimate that we need an extra £2m to allow for the minimum implications of the Community Care Act, Children Act and the revenue consequences of the specific grants. This means a shortfall of £4.3m between the Standard Spending Assessment and what we need as an absolute minimum in 1992-93 to meet legislative requirements."
This is the reality for my constituents who want assistance with home care and the variety of levels of provision such as day care and respite support, which enable people to remain independent or semi-independent.
In the period since the Government came to power, the pattern of expenditure on personal social services has been changed. By virtue of the Government having reduced the rate support grant, they have taken some £6 billion out of the budget of personal social services. That money should have been spent on preventing people from having to enter the hugely costly care programmes that we are discussing today. I do not want to expand that point, but it is
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important for the Government to accept that their local government policies have greatly damaged the prospects of people who genuinely wanted to remain, and could have remained, in the community. It will cost the Government more to adopt those policies than if they had allowed people to remain independent or semi-independent if they wished.The role of housing in relation to community care is absolutely vital. Last year was the first year since the 1920s when no new council houses were built in my district. No one is making the sort of provision we need to enable people to remain semi-independent by moving into sheltered housing when they can no longer remain in their own homes. The voluntary sector and housing associations have simply been unable to expand the provision in the way needed during a period when there has been an increase in the number of elderly. Alongside those policies, we have seen a clear effort by the Government to make it easier for people to enter private institutional care. There was a change in 1981 in the supplementary benefit system. People have told me that they have struggled to try to get telephones, day and home care facilities, but their local authorities have genuinely not been in a position to assist them because they did not have the resources. However, as soon as the decision was made for those people to give up the ghost and go into institutional care, the money flowed.
The money is available, but not where it is actually needed. It is not used to allow people to remain independent or semi-independent. It is not used on basic services such as home care and facilities that would allow people to remain in their own homes, which is tragic. I have met many people who have been affected by those policies, and I believe that the Government have made regrettable decisions.
It is also important to mention the way in which a market experiment in the private care sector has, with substantial public support and money, had a bearing on the type and range of services now available. Provision in the private sector is unplanned. If it is planned, it is done purely and simply by entrepreneurs who realise that they can make money by providing establishments in a particular district.
Perhaps because there are not many large Victorian mansions in Wakefield, vast numbers of people who have lived all their lives in that district have had to move away to live--often for the rest of their lives--many miles from where they were brought up. Provision for people in need has not been available where those people live, and they have had to move to the facilities. If there were proper planning of community care provision, those people would have been granted the necessary facilities in their homes.
Mr. Nicholas Winterton : I am surprised that the hon. Gentleman is making such a strong argument. In my short speech, I spoke of a private proprietor who had built a purpose-built nursing home for the infirm and those who could not operate within the community from their own flats or houses. I hope that the hon. Gentleman will be prepared to admit that, if special accommodation is not provided by the county council social services or through the old geriatric hospital wards, it must come from another source. The private sector can fill and is filling an important vacuum.
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Mr. Hinchliffe : I understand the hon. Gentleman's point. I certainly do not disagree that, where provision is specialised and limited- -as it might be for young disabled people--it might be necessary for the person requiring that care to travel some distance from where he or she lives. However, I am not talking about people with specific needs, but about elderly people who simply need elements of care that are not provided in their communities. I know of a number of examples where individuals have been discharged from NHS geriatric care and have been told that they must move into private care as there is nowhere else for them. As private care is not available in their local authority district, those people have had to travel to find accommodation outside their local authority area. They have ended up in the private care of another local authority. After some time, they have applied to that local authority for funds to return to their own local authority district where they have lived all their lives. They are then told that the authority is not prepared to support them because they are ordinary residents.
They have to live out the rest of their lives in a district many miles from their own homes where they have lived all their lives. I know of a number of such deplorable cases. As private care is largely unplanned, it is often not in the interests of the many residents who have to move from the district where they have lived all their lives and where they have their friends-- [Interruption.]
Having been given a nod by the Whips, I shall come to my central theme, although I should have liked to go on for at least another half an hour. Private sector provision comes primarily in one form : institutional provision, which is the easiest way to make money. I do not believe that institutional provision should be the only facility available to the elderly or disabled. There are other forms of provision which could be available to people in their own homes. People keep plugging the fact that the new legislation will introduce assessments. Hopefully, the assessment scheme will be introduced in the 1993 legislation, but assessment alone will not cure the problem. A social worker can assess a person, but only on the basis of the services available at any one time. If there are no alternatives to institutional care, assessment is nonsense. It would be wrong to assume that assessment will cure the problem. I shall briefly summarise the points that should come out of the debate, and I hope that the Government will take note. The Government have engineered a deliberate redirection of public resources away from preventive domiciliary supportive services in the community towards institutional care in the private sector. It is ironic that, up to the last financial year, the amount of money spent on institutional care in the private sector through income support provisions--previously, supplementary benefit--was about £6 billion. That sum was provided to people entering private care since 1981. The amount of money taken out of local authority preventive services budget was about the same--£6 billion. That is what the Government have achieved during their period in office.
The incoming Labour Government will have a huge challenge : to engineer a complete transformation of residential care. No one has referred during the debate to the quality of care available in homes. The Government have commissioned various reports ; the report analysing the costs of care did not mention quality. I agree with Lady Wagner who said that local authority homes should be
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"progressively adapted to provide fewer residents with better accommodation on the model of very sheltered housing."That is the policy that we should adopt for residential care. We should not simply put people into Victorian houses miles away from where they have lived and forget about them, as happens at present. I know that my hon. Friend the Member for Manchester, Withington (Mr. Bradley) agrees that, when we are in government, we must urgently implement a substantial redirection of public resources away from residential care towards supportive services in the community, whether in the voluntary or local authority sectors or elsewhere. We shall thus enable people who choose to live independently to remain in the community with the support facilities which they require and which, in many cases, have been removed by the Government. 5.49 pm
Mr. Patrick Nicholls (Teignbridge) : Although the hon. Member for Wakefield (Mr. Hinchliffe) may have thought he was introducing a contentious note, only in the closing seconds of his speech did I find much to disagree with. It was the second time that I have heard that speech, but it was well worth a second airing and there was a great deal in it with which I would agree.
The hon. Member for Wakefield fairly pointed out that the amount of money spent on residential care is massive. Our report notes that since 1979 the amount spent on income support for people in residential care and nursing homes has risen by about 160 times--a massive increase. Without wishing to spoil the atmosphere of consensus, I must point out that, although the hon. Gentleman said that the money could have been spent in better ways, I have a strong suspicion that, had it not been increased by this amount, he might have said that it should have been increased by more. That sums up the nature of the dilemma that he identified.
It is common ground between us that residential care of the standard that we expect for our fellow citizens is not a cheap option. Whatever else divides us, that statement cannot. It is an expensive option, and so it should be. The chances are that it is the most expensive option of all, so on social, pragmatic and financial grounds, I am sure that the hon. Gentleman was right to draw our attention to the fact that there may be better ways of spending this much money.
I do not, however, see the spending of money in this way as inhibiting our reaching a more attractive regime. It is a necessary step on the way there. We are getting away from the institutionalised Victorian establishment to something which approximates more closely to the sort of conditions that people enjoyed or wanted to enjoy when they were still independent enough to live in their own homes. The type of home with which all hon. Members will be familiar, operating at its best, is a step in the direction of the right sort of care. We owe the hon. Member for Wakefield a debt. The last recommendation in our report is that the Government should undertake a study into the types of service that should be made available as alternatives to residential or nursing home care. That recommendation was included to satisfy the point made by the hon. Member, and it makes the report all the better.
In a sense, however, we need the evidence to back up the hon. Gentleman's suspicions. I am sure that he is right to say that we could be more creative, that we could keep
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certain people in their own homes either for ever, or at least for longer. That is only common sense. I must sound a note of caution to the effect that the evidence does not yet exist. I share the hon. Gentleman's strong suspicions, but quantifying them will depend on the evidence. If the recommendation in the report is taken up, we may well gain the evidence that would carry the hon. Gentleman's suggestion further ahead.The recommendations in the report would not have been made without the highly skilled chairmanship provided by the hon. Member for Birkenhead (Mr. Field), who shows us where consensus lies and who makes it clear that the easiest options of all are not available. Many people who take an interest in these matters might say that all that is necessary is to spend more money. This above all others must be an example of a problem on which expenditure of money would do the trick. As the hon. Member for Wakefield and I would agree, however, there is more to it than that. Our acknowledgement of that lends our report credibility and makes it harder for the Minister not to follow at least some of our recommendations.
The first recommendation contains the following statement : "We do not recommend a general uprating of the Income Support level, other than the normal annual uprating. We welcome the increases to be made in the 1992 uprating, particularly the additional £15 a week rise We understand and sympathise with those who have asked for a general uprating, but we believe that in all probability it would simply push fees up further and actually exacerbate the problem." That says it all. The hon. Member for Birkenhead, with his customary fairness which makes it so difficult to attack the parts of his presentation with which one does not agree, said that a general uprating would merely put the Government, the Treasury, the taxpayer and the system over a barrel. So the message should not go forth that this is just a question of spending more money and then the problem will be solved.
The recommendations can be divided into three categories. Recommendation (xvi), which I have already mentioned, falls into the first. It is valuable and free-standing. The next category discusses specific ways in which money might be spent to deal with a problem that was always bound to exist before community care was finally implemented--but it does so in a targeted way that would not amount to a general uprating. The third category I will refer to in a moment. The difficulty with which the Government have to wrestle--I can say this in a debate in which there has been far more agreement than disagreement--is that, although we have pointed out the dangers of a general uprating and done our level best to come up with a package of recommendations that do not amount to a general uprating, it may be hard to implement the recommendations in their entirety in such a way that they would not amount to a general uprating, thus having the precise effect that the Committee did not want.
We Back Benchers do not have to wrestle with these problems ; we have done our part by pointing out responsibly how to deal with the problem. But we would do our own credibility no good and we would not serve those with an interest in this debate if we did not acknowledge that, unless we are careful about our solutions, we shall bring about precisely what we do not want to achieve.
Finally, I arrive at the third category of recommendations, which includes action that can be taken that will not
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require expenditure. Recommendations (vii) and (viii) amount to much the same thing. The Committee was given clear evidence that some health authorities indulge in what can only be described as sharp practice, either by passing on to the social security budget or by passing on to relatives obligations that the authority is supposed by law to fulfil. The recommendations try to rectify that ; the practice must be stopped.Health authorities may reply that they want more money, but then they would, wouldn't they? Times do not change ; that is a respectable pressure to bring to bear on the Government of the day. But first things first : if authorities have an obligation in law, they must discharge it. Whatever else may cause the Minister difficulty when she sums up, I cannot imagine that she will not be able willingly to clasp to herself those two recommendations. She can do that without embarrassment or fear of comparison with past speeches.
My hon. Friend the Member for Chislehurst (Mr. Sims) alluded to recommendation (x)--the consideration of capital assets in connection with income support cases when one carer is present and one is not. This recommendation combines compassion, common sense and--although we do not have the evidence to assess this--good solid fiscal sense. For that reason, if for no other, it should be adopted.
The report does not underestimate the problems ; it tries to deal constructively with them, and it responsibly points up the fact that we must be careful lest, by implementing the recommendations in their entirety, we bring about what we do not want to achieve. Mercifully, we Back Benchers do not have to wrestle with that.
5.59 pm
Mr. David Bellotti (Eastbourne) : First, I thank the Chairman, the hon. Member for Birkenhead (Mr. Field), and all the Members of the Select Committee who worked hard to produce the report and the excellent recommendations which are contained therein.
The report is simply a look at the current situation which will grow more serious as time goes on. The United Kingdom has 10 million retired people, about 18 per cent. of the population, but that figure will increase considerably in the decade to come. By the year 2030, although the overall population will rise by about 7 per cent., the rise in the 60 to 74-year- old age range will be about 36 per cent. and the rise in the over-75 age range will be more than 44 per cent. Those figures show that we must consider the report's recommendations seriously, because, unless we act properly on them, the situation will be more difficult to deal with as time goes on.
First, we must determine our principles for care in the community. There should be a mixed economy of care. It is for the House to ensure that all three sectors, public, private and voluntary, have the opportunity to develop and grow during the challenging years ahead. We should try to maintain high standards in all three sectors because that will lead to an element of choice for the client or the customer, help us to ensure that we obtain value for money and, to some extent, maintain standards, because only by rigorous inspection and comparison between the three sectors can standards be maintained.
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In the real world, however, local authority public sector provision for residential care is in difficulty. Sussex is no different from many other areas of the country. There, the local authority is having to reduce the number of places available and to close existing residential homes in order to find the money to bring the remaining homes up to the standard which should exist across the three sectors to which I have referred. Therefore, the number of places in the public sector is being reduced.The voluntary homes are also in difficulty because of recent changes in the financing of many of those which are registered as housing associations. Many of them are finding it difficult to balance their books, and relatively few are looking forward to developing new projects in the next 10 years. Their development plans are few and far between.
The third sector, the private residential and nursing home sector, has suffered because of the gap which has been created between income support and the real cost of delivering care. I was extremely pleased to see that one of the report's major recommendations was that the Government should immediately commission research to provide information about the shortfall between income support and fees paid, so that the funds to be transferred from the Department of Social Security to local authorities in 1993 can be accurately determined, because, if a problem exists now, it will be much worse then. That is important because, if funds are not there, standards of care will decline.
Slightly less important, but nevertheless important to homes that I visit, is recommendation (ix), which has not yet been referred to, requesting the Department of Social Security to ensure that high priority is given to assessing and paying claims for income support in care homes. I have visited many residential homes in Eastbourne where the proprietors are concerned about the time that it takes for those receiving income support to obtain it. That causes initial problems at the very moment when confidence in the system is needed. The 7.7 per cent. increase in social services spending in the recently announced standard spending assessment has been referred to by the Association of Metropolitan Authorities as "absolutely devastating". The Association of County Councils has also expressed strong concern. The problem with that figure which gives local authorities cause for concern in the public sector is that it is not a 7.7 per cent. increase above their spending last year but above the SSA, which is what the Government thought that they should have spent. Therefore, the real increase in the funds available to social services departments next year will not be at the level above inflation which would meet the existing problems. Many social services departments throughout Britain are already spending well above their SSAs.
An example of where that is not only occurring but is leading to delay is in the provision of a much needed facility by the Key housing association in Kilmarnock. Because Strathclyde region cannot be sure about next year's funding, it is unable to give the sort of encouragement that such a proposal has so far received, and there could well be a delay in the provision of residential accommodation as a result of those delays and uncertainties. It is important that not only the right figure is arrived at through the SSA, but a figure that will give people confidence to move forward.
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