House of Commons Hansard Debates for 10 Dec 1991

Column 771

In evidence to the Committee, widespread concern was expressed about the gap which is emerging. The Royal National Institute for the Blind, which I quote not least because one of its residential homes is in my constituency, said that, from April 1991, its fees were £262 per week, whereas its real average costs were about £300 per week. It concluded that there was an urgent need for the weekly limits to be raised so as to ensure that visually impaired people received the care they needed.

I am sure that the Minister is aware that that concern is shared by other voluntary providers and by the private sector providers. In addition, private providers tell hon. Members that, unless the gap can be reduced or some other solution arrived at, they are particularly worried about the future. The British Federation of Care Home Proprietors says :

"As the gap between income support and real costs continues to widen, choice, a major concern of the Government"--

something to which, as I said at the beginning, I too am committed--

"will be restricted and a two-tier system of residential care may be the inevitable and regrettable consequence."

I think that all hon. Members will accept that we do not want to support anything that would lead to the evolution of a two-tier system of care. The report contains many examples of concern expressed on that front. Given the comparison of the fees, of which we had much evidence, it is not surprising that concern has been expressed from so many quarters.

Another report dated 7 May 1991 comparing the income support for 1991-92 with two surveys one from Price Waterhouse and one from Laing, it is easy to see why that concern is so widespread. For residential care running costs, income support for the present financial year was £160. The Price Waterhouse survey concluded that the real cost was £187 and Laing concluded that it was £204. In nursing homes, the comparative figure for income support was £255. Price Waterhouse concluded that the real cost was £293 and Laing, £287.

Those figures will be well known to the Minister, but they illustrate and add to the views being expressed from so many quarters. One way of providing residential care is often for individuals to sell their properties when they retire and to use the capital to purchase their care. Unfortunately, it is becoming more difficult to do that. Apart from the problems of selling property at this time, the average house realises only £66,000. Even if the whole of that sum is invested, the income thus produced is unlikely to be sufficient to support someone living to a very old age. An extremely helpful booklet produced by Pearl Assurance states :

"Many people use the proceeds from the sale of a house to help finance the fees. Even large amounts of capital do not last forever, so it is a good idea to get professional advice well in advance of the time you anticipate moving into a home."

Given the large number of people who are likely to enjoy a quality of life into old age, consideration must be given to how they can be financially supported, because that cannot be done only by the sale of their property. Price Waterhouse points out that average residential care and nursing home costs in London and the south-east are 15 per cent. higher than in the rest of the country.

Current uncertainty means that developments such as that in Kilmarnock which I mentioned are not proceeding as we would wish, and it is affecting individuals who are receiving care but who are not properly funded. I know

Column 772

that the director of nursing at one Sussex establishment has written to the Secretary of State and to a number of other right hon. and hon. Members, pointing out that his home has provided places to ex-hospital patients, but that they have not been awarded the income support to which they are entitled.

On 24 September, the National Association of Mental Health legal director successfully represented 12 of the ex-hospital patients in that home before a social security tribunal, which awarded them income support. However, the Benefits Agency decided to appeal against that decision to the social security commissioner. While that process continues, those individuals are left without any income. The Minister should give consideration to such cases, which place enormous pressures on the establishments concerned, and which could arise even after "Care in the Community" has been implemented. In all this, we want also to protect the carers. At some stage, they could become the very people who need financial help for residential care. If we mortgage their future on behalf of those for whom they care, we shall not be providing for their own care in due course. Clearly, income support levels are not high enough, and the Government must address the alternative solutions available to them. Funding must also be reassessed--and I am sure that if we put our minds to that task, we could all do better.

6.13 pm

Mr. David Shaw (Dover) : I pay tribute to the Chairmen of the Social Security Select Committee and of the Health Select Committee, who have found a way around the difficulties of operating together and have produced a more interesting report as a result. Having been through that process once, the Social Security Committee is clearly interested in other areas. When problems such as those created by the Maxwell affair, for example, come to light, that Committee and the Department of Trade and Industry could operate together.

The report therefore establishes an important precedent : it means that Government policy will not always be departmentalised but will be seen in the round. The problem with Select Committees is that they are sometimes compelled to take a narrow view, rather than the broader view that is reflected by the report.

The report gives further evidence that residential and nursing homes are an enormously important and valuable source of care for the elderly. The Government have made significant improvements in that regard. I am sure that my hon. Friend the Under-Secretary of State must be delighted that she will be summing up in a debate that concerns an area of activity in which expenditure has increased 160 times under this Government. Even given the expenditure that the Government have devoted to the public sector, there cannot be many Ministers who find themselves in such a favourable position. The number of claimants has increased from 12,000 in 1979 to 220, 000. There were 9.5 million old age pensioners in 1979, but there are now some 10.5 million. Those extra 1 million pensioners must account for many of the additional claimants. The frail or very elderly account for an increasing number of pensioners, and that emphasises the importance of nursing home and residential care.

The evidence to the Select Committee suggests that the private sector has not only expanded well in terms of

Column 773

growing numbers and additional services, but of maintaining its assets. There was, however, evidence that public sector homes have been poorly maintained and that councils had spent their money elsewhere. Councils have had an enormous amount of money through their hands, and have spent it in an equally enormous number of areas over the past 12 years.

Mrs. Alice Mahon (Halifax) : A recent report named my local authority of Calderdale as the second most efficient metropolitan council in the country. Because of the threat of poll tax capping this year, it was compelled to cut £5 million from its budget. I do not think that even the hon. Member for Dover (Mr. Shaw) could accuse that authority of being profligate, but those cuts will affect the care of the elderly in Calderdale.

Mr. Shaw : The hon. Lady ought to examine local authority budgets. I was on a local council for some years that thought it was well run, but we still found it possible to get rid of a tier of management. It is always possible to do that, and to use elsewhere the money saved. Many councils have employed too many staff over the years, have been too inefficient, and have not maintained their homes for the elderly and residential care homes as well as they should have done. The Committee was told of a backlog of maintenance. That is because councils do not keep proper accounts or records. One of the problems in the public sector is that no one keeps a balance sheet, so there is no proper record of maintenance costs and of depreciating assets--whereas the business man or woman who manages a private care home is alive to the importance of maintenance, and of protecting the value of that asset.

The Government made a good move in calling in Price Waterhouse, because clearly there was concern among residential care home owners about their funding through the income support mechanism. We welcome the Government's commitment to keeping finance and income support levels under review ; the Committee will examine the position from time to time, and ensure that the levels remain reasonable. As the Committee's Chairman pointed out, the Government must maintain a fine balance. They must be careful not to make income support too generous, thus causing the taxpayer to lose out and causing funds to be taken from other provision for the elderly and disabled. The Government must exercise the wisdom of Solomon : although they must not put too much money into that sector, if they put in too little, the owners of care homes will tend to withdraw the little extra facilities that are so enjoyed by the elderly people. As the report points out, resources must be made available to those who enter residential care with no resources of their own for those "little extras". Their spouses may not have been able to save much during their lives ; they may have had low- paid jobs. Thank goodness, the current pensions policy is improving the position : many more people will retire with second pensions. Many others, however, will have retired some time ago, and will not have sufficient resources. The Government should consider setting up a scheme to provide top-up money when residents' families cannot provide it themselves.

Column 774

The question of evictions is open to misconception. The evidence of such evictions is very weak ; I felt that the evidence presented to the Committee was based more on political considerations than on hard numbers. One organisation suggested, however, that--although no actual evictions had taken place--some people had been discouraged from going into homes because of the cost involved. We recognise that some homes are more expensive than others, and that some provide more facilities than others ; we must ensure, however, that no one falls through the net because basic income support is not available.

The report makes a recommendation about the assessment of claims for income support, and the payment of such support. We are led to believe that there are administrative problems. As we know, all Government Departments have such problems, but a review of administration might be helpful.

In my constituency, a care home owner admitted an elderly person over a weekend after that person had suffered a fall in her own home. The home owner had not waited for the bureaucratic processes to be completed ; she had acted out of the goodness of her heart. Rather than being rewarded by the social security system, that home owner suffered a disadvantage. Payment of income support is related to pension payment days, and she was not remunerated for the first five days of the elderly person's occupation. The home owner had to pay herself. It is clear that legitimate and reasonable owners of residential care homes are suffering. The less money is given to such homes, the less is available for the "little extras" to which I have referred.

The hon. Member for Wakefield (Mr. Hinchliffe) mentioned alternatives to residential or nursing home care. Although I disagreed with some of what he said, I agree that we should consider whether more people can stay in their own homes. As I have said, there has been a substantial increase in the number of pensioners, but surely new technology and the availability of volunteers could enable more people to stay at home for longer. We should take a radical approach to the position of elderly people beyond the year 2000, and consider whether technology can allow them to enjoy a better standard of living and to rely less on residential and nursing homes. Surely, in the early years after retirement, fewer people will need to go into such homes.

I commend the report. I believe that many of its recommendations deserve wider and deeper consideration, and I hope that the Government will take them on board.

6.25 pm

Mrs. Alice Mahon (Halifax) : I congratulate my hon. Friend the Member for Birkenhead (Mr. Field) on his excellent chairmanship of the Committee ; I also congratulate the hon. Member for Macclesfield (Mr. Winterton), who played an important role. I welcome the recommendations in the report.

The report addresses itself very well to a specific "client group", the elderly and sick. Over the past decade, the care of that group has been privatised : the hon. Member for Macclesfield illustrated the process very clearly when he referred to an excellent nursing home in his constituency, a fairly large institution containing trained nurses. The

Column 775

taxpayer financed the training of those nurses : there is a hidden bonus for the owner of that home, and for the owners of many others. In the Select Committee, the hon. Member for Teignbridge (Mr. Nicholls), who is not in the Chamber now, moved to amend paragraph 88 of the report. I am sad about that. The paragraph clearly spelled out the story of supplementary benefits and income support payments to fund care in residential and nursing homes, saying that it was a telling example of what could happen if change was made in an ad hoc way.

The section that was deleted struck me as very important. It pointed out :

"no overt decision had been made to phase out geriatric wards ; the practice grew as health authorities saw the opportunity to transfer costs to the budget of another Government Department by transferring one aspect of care to the voluntary and private sector. That practice has now brought about a major change in the NHS. A service free at the point of delivery is being changed, for some, to one in which they or their relatives are asked to make what is often a considerable weekly contribution."

When Opposition Members talk of creeping privatisation, that is exactly what we mean. I am sorry that an excellent paragraph was amended, effectively to blame carers--or their neighbours or female relatives--for neglecting to do their unpaid duty.

Paragraph 94 expresses dismay that the funding of nursing home care should be private, and that health authority managers should draw a distinction between the elderly and others who need care. I hope that the Minister will take note of that important paragraph. I have argued with my district health authority for many years I know that many hon. Members have done the same with theirs--because it has for various reasons shifted the problem of elderly sick people to the private sector. It is increasingly difficult for the relatives of the elderly sick to obtain even respite care in many hospitals when they themselves need a rest. The crisis has occurred because of the Government's policy--which, whether or not it was deliberate, has been disastrous, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said. We have ended up in a mess.

The hon. Member for Dover (Mr. Shaw) attacked local authorities, but that will not wash. It is no good knocking local authorities--we have only to consider the figures to see the massive amount that has been removed from rate support grant while the number of elderly people has increased. If the local authorities had been given the money that has been poured into the private sector to be spent on domiciliary packages, more home helps, special care attendance and occupational budgets to provide aids and adaptations for people in their own homes, we could have saved the Government and the country millions of pounds. My local authority of Calderdale spent responsibly, and a Government Department patted it on the back, saying that it was the second most efficient metropolitan authority in the country.

I think that my hon. Friend the Member for Wakefield said that £1.7 billion has gone into the private sector in the current year. With that money, we could have provided what the people wanted and real choice. I imagine that, for 90 per cent. of the elderly sick, the choice would be to receive nursing home treatment under the national health service or the care packages which would enable them to stay in their own homes. If local authorities and councillors had wasted the money in the way that many of us believe the Government have done, they would have

Column 776

been surcharged and hounded out of office. It is a disgrace that Government Departments are not subjected to the same scrutiny and punishments.

I do not want to criticise those who provide private care, because I recognise that there is as much good care in the private sector as there is bad. However, I criticise the trend towards not having highly paid and experienced staff. Many of the private homes are pretty, Laura Ashley, chintzy places, but do they have rehabilitation programmes or free therapy for their residents? Do they have the orientation programmes which I have seen in many of the local authority homes that I have visited in my constituency?

The crux of the report is funding, and the growing gap between income support and what it now costs to keep people in either nursing homes or elderly residential homes. The growing gap now means that the elderly people or their relatives must find that difference. When the Under- Secretary of State for Social Security, the hon. Member for Maidstone (Miss Widdecombe), was in a less exalted position, I remember listening to her make a clear and, I thought, slightly emotional but honest contribution to a debate in the House. She talked about Florence Smith, an elderly constituent of hers, and how she was caught in such a gap.

Since she became Under-Secretary, I have written to the hon. Lady about such gaps experienced by many of my constituents. I am afraid that her reply was not as sympathetic as the contribution that she made as a Back Bencher when talking about Florence Smith. She also told me that there had been no evidence of evictions, but, however hon. Members interpret it, the evidence given to the Select Committee by Mr. Harris of the Association of Metropolitan Authorities was clear. He said :

"about 24 per cent. of our member authorities are saying to us that they have recorded instances of eviction."

Mr. David Shaw rose --

Mrs. Mahon : I shall finish this point, and then I shall give way. A constituent of mine was on the verge of being evicted. Fortunately, her relatives were able to move her to another home which was cheaper : that is an increasingly common practice. Elderly residents are being downgraded and sometimes have to share rooms, and that situation will get worse. I am concerned that that will happen long before the community care changes come into force.

I want to draw the House's attention to recommendations (vii) and (viii), which are important. They deal with hospital discharge procedures and state that district health authorities should obey circulars. We need to know how the recommendations will apply in the new internal market for health care. We know that circulars that go to trusts are sent for the purpose of information, not action. If the recommendations are shortly to be accepted by the House, we want to know specifically whether the opted-out hospitals will be excused from obeying that recommendation. If so, there is not much point in us debating the issue. The report is excellent, and I hope that its recommendations will be carried out.

I finish where I started, by saying that the report confirms absolutely that there has been a wholesale privatisation of care for the sick and elderly. That is unfair, and it is also slightly sinister to say that, when somebody reaches a certain age, he can no longer receive care under

Column 777

the NHS. I welcome the fact that that has been exposed and, despite the amended paragraph 88, I welcome the recommendations as a whole. 6.36 pm

Mr. Michael J. Martin (Glasgow, Springburn) : I shall be brief, as I understand that the Opposition Front-Bench spokesman and the Minister want to reply to the debate. I also wish to put on record my congratulations to the Select Committee and its Chairman for their hard work.

I hope that we never reach the position that I have sometimes, although not often, met in my constituency, when I have received a phone call from a private home to the effect that it could no longer keep a patient who had perhaps become doubly incontinent. If the relatives could not pick the patient up, he would be lodged in the casualty department of the local hospital. It is scandalous that elderly patients should be treated in that way.

I repeat what the hon. Member for Antrim, South (Mr. Forsythe) said about patients' private needs payments. It has been brought to my attention that that money, which patients regard as pocket money, is sometimes taken from them by private residential homes to be used as payment.

I take issue with some Conservative Members who spoke of second pensions solving the problems of the elderly in our communities. I ask them to visit some of the communities that I represent, from which industry has disappeared and in which it is not only the person approaching pensionable age who is unemployed and in receipt of social security benefit, but the caring young people in the family who want to do the best for their relatives. I do not see how those people can accrue a second pension. To get a second pension, a person needs a job, and the jobs are just not there.

I have no objection to private residential care for those who can afford it, but the Minister must admit that local authorities do an excellent job in terms of residential care and that there should be more local authority residential care places. The Minister must know that, when Conservative Members attack local authorities, they are attacking--sometimes unconsciously--dedicated men and women who have fought for years to get first-class old folk's homes.

If we mean business in looking after our elderly--and not just the elderly, as young and middle-aged people may be stroke victims or have other problems which mean that they need residential care--local authorities should be encouraged to build more places. I hope that the Minister will encourage local authorities which do an excellent job in terms of residential care.

6.40 pm

Mr. Keith Bradley (Manchester, Withington) : It gives me great pleasure to commend to the House the fourth report by the Select Committee on Social Security. It is a model of detail and clarity in reporting on private residential and nursing homes. It is of great credit to the Committee that it describes the situation so clearly and that it points out many of the problems that have come about as a result of Government policy towards private residential care over the past few years.

I thank my hon. Friend the Member for Birkenhead (Mr. Field) for his kind comments in his introduction to

Column 778

the debate. No one has more expertise or knowledge of these matters, and it is to the credit of the House that he brings those qualities to bear in our debates. He has always been a source of inspiration to me and I hope that he will take it as a compliment when I say that, from the days when I was a student, he has been an inspiration to me.

I intend to reinforce and highlight some of the recommendations that have been mentioned in many thoughtful contributions this afternoon and I will pose a series of questions to the Minister, whom I welcome to her first estimates debate. I hope that, in the short time available, she will be able to answer those questions. I support my hon. Friends the Members for Wakefield (Mr. Hinchliffe) and for Halifax (Mrs. Mahon) in their general comments on the broad area of policy on residential and community care. Many people who care or who are cared for find it difficult to understand why they cannot get the resources for that care when such vast amounts go towards people who are in residential care. Such people have been disappointed, to say the least, that the Government postponed the community care programme by two years because they saw it as an opportunity for the balance of resources between residential care and community care to be readdressed. They also saw it as an opportunity to get the packages of care that they sought implemented as early as possible.

My hon. Friend the Member for Halifax made the point that the rundown of long-stay care for the elderly in our health service and the move towards the elderly having the opportunity to go only into private nursing care is to be deprecated. I am not in favour of long-term institutional care in hospitals, but the balance between the opportunity for decent health care for the elderly in our hospital services and the opportunity for other care has gone much too far. In my local hospital in Withington, the number of beds for the elderly has decreased in the past few years from 140 beds to barely 20.

I was informed today that elderly people who are trying to get into hospital are being put on to wards in which the nursing staff have not been designated specifically for the care of the elderly. They are put into such wards because there are not sufficient resources in the health service to open up other wards that have been closed because of the general lack of resources in the health service. We must consider clearly the balance between health care provision in the national health service and health care provision in private nursing homes.

We must also examine the way in which the run-down of resources through personal social services and housing, as my hon. Friend the Member for Wakefield pointed out, has led to local authorities having to suspend many innovations. Cities such as Sheffield and Manchester have been at the forefront of examining alternatives to residential health care to ensure that people can live happily in the community. I commend the programme of the development of elderly persons' resource centres in those cities.

In Withington, we have such a centre, which provides domiciliary care, meals, laundry services, recreation services, shopping facilities and companionship. The people who attend those centres can still live in their own homes because of the support staff who work from those resource centres. The number of people in the catchment area of the resource centre who now seek residential care has dropped dramatically. Few now seek residential care because of that support in the community.

Column 779

I hope that the Government willl re-examine the funding of such developments in local authorities in conjunction with their community care programme so that local authorities and others can again consider a flexible response to ensure that we do not only seek residential care, but that we look forward to proper community care and support in the home.

My hon. Friends have highlighted some of the report's recommendations. The report is clear that there is substantial evidence from many organisations such as the citizen's advice bureaux, the Association of Metropolitan Authorities, Mencap and MIND--the National Association for Mental Health-- that the level of income support does not match the costs in private residential care and that there is a threat, although Conservative Members may doubt it. People in such homes are anxious that, because of the gap between income support and charges, there is a threat of eviction. Indeed, there are cases of eviction. They may be few and far between, but they cause worry to elderly people who fear that the gap may lead to them being put in the same position.

An AMA survey in September 1990 showed that 24 per cent. of local authorities gave evidence of evictions. It is a particular problem in the south-east, where there are escalating costs. There have been examples in local councils in the south-east--Hertfordshire springs to mind--of evictions taking place. We must study the gap closely and we must realise that, in many of the homes that have come on to the market, on which there has been significant capital outlay by people moving into the private sector, the costs have escalated because of the massive increase in interest rates. Those costs have been passed on to the residents, so the gap has widened.

We have heard today that the gap has had to be filled by resources from relatives, from charitable organisations and, most appalling, from the meagre personal allowance available to people in residential homes. They cannot then use that small amount for the few personal items that they may want to buy when they are in residential homes. We must ensure that the gap does not lead to anxiety about possible eviction. We must also ensure that the escalation of costs does not lead to elderly people having to move from a single-bedded room to shared accommodation, which would be a lowering of standards in their residential home--and it is their home. We must ensure that those problems in the south-east are addressed.

I support the recommendation--I hope that the Under-Secretary will do likewise--that the extra allowance that is given in the Greater London area should be extended to out-of-area boroughs that have similar high charges. Her Department should act on the recommendation that local officers should be able to top up that gap for claimants if no other resources are available. There should be local flexibility through income support benefits to meet the different charges around the country.

I also support the suggestion that has been made by the National Association of Citizens Advice Bureaux about housing benefit continuing to be paid until the new system commences in 1993. I am pleased to see the Secretary of State for Social Security in his place, because he has said that the decision in January 1991 to stop such payments was taken because

"It has never been the intention, nor is it sensible, that in the generality of cases Housing Benefit should be available as an alternative to income support".

Column 780

After 1993, the finance to meet the charges will come from income support, housing benefit and local authority community care budgets. Therefore, would it not be sensible to reintroduce the housing benefit element now to ensure that that gap can be met?

I strongly urge the Under-Secretary to look closely at the recommendation that the personal allowance should not be used as a contribution to bridge the gap between the charges and the benefits. The personal allowance must be ring-fenced to ensure that people in residential care can have a small amount of money for their personal needs.

Several hon. Members have highlighted the position of carers who may be disadvantaged because of the capital rules on income support. Their position was well summed up by the Carers National Association, which has stated that the current rules could have "disastrous consequences" for the family and friends of the claimant who may have moved into the home to take on the caring responsibilities. We must not do anything to discourage people from taking on that caring role. People often give up their own home to move into the home of the person for whom they will be caring but may lose that home as a result of the income support capital rules.

Although a spouse may be protected if he or she stays in the home, if the partner goes into permanent residential care, the spouse may want to move into smaller and more appropriate accommodation. In that case, the spouse must forgo 50 per cent. of the proceeds of the sale of the property, which means that his or her opportunity to purchase something more appropriate is diminished. I urge the Minister to comment on that and to look at the way in which capital is treated for income support purposes to ensure that such disadvantages do not continue.

Perhaps the most crucial recommendation is that relating to the funding that will be available for community care after April 1993. The report highlights three issues : the amount of money to be transferred from the budget of the Department of Social Security ; the way in which housing benefit will be calculated after 1993 ; and the division of responsibility between the health authorities and the local social service departments.

The first issue is the amount of money that will be transferred in income support from the social security budget into the community care budget. The Association of Metropolitan Authorities estimated in its evidence to the Committee that there would be a £300 million shortfall in that provision. Although the Secretary of State questioned that figure in his evidence, he did not say what he believed the shortfall would be. However, there is irrefutable evidence that there will be a shortfall, and if we do not ensure that that gap is identified and ascertain where the resources to meet that gap will come from, not only will the people who are currently seeking community care be disadvantaged, but, more importantly, future generations who might seek care in the community will not receive the resources that at present they believe that they will get.

I should be grateful if the Under-Secretary could comment on the way in which housing benefit is calculated. I hope that the Government do not intend to set a national figure that will apply throughout the country. Without regional and local variations, a further gap will be created. We must ensure that there is local

Column 781

flexibility when assessing housing benefit so that it is sufficient to meet the charges that are imposed locally and to ensure that the gap does not widen.

We must also ensure that the Department of Social Security and of Health reach a clear understanding about the way in which the community care system will operate in future. From my reading of the evidence, it appears that there is a certain amount of buck-passing between the Ministers in the two Departments about who will identify the gap, where the resources will come from and who will come clean about the budget that will be set for community care provision. The local authorities need to know now how the standard spending assessments will be calculated so that they can make definite financial plans. Such planning is crucial if our hopes for community care are to be realised after 1993. The local authorities need to know where the resources will come from and how they will be allocated between the different areas of the country.

I end with some final thoughts for the Under-Secretary. Many questions have been posed and many recommendations highlighted in this debate. The Opposition commend them all, and I hope that the Minister will say that she will implement them. More crucially, however, will she tell the House how the Government will meet the identified shortfall in community care funding? If they do not meet that shortfall, there will be a sorry start to the future system of community care.

6.56 pm

The Parliamentary Under-Secretary of State for Social Security (Miss Ann Widdecombe) : I begin by joining in the congratulations paid by hon. Members of all parties to the hon. Member for Birkenhead (Mr. Field) on the production of an excellent report, and to my hon. Friend the Member for Macclesfield (Mr. Winterton) who chaired the Select Committee on Health, which was also involved.

I welcome the hon. Member for Manchester, Withington (Mr. Bradley) to the Opposition Front Bench and look forward to many a debate with him. I look forward especially to a future opportunity to develop his views on the desirability of keeping national insurance contributions as low as possible and of working out exactly how that fits in with the policies of some of his right hon. and hon. Friends, but that is for another occasion, Madam Deputy Speaker.

Before turning to the detail of the debate, my hon. Friend the Minister of State for Health, who has been present for most of the debate, has asked me to apologise to the House on her behalf for the fact that she could not stay throughout.

The hon. Members for Birkenhead and for Halifax (Mrs. Mahon) and my hon. Friend the Member for Macclesfield referred to my part in the events of 1990. It could scarcely be more vivid in their memories than it is in mine, but what is also vivid in my memory is the aftermath of those events, which was the Government's sensible accommodation of the fears and anxieties that had been expressed. I refer not only to the substantial amount of money that was made available, resulting in a £45 per week rise for nursing homes, which cost us a total of £225 million, but to the amendment that allowed the Secretary of State, after community care had been in place for some time, to take

Column 782

account of the local authorities' assessments of reasonable rates and of their experiences in general. I will not say that much of this debate has been irrelevant, because that sounds as if I am dismissing what has been said, which I am not, but it is irrelevant in the context of 1993, because the advent of the new system will answer many of the problems that have been identified.

The fact that we can examine what local authorities are doing has been comprehensively ignored, yet it could have an effect on many of the points that were raise.

The hon. Members for Birkenhead and for Withington raised the problem of evictions. They seemed to be selective in the evidence that they quoted. I was particularly surprised to hear the hon. Member for Withington home in on Hertfordshire, because, among those giving evidence to the Select Committee was a Mr. Herbert Laming, the director of social services in Hertfordshire. He said :

"there is no statistical evidence that is known to me at the present time of people who are actually being discharged from the private sector We do not have evidence to bring to you of a substantial number of people who have been discharged against their will from the private sector."

We must take into account that evidence, as well as the other evidence, which seems to point the other way but has not been statistically upheld and has never been put before us in any form that we could check or examine.

Mr. Hinchliffe : Will the Minister accept that I have an example? A private care home in my constituency accepted an elderly lady for respite care. Her son and daughter who cared for her were going abroad for a fortnight's holiday. After a period, the home evicted the woman, put her in a taxi and sent her to the local police station. Is that an eviction? Is that responsible behaviour by the private sector? Does the Minister accept such behaviour? It is happening elsewhere to my knowledge. It is not merely anecdotal evidence. There is clear evidence.

Miss Widdecombe : The hon. Gentleman said that it was happening elsewhere to his knowledge. Perhaps he could produce chapter and verse evidence of such incidents.

Mr. Hinchliffe rose --

Miss Widdecombe : May I finish, please?

If the hon. Gentleman sends the evidence, we will examine it to see what happened in that case, and whether it is evidence of a larger problem. There will always be homes, local authority as well as private sector, which do not always behave as well as they should within the rules. That is not evidence of a general trend. The hon. Gentleman has not produced evidence of a general trend.

The problem of carers was sensibly raised by my hon. Friend the Member for Chislehurst (Mr. Sims) and by several other hon. Members, including the hon. Members for Withington and for Birkenhead. We already make exceptions to the capital rule where homes are occupied by a spouse, a relative over the age of 60 or a relative who is incapacitated. We have considered whether any further easement is possible. Although I cannot give the House any good news on that score tonight, I can say that we are considering the matter. We have to consider factors other than merely resources. Opposition Members seemed to suggest that the hold-up was resources, but there are other factors, not least the fact, that, if we needed primary legislation, it would come on stream in about 1993, when the

Column 783

responsibility for assessment and the decision about what to pay passes to local authorities. No new cases would come on stream for us to deal with. There seems to be a slight practical difficulty there. Furthermore, we would have to devise fairly tight rules. Yes, the cases quoted are clear ones, in which carers have been in the home for a long time, but obviously we would wish to avoid a position in which the carer was in the home for a short time in the expectation that he or she would then be allowed to stay there. All those factors are being taken on board.

The hon. Member for Antrim, South (Mr. Forsythe) raised the problem of the personal allowance, as did several hon. Members. My right hon. Friend the Secretary of State alluded to the problem when he was giving evidence to the Select Committee. It is my understanding that, after 1993, the personal allowances will have to be given to the individual, but we have a problem. The personal allowance belongs to the individual. It is for the individual to do what he or she likes with it. We cannot forbid individuals to use that allowance in whole or in part to pay fees for their care. So that is another problem. Opposition Members want us to forbid the use of that personal allowance, if only in part, for a particular purpose.

My hon. Friend the Member for Chislehurst said that, on Ministers' own admission, we no longer paid the full rate of fees. That is not true. We have said that we have never been committed--it is not something new--to paying the full fees, however high. In many instances, the income support rates cover the fees.

Mr. Frank Field : The Minister asked my hon. Friend the Member for Wakefield (Mr. Hinchliffe) to give her more evidence of evictions. May we ask her for evidence? History seems to be being rewritten. Could she give us just a handful of examples of people who were moved from geriatric beds into the private sector in the early stages of the development of the policy and were given the assurance that she says was publicly given that the Government had no intention of meeting fees, however high? Is not the truth that practically everyone was told, "Don't worry--social security is picking up the bill."

Miss Widdecombe : Social security has always been committed to meeting a reasonable rate. The hon. Gentleman has acknowledged, indeed it is in his report, that, by simply increasing the income support rate, all that we do is cause the fees to rise behind it. That point has been made consistently. That is the point that we have addressed in saying that we will not meet fees, however high. I do not believe that we ever said to anyone in geriatric care or anyone who entered a home for any other reason, "Don't worry--social security will pick up the bill, however reasonable or however high." The hon. Gentleman challenged me, but I challenge the hon. Gentleman to provide the examples of where we said that.

The hon. Member for Wakefield (Mr. Hinchliffe) made an interesting speech. He seemed to suggest that the problems with the policy had largely been caused by the Government withdrawing funding from local government for domiciliary and other services, thus forcing people into residential care. I do not know how he reconciles that with the 59 per cent. increase in spending on local authority care services since 1979.

Next Section

Home Page