House of Commons Hansard Debates for 1 Jul 1992

Mr. Rooker : I beg to move amendment No. 7, in page 2, line 34 at end insert--

(1G) Arrangements shall only be made by virtue of this section where the voluntary organisation or other person providing the accommodation makes a contract with the local authority as to the charges they will impose, the frequency of increase, the criteria to be used in raising charges and details of any supplementary changes to residents including a statement of policy regarding any differentiation between residents in accommodation at public expense and other residents.'.

The amendment allows us to discuss once again the charge levied in residential and other homes. We mentioned them in Committee and we had hoped that the Minister would go away and think about them a little more. We were struck by the boldness of his approach in Committee ; he thought that it was fine to levy extra charges for second helpings at dinner. He said that that was part and parcel of the system.

We are pleased to see the Secretary of State present for the debate on this important amendment. I presume that she left her ring fence outside--we have been looking for it all day.

Mr. Michael : Perhaps she has won it.

Mr. Rooker : That is quite possible. In any case, we are pleased to see her here.

I am not attacking any particular sector. Some residential and nursing homes in this country provide top-quality care without extra charges for second helpings of food, single rooms, newspapers, hairdressing, trips, breakfast in bed, alcoholic drinks, incontinence pads or toothpaste. Such homes are, however, few and far between. Many homes do charge for these services. We should like to know whether the Minister has thought about the subject again. Before local authorities take out contracts with homes covered by this Bill, they ought at least to know what they

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are paying for. They ought to know in advance what the supplementary charges are and how often charges are increased. In passing, I should like to mention the immoral funding arrangements brought about by the Government's practices. I refer particularly to the nursing home sector. All residents in such homes receive exactly the same service--there are no supplementary charges for different services--but residents pay different fees depending on whether they are staying at public expense with DSS income support or at their own expense, perhaps by spending the assets from a family home.

I do not object to their being regarded as disposable assets. I cannot, however, see the morality of allowing home owners to charge some people more for the same services of the same quality. The differences are enormous and range from £70 to £90 a week for exactly the same services. Home owners have to ensure that a third or perhaps half of their residents are self-funded.

The first question one is asked when seeking a nursing home for a friend or a relative is, "Do they have their own home?" I was asked that three times last year. In the case of single people, a residence for disposal immediately signals, that, for a while, such people can pay more. Residential home owners would go bankrupt if they did not charge some people more than others.

Why should some residents subsidise the Government who are not paying the full whack in income support? There is a degree of immorality about that. No Minister has ever addressed that problem in correspondence, in written answers, in Committee or in a public speech. In Committee, the Minister spoke about supplementary charges for extras, and when one of my hon. Friends spoke about an extra charge for dumplings the Minister seemed to think that that was okay. I emphasise that differing charges apply for the same level of service and I am not discussing charges for single or double rooms.

Mr. Dennis Skinner (Bolsover) : It is a wealth tax.

Mr. Rooker : It is.

If differential charges were abolished overnight, many homes would go out of business, people would be thrown on the street and on the public purse. It is never fully explained to relatives or to the people immediately concerned that they will have to pay more if they have their own resources. The House should not remain silent on the issue, and the amendment provides an opportunity to raise the matter.

Mr. Bayley : Money is the key to care : with it people can enter care : without it, they are locked out. That was brought home to me today when I received a letter about a constituent of mine from the trade union branch of which he was a member about 20 years ago. I shall read two short extracts :

"Mr. Rogers is 88 years old, and until his wife died in April of this year they were both residents of the Fulford Nursing Home in York for the last two years the annual increase in his payments have been immediately absorbed by increased residential fees Mr. Rogers finds he can no longer afford to stay in the Home and has been obliged to seek temporary accommodation with his son. He does not know where he will go next, and fears that he will not be able to afford the cost of residential care in the future. He tells me that many elderly and frail people now live in daily fear of losing their homes. It seems to me that it is intolerable that the elderly are being

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put in this situation, and I would be obliged if you draw attention to the plight of Mr. Rogers and other elderly people in residential care."

The plight of Mr. Rogers is not isolated. An article in my local paper, the Yorkshire Evening Press, describes the case of two elderly women, Mrs. Lily Lupton aged 83, and Mrs. Mary Brennan aged 79. They had to leave the Riverside Lodge nursing home when it increased its charges to them by £35 a week. Ironically, the home's motto is "Where friendliness abounds". I was a member of York health authority at the time that those two elderly ladies were evicted from their home. The cost of caring for them fell immediately on the public sector.

9.15 pm

Earlier this year, the Social Services Policy Forum--a consortium comprising the Association of Directors of Social Services, British Association of Social Workers, National Institute for Social Work, the Joseph Rowntree Foundation in York, and other bodies--published a report on social services financing. It stated that the Government's community care reforms raised expectations, and added :

"These expectations are likely to be dashed unless there is an informed public debate about the level of services that should be available and the resources required to provide them."

Mr. Deputy Speaker (Mr. Michael Morris) : Order. I have listened attentively to the hon. Member, but the amendment specifically relates to charges, not to the overall provision of community care. I hope that the hon. Member will return to the subject matter of the amendment.

Mr. Bayley : I take your point, Mr. Deputy Speaker.

It is necessary for public provision to be made, to ensure that residents whose charges are met at public expense will obtain the care that they need. That is extremely hard for social services departments to plan, until such time as they are aware of the Government's budgetary allocation for the social services reforms. I hope that the Secretary of State will take account of four matters. The current distribution of funding from the social security budget relates not to local care needs but to the local distribution of private residential care homes. That pattern should not necessarily be reflected in the long-term allocation of funds. There is a care gap--vividly illustrated by the two cases that I cited--between the level of support available in the form of social security payments and the cost of residential care. Unless that gap is closed, those requiring care will lose the accommodation that they need. Where such a gap exists, who picks up the tab? It is usually the resident's relatives, but often they are themselves elderly and on low incomes. Their ability to top up fees is limited, and they may be caused considerable hardship.

In other cases, no one is available to top up the fees, and in those circumstances the resident will suffer the fate that befell my constituent, Mr. Rogers.

I also ask the Secretary of State to take note of the existing strain on social services departments' budgets. They are under enormous pressure--

Mr. Deputy Speaker : Order. The hon. Member for York (Mr. Bayley) is relatively new to the House, but he must address the amendment, which concerns charges and negotiations between local authorities and residential homes. I am sure that the hon. Member can be creative

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and constructive in speaking to the amendment, but he is not doing that. He must either speak to the amendment or sit down.

Mr. Bayley : As my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) suggested, there should be no gap between the quality and range of care provided for those who are in homes at public expense, and provision for those who are able to pay for their care. Many people in private homes are required to pay additional charges on top of the basic fee, which will presumably be paid by the social services authority after April next year. I fear that, unless the Government clarify the level of funding of local authorities now, nine months from today, when the reforms come into operation, authorities will have had no time to negotiate contracts with the care providers to ensure that a comprehensive package of care is available.

Mr. Skinner : My hon. Friend has identified a cornerstone of community care provision. His point--which, let me add, relates to the amendment--is that the amendment refers to the differentiation that may or may not exist between private and local authority care. I hope that you are listening carefully, Mr. Deputy Speaker, because this is very important. My hon. Friend is pointing out that, if local authority funding is reduced or is not provided in the necessary proportion, there will be a difference between public and private care. I cannot for the life of me see how he can speak to the amendment without referring to public funding, and I hope that he will continue. I am listening carefully.

Mr. Deputy Speaker : We are all listening carefully ; that is why, when the hon. Member for York was out of order, I drew the fact to his attention. His most recent remarks, however, were in order.

Mr. Skinner : He is in order now.

Mr. Deputy Speaker : Order. I want to listen to the hon. Member for York, not to the hon. Member for Bolsover (Mr. Skinner).

Mr. Bayley : Many studies show that a wide range of services for elderly people demand extra payment on top of the basic fee. They include physiotherapy, occupational therapy, chiropody in almost all homes, personal laundry in a few homes, medicines, hairdressing, incontinence pads --which were mentioned by my hon. Friend the Member for Perry Barr--and, in some instances, entertainment. Unless local authorities are prepared to pay a comprehensive fee to cover all those services, we shall not secure the classless society that the Government wish to introduce. There will be two classes of resident : one class will enjoy the rewarding quality of life that old age deserves, while the other will be faced with a lesser quality of life. That is indefensible.

Ms. Lynne : I wish to pursue the question of supplementary charges, to which the hon. Member for York (Mr. Bayley) briefly referred. I understand that community health workers are not allowed into residential homes and, in particular, nursing homes, and I fear that nursing homes will start to charge for physiotherapy and other back-up facilities.

At present, a general practitioner can be called in and recommend physiotherapy, but the physiotherapist cannot

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enter the nursing home. I am worried about the fact that patients will face charges because nursing and back-up facilities are not allowed to come in.

Ms. Jowell : Great uncertainty surrounds the implementation of the legislation. The Minister has provided us today with welcome assurances that the plans will proceed as intended, but I have one or two points to make about the funding of residential care which, if not properly addressed, will further compound the difficulties referred to in the amendment regarding the charges levied by individual residential care homes and nursing homes.

If I may identify one source of uncertainty, according to a letter sent by Mr. Laming, of the inspectorate of the social services and Mr. Foster of the management executive to all directors of social services :

"The current broad patten of funding through social security support should be regarded as an implied commitment for 1993-94 in respect of new clients requiring residential or nursing home care." Otherwise interpreted, that means that about the same number of nursing home beds should be taken up after April 1993 as would have been taken up under the old system before 1993.

There is a discrepancy between the estimates offered by the Department of Health and the Local Authority Associations as to how many new beds there will be. The Department of Health estimates that there will be between 20,000 and 25,000. However, the present rate of growth, at 8 per cent. per annum, suggests something more like 35,000 to 40,000 beds. That creates uncertainty not just for local authorities but for those homes that are directly affected. It has a direct bearing on their financial calculations and therefore on the additional income that they are likely to have to raise by levying charges to close the gap.

I am particularly concerned about the responsibilities that will be placed upon local authorities after 1993. They will have to underwrite the full cost of a place in a residential or nursing home. If the funding level is not right and local authorities do not have enough money to cover the cost of all the people who have been placed in homes, or if, in particular, the manner of distribution is not right, local authorities will be engaged in searching for cheaper and less effective solutions. We must also assume that nursing homes and residential care homes will be looking at new ways to levy supplementary charges to make up for the money that is not available from the local authorities in order to meet the full cost of the care that they provide.

In the early stages of the national health service reforms, the Government found it possible to provide contingency funds so that some trusts, for instance, could avert their looming financial crises. I ask the Minister to announce similar contingency funding in order to provide protection for elderly and vulnerable people throughout what is likely to be a pretty choppy transitional period.

Mr. Yeo : I am glad to be able to advise the hon. Member for Birmingham, Perry Barr (Mr. Rooker) that I have had another think about the line that I took in Committee, in particular on the question of additional charges. I know that he will be pleased about it. I recognise that I was wrong in Committee to take the line that I did. I did not express myself anything like robustly enough.

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I have no hesitation in saying that the Government see absolutely no reason to intervene in the negotiations between home owners and individual residents who are paying their own fees. We do not wish to dictate what are freely negotiated terms between two private parties. We see no reason to impose our judgment on what those parties should agree to.

Mr. Hinchliffe : We are talking not about companies in the City but about vulnerable elderly people. I am astonished to hear the Minister's language. Will he listen to what Opposition Members have said?

Mr. Yeo : I know who we are talking about, just as much as the hon. Gentleman does. In fact, the category with which we are dealing now involves those who are able to meet the cost of the charges from their own resources. Therefore, their vulnerability is qualified by that.

9.30 pm

Mr. Michael : Will the Minister accept that many people are in difficult circumstances when decisions of this sort are being made? Often, not only the individual, but the carers who share in those decisions, do not have professional advice. I am sure that he is aware of the document that has been produced by the Carers National Organisation which shows that 33 per cent. of carers have no access to professional services or support. Therefore, does he accept that we should be making sure that there is protection along the lines urged by my hon. Friends?

Mr. Yeo : Opposition Members are suggesting that people should be denied the right to use their savings in the way they choose. No Conservative Member will support a measure that compels people to limit their charge for a particular service to a level that has been set arbitrarily and centrally and which prevents people from legitimately devoting resources to obtaining a service if they are able to do so. That would be an absurd imposition. It would be east European in its nightmarish consequences.

It is for local authorities to negotiate the best possible terms for the residents they sponsor and we will expect them to negotiate toughly in order to secure the best value for money. If the analysis given by the hon. Member for Perry Barr is correct, the effect of preventing home owners from setting their own charges would be directly to raise the cost to the public sector of keeping other residents in those homes.

Mr. Rooker : That is exactly the point. The public sector--the Government through the Department of Social Security--can bulk-buy by using income support. Therefore, it gets the same service at a lower cost than my individual constituents who cannot bulk buy because they have an asset. In effect, such individuals are institutionally ripped off. That is indefensible.

Mr. Yeo : I have already explained to the House why I do not think that the Government or the House should seek to impose terms between two private parties that are free to negotiate. As I have said, the consequence of accepting the analysis of the hon. Member for Perry Barr would be substantially to increase the cost to the taxpayer of keeping the residents in residential homes and private nursing homes.

I must correct the impression that the hon. Member for Perry Barr gave about the view that I expressed in Committee on the issue of extra payments. I do not think

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that any of my remarks in Committee could be construed as meaning that basic services could be subject to any additional charge. Part of the contracting process, in which local authorities will be engaged after April next year, is to ensure that home owners provide a proper and adequate standard of service for all residents, including all publicly funded residents. I must make it clear to the hon. Member for York (Mr. Bayley) that I see no reason why those same residents should not purchase additional items or services out of their own resources or the resources of their families.

The hon. Member for Rochdale (Ms. Lynne) asked about entitlement to NHS services. Those who live in residential homes have the same rights and access to NHS facilities without payment of any charge as they would if they were living in their own home.

Ms. Lynne : In nursing homes, even if someone is registered with a general practitioner, he or she does not get the community nursing facilities, physiotherapy or any of the other community health services.

Mr. Yeo : It is part of the contract that the services provided by the nursing home will include some that would be health services if someone was not living in the nursing home. The price charged by the nursing home includes those services. For that reason, they will not also be available free under the national health service.

Mr. Skinner : When the Minister was banging the Dispatch Box, he said that the Government had no intention of interfering between bodies that make charges or otherwise. He took a strongly purist line. Why do the Government interfere with dental charges, and charges for specs and teeth? Why do they force local authorities to put rents up? The Government cannot have it all ways. The Minister cannot say that the Government do not interfere and, then, when they want to hammer the people at the bottom of the pile by shoving rents up and having health service charges, give a different set of criteria. If the Minister does not intend to interfere with people who negotiate will he, as a member of the Government, vote for the 30 per cent. for the top people's salaries, or will the Government interfere?

Mr. Deputy Speaker : I hope that the Minister will not be tempted down that route.

Mr. Yeo : I welcome rather belated arrival of the hon. Member for Bolsover (Mr. Skinner) in the proceedings on the Bill. We had half a day on Second Reading and 10 hours in Committee. I have been on the Bench since 3.40 pm, whereas the hon. Gentleman has just drifted in after what must have been a pretty good dinner.

Mr. Skinner : Unlike the Minister's hon. Friends sitting behind him and unlike those who are missing, I do not come in here half drunk because I do not go to the bars. So--

Mr. Deputy Speaker : Order. No hon. Gentleman or hon. Lady is the least bit drunk in the Chamber.

Mr. Yeo : I was doing my best to be charitable to the hon. Member for Bolsover because he was talking such indescribable claptrap that I thought that there was only one possible explanation. Naturally, I accept his assurance that he has not been anywhere near the bars.

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I will explain to the hon. Member for Bolsover a distinction which, I hope, is not beyond even his understanding of these matters. My concern is that there should be no interference by Government or by Parliament between two freely contracting parties when both are in the private sector. It is quite another matter to say that the same principle should apply when individuals are contracting with the state, whether for the renting of a council house or for the purchase of dental services or eye tests. There is no point of comparison between the delivery of those services, the price at which they are charged and the way in which that charge is set, and the situation between the private owner of a private residential or nursing home and a private individual who has the resources to pay his own way into it. There is no point of contact between the two cases. The hon. Member for Dulwich (Ms. Jowell) raised a point about the shortfall in funding. After next April, local authorities will be increasingly important purchasers of services from the independent sector. After a year or two, they will be by far the largest purchasers. As a result, they will be able to obtain good value for money from the providers. We should expect them to negotiate extremely toughly to ensure that the present gap between the charges levelled by residential homes and nursing homes in some areas and income support limits--there is no concealment of that fact, which we acknowledge--should be narrowed by the negotiating position that the local authorities will then be in. To the extent that there is still a gap, we will consider it when settling the funding arrangements for the policy.

The amendment would represent a gross intrusion on people's ability to decide the level at which fees should be set for residential homes. It also implies that the local authorities will not build into their own contracts arrangements that govern the basis on which fees will be increased in future. For those reasons, it would be in the interests of all those who will benefit in the long term from our community care policies if the House rejected the amendment.

Mr. Rooker : With the leave of the House, Mr. Deputy Speaker, I shall reply. I became more and more angry as the Minister spoke. You or I would hardly expect to walk into a shop in Whitehall or Victoria tomorrow and be asked to pay a different price for a commodity on the shelf depending on whether we got our money from the DSS, from investments or as salary. The Minister now accepts that that is what will happen. Frankly, that is just not on. The Minister says that, from next April, local authorities will be in a position to bulk-buy at a lower cost residential care places, but such deals will not be forthcoming in respect of people who fund themselves.

Some 68 per cent. of dwellings in England are owner-occupied and there will be a substantial increase in the number of people who will be releasing their disposable assets as the first call in respect of their care costs. I make no complaint about that, but I cannot see the morality of charging people more than their neighbours on a daily and weekly basis for the same service in the same home just because their neighbours are funded by the local authority, as it will be in April, or the DSS, as it is at present. We want equality of treatment--the same charge for the same service, and I find it unbelievable that the Minister should regard that concept as in some way east European.

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It would be a wholly different matter if this were a question of taxation, although I suppose that, in a round-about way, that is what it is. The nursing home owners do not like having to do what they do ; they have to do it to stay in business, but they are apologetic about it. They have told me that they have never heard a Minister address the issue in public. Now, we have the Minister's remarks on record and I suppose that we must be grateful for that.

If there were a price commission in this country, we should be the first to complain that our constituents were being charged different prices for the same service. That position cannot be tenable and I do not see how we can possibly accept it. It is as though Sainsbury's were charging people different prices for the same goods because their income came from different sources. The Minister must know that there is no foundation for his argument and that he could not sustain it before an independent body.

The practice has been allowed to grow like Topsy. The Government intend to allow it to continue and to shift the blame to local authorities from next April.

We did not intend to vote on any of the amendments and we are not complaining about the Bill, but the Minister has made me so angry that I shall be happy to hear whether my hon. Friends wish me to withdraw or press the amendment. [ Hon. Members :-- "Vote."] In that case, I shall press it.

Question put, That the amendment be made :--

The House divided : Ayes 53, Noes 154.

Division No. 49] [9.43 pm

AYES

Ainsworth, Robert (Cov'try NE)

Ashdown, Rt Hon Paddy

Ashton, Joe

Barnes, Harry

Bayley, Hugh

Beggs, Roy

Boyce, Jimmy

Callaghan, Jim

Campbell, Menzies (Fife NE)

Campbell-Savours, D. N.

Clwyd, Mrs Ann

Coffey, Ms Ann

Connarty, Michael

Dalyell, Tam

Davidson, Ian

Davis, Terry (B'ham, H'dge H'l)

Dixon, Don

Donohoe, Brian

Eastham, Ken

Flynn, Paul

Forsythe, Clifford (Antrim S)

Foster, Derek (B'p Auckland)

George, Bruce

Godman, Dr Norman A.

Gunnell, John

Hall, Mike

Hinchliffe, David

Hoyle, Doug

Hughes, Kevin (Doncaster N)

Jones, Barry (Alyn and D'side)

Jowell, Ms Tessa

Kennedy, Charles (Ross, C & S)

Kirkwood, Archy

Livingstone, Ken

Llwyd, Elfyn

Loyden, Eddie

Lynne, Ms Liz

Mahon, Alice

Martin, Michael J. (Springburn)

Meale, Alan

Michael, Alun

Morgan, Rhodri

Morley, Elliot

Pike, Peter L.

Powell, Ray (Ogmore)

Rooker, Jeff

Taylor, Rt Hon John D. (Str'gf'd)

Taylor, Matthew (Truro)

Tyler, Paul

Wallace, James

Watson, Mike

Wigley, Dafydd

Wise, Audrey

Tellers for the Ayes :

Mr. Dennis Skinner and

Mr. Thomas McAvoy.

NOES

Adley, Robert

Ainsworth, Peter (East Surrey)

Aitken, Jonathan

Alexander, Richard

Alison, Rt Hon Michael (Selby)

Arnold, Jacques (Gravesham)

Atkinson, David (Bour'mouth E)

Atkinson, Peter (Hexham)

Baker, Rt Hon K. (Mole Valley)

Baker, Nicholas (Dorset North)

Banks, Matthew (Southport)

Bates, Michael

Beresford, Sir Paul

Blackburn, Dr John G.

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