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2.56 pm

Mr. John MacGregor (South Norfolk): In the time available to me, I want to concentrate on only one issue: that relating to national required standards for residential and nursing homes for older people, as proposed in "Fit for the Future?".

I want to do so because I have had many reasonable and responsible representations from my constituents on the matter. It seems that we may not be able to debate it

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in detail in the House, despite what the Minister of State said, because, as I understand it, the measure will be introduced by negative resolution. It would be helpful for him to make a further announcement on that today.

Of course I support high and ever higher standards--as high standards as the community can afford--with higher living standards all round. I take the same test as the Secretary of State. I look for the standards that I would expect for my relatives. Indeed, I have been through that closely recently and so speak with some feeling on the subject.

There is huge concern among the providers of both local authority and private homes about the possible impact of the implementation of the proposals. I thought that it was offensive and unworthy of the Secretary of State--I am sorry that he has gone--to say that we were concerned only about the providers and not the provided--that is totally untrue. I thought that it was offensive to the many highly dedicated people who provide services as providers. It is clear that we should be concerned that the providers are able to provide. It is in that context that I make my remarks.

I want to make three points, which have been put to me by proprietors and representatives of the local authority, in relation to the standards. The first is--I make the point quickly--the fear about the volume of regulation and over-prescription that will flow, if one reads some of the points in "Fit for the Future?" report.

It is not just a question of the fees, which the Secretary of State referred to. The real cost is the administrative burden on the providers. Therefore, I hope that, in drawing up the regulations, the Government will not be unnecessarily prescriptive, will look at the implications for, and impact on, the providers, and will go through what the Lord Haskins committee said, so that we can be sure that the regulations are not overburdensome.

The second point is in relation to staffing. There has already been a big increase in staffing costs for private residential homes, partly because of the impact of the national minimum wage and the working time directives, which in some cases have pushed up staffing costs by 16 per cent. in one year alone. I am told that holiday pay for part-time staff is having a particularly heavy effect on a number of those homes.

The point, which the Secretary of State evaded, is that, at a time when fee increases are not properly reflecting cost increases--as we all know, a large part of the fees must come from local authorities--and margins in those homes are being seriously eroded to dangerously low levels, the issue of cost must be taken into account.

The Secretary of State side-stepped that issue, as did the former Secretary of State--when the first said that local authorities were having to prove their case, and the second said that the test would be whether they do their job properly in local authority homes. That was not really the point. The point was that, if extra burdens and costs are being imposed by the Government on both types of homes, and much of the funding comes from the public sector, we would need to know how the costs will be met and where the funding will come from. The Secretary of State carefully avoided answering that question, but it is important that the Minster of State should do so. It is a great, and legitimate, concern to providers.

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The third point that I should like particularly to raise is that of physical accommodation standards. I need not go into great detail on the issue, as it was debated in Westminster Hall, on 15 February 2000, in a debate initiated by my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard), in which she explained some of the points that particularly concern those of us in Norfolk. The Minister of State was present at that debate and replied to it.

I visited all types of homes in my constituency--local authority homes; the large new purpose-built homes that have been provided in the private sector, and one in particular; and the small homes that have been developed out of old country houses and that type of building. There are approximately 415 private homes in Norfolk, with an average size of 20 beds. I shall concentrate on the smaller homes, as that is the where the bulk of the provision is currently coming from.

I rather get the impression that "Fit for the Future?" recommendations were designed for, and concentrate on, the large, newly built homes. The problem is that it will be many years before that type of home can replace all the existing ones. The interim period is going to be a worrying one. I understand that, in its current survey, the National Care Homes Association has estimated that 52 per cent. of homes have fewer than 20 beds and do not meet the standards for communal space, and that 10 per cent. of homes do not meet the standards for single and double rooms.

The problem is that if the regulations are implemented as they have been proposed in "Fit for the Future?", many of those homes will be forced to close. Therefore, my main plea to the Minister is that the regulations must be developed and implemented sensitively.

Mr. Tom Clarke (Coatbridge and Chryston): Will the right hon. Gentleman give way?

Mr. MacGregor: I shall give way just once, as I am anxious not to exceed my time.

Mr. Clarke: I am grateful, and I take the point that the right hon. Gentleman is making--that some of the standards that will be required are not being met. However, does he not look at the other side of the coin--does it not worry him that vulnerable, elderly people are living in such conditions, and that, until the Bill was introduced, that issue was not being addressed?

Mr. MacGregor: I shall come to that point in a moment, as I have talked to residents in the types of home that I am talking about, including local authority ones, and I want to say something about that. I shall come back also to the issue of cost. There is not much point in simply saying that standards must be much higher, in over- regulating and in over-prescribing requirements if the result is that the homes on which we depend have to close. That is the point that I am trying to make. I also want to make the point that the homes that I am talking about and have visited do provide a high standard of care that is much appreciated by the residents themselves.

I was speaking about closures. I understand that Caring Times, which undertook a survey recently, came to the conclusion that, if the full "Fit for the Future?" standards were imposed, 54 per cent. of beds in the surveys that it

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undertook would be lost, and that more than 50 per cent. of the homes would close, because they would be bankrupt. We really do have to address that issue. My particular concern is that the smaller homes, which that same survey highlighted, were the most vulnerable.

The proprietors of those homes have sunk a lot of capital in them to improve standards. They are dedicated, and they have done a good job in recent years. Many of them are approaching retirement age, but they may not be able to sell. Their homes--for a reason that I shall give in a moment--may not be viable, and they will simply close. It would be self-defeating for the vulnerable--for those for whom the Bill is intended--if the outcome were that there were many closures.

"Fit for the Future?" had paragraphs on compliance costs, and seemed to suggest that, because there is over-capacity--which one or two Labour Members have mentioned--in the country as a whole, the effect of closures would not be that great. That suggestion is flawed, for three reasons. The first is a decline in capacity, which the Laing and Buisson Consultancy has already predicted will--in the near future, because of current trends--be up to 10 per cent.

Secondly, as has been graphically brought home to me, if one or two rooms in a small home of 20 or fewer rooms have to close, in current circumstances, in which margins are extremely tight, that home would cease to be viable. If the home has to shut down one or two rooms, it will close. Therefore, "Fit for the Future?" has ignored a big gearing effect.

The third reason has already been dealt with by my hon. Friend the Member for Woodspring (Dr. Fox)--the geographical effect. In my constituency particularly, many small homes are scattered round the constituency, serving local communities. If some of those homes are forced to close, residents will have to go elsewhere, a long way from where their relatives reside. Those residents, and their relatives, say that they want to stay in those homes. They are quite happy to stay in a home which may have one or two rooms that are rather smaller than the proposed regulations would suggest. The benefit to them of being in the home that they have been in and of being close to their relatives is much greater than having a slightly larger room.

On 15 February, the Minister said that the standards must be "realistic and affordable", and that they must give providers a sensible time scale in which to make the necessary changes. I very much welcomed that comment, which suggested that he was taking some of these points on board. I ask him to spell that out rather more. All I am asking for is the application of common sense in examining some of the proposals in "Fit for the Future?"

The National Care Homes Association had a point when it said:


I think that I would have put it slightly differently and said that one does not measure the quality of care by a tape measure alone, as so many other qualities are required.

In the homes that I have seen, some of the rooms would have to be shut under the proposals--they cannot be physically enlarged--but are only a little smaller than would be required in the regulations. They are smaller

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because the previous local authority specifications were lower, or, sometimes, for the simple reason that they were measured in feet rather than metres. It seems that common sense is very much required.

I ask the Minister to reassure the many proprietors in my constituency and elsewhere, first, that the regulations will not be applied retrospectively to homes in which some rooms may miss the target by only a little and the residents--some of whom I have talked to--are perfectly content with their rooms and do not want to move elsewhere; secondly, that costs will be taken into account, and that, if extra costs are imposed, assistance will be given to both private and local authority homes to help them to meet those costs; and, thirdly, that, for existing homes, especially the small ones, there should be a long transitional period.

Those proprietors are deeply anxious. They have sunk much capital, often after heavy borrowing, into their homes, and their capital is at stake. They are dedicated to providing a service, and it is not enough for the Government to say to them that nothing will happen until April 2002. They need more specific reassurance now, and I hope that the Minister will be able to give it today.


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