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Mr. Bercow: I am somewhat reassured by the letter my hon. Friend has apparently received from the Minister, but does he not agree that it is only right that such an assurance should have been forthcoming, given that, otherwise, the Minister would have been implying that en-suite bathrooms did not constitute usable space, which would have been bizarre, even by the standards of the current Government?
Mr. Hammond: My hon. Friend is right. My point is that the process followed by the Government, if it were intended to introduce workable standards in an orderly fashion without damaging the market, has failed. Instead, that process has resulted first, in the breakdown of the negotiations that the Minister expected, wrongly, would reach enough of a conclusion to enable him to make an announcement to the Standing Committee; and secondly, in a lack of clarity about issues such as whether or not en-suite bathrooms and door-sweep areas are to be included. I am merely speculating, but, as the Minister makes announcement after announcement in an attempt to reassure the market, it strikes me that, in his efforts to make the arrangements workable, the Minister is having, time and again, to overrule civil servants who have led him seriously astray and left him with a system that would be unworkable and unaffordable.
7.30 pm
We still have no definitive answer to clarify the mystery of what the minimum acceptable room size will be. Similarly, we do not have a time scale for compliance in existing properties. We are still in a mess. I do not pretend that the new clause will solve all the problems. Clearly this is a matter of process rather than one of legislation. However, I believe that the new clause would lead to cleaner, better, more informed and more transparent processes for arriving at national minimum standards. It would ensure that the Minister had all the relevant information. To put it bluntly, he would be able to see the size of the bomb crater that he would create in
his own backyard before he published the draft standard. There would then never be a danger of disrupting a market by allowing rumour and speculation to get a hold.Critically, the new clause will provide for proper parliamentary scrutiny of these most important parts of the regulatory system. I suspect that my hon. Friends will agree strongly with me that it is outrageous that a key element of the Bill, which could destroy people's businesses and livelihoods, should lie outside and beyond the scrutiny of Parliament.
I hope that the Minister will be able to give us some reassurance. Perhaps he will be able to tell us when he will make a definitive announcement, and what the time scale will be for compliance with the definitive room size that he determines. Of course, he will tell us that he is still in the process of consultation, and we have no objection to that. Indeed, it is valuable. However, we know that the Department can act when it has to. It managed to consult 12 million people in its so-called national health service survey in a fortnight. Apparently, it cannot talk to those responsible for about 17,000 care homes in much less than a year so as to get them on board and understand their responses to the consultation process. Meanwhile, individual owners of care homes and residents--those who live in fear of what will happen to their homes, many of them having gone into them expecting to live out the remainder of their lives there--are suffering from blight. Repairs are not getting done, and extension plans are being put on hold. The system has degenerated into chaos.
It is easy, tempting and convenient for government to express national minimum standards for care homes in terms of what is easily measurable--for example, the size of a room, the number of staff, the number of choices on a menu and the number of square metres available per resident in the day room. I have serious doubts about that, which I know are shared by other hon. Members on both sides of the House. Are we measuring what matters or what is easily measurable? What matters to those who are being cared for is the quality of care being delivered. The danger of introducing prescriptive national minimum standards is the elimination of choice and diversity.
It seems self-evident that if there is a given income--usually provided by a local authority--for housing a resident, it can be spent in several ways. For example, a larger bedroom may be provided, but there may be smaller areas of communal accommodation. Smaller rooms might be provided for both purposes, but there may be a vastly superior menu. There might be smaller rooms but a much higher staffing ratio, or much better qualified staff. There should be choices because different residents will have different needs. Someone who has limited ambulatory capability--in other words, someone who cannot walk about--will not have much use for elaborate day-room facilities. Someone who is active and sprightly may have little need for a large bedroom. It seems self-evident that there should be no one set of prescriptions to govern all the accommodation in the marketplace. That would have the effect of eliminating choice still further.
The new clause would improve on clause 23. It would ensure that future proposals for new national minimum standards were better informed. It should help to avoid shambles such as those created by the circulation of "Fit for the Future?" Crucially, it would allow for proper
parliamentary scrutiny of these vital national minimum standards, which have a huge impact on individuals and on the public policy agenda.
Mr. Hutton: I am listening carefully to what the hon. Gentleman is saying, and he is setting out his case clearly. Will he confirm what I think I heard him say? Is he saying that there should not be a national room-size standard for residential or nursing care homes?
Mr. Hammond: I questioned whether there should be rigid criteria which reduce choice and--[Interruption.] The record will show what I said. I shall clarify what is in my mind and what concerns me. The Minister knows of my concerns because he has heard me express them before. I believe that different people have different needs and different wants. We are talking about people, not statistics. There needs to be enough flexibility in the system to cater for people's diverse needs and wants.
In an ideal system, we could have 12 sq m rooms for everybody, and payments high enough to allow care homes to provide additional services. However, if resources are constrained so that we are forced into choices, surely it is better not to lay down certain criteria and state that they will apply to all care homes, but to lay down some variable geometry. That might be sensible. Some care homes might provide better bedroom accommodation and fewer communal facilities. Others might provide better communal facilities and less bedroom space. One category of home will appeal to one category of resident and another type will appeal to a different category.
Mr. Hutton: I understand what the hon. Gentleman is saying about the need for discretion in terms of a possible national minimum room-size standard. I shall take up his argument when I respond. However, does he think that there should be a national minimum room-size standard, perhaps subject to discretion?
Mr. Hammond: The Minister knows very well that minimum standards are required by local authorities, and that they vary from area to area. I can see advantages in having national minimum standards--but we must regard them as the minimum. As I said in response to an intervention from my hon. Friend the Member for South Dorset (Mr. Bruce), if we introduce minimum standards we run the danger of their becoming the normal standards.
If we introduce minimum standards at a level low enough to allow, within the resource envelope available, some discretion to provide above-minimum standards in other areas, we must always avoid the minimum standard becoming the norm. Some sort of variable geometry, which recognises the reality of a trade-off and takes into account the fact that different residents will have different needs and wants, is the way forward.
Mr. Burstow: I wish to clarify the hon. Gentleman's exposition. He is saying that there is a clear link between quality and costs, and that standards may need to be lower to accommodate the current financial envelope. Which is his preference? Is he saying that we should increase resources to enable a higher standard to be achieved, or that we should lower the standard?
Mr. Hammond: The hon. Gentleman misquotes me. I was saying that if we want room for discretion--and if
we want diversity there must be room for discretion--the minimum standards will have to be set at a level which leaves some resource in the hands of the provider, so that he can add to that minimum provision in one area or another. If the minimum standard in each area where a minimum standard is set--room size, staffing ratio, meals--is at a level which, together, consumes all the resource available to the provider, there is no possibility of diversity and variation between providers, and the consequence of that is no choice for those entering residential care.Amendment No. 38 seeks to leave out from the powers to make regulations a reference to imposing
- requirements as to the financial position of an establishment or agency.
I am not sure what the criteria will be. The Minister knows that a considerable number of care and nursing homes operate in receivership. That, I am afraid, is the nature of the pressures in the marketplace. The Minister assured me in a letter that the provision that we seek to omit, which concerns requirements as to financial position, would not be used to disallow the registration of an operator merely because it was operating in receivership.
One's financial position cannot get much worse than operating in receivership, so I am not sure quite what the Minister has in mind. However, the provision will act as a barrier to entry. It will stifle new entrants to the sector if they are required to show a financial robustness which, typically, start-up businesses may not have. That would be a massive own goal for the Minister because competition among providers is essential to him in ensuring good quality and sensibly priced provision.
We also run up against the problem of who will make decisions about adequacy of financial position. By and large, the people doing the inspecting, registering and regulating will be people who know about the care and accommodation of frail elderly people, not accountants, and that is a major problem.
Amendment No. 39 will not get the attention that it deserves, but it is important, as it would enable the Minister to make regulations to
- make provision in the case of an establishment providing cosmetic surgery
- the nature of statements that may be made with regard to the services provided; and . . . the titles that may be used to describe persons carrying on, managing or employed at such an establishment.
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