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7.45 pm
Mr. Burns: I add my support to the important new clause moved by my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond). However, I warn my hon. Friend that I have a grave reservation about part of it.
As my hon. Friend said, minimum standards are a fundamental part of the Bill and of its impact not only on care home owners in the private sector but on local authorities that still own and control residential homes.
As I said in an intervention on my hon. Friend, there is grave concern among many local authorities, not least Essex county council, about the bills that they will have to pay to upgrade their homes to a decent standard. For a variety of reasons, over the years some authorities have fallen behind in renovations and improvements, to the point where the cost of complying with any minimum standard issued by the Department of Health would be excessively high--and that is before we even come on to the issue of the quality of care. The quality of care could be, and in many cases will be, infinitely better than the quality of the buildings in which people may live.
Therefore, I am concerned about who will finance local authorities' need to improve their homes. As I have said, Essex county council has a real problem. It already spends significantly above its standard spending assessment on social services. As the Minister will know, there is no relaxation or abatement in the demands that are being put on social service budgets by the needs of the populations that they and local authorities have to meet. To have to find on top of that a significant amount of money to enhance their residential homes stock will be an onerous burden.
Has the Minister made any provision for helping local authorities through central Government grants to take that into account? Many hon. Members whose local authorities are concerned about that would be grateful if the Minister could deal with it when he replies.
Mr. Bercow: Given the financial constraints that local authorities face, does my hon. Friend agree that those authorities would welcome from the Minister tonight a clear idea of the timetable within which they will be expected to achieve the minimum standards that he favours? Does my hon. Friend also agree that it is incumbent on the House in taking forward the Bill properly to distinguish between desirable standards and those that are essential to human safety?
Mr. Burns: I am grateful to my hon. Friend for raising two crucial points. I hope that the Minister listened carefully to my hon. Friend's point about the timetable that the Government expect local authorities to use to bring the physical structure of their residential homes up to the standards required. With regard to the quality of care, there is probably no problem in the vast majority of residential homes.
My hon. Friend's second point is critical. It would be desperately perverse if residential homes were penalised because they were way above the minimum standard.
By definition, the service that they provided would be too good according to the criteria of the bureaucracy entailed in establishing any minimum standard. I hope that the Minister will bear that in mind. It would be terrible if care home owners were penalised because they had enhanced and improved, or were seeking to enhance and improve, the quality of their service way above the minimum standard
Mrs. Lait: I agree with my hon. Friend, but does he agree that the unintended effect of minimum standards could well be that local authorities get out of residential provision entirely, and such provision then becomes a private sector monopoly?
Mr. Burns: That is a logical conclusion to draw from the situation facing several local authorities. Particularly in the case of Essex, unless the Government are exceptionally generous in providing ring-fenced additional money to help authorities deal with their residential home stock, local authorities will have to sell those homes into the private sector. If they do not, the homes will not reach the minimum standards that the Government plan to establish. Presumably, they would then have to be closed down, and that would be intolerable.
I do not entirely agree with the conclusion of my hon. Friend the Member for Beckenham (Mrs. Lait) that it would necessarily be a bad thing for local authority owned residential homes to move into the private sector. There is a great deal to be said for that, particularly in view of the problems that the public sector has faced for many years because the financial resources have not been made available to it by central Government to allow it to keep pace with the standards and quality of private homes.
Mr. Swayne: Will my hon. Friend give way?
Mr. Deputy Speaker: Order. Before the hon. Gentleman gives way, I appeal to him to face the Chair.
Mr. Swayne: Given my hon. Friend's inference that the provision is a potentially welcome privatisation measure, those on the Treasury Bench no doubt welcome the fact that there is not a single Labour Back Bencher present to hear the real consequences of the Bill.
Mr. Deputy Speaker: Order. We do not need to worry about who is not in the Chamber. We are in the Chamber. That is the important thing.
Mr. Burns: I echo the comments of my hon. Friend the Member for Runnymede and Weybridge about minimum standards. When Governments start laying down minimum standards, there is a danger that an attitude of mind develops, and that what began as a minimum becomes set in stone. The troubles multiply as people try to enforce the minimum standards. If they have got it wrong in any way, tremendous problems can result for the care home owners providing residential care and nursing care to our citizens.
Similarly, as my hon. Friend pointed out, there is considerable uncertainty about what the standards will be and how much parliamentary scrutiny the process of establishing them will receive. I assume that the Government intend the standards to be a movable feast as changes are needed in the light of experience and developments in the provision of residential care and nursing care for members of the community.
There is one aspect of my hon. Friend's new clause about which I have serious concerns. I do not criticise my hon. Friend lightly, because he does not deserve criticism, but part of his new clause suffers from what may tactfully be described as careless or ambiguous drafting. I refer to subsection (4)(b)(ii).
Under subsection (4), the Secretary of State shall
- consult such persons as he considers appropriate
- request the Commission to give him advice as to the likely impact of the proposed statement or the proposed amendment
- the cost of supplying such services in accordance with the statement of minimum standards.
Mr. Hammond: I do not want to engage my hon. Friend in a detailed grammatical debate, but I feel obliged to defend myself. It seems to me that the cost of supplying a service can be incurred only by the supplier. The cost of purchasing a service will be incurred by the purchaser.
Mr. Burns: I thank my hon. Friend. His knowledge of the construction of the English language is probably superior to mine. I do not want to continue to argue with him, and I accept his clarification, but that has implications for the person to whom the service is supplied. There should be a sub-paragraph (iii) referring to the cost to the user of the service supplied in accordance with the minimum standards.
I have good reason for considering that to be important. The sheer horror of the situation will become apparent only next Tuesday. I expect that the Minister saw or had drawn to his attention the main story on the Channel 4 news last night. I do not know how many of my hon. Friends saw it. The subject, which has a serious impact on many hundreds of thousands of elderly people and their families, was the leak of what the comprehensive spending review to be published next Tuesday will say about long-term care, its cost and how that will be met.
As the Minister will remember, although he was not at the Department of Health at the time, the former Secretary of State, when announcing the royal commission, said that it must complete its work swiftly. The original timetable set was 12 months from its inception in the summer of 1997. Because of the sense of urgency and the rhetoric, we expected the Secretary of State to consider the recommendations and make an announcement to the country fairly swiftly.
The 12-month period would have ended in July or August 1998. It is now July 2000 and we have not heard a single word from the Department of Health about how
it is to move forward. I understand from the Channel 4 report last night--this will have a direct bearing on new sub-paragraph (iii), which I urge my hon. Friend to include in new clause 4--that the state is to pick up the bill for nursing care in nursing homes. The Government would be absolutely right to make such a decision. The difference between what the health service should provide and what the individual should pay for has become increasingly blurred as the National Assistance Act 1948 has become more and more irrelevant to society's changing needs over the past 52 years. If that is what the Government intend to do, it is a step in the right direction.
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