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Mr. Collins: The powerful case that my hon. Friend is developing seems to be an argument in favour of new clause 4. The Minister may be reluctant to accept subsection (4)(b)(ii) because the only advice that the Secretary of State will wish to take will be that of the Chancellor, who will tell him what he can and cannot spend. The Secretary of State has no interest in independent, possibly awkward, advice.
Mr. Burns: My hon. Friend makes an extremely pertinent point in his correct analysis of the thinking in the Department of Health. He identifies the straitjacket within which Health Ministers must operate. They have received different moneys from the Chancellor for hospital and medical care, and I imagine that the Chancellor thinks that enough is enough.
Mr. Burns: I am grateful for your guidance, Mr. Deputy Speaker. In conclusion on that point, then, I feel that the new clause should include a subsection (4)(b)(iii). The Government will apparently announce on Tuesday that they will not fund long-term care. They may raise the £16,000 threshold, but will still expect families to sell their homes to pay for long-term care. That takes us to the need for an analysis by the commission or by those whom the Secretary of State consults of the costs of the minimum standards to the users of the services. Those costs must include the costs to families or individuals for living in a residential or nursing home.
We shall not know until Tuesday whether Channel 4 was accurate, but if it was, there is even more need for a change to new clause 4. It is, of course, too late to amend the new clause tonight. I shall support my hon. Friend the Member for Runnymede and Weybridge if he wishes to pursue his new clause, but, without being unduly unfair to him, repeat that it is a pity that my additional proposal is not in the new clause.
Mr. Burstow: I support the new clause, which provides a basis for exploring the Government's attitude towards national minimum standards and the process by which we have reached our present point. The Bill is primarily a vehicle for a series of regulation-making powers, giving
The Standing Committee explored in some detail an issue that we must revisit--the need for a clear and transparent process that gives the House and the other place an opportunity to debate both the statutory instruments that give effect to national minimum standards and those standards themselves. As we know from "Fit for the Future?", the standards will contain an awful lot of detail, and many devils lie in the details, which has raised much concern outside the House.
The debate about national minimum standards is at least in part motivated by understandable anxieties among care home owners, and all Members will have had representations from them. It is important to record, however, that minimum standards exist for the safety and security of the consumers of the service, and act as a guarantee for them. That should be our starting point in constructing any minimum standards. I entirely accept that legitimate concerns exist about minimum room size, staffing ratios and so on. We must address those questions, but other standards--identified in "Fit for the Future?"--are welcome and should be implemented at the earliest opportunity.
The debate about minimum standards will of necessity be better informed if we consider what has happened to date rather than talking only in the abstract about future domiciliary care, day care or any other type of care. It is crucial to bear in mind that a key element underlying minimum standards must be the principle of maintaining the independence and dignity of people in care. We must consider how to provide choice and how to ensure as much control as possible for the individual. "Fit for the Future?" covers such issues as social activities and other measures of quality that ought to be covered by minimum standards. I do not see room size as an adequate proxy for quality.
That said, we must recognise that standards change over time and cannot be absolute. My generation may expect something different in a care home from what a future generation will expect. Perhaps there are differences in what those living in care homes expect. Those differences should be borne in mind. Equally, on choice, someone living in a care home may have chosen a particular location because it is a listed building with unique features. That may be the very reason why that person has chosen that home, and we should not lose sight of that fact as we implement standards. It would be wrong to drive out of business a home in which people are receiving the quality of care and life that they want just for the sake of complying with a minimum room size standard.
The regulatory impact assessment attached to "Fit for the Future?" said that 7,000 additional nurses would be required to give effect to the national minimum standards. We know all too well from questions and debates that the Government are struggling to recruit and train enough nurses to fill the 17,000 vacancies in the national health service. To suggest that we can find another 7,000 beggars belief. As we consider "Fit for the Future?" and the emerging national minimum standards, we should be given clear timetables showing when consultation will end
Mr. Bercow: I agree with the thrust of what the hon. Gentleman says, but may I focus his attention on Government amendment No. 61? Given that clause 22, which will be amended under that amendment, contains no fewer than 10 subsection and 34 paragraphs, what precisely is the merit of, or the need for, Government amendment No. 61?
Mr. Burstow: That is an interesting point. When the Minister responds, we may discover that the Government are attempting to respond constructively to concerns that were expressed in Committee by the hon. Member for Runnymede and Weybridge (Mr. Hammond). The hon. Member for Buckingham (Mr. Bercow) may have to wait to listen to the Minister's gracious comments on those matters.
In Committee, several hon. Members expressed concerns about the impact that standards would have on the supply of places in care homes, but the availability of domiciliary care is also important. The Government need to accept that there is a crisis of confidence in the care homes sector. How many homes are closing in any given week may be a matter of dispute, but I have heard that one a week, possibly more, are closing. They may be closing for the perfectly legitimate reason that they do not provide a good standard of care. Such homes should be closed, but many others are closing because they cannot provide a decent rate of return on the investment that they have made in their businesses.
Fees have not kept pace with costs. That key problem predates the Bill and national minimum standards, but the uncertainty about those standards has added fuel to it. As the hon. Member for West Chelmsford (Mr. Burns) has said, local authorities are under financial pressure on the provision of social care and the increasing demands that are placed on them. As a result, they must be ruthless in exercising their role in purchasing care places. They are undoubtedly holding down fees as much as they can. There have been some increases, but they have not been adequate in many cases.
The link between quality and the cost of meeting the standards is not straightforward. The equation is more complicated than that, but there is a link. If the standards are driven up--I would entirely applaud and support that--it must be recognised that, at some point, that will have a bearing on the fees that need to be charged and the incomes that need to be provided. We shall expect care assistants and others involved in domiciliary care and care homes to receive more training to meet the new national minimum standards and to ensure that adequate numbers of staff are registered with the commission.
All too often, better trained staff look for better paid jobs. Care assistants in care homes are not paid decent salaries. They can get better pay stocking the shelves at the local supermarket. If we do not recognise that problem, we shall store up problems for ourselves. There will be a flight from the sector as a result of improving the qualifications of its staff because they can get better jobs in other aspects of social care, where their skills are more fairly rewarded.
The hon. Member for West Chelmsford, who is no longer in his place, rightly expressed concern about the link between improvements in standards and the potential increase in costs to the consumers--those who live in care homes. He linked that to reports of yet other leak about what the Government have in mind for long-term care and the relative distribution of the consequent costs between the state and the individual. We shall have to wait for the White Paper, rather than the comprehensive spending review, to find out whether the leak is true.
If "Channel 4 News" is to be believed, I hope that the Government, even at this late stage, will give further thought to what the Prime Minister said before the general election. He said that he did not want to live in a country where old people had to sell their homes to pay for their care. The many hundreds of thousands of people who thought that the Government would take serious action on that feel betrayed and let down by the Government in that respect.