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8.30 pm
Dr. Brand: I am sure that the motives behind "Fit for the Future?" were right, but it has caused great concern, mainly because it does not necessarily address the issue of fit for the purpose. I have been struck by the complaints. Small care home owners are concerned about rigidity--the bricks, mortar and buildings--and are relaxed about the excellent quality standards for care and staffing. Conversely, the larger providers--those quoted on the stock market which run large granny factories--were relaxed about the bricks and mortar, but extremely concerned about meeting the staffing levels and qualifications. There is no doubt that care is more to do with staff than with buildings.
It is right that the Government should set minimum standards for staffing and training, which are vital. We should commend the Minister for his efforts in that area. However, minimum structural standards for care homes could be best addressed through ministerial guidelines to the commissioning agents. Different homes suit different people. That is not only because different personalities are happier in different settings, but because their physical, emotional and social needs may be different.
It would be sad if a fixed ratio were imposed on the double occupancy of bedrooms, as opposed to single occupancy. Even in a place such as the Isle of Wight, there are cultural differences. In one part of the island, it is the norm to share. In other parts, everyone wants an en suite room and not to talk to anyone else. We must accept that that is part of giving residents choice.
The issue of communal facilities has been mentioned. In nursing homes dealing mainly with post-operative conditions, people spend a great deal of time in their bedrooms. They do not want to go out, mix or sit in a dining room. They want to rest in peace and quiet and then go home. If that is the business that the establishment is in, it seems unreasonable that it should be required by regulations to have facilities that it does not use.
In Committee, I supported the imposition of statutory standards by affirmative resolution, but these should be backed by ministerial guidelines which, in time, may
show where statutory standards may go in the fullness of time. That will help health authorities and local authorities in their commissioning role. There is a need for standards to rise even in places such as the Isle of Wight, where we have done well at the expense of some less effective and less successful home owners. One must accept that we are dealing with a part of the business sector, and that businesses should compete. With that goes grief from time to time.There is no doubt that what is happening to the sector is unreasonable. One of my slight criticisms of new clause 4, which is well drafted, is that it does not give a time scale for consultation. Consultation is vital. The Government consultation on "Fit for the Future?" was announced in October last year and it took until a week after Christmas before I could get copies to the people affected by it. It was difficult to get responses in within the deadline and, when people put in their responses, nothing happened. In the meantime, we have had a long period of uncertainty, which is having a detrimental effect on investment in raising standards and on those who were about to retire, but cannot at the moment.
We have rehearsed the arguments and we have heard indications of comfort, but no real comfort from the Minister. I hope that he will go further than he did in Committee.
Mr. Hutton: First, I wish to explain to the hon. Member for Buckingham (Mr. Bercow) why amendment. No. 61 has been tabled. The amendment will place an obligation on the Government to consult the people and bodies whom they think appropriate before making any regulations under clause 22 and before making any significant amendments to regulations made under clause 22. In tabling the amendment we are responding to concerns raised by the hon. Member for Runnymede and Weybridge (Mr. Hammond), who raised the issue in Committee. I assured him then, and I confirm today, that it was always the Government's clear intention to consult on all the regulations made under this clause. However, I am happy to table this amendment to put the matter beyond any reasonable doubt.
I hope that the hon. Member for Runnymede and Weybridge will be pleased to see that we have actually gone further than his amendment would have required, in that we have included a requirement to consult on any substantial changes to regulations that have already been made under this clause. I hope that that will be welcomed by the hon. Gentleman and his colleagues.
We have had a wide-ranging debate about some other issues, particularly new clause 4. This is a familiar theme to those Members who take an interest in national minimum required standards. The hon. Member for Southend, West (Mr. Amess) spoke with his usual passion--if not accuracy--about the subject. The hon. Member for West Chelmsford (Mr. Burns) spoke with substantial knowledge, gained from his time as a Health Minister. I thought that his contribution was important and useful.
The hon. Member for West Chelmsford explained the difficulties that he had experienced in his own county, Essex. It is my own county, too; I lived there for many years.
Mr. Keith Simpson (Mid-Norfolk): An Essex boy!
Mr. Stephen Day (Cheadle): That explains a lot.
Mr. Hutton: It might explain a few things, but I do not think that we should go there today.
The hon. Member for West Chelmsford was explaining some of the problems that small care home owners in Essex were experiencing primarily with the room size standard. He will be aware that the problem in Essex perfectly illustrates the need for the changes in the Bill and the new laws that we are proposing. Essex county council has had a 10 sq m standard since 1991, and the council gave care home owners 10 years to comply with the standard. The hon. Member for Southend, West was moaning about the standard, but it was introduced nearly 10 years ago in his constituency and that of his hon. Friend the Member for West Chelmsford. To be fair to both hon. Members, I must say that I have no information about the extent to which the standard has been implemented by the county council and, in particular, the social services department. It may be possible for us to correspond about that.
The hon. Gentleman was concerned about the fact that the county council had never applied the standard to its own homes. In the Bill, we are creating a level playing field between the public and private sectors. I should have thought that the hon. Gentleman and his hon. Friends would at least welcome that advance.
Mr. Burns: Will the Minister give way?
Mr. Hutton: I will in a minute. Conservative Members have taken nearly an hour and three quarters; I have spoken for four minutes.
An important point has been made today--all who have spoken made it effectively. We have tried to make it too; certainly, I made it repeatedly in response to the concerns expressed by the hon. Member for Runnymede and Weybridge in Committee. We absolutely must get the emphasis right. The quality of care must be measured accurately, and that cannot always be done with a tape measure.
Not all hon. Members--although, to be fair, the hon. Member for Isle of Wight (Dr. Brand) probably came closest to it--have sufficiently stressed the importance of room sizes as a measurement of quality. We should ask ourselves whether, if we were going into a care home, we would want to be in a small room, or in a reasonably sized room. The hon. Member for Southend, West said that some care home owners were saying, "These people do not spend much time in their bedrooms." We should bear in mind, however, that in a typical residential or nursing home the bedroom is probably the only private space for residents.
The care home owner may believe that a resident is not spending much time in the bedroom. That is an observation. It must be recognised, however, that for many people the size of the room is an important issue. I am certain that, whatever hon. Members on either side of the House may say, it would be important for us if the time arrived for us to be in care homes.
Mr. Hammond: The Minister asks whether any of us would want to be in a small room. Viewing the question
in isolation, everyone would probably prefer the idea of a larger room; but we cannot consider such questions in isolation. If limited resources are available, choices must be made. That, I think, is the point that some of my hon. Friends have been trying to make.
Mr. Hutton: Obviously, the hon. Gentleman is right. The whole process of government and decision making in this place is about making choices. I will not pretend that we do not have difficult choices to make in setting national minimum required statements; of course we do. It would be naive to imagine that we could sail through it without having to make difficult judgments. What planet does the hon. Gentleman live on?
Of course these are difficult issues. That is why the process is taking time--that is a matter of record; it is taking time to make the right decisions, but we are determined to get them right.
Mr. Bercow: A couple of minutes ago, the Minister referred to room sizes, in the plural. In the light of his earlier challenge to my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond), will he confirm that he is irrevocably committed to a single national minimum room size?
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