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2.23 pm
Mrs. Joan Humble (Blackpool, North and Fleetwood): I am sure that we can all agree that this debate is very important. It affects many people--not just the elderly, but those with disabilities and young people who will need to look to the future when they may need long-term
care. The Government inherited a system in a mess. It was full of uncertainty, with no coherent policy on funding for long-term care. That has caused concern and anxiety to the users of the services and to the planners who need to deliver the services.
In what is a complex debate, I shall concentrate on two key points. First, we need to consider a fairer system of funding long-term care and finding solutions that are fair to the current generation of older people and to younger people, so that they know what to expect for their futures. Secondly, I shall consider the quality standards necessary to reassure people about the care available to them, given the uncertain and variable pattern found in different parts of the country.
One of the major reasons behind the Government's decision to set up the royal commission was the genuine anger and resentment that had built up in the 1980s and 1990s among many older people who had been forced to sell their homes. That has been mentioned already in the debate. We should not use those older people as a political football--they are real people with real concerns that should be addressed in our debate. The problem is not new, but it demands complex solutions. I doubt whether any homes in my constituency are worth less than the £16,000 capital limit introduced by the previous Government, so virtually all home owners fear losing their homes if they go into residential care.
Many people come to Blackpool and the Fylde coast to retire. They save up and buy a home to live by the seaside, and then when they need residential or nursing care, they face selling the lovely bungalow they had bought to settle in for the rest of their lives. We must find a fairer way to fund long-term care, but--just as important--we must give back to today's pensioners a faith in the state and a belief that Members of Parliament listen to their needs and are willing to address them.
Many of my constituents will welcome the Government's announcement today that they will examine the charges for nursing care. That issue formed a large part of the Sutherland report. It is difficult for many people to understand why nursing care provided in one setting is free, but not free if it is provided in an alternative setting. I hope that all the issues covered by the report will be examined to offer people reassurances and to enable them to understand the system, because they do not understand it now.
I am sure that many people will also welcome ways to delay the sale of a property to finance care. We have all had cases of constituents who had gone into residential care but had then recovered sufficiently to want to go back to their homes, only to find they had a "For Sale" sign outside. Any mechanism that we can introduce to ensure that homes are not sold prematurely will be very welcome.
In this debate, we must consider the spectrum of care available. Many people prefer to remain in their own homes as long as possible, so we need to consider the support services available to them--whether provided by social services, health services, voluntary organisations or church groups. I also welcome the Government's announcement of the long-term care charter. That charter and the draft guidance that was issued to social services, health departments and housing authorities will improve services for people needing on-going support by setting out exactly what they can expect from their local service
providers. Many people come to my surgeries to find out what is available: information should be much more easily available in local libraries and day centres.
The introduction of the charter next year will be a vital step towards the seamless service that should be provided for people. We think of the services as a spectrum that starts with people in their own homes having home helps coming in, then going to day centres, followed by residential care, where they end their lives. However, it does not always follow that pattern, even for people who have been in residential care for some time.
I attended the 100th birthday party of an elderly blind lady who had been in residential care for three years. Two or three weeks before she turned 100 she decided that she could manage in the sheltered accommodation in which she had previously lived. I walked across the road with her to the home in which she had lived until recently, and she marched into the room where all the other residents were sitting around. Even though she could not see any of them, she said, "I know what you are doing. You're all sitting there slumped in your chairs and you're only 70. I'm 100 and you should imitate me and get out into the community." People's social and health care needs can improve, as well as deteriorate, and we need a flexible system that can cope with that.
I especially welcome the Government's announcement that they will look at and regulate home help services. Traditionally, people have thought of such services as involving cooking, cleaning and basic domestic tasks, but that is not so now. Home help services have become home care services, and they are often intensive. The workers going into elderly people's homes perform very personal care tasks for them. Because such work has never been regulated, untrained and unqualified young people have gone into the homes of frail, elderly and vulnerable individuals to perform very intimate functions without supervision or regulation. I believe that those elderly people are therefore at risk. Any mechanisms that wecan employ to introduce appropriate registration and monitoring of home care services will reassure them. They welcome the people who come into their homes to look after them, but they need to know about those people's backgrounds and training.
Ms Debra Shipley (Stourbridge):
I agree with everything that my hon. Friend has said about home care help, and I endorse her view that not all the people caring for the elderly are of the appropriate type. I hope that a vetting system can be established, but does my hon. Friend agree that it would have to be statutory rather than voluntary? Does there not have to be a requirement that the people providing that help are vetted, and should not sanctions be applied to people who fall short of the required standards?
Mrs. Humble:
I recall that, four or five years ago, Lancashire county council social services department introduced a voluntary system of registration and inspection of domiciliary care agencies. That has worked very well, but such systems do not operate elsewhere in the country. We need to consider whether a national voluntary system would work: if it would not, we should consider putting the system on a statutory basis. The bottom line is that we must protect those vulnerable people who are cared for in their own homes.
I also welcome the announcement by my right hon. Friend the Secretary of State that he is to examine the charges for home care services, as they vary across the country. Why should a frail, elderly person in my area pay more--or less--than one in Kent, Shropshire or somewhere else? It is very important to find a way to remove the huge variation in charges that exists.
There is a perverse incentive for local authorities to place people in residential care, as that is often cheaper than providing intensive support in a person's home. Most people who come to see me want to stay in their homes for as long as possible, but their local authorities often encourage them, for financial reasons, to go into residential care before they want to. As part of the comprehensive review, I hope that the Government will consider that problem and listen to what elderly people say.
We must also remember that not only elderly people require long-term care. In his opening remarks, my right hon. Friend referred to the many younger disabled people who require long-term care and who prefer to receive it in a community setting. I should like to take this opportunity to pay tribute to the thousands of informal carers supporting relatives or friends in the community. Over the past two years, I have had several meetings with the parents of adults with disability at one of the day centres in Fleetwood in my constituency. Those parents are in their 70s--some are in their 80s--and have cared for their now adult children throughout their lives. They have done so with love, care and affection, and they have accepted their responsibilities as parents. However, they are getting old: the elderly carers now need care, and the adults with disability must plan for their future.
In Lancashire, the local authority has been developing schemes to involve those carers in planning the future long-term provision for their adult offspring. Some of the necessary resources have come from the very welcome additional funding that the Government have made available to support carers. The carers whom I meet are pleased to be part of the planning process. In the past, they felt very excluded and that decisions were being taken by faceless bureaucrats and social workers a long way away in county hall. They very much welcome the fact that they are now being consulted, but my hon. Friend the Minister of State will not be surprised to hear that they want more--more respite services, more support and more homes in the community for their children.
Many other people in the community provide care. Their role is vital in ensuring that the phrase "long-term care" means what it says. I am sure that all hon. Members will praise the professionals whose job it is to look after people with care needs, in both the residential and community setting. However, without the support of informal carers, many of those professionals could not do their jobs. I hope that the House will take the opportunity provided by this debate to pay tribute to the invaluable work of those informal carers.
The second element that I want to mention is the quality of care. The recommendation for a national care commission is excellent, and will be widely welcomed. Standards of care are very variable, depending on where people live and on whether they are able to find out about the services that are available.
Mention has been made of the quality of care in nursing and residential homes. The Department of Health commissioned the Centre for Policy on Ageing to consult
on and prepare draft standards for such homes. Those draft standards included minimum requirements for space, facilities and quality of service provision. I understand that the Government have considered the CPA document and have published a consultation paper entitled "Fit for the Future?".
The question of standards is very important. Everyone wants standards to be improved, but it is also vital to ensure continuing provision in communities so that people can choose. Care for older people should be consistent throughout the country. Many of the requirements in the consultation paper are found already in good quality residential and nursing homes. Other requirements can be adopted at little or no cost, and they will substantially improve the quality of care provided.
However, it must be acknowledged that, in Lancashire, some of the physical elements of the standards could be achieved only with great difficulty, and some could not be achieved at all. It is not easy to move walls in old buildings, for example, and many of the care homes in Lancashire are both old and small. Although many people prefer them because of their homely environment, they would be hard to adapt to modern requirements. Simply knocking down a wall between two small rooms to make a larger one is not always the answer, as that may undermine the viability of a small home.
The regulatory impact analysis in the consultation document attempts to quantify the impact of the proposed changes. Given the surplus capacity in the market, the analysis states that
I recently met representatives of the Lancashire Care Association, who told me that of the 556 private homes in the county, 394, or 71 per cent., will not meet the proposed standards. That is nothing to do with the quality of care in the homes; it is the physical nature of the buildings. The picture is even worse in Blackpool, where the figure is 91 per cent. There is understandable concern. My worry concerns the residents of such homes and elderly people planning to enter them as part of their long-term care. We must ensure that there will still be homes for people to go into and that elderly residents in existing homes will not be threatened with evictions or moves. All that must be considered in the context of wanting the highest possible standards.
I urge my hon. Friend the Minister to consider carefully the representations that have been made. All those to whom I speak, including those in the private care sector, want to improve standards, but they want to have time to do it. They want to discuss some aspects of the document that they feel are not conducive to improving care standards. It is an important issue in my constituency. Lancashire, with perhaps Kent, has the highest number of private care homes. We have 20,000 residential and nursing home beds. It is clearly an issue, but I stress that there is a genuine commitment to move forward because we want top quality homes so that people will want to enter them and, if necessary, enjoy their final years in them.
On a more positive note, Blackpool is improving standards through a new star rating system. People can choose a hotel in Blackpool by how many stars it has, and now they can choose a residential or nursing home in the same way. It is a new and innovative scheme that I commend to my colleagues. I believe that it is the first independent scheme--it is not run by the local authority. There was a good deal of consultation between my local council, the private sector and the voluntary sector to consider ways of guaranteeing standards in homes. They brought in a company called Residential and Domiciliary Care Benchmarking Ltd.
I have seen the documents involved. They are immensely complex and ask a range of questions across every possible aspect of care in a home. Care home owners have to pay for the scheme, which is self-financed, but they come forward voluntarily, answer the questions and are assessed according to the star rating. Blackpool council's care homes have been subject to the same scrutiny as the private sector. The new scheme has already raised expectations, increased staff awareness of good practice, encouraged the spread of training and, perhaps most importantly, enabled purchasers of care--elderly people and their relatives--to make informed choices about which home they want to enter.
"compliance could be achieved without markedly destabilising the market."
However, that is not what care home owners in my constituency tell me.
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