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3.27 pm
Sir John Stanley (Tonbridge and Malling): I wish to focus my remarks on one group of people and on one provision in one piece of legislation. The people on whom
I want to focus are those who are called the "preferred rights group". They were in residential homes on 1 April 1993 and therefore, by definition, they include some of the frailest and most elderly in our community. The legislation on which I wish to focus is section 43 of the National Health Service and Community Care Act 1990, which inserted a key new section, section 26A, into the National Assistance Act 1948.
The key consequences of what the then Conservative Government did to that group of people were to give with one hand and to take away--and to take away a great deal--with the other. They conferred an entitlement to a higher rate of income support on that group of frail, elderly people and they preserved their rights to that higher rate. However, in section 43 of the 1990 Act, the then Government imposed a statutory block on any form of financial assistance, through local authority social service departments, for that group. That block was total and inflexible and it was not capable of being tailored to any individual's circumstances. It left no discretion whatever in the hands of local authority social services departments and it took no account of the consequences for individuals of those legislative provisions in particular cases.
The course of events in a significant number of individual cases has been as follows: inescapably, as elderly people get older, they become more frail and incapacitated and require more care, and the cost of providing that care inevitably escalates. The residential home is therefore obliged to increase its fees to cover the cost of increased care. As fees go up, they often rise beyond the level of the higher rate of income support. In those circumstances, if the individual resident has no means left of providing additional funding and has either no relatives or none willing or able to provide the increased funding, one appalling option is left--eviction.
The royal commission on long-term care recognised that this was a very serious position. In paragraph 4.30 of its report the royal commission said that it was aware that "preserved rights" rates of income support
I can only try to bring home to the House just how time critical it is to deal with the outrageous situation that will exist as long as section 43 remains on the statute book unamended. I shall tell the House of the latest constituency case with which I have been dealing.
My constituent is 96 years old. She is a widow. She has multiple infirmities, but she is sound of mind and therefore fully aware of what is going on around her. She has been living in a nursing home in my constituency since 1989--for the past 10 years--and her room there has become her home and her security. She is, by definition, one of the preserved rights cases on whom there is, under section 43, a total block on any financial support from local authority social services departments.
In August, my constituent's daughter and son-in-law came to see me with what for me has become an all too tragically familiar request. They found that the nursing home, faced with increased care costs for my constituent, was no longer able to cover those costs even with the higher rate of income support, and had said that there was no alternative but to have her forcibly removed from the home that she had been occupying for the past 10 years.
I brought the case to the attention of the Secretary of State, who said that there was nothing that he could do. I brought the case to the attention of the Kent director of social services, who took fresh legal advice and confirmed that the position was exactly as I have described it to the House: section 43 is totally inflexible and there are no circumstances in which it is legally possible for local authority social services departments to provide top-up funding, even when the individual concerned is facing eviction. He went on to say that he and all his care team considered that my constituent should remain in her home.
I am sorry to have to tell the House that my constituent's eviction took place yesterday, Wednesday 1 December. She was moved, forcibly, to a cheaper home where she no longer even has a room of her own. Earlier this morning, I rang my constituent's daughter. I wish that the whole House could have heard the conversation, because she could have conveyed the trauma of the situation and its impact on her mother far more eloquently that I possibly could. However, I took down what she said to me as best I could, and these are her words. She said:
I hope that my sense of shame will be shared in all parts of the House. I am sure that no right hon. or hon. Member would want their constituents to face such treatment. I hope also that Ministers will take account of the fact that, while section 43 remained unamended in the four years between it coming into operation on 1 April 1993 and the general election in 1997, it remains unamended today. I hope that that is a matter of the utmost concern to the Secretary of State.
I shall end by making a proposal. I put the proposal forward not as a rhetorical gesture, but with the utmost seriousness and sincerity, believing that it can produce an immediate solution to the problem.
We require an amendment to section 43 that would enable local authority social services departments to provide the necessary top-up funding to prevent an eviction taking place. I suggest to the Secretary of State that the situation calls for emergency legislative treatment, and I propose a short, simple legislative provision. I do not believe that any hon. Member in any part of the House can consider it acceptable that, at the end of this century, frail 96-year-old people are forcibly evicted from their home because the legislation provides no other option.
I have examined the legislation. It could conceivably be amended by secondary legislation but, assuming that that is not possible, the primary legislation required would not be more than two or three clauses. The House is perfectly able to deal quickly with emergency legislation. I am in no doubt that the legislation would receive all-party support. I have no doubt that such a two or three-clause Bill could go through the House in all its stages in a day, and through the other place also in a day. If the political will existed, that amending legislation could be on the statute book by Christmas.
Ms Rachel Squire (Dunfermline, West):
I, and I am sure other right hon. and hon. Members, share the deep sense of shame and disgrace so powerfully expressed by the right hon. Member for Tonbridge and Malling(Sir J. Stanley). We must ask ourselves how our society has reached a point when elderly residents of homes that they have occupied for many years do not seem even to be covered by the United Nations convention on human rights.
Whatever system of funding long-term care is eventually decided on, I hope that we ensure that nothing similar can happen again. In the light of what the right hon. Gentleman told the House, I urge my hon. Friend the Minister to give serious consideration to the urgency of amending the legislation.
On the wider issue, I pay tribute to the royal commission for tackling so ably and effectively the subject of long-term care, and for producing an excellent report. I also pay tribute to the Government for establishing the royal commission so early in their term of office, and for showing a genuine commitment to tackling one of the most complex, sensitive and difficult areas of welfare reform.
I admit that, like many other hon. Members, I had hoped that it would be possible to have a full Government response to the report by now. However, I would much rather the Government took their time and made a full and comprehensive response than rushed to make an inadequate and problematic one. A properly considered resolution, as my right hon. Friend the Secretary of State
said earlier when he outlined his timetable, is certainly in order, especially as we inherited a total mess from the previous Government of 18 years, who seem to have combined the closure of free NHS provision, such as Milesmark hospital in my constituency, with a massive increase in independent sector residential and nursing home care, much of it means-tested.
The previous Government also failed to deliver on community care. In its report to the royal commission, Alzheimer Scotland--Action on Dementia stated:
All of us hope to end our days in our own home, and we as right hon. and hon. Members have a responsibility to do our utmost to make that possible for as many of our constituents as we can. However, our present funding system for long-term care, which combines a false division between health and social care with a lack of an integrated and diverse range of domiciliary services in many parts of the country, pushes people into institutional care. I make no criticism of much residential and nursing home care provision. I have such homes in my constituency which provide a high level of care and a decent life style, but they should not be the only option.
I welcome the Government's actions so far and their efforts to break the mould of institutional care and to promote the possibility of independence in one's own home--for example, the Government's special grant to local authorities of £293 million this year to support independent living at home for older people, and the improvement of services to carers through the allocation of £140 million over three years to fund respite care.
I welcome the announcement today of the publication of the long-term care charter setting out a national framework for improving housing, health and social services to promote independence. Those measures, combined with other Government action, such as the £100 winter fuel allowance, free television licences for over-75-year-olds, and the reduction to a 10p rate of income tax on savings from last April, all make it possible for more people to remain in their homes.
Those steps are all welcome, but we must tackle the crucial issue of who pays and for what when long-term care is needed. I urge the Government to consider carefully the recommendations of the royal commission on the funding of long-term care. That is seen by many of our constituents as one of the most important political decisions that the Government will make.
We have a moral responsibility to provide decency and dignity for the elderly, who are the majority, although not all, of those requiring long-term care. That is especially the case for the present elderly population who endured so much during the first half of the century to give our generation and subsequent generations greater opportunities and a better life style than they have had.
Today's pensioners believe that they deserve state-funded long-term care. They believe that they have paid for it through their taxes and national insurance
contributions. The majority believed that they had a responsibility to work hard, to pay tax and national insurance and to support their families, but they did so believing that, on their death, any savings that they had accumulated or assets that they had acquired could be passed on to their children and grandchildren. They believed that if they ever became ill and in need of full-time care, it would be provided without additional charge.
We are dealing here with a generation who accepted responsibility for their lives and those of their families. Even today, around 1 million do not claim benefits because they see them as charity. However, today's pensioners, certainly in my constituency, feel betrayed--a word that many have used to me, not just the political activists or members of the lobby groups with whom we all come into contact.
It is all very well for us to say that a two-tier system of free NHS care and means-tested social care has existed since Beveridge's reforms. That is true, but the majority of today's pensioners see it differently. Their view is that during their working lives they paid for long-term care in the event of their ever needing it. Until the previous Government, most long-term care was provided free in NHS long-stay beds, but during the past 20 years, thousands of those beds have been eliminated and replaced by means-tested care.
Particularly galling to pensioners who have worked and saved all their lives is that they now have to pay, whereas those with no assets or savings do not. If one of the Government's aims is to encourage people to save more and to make arrangements for an income in their retirement, we must consider carefully whether our eventual decision on long-term care will achieve that.
I urge the Government to recognise and deal with the crucial injustice highlighted by the royal commission that someone diagnosed with cancer receives care free of charge, while someone diagnosed with Alzheimer's disease is required to pay. Any action on long-term care funding must tackle that.
I appreciate that the cost implications are substantial, but for a number of reasons I urge the Government to be cautious in believing that they can offset the costs of long-term care to the state by going down the road of private insurance. First, the private insurance sector is not particularly interested in long-term care in general. It made that clear in its evidence to the royal commission. In the United States of America, that most privatised of care markets, only 5 per cent. of the population is insured against long-term care.
Secondly, I know from my own experience that private insurance companies are basically reluctant to provide any kind of cover to anyone with a blemished health record. Because I had a serious illness a few years ago, I, a Member of Parliament, have been refused insurance by private companies as large as Scottish Widows. It has now been five years since I had major surgery and radiotherapy, which is considered to be a bit of a guarantee that one will be around a bit longer yet, but if I sought long-term care insurance I would be required to pay a thumping price for it, which I would find difficult even on a Member of Parliament's salary, let alone the average family income. As a result, I believe that the private sector would cherry-pick and the state would end up carrying the majority of such costs. We need to take that into account.
"are becoming increasingly inadequate. Many of the people concerned are in increasingly difficult circumstances. As they survive longer, it seems increasingly difficult to justify treating this group of people differently from those who entered the care system on or after 1 April 1993, for whom local authorities meet fees in full, subject to a contribution based on means. Equity demands that they should be treated in the same way. We recommend that the Government should consider whether 'preserved rights' cases should be brought within the post-April 1993 system or whether some other solution can be found to address the shortfall in funding experienced by this group."
Of course I very much welcome the royal commission's recommendation, but its implementation is time critical. I share the disappointment expressed by hon. Members who have already spoken about what the Secretary of State said about his time scale for responding to the royal commission's report and introducing the legislation necessary to give effect to that response. As hon. Members have pointed out, we are promised a White Paper this summer, and, on that basis, we cannot even be sure that legislation will be forthcoming before this Parliament ends.
"The move has been terribly, terribly distressing for my mother. When it was time for me to go, my mother took my arm and said, 'Please don't leave me. Please don't leave me. I want to go home.' To which I could only reply, 'Mother, this is now your home.' It was heartbreaking. I wish you people in Parliament could have been there."
It is a monumental disgrace that there is legislation on the statute book that results in infirm, elderly people who have made their lifetime's contribution to this society, have paid their taxes and national insurance contributions throughout their lives--and, in this generation, helped to see this country through a world war--being offered by the state at the end of their lives only the option of eviction from their home. I am deeply ashamed that such legislation has been passed and has so far remained unamended.
"Figures show that community care has meant a redistribution of places between types of provision within the institutional sector, not an increased provision of the human resources necessary for successful domiciliary long term care."
Part of my anger with the present system is due to the fact that, too often, it does not allow a real choice between long-term care in one's own home and residential or nursing home care. Although I accept that that is not always a realistic option, all too frequently families and individuals have been pressured into accepting some form of institutionalised care.
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