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Mrs. Humble: Will the hon. Lady comment on that part of the royal commission report that deals with insurance? It points out that women are more likely to be in residential care for longer, but that they also earn the least. Therefore, the people with the least to pay would have to contribute to a system, but the insurance companies would have to pay out the largest sums for them.
Miss Kirkbride: The hon. Lady ignores the fact that many working women participate in the work force, and their number is increasing. Not everyone will be able to save, and there will always be a safety net. However, the primary political concern at the moment is for those who have saved all their lives and now have to sell their homes to pay for their long-term care.
Two issues have already been set out. On the one hand, it is difficult to say that such people should not contribute to their long-term care needs if they leave an inheritance to their children and benefit from other people's tax bills. On the other hand, if we can offer those people an insurance scheme, a portion of which is guaranteed by the state--that is similar to the proposals that we made before the previous election--we can share the provision of the care that people reasonably expect now that standards of living are improving.
Like the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who fears that some of the care homes in his constituency may need to close, I make a plea for care homes in my constituency because I fear that Worcestershire is facing a serious situation. Historically, Worcestershire gets a poor settlement from the standard spending assessment, and that has not been addressed by the Government's reforms of the SSA. Last year, our social services budget was cut by £5 million. Nevertheless, the county council was able to offer care homes a funding increase of 3 per cent.
My right hon. Friend the Member for Tonbridge and Malling (Sir J. Stanley) mentioned the huge problem of preserved rights. That keeps people in long-term care homes on a low amount of money, which means that, in most cases, others subsidise their stay, although sadly that is not true in the case of my right hon. Friend's constituent. The amount of money that is available for long-term care needs is a growing problem.
The Government's programme to improve employment rights, such as the minimum wage, is part of that problem. The Government's own figures suggest that the minimum wage costs industry as a whole some £8 billion. The working time directive, which will significantly affect care homes, costs around £6.5 billion. It is estimated that the cost of running a care home has increased by some 9 per cent. over the past year. Yet, as I said, care homes in Worcestershire have received only a 3 per cent. increase in funding. We do not know what the increase will be this year, but it will clearly affect care homes a great deal because it is very unlikely that any increase will match the costs brought about by the Government's legislation for improved employment conditions.
We are talking about not only jobs but the closure of people's homes. Many will have been used to living in a care home for several years. I therefore appeal to the Minister to consider that matter along with the proposals, however welcome, that people going into homes should be assessed according to national requirements. I appeal to him also to consider what impact the proposals will have on various counties, particularly Worcestershire, and how they will be financed in counties that, like mine, have historically received a low SSA.
I draw attention to the "Fit for the Future?" proposals, mentioned by the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), which are causing great concern in my constituency. My hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) put forward the very valuable proposal that we should be increasing the amount of money available for those nursing homes that make improvements, rather than trying to penalise those that cannot improve because of strict financing requirements and low funds.
Mr. Desmond Browne (Kilmarnock and Loudoun):
As I have listened to the debate, I have collected a whole sheaf of paper containing comments that I hoped to make in response to contributions by other hon. Members. They will understand, however, that as time is short, I will cut to the chase.
I hope that hon. Members will excuse me for taking the opportunity to speak in support of the call by my hon. Friend the Member for Dunfermline, West (Ms Squire) for the same rules to be applied throughout the United Kingdom in the determination of which services will be free and which will be means-tested, and how the means test will operate. If I understood my right hon. Friend the Secretary of State, he said in his introductory remarks that he was aiming to achieve consistency throughout the UK, and perhaps when replying my hon. Friend the Minister of State will address that issue.
We are reaching the end of a century that has been rich in advances for older people, from the introduction of the old age pension in the early years of the century, through the advances made by the Labour Government in 1945 in implementing the Beveridge report and introducing the national health service, to the present, where the issue is how we provide for those who, through improved nutrition, a better standard of living, better health services and so on, are living longer.
As my right hon. Friend the Secretary of State said in his introductory speech, we should see that not as a problem, but as a success story. The aspiration of every Labour Government has been to reduce poverty, improve living standards and improve health. The task that we now face is to manage the consequences of that success.
The challenge to us is to ensure that we put in place arrangements that continue to fulfil our aspirations to promote social justice and social welfare. We need to put
arrangements in place that will enable our older people to remain part of the local community, with clear rights to services to meet their reasonable expectations. Clearly, because of the legacy of the previous Government, we are not getting that right at present.
Sir Stewart Sutherland and his committee thought not, and others agree with him. In a memorable quotation, Professor Alan Walker said that care services for older people put in place since the formation of the NHS and national assistance have been
Echoing the words of the Audit Commission, the Sutherland commission stated in its executive summary:
What the Government asked Sir Stewart Sutherland to examine is not a picture with which we should be comfortable. In each of our constituencies, there are older people who want to remain at home, but cannot do so because the services are unavailable. In each of our constituencies, older people assessed as requiring intensive 24-hour support cannot be admitted to an establishment because the funds are unavailable. In each of our constituencies, carers are placed under extreme pressure over many years because support services are unavailable.
How did we get into such a situation? To understand that, we must examine the funding of community care in the past. In the 1980s, it became the norm for older people who had become more dependent to be admitted to institutional care. That was a pattern quite different from previously, and in some ways we are still dealing with the legacy of that change.
To some extent, it is still the expectation of individuals and families that care in an institution is the inevitable consequence of increasing dependency among older people. That is not necessarily their wish, but their expectation, because that is what they have been conditioned to expect since the 1980s.
I shall digress for a few minutes to instruct the House that that is not a new idea. As I was preparing for the debate, I was reminded of a Para Handy tale. As some hon. Members may know, the great Para Handy tales were written by Neil Munro at the turn of the century, at just about the same time as pensions were being introduced. They are a wonderful set of short stories about the Vital Spark, the puffer that plied its trade up and down the Clyde crewed by Para Handy the captain, the chief engineer, and Dougie, the boy.
Tale No. 27 is entitled "Pension Farms". It was written in 1906. Let me set the scene for the House:
When, in the 1980s, the Audit Commission urged the Government to action, it did so because it had found two things about those pensioner ferms that were growing up. First, the uncapped budget for nursing home and residential places was out of control and far beyond any financial projection provided to the Treasury. Secondly, it was becoming normal for older people to be placed in residential and nursing homes because funds were available for such placements but not for services at home. The Audit Commission called that--a phrase that we have already heard today--the "perverse disincentive" to care at home.
"50 years of broken promises".
When the Audit Commission examined community care in 1984, its report concluded that
"the only option that is unavailable is doing nothing",
and as the hon. Member for Sutton and Cheam (Mr. Burstow) said, the status quo is not an option. That should be our watchword, and indeed it is.
"The Commission conclude that doing nothing with respect to the current system is not an option."
There we have three ways of saying the same thing.
"The Vital Spark was making for Lochgoilhead, Dougie at the wheel, and the Captain straddled on a waterbreaker, humming Gaelic songs, because he felt magnificent after his weekly shave."
As they were looking over what they call the Glasgow promontory, Macphail was musing that there was a hen farm at the end of the promontory, and he had always
wanted a hen farm. Para Handy told Macphail that he did not want one of those; what he wanted was a pension farm. The tale continues:
"'Rearin pensioners?' remarked Macphail, 'ye would lie oot o' your money a lang while rearin pensioners; ye micht as weel start growin' trees.'
So, this was nothing new.
'Not at aal, not at aal!' said Para Handy, 'there's quick returns in pensioners if you put your mind to the thing and use a little caation. Up in the Islands, now, the folks iss givin' up their crofts and makin' a kind o' ferm o' their aged relations.
I have a cousin yonder oot in Gigha wi' a stock o' five fine healthy uncles--no' a man o'them under seventy. There's another frien' o' my own in Mull wi' thirteen heid o'chenuine old Macleans. He gaithered them aboot the islands wi' a boat whenever the rumours o' the pensions started. Their frien's had no idea what he wanted wi' them, and were glad to get them off their hands. 'It's chust a notion that I took,' he said, 'for company; they're great amusement on a winter night,' and he got his pick o' the best o' them. It wassna every wan he would take; they must be all Macleans, for the Mull Macleans never die till they're centurions, and he wouldna take a man that wass over five and seventy. They're yonder, noo, in Loch Scridain, kept like fightin' cocks; he puts them ott on the hill each day for exercise, and if wan o' them takes a cough they dry his clothes and give him something from a bottle.
'Holy smoke!' said Dougie, 'where's the profits comin' from?'
'From the Government' said Para Handy. 'Nothing simpler! He gets five shillings a heid in the week for them, and that's £169 in the year for the whole thirteen--enough to feed a regiment! Wan pensioner maybe wadna pay you, but if you have a herd like my frien' in Mull, there's money in it.'"
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