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The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Mid-Worcestershire (Mr. Luff) on securing this debate
I should say at the outset that I am not in a position to respond to the issues concerning the conduct of BT. However, the hon. Gentleman fairly placed his views on the record.
Mr. Such's case highlights the importance of health and social services working effectively in partnership to ensure that disabled people with on-going health and social care needs receive the care and support that they need in a setting that is right for them and their families. The case also illustrates the problems that arise when, for whatever reason, such care is not provided or does not produce the desired results. Health and social services must come together to provide a fully co-ordinated service that deals with the needs of the whole person and the family.
It would be usual in most cases for the disabled person to be cared for in the family home, but a small number of patients have a very limited number of options available to them, often because of their circumstances, their age and where they live. Returning to the family home may not be possible and general residential or nursing home provision for older people may not be suitable for their needs. In such cases, special schemes have to be accessed. Where those do not exist, as in many rural areas such as Evesham, special facilities have to be developed. Some of those cases present particular difficulties for health and social services, and raise significant complexities in relation to housing and benefits policy.
As the hon. Gentleman said, Mr. Such was looked after for a long period by his wife and children in their home, but in the long run that was simply not a sustainable situation, for reasons that the hon. Gentleman clearly set out. I, too, acknowledge, from what I know of the case, the enormous devotion that Mrs. Such has shown during that period. Since that time, Mr. Such has remained in hospital, separated from his wife and family. That is a very disturbing situation. Mr. Such does have special and complex needs, but every effort must be made to resolve the matter as soon as possible.
At the risk of duplication, I want to set out the main events in this sad and complicated story, and some of the difficulties and dilemmas that have frustrated progress. I will then outline the action that may be taken. If there is time, I shall turn to some wider policy measures that the Government are taking, which may assist in this and other cases.
Barrie Such was the unfortunate victim of a tragic accident in January 1993, which left him with substantial and permanent disabilities. Following his discharge from hospital in August 1993, he was cared for at home by his devoted wife, Wendy.
Adaptations were carried out at the family home--that is what would normally happen in such circumstances--but they were not successful. Quite simply, the house is too small to accommodate all the equipment that Mr. Such needs and to allow the rest of the family to have normal access to facilities such as the kitchen and bathroom. As the hon. Gentleman said, plans to extend the property fell through at the last moment.
Mrs. Such bravely continued to care for her husband in those circumstances for four and a half years, with the help of only the district nurse and a home carer who was provided by social services. That was not a sustainable arrangement, and eventually Mr. Such was admitted to a nursing home for a period of respite.
It was clear by then that Mrs. Such would need substantially more help, as well as more suitable accommodation, if she were to be able to resume looking after her husband. The nursing home, which catered for older people, could not provide the special care that Mr. Such needed. I acknowledge that his health deteriorated. He moved to the Evesham community hospital in November 1998.
As the hon. Gentleman said, this is an unsatisfactory story, but one in which he has not been able to identify a principal villain. I have been assured that the professional staff who are working directly with Mr. and Mrs. Such have rightly been committed to finding a solution that will ensure that Mr. Such's complex physical, social and emotional needs can be fully and safely met, but they have been frustrated by a number of complications and dilemmas. The result has been delay in making arrangements for the long-term care of the hon. Gentleman's constituent. Mr. Such is still in a community hospital, which was originally intended as a temporary arrangement and is an inappropriate setting for his long-term needs.
I do not want to minimise the problems that have arisen as a result of the failure to resolve the situation. Mr. and Mrs. Such have had to continue to live apart. They have also had to live with the uncertainty and worry caused by the lack of any real progress.
Various options have been considered during the past two years, including placement in extra-care sheltered housing and in a local nursing home. It took time to explore those facilities, but in the end neither option was considered suitable because each is geared mainly to the needs of older people and could not provide a stimulating environment for a younger disabled person.
I understand that general agreement has been reached among all the agencies involved in Mr. Such's care that the most appropriate environment for him is with his family in a suitably adapted house, where a 24-hour package of care can be provided by health and social services. Two main issues arise from that plan. First, suitable accommodation must be identified. Secondly, a care package must be set up and funded. Health, social services and housing agencies in Worcestershire all have an important part to play in implementing the plan.
Mr. and Mrs. Such naturally want to continue to live in their village in Worcestershire. They want to live together, in a property that is large enough to accommodate them, their three children and a personal care assistant for Mr. Such. Their own home is not viable, but there is a shortage of suitable alternative properties in the area. I understand that Mr. and Mrs. Such have found a property which they might wish to purchase. Wychavon district council has prepared a scheme in outline. A surveyor will shortly carry out a thorough feasibility study on the property, but I must make it clear that it is not yet known whether the property will prove suitable.
If it is possible to proceed with that property, the costs of conversion will be considerable. Some of the cost could be covered by a disabled facilities grant and by the sum
An application has been made to a local charity for funding. The county social services department has indicated that it would consider what powers it has to assist under the Chronically Sick and Disabled Persons Act 1970. It is important that the housing and social services departments work together to provide the right solution for Mr. and Mrs. Such.
I understand, although I know that this is not the preferred option, that Wychavon district council is exploring the possibility of rent or full purchase in conjunction with Evesham and Pershore housing association. In some cases, clients may find arrangements with a housing association a better and less costly option than having to convert their own home. It is important that whatever home is found for the family, the solution does not, as far as possible, disadvantage Mr. and Mrs. Such financially.
Turning to the care arrangements, it is clear that if Mr. Such is to enjoy a reasonable quality of life at home in the community, he will need an extensive package of health and social care, as well as housing. Mr. Such will also need a round-the-clock team of trained personal care assistants to meet his basic health and social care needs, along with qualified inputs from the primary health care team, local therapy services and various aspects of social day provision. It is important to consider the views and wishes of Mrs. Such as the main carer, in making decisions about the detail of the care plan.
The health authority and social services department in Worcestershire were initially unable to agree about the assessment of Mr. Such's continuing care needs. The arbitration procedure under the continuing care agreement was invoked but the matter was not resolved. I understand that health and social services have now agreed jointly to fund a package of care. The NHS will provide the health care components of the package and Worcestershire county council will make arrangements for the social care elements. A specialist nursing agency has been identified which could provide the necessary care. The care arrangements and the necessary funding could be put in place almost immediately. The building or refurbishing of a property to accommodate Mr. Such with his family would clearly take some time.
To sum up, Mr. Such was looked after by his wife for almost five years with a relatively modest amount of support. That arrangement--inevitably, I think--broke down and it is now clear that a much more substantial package of care is required. That can only be achieved by agreement between the three key agencies--health, housing and social services--to find suitable accommodation and to put in place the care package. Some progress has now been made in clarifying the funding arrangements for personal care. The fundamental problem is accommodation. It is vital to make progress on that issue, so that Mr. Such does not remain in hospital for any longer than is necessary.
I have asked my officials from the NHS executive regional office and social services inspectorate to meet with representatives of Worcestershire health authority and social services department as soon as possible to facilitate a rapid resolution of the matter. My officials will establish with the authorities whether all options for meeting the capital costs of new accommodation for the family have been explored. They will also monitor the implementation of the care plan and the funding agreements that have been made. I have also asked my officials to ascertain whether there are any similar cases involving younger disabled people in Worcestershire and, if necessary, to investigate the circumstances in those cases. I again acknowledge that the hon. Gentleman has said, fairly and rightly, that there are no villains in the case. None the less, I am anxious to ensure that lessons are learned from the handling of the Worcestershire case.
I have said that health and social services in Worcestershire must work together to move forward the care plan for Mr. Such. That will require close co-operation with the agencies in the area. I shall now outline some of the measures that the Government have introduced to bring about significant improvements in the provision of health and social care services.