Mr. Michael Ancram (Devizes): I am grateful for the chance to raise the subject of the deeply worrying bed blocking crisis in Wiltshire. As a phrase, bed blocking sounds dull, but its impact is anything but dull. Every bed blocked in a hospital means an operation postponed or a treatment delayed, and that is often multiplied many times during the period for which the bed is blocked. In human terms, bed blocking is a cause of fear, apprehension and often suffering. For the individuals affected, it makes nonsense of the Government's aspirations to cut hospital waiting lists. It would be a blot on the Government's record of health provision in Wiltshire even if it were unavoidable. The fact that it is avoidable means that there must be strong criticism and demands for urgent action to rectify it.
It is difficult to be certain of the total number of beds genuinely blocked in Wiltshire hospitals. Bed blocking can occur for various reasons, some easier to ascertain than others. Currently, 68 hospital beds are blocked in Wiltshire for lack of Wiltshire county council funding for residential or nursing home placements. That is a lot of beds, and the knock-on effect of 68 beds being blocked is exponentially serious.
Bed blocking is not a logistical or supply problem about beds; it is about people who cannot get into hospital when they need to, and people who are held in hospital when they do not need to be because there is nowhere else for them to go. Bed blocking is a major human problem. However, it comes at the end and as a consequence of a long row of other problems. If solutions are to be found, they have to be found right along that row.
The figure of 68 beds blocked follows hard on the heels of the county council's purchase of 54 additional residential placements with special funding made available by the Government through the Wiltshire health authority. Such is the nature of the problem that the much-needed assistance has proved a temporary sticking plaster rather than a cure.
The problem is not in the hospitals themselves, but in the Wiltshire county council social services budget. Its cause is simply that, in terms of Government financial support, Wiltshire is being underfunded and unfairly treated. The purpose of this debate is to seek from the Government short-term measures to meet the current crisis and long-term measures to prevent it from recurring.
All that my colleagues and I ask for is fairness, fair shares and an even playing field. The reason for raising the matter today is that the current situation in Wiltshire is totally unacceptable and is getting worse. Bed blocking in Wiltshire is a problem that need not occur,
At the moment the funding is not fair, as I will seek to show, and the result is socially unacceptable, economically nonsensical and politically offensive. It is politically offensive because people in Wiltshire see Government resources apparently being skewed away from rural areas to more Government-friendly urban authorities. It is socially unacceptable because of the stress and pressure that it creates for people whose families are involved on both sides of the blocked bed--those awaiting hospital treatment and those awaiting placement elsewhere. It is economically nonsensical because the cost of blocked hospital beds is far greater than the cost of the placement beds that currently cannot be funded.
I shall give some examples. The cost of a hospital bed is about £1,100 a week, which contrasts with the net cost to the county council of less than £250 a week per nursing home bed and less than £150 a week for a residential care home bed. Delayed hospital discharges are therefore nonsensical economics. As well as being bad for disabled and older people, that is bad for the health service in meeting its Government targets and serving the local population.
The cost of placing 68 mainly older people in residential or nursing placements is £719,785 a year. The cost of 68 hospital beds for the same people at £1,100 a week is, by my calculation, almost £4 million. The chain of causation is relatively simple. Beds are blocked because the county cannot afford to fund placements for those currently occupying the beds. They cannot fund placements because the funds are not there, and the funds are not there because Wiltshire is underfunded by the Government. The solution is to get the funding right to meet the particular needs of Wiltshire, which exacerbate the problem. I shall set out in reasonably simple terms what is wrong, and then suggest what could be done to rectify the situation.
Wiltshire county council currently spends 18 per cent. more on social services than the Government, through their standard spending assessment calculations, think necessary. At the same time, the SSA allocated to Wiltshire for social services is the ninth lowest of all social services SSAs in England. Next year, Wiltshire social services SSA per head of population is only £128 compared with the shire counties average of £148, which is £20 more, and the national average of £178, which is £50 more. If Wiltshire had the same SSA as the shire counties average, it would have £8.4 million more for social services. On the figures that I have given, it is not difficult to see that that money would go a long way towards resolving the problem.
Wiltshire social services SSA for next year increased by only 2.4 per cent. With Wiltshire social services overspending by £1.5 million this year--that is 2.3 per cent.--and that overspend being rolled forward into next year, even with an increase of £1.5 million in social services specific grants for Wiltshire social services next year, the SSA specific grant total will only balance this year's overspend. That does not allow for inflation or for the increasing number of elderly and disabled people who will need its services next year. Rationing of services and delayed hospital discharges will increase next year under the current provision.
A major difficulty for the county is that the Government take little or no account of the three cost factors that impinge on social services in Wiltshire. Those cost factors may have a separate impact on some other authorities, but in Wiltshire they cluster, so they to have a major and unique impact. First, Wiltshire is an area of high employment with high employment costs, which reflects its location along the high-tech M4 corridor and the outer London commuter employment belt. Neighbouring authorities, such as Hampshire and Oxfordshire, receive an area cost adjustment weighting of 6 per cent., which is denied to Wiltshire county council. Allocating more to other authorities through the area cost adjustment next year has cost Wiltshire social services £0.3 million against the SSA increase that it would otherwise have received. That adds insult to injury.
The Government are inconsistent in their stance on the area cost adjustment, as health services in Wiltshire are being allocated additional finance to take account of higher employment costs in Wiltshire. Perhaps the Minister will explain that inconsistency.
Secondly, Wiltshire serves a large, rural and sparsely populated area. The higher costs of providing services in large rural areas are not adequately recognised by the Government. For example, detailed calculations undertaken in the county council in 1997 showed that a team of social workers and occupational therapists assisting disabled and older people had higher costs than a team covering an urban area with the same population.
In sparsely populated rural areas, smaller service units must be established to ensure that services remain locally accessible to the local rural population, but smaller service units usually have higher costs. For example, the 31 beds in a residential care home in a village in a largely rural area had a cost per bed per week of £333 in 1999. A residential care home with 57 beds in a large town had a weekly bed cost of £232, which is more than £100 less per week. That pattern of differential unit costs was found to be consistent across 19 residential care homes of between 30 and 57 beds within the county council area. However, the higher costs of providing social services in rural areas are not recognised by the Government. Instead, it is the urban areas that get higher levels of funding.
Thirdly, Wiltshire is distinctive in having one of the largest military populations in the United Kingdom. The higher demand that that generates for social services for children and families was identified by the joint review undertaken by the Audit Commission and the Department of Health inspection of social services in Wiltshire. The report stated that
The foregoing points to the nature of the problems that give rise to blocked beds. Ultimately, it all comes down to a lack of adequate or fair funding to enable Wiltshire to meet the genuine shortfall against need in its social services budget. It does not help for Wiltshire to raid other constrained budgets to try to meet some of the shortfall. That would merely shift the hardship, not solve the problem, and it would exacerbate the sense of unfairness. We need to look for genuine solutions. We believe that they could be available if only the Government would consider them favourably.
In the medium term, the Government's funding formulae should recognise the higher costs of providing services in rural areas, the applicability of the area cost adjustment to Wiltshire and Swindon, and the costs of providing civilian services to the garrison towns, especially with the further increase of military personnel in Wiltshire that is now envisaged. More immediately, the Government could make additional funding available to social services, either directly or through the NHS, to allow all delayed hospital discharges to be tackled. They could increase the specific grants for social services for community care next year to prevent hospital-delayed discharges continuing in 2001-02. They could make a specific grant available for social services for next year to cover the costs being passed to social services that will result from the Government's response to the royal commission on long-term care. It is estimated that those costs for Wiltshire will be more than £300,000. The Government should consider those suggestions carefully.
I began by criticising the Government over central funding. I have long suspected that they do not understand rural England or the special needs of a rural county such as Wiltshire. Thus, they do not understand the hardship that they are creating in such counties. I am happy to be proved wrong this morning. I have explained what the Government could do at once and in the medium term to prove me wrong. I live in hope that the Minister, who has my gratitude for listening so attentively, will understand the depth of feeling in the county about its cruelly unfair and inadequate funding. I hope that she will bring relief to my constituents and my Wiltshire colleagues by accepting our suggested solutions.
Ms Julia Drown (South Swindon): I congratulate the right hon. Member for Devizes (Mr. Ancram) on securing the debate. The issue is important and I am glad of the opportunity to contribute, and to put the case from the Swindon end of Wiltshire.
The right hon. Gentleman claimed that the problem arises from a failure to understand rural areas and from the Government's focus on urban areas. That is not correct. The Public Accounts Committee has examined what is happening all over the country. Its report entitled "Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals", which was published this month, showed that difficulties such as those we are considering happen throughout the country, and there is no distinction between urban or rural areas. The problem arises in both the urban and the rural parts of my constituency of South Swindon.
Mr. James Gray (North Wiltshire): I am interested to hear the hon. Lady accept that there is a health service crisis in this context in both urban and rural areas. That is our point. However, my right hon. Friend's argument was that it arises from the standard spending assessment--which is a social services matter and does not relate to the health service. Wiltshire county council is much worse funded than Swindon borough council, for example.
Ms Drown : First, I have not said that the NHS is in crisis across the country. A huge majority of people--I hope that that proportion is reflected in the hon. Gentleman's postbag as it is in mine--receive a fantastic service from the health service. Problems exist and no doubt every day very difficult decisions are taken. However, we should not unnecessarily raise the fears of our constituents, most of whom receive wonderful service.
The hon. Gentleman is right to point out that there are problems with the standard spending assessment. They have existed for many years, under Conservative Administrations as well as under the present Government, who inherited them. However, the present Administration is studying the problem, and I shall deal with that issue later.
It is always difficult for Labour Members to listen to Conservatives talking about insufficient funding of services, because it is those same Opposition Members who say that the Government's spending plans are reckless. We hear that the priority should not be public services but tax cuts. Those two sides of the coin are not consistent. Supporting public services and calling for increased funding--I agree with that for health and social services--means supporting the Chancellor of the Exchequer when he announces increased spending aimed at improving services for our constituents.
Mr. Robert Key (Salisbury): The problem with that argument is that the Government are not spending enough money on services in Wiltshire. That is precisely the point. They tell us in Parliament that they are
Ms Drown : If the hon. Gentleman examines the figures, he will see that social services expenditure in the standard spending assessment has increased year on year. I support him in saying that we should spend more on social services across the country, but he cannot deny that, year on year, more money has been spent on the health service and on social services. Over the next three years, the health service will receive the biggest ever increase in investment from the Government.
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart) : My hon. Friend may be aware that Wiltshire county council's overall standard spending assessment has not just increased, it is above the national average. Similarly, the council's personal social services spending allocation is above the national average. That might support her case.
Ms Drown : I thank my hon. Friend for that information. I want to talk about the title of the debate. Language is important, and the term bed blocking is unfortunate, because it makes it sound as if the person occupying the bed is somehow responsible for the problem, when he or she is not. As the right hon. Member for Devizes said, that person wants to be somewhere else: either in a nursing home or cared for at home. It would be more helpful if we were to use the term "delayed discharges" instead. That term implies that the person in hospital is suffering from the problem just as much as the wider community.
The main hospital in Wiltshire is the Princess Margaret hospital, which is in my constituency. There are roughly 30 patients there and in intermediate care beds around the town who are waiting for social services funding from Swindon borough council. That is not a new phenomenon, but it is nevertheless important, and must be dealt with. I was pleased that the Public Accounts Committee report stated that the NHS was encouraging good practice on the issue, both through targeted funding and by pushing the Government's aim of reducing delays in discharge by 30 per cent. by 2003. Clearly, the Government are trying to ensure that there are improvements in that sector.
We need to recognise that much work on this issue is being done on the ground by hospitals, health authorities and social services departments. There has been an improvement in services and relations between those bodies, and I hope that the Minister and all hon. Members present will join me in congratulating the staff of those hospitals, health authorities and social services departments on the good work that they are doing to combat the problem. They are improving the way in which they collate information about patients, and they are having weekly or daily meetings, where necessary, to ensure that they are addressing the needs of individual patients. The trusts and the local health authorities have worked together to minimise delays and to find areas in which services could be improved.
Ms Drown : I am certainly not saying that there is no such problem. I began by saying that there was a significant problem. At the moment, there are roughly 30 patients whose discharge has been delayed. However, it would be wrong not to recognise the huge amount of work that is going on locally to try to deal with the problem. For example, there have been particular pressures at winter time. I was delighted by the programme of work that the local hospital put together to tackle those difficulties. It was not simply a matter of trying to set up more beds and get more nurses and doctors, it involved all the skills of the wider NHS team. More therapists were brought in so that people could be rehabilitated more quickly and go home. Laboratory staff came in to work extra time so that tests could come through more quickly and people could be seen more quickly. A group of staff was charged with preventing unnecessary admissions. All that work is important and it is worth congratulating those concerned.
I am also pleased that Swindon borough council, with the health authority, has recently agreed to fund an additional 14 placements, which will relieve the pressure. That has not been easy because, despite an increase in the SSA and the budget in excess of inflation, which is much appreciated, both local authority and health authority funds are tight in Swindon and money has been taken out of reserves. Those reserves, which were already low, are even lower, but significant sums have been found to support people.
To return to the point about rural and urban areas, the right hon. Member for Devizes said that Wiltshire social services has already been given an additional grant this year to try to alleviate the problem. Wiltshire is more rural than Swindon, which has not received the same grant. There has been Government action in Wiltshire, and Swindon would appreciate a similar grant because of its particular difficulties.
Mr. Gray : I want to correct a slight misinterpretation which the Minister may have made of the figures for SSAs in Wiltshire. Social services SSA for the county of Wiltshire is £128 per head. The shire county average is £148 per head, and the national average is £178 per head. Wiltshire county council social services SSA is £50 per head less than the national average. The Minister's interpretation of the figures does not bear detailed examination.
Ms Drown : Those remarks may have been better addressed to the Minister, but I shall comment on them. There is an issue with SSAs. The existing formula could be improved, and I am pleased that the Government have agreed to examine that. As responsible Members of Parliament, we cannot say that every local authority in the country should receive the same amount per person because needs vary. Our own constituencies include areas of higher and lower need, and that should be reflected in the services provided in those areas. Such issues are written large throughout the country. We know that there is a link between health and poverty, and that poverty leads to poor health. Those of us in
The hon. Member for North Wiltshire (Mr. Gray) is trying to make a political point from a sedentary position. He is being irresponsible in not recognising that we all have a responsibility for the wider country. Members of Parliament who represent relatively prosperous areas must accept that sometimes it is not fair to claim the same amount of Government money, pound for pound, as areas with five times more unemployment and five times more poverty. Where there is poverty and ill health, the problem must be addressed, and it would be wrong for responsible Members of Parliament selfishly to press for more and cause more ill health and poverty elsewhere. I hope that the hon. Gentleman, as a responsible member of a political party, accepts that.
Mr. Gray : I apologise, Madam Deputy Speaker, for making an intervention from a sedentary position, and I shall now make it standing up. My point was that I stand here as the Member of Parliament for North Wiltshire and I shall argue the case for North Wiltshire. I shall argue the case for Wiltshire to have the same funding as the rest of the country, and even to have more funding if possible. I do not stand here as a Minister. The hon. Lady is a Back Bencher and should be arguing for the same funding for the people of Swindon as for the rest of the country. I am amazed to hear her accept that Swindon should be less well-funded than elsewhere. That will be well noted by her constituents.
Ms Drown : I thank the hon. Gentleman for his statement. If I were him, I would question my conscience. If I were a member of the Conservative party, I would question whether he should ever be in a position of responsibility. We have a duty to consider the big issues. The logical conclusion of his argument is that no money should go to overseas aid, for example, because that would take away money from his constituents. Such an argument is morally reprehensible. Of course, I will argue for the best for my constituents, but I will always take into account the wider needs of the country and of the world because that is what we, as responsible politicians, must do. I hope that the hon. Gentleman will share that aim.
Swindon has enjoyed relatively generous settlements under the Government--indeed, much more generous that under the previous Conservative Administration. Our social services standard spending assessment for 2000-01 has risen by 22 per cent. compared with 1997-98, and it is interesting to look at the figures for Wiltshire. Like Wiltshire, Swindon's spending is 18 per cent. above SSA, which demonstrates the pressure on services. However, although the settlements are generous they have not kept up with demographic changes. Swindon's population, including the number of elderly people, is growing rapidly, which puts extra pressure on services. Moreover, we start from a very low base. For the first two years, we had the lowest council tax of any unitary authority in England, which was due to our national inheritance from the previous Conservative Government. Moreover, Wiltshire county
The same debate about rural and urban areas has taken place in respect of education, and an effective cross-party group--the F40 group--has considered SSAs. We recognise that the Government have tried to address the problems associated with SSAs. The most recent settlement introduced a policy of funding floors, which we should all welcome, because it will help authorities that are lagging behind by ensuring that they catch up with average funding levels. However, we must ask the Government to go further. In particular, we must consider partnership grants to support work on the ground in our constituencies. Reference was also made to the area cost adjustment, and it is true that that has not helped. As a result, Swindon has lost £655,000, while other authorities with similar costs have gained by such funding.
We should also reflect on the pressure on the Princess Margaret hospital, which has undoubtedly led to specific and occasionally severe problems. My constituents often tell me that there are not enough acute beds in the new hospital, which is being built thanks to this Administration. However, because of delayed discharges, as many as 16 per cent. of acute beds are not being used effectively. If we can overcome that problem and demonstrate that there are sufficient acute beds, we can concentrate instead on other services, such as home care and intermediate care, so that our constituents can have the best, most appropriate services. I am pleased to say that a recent planning application has been made for an additional 60 intermediate beds, which would greatly help in addressing this problem.
As the right hon. Member for Devizes pointed out, solving the problem of delayed discharges would mean better economics for the public purse and better health. Those who have been discharged from acute wards are less likely to get infections. Moreover, there would be a huge psychological impact on patients. In Swindon, an excellent scheme involving purchasing beds in one of our residential homes--Langton house in Wroughton--has had an amazing impact on the people who have been discharged. The doctors and nurses who discharged them from the acute hospital thought that they might not be ready to go home for eight to 12 weeks, but, simply because they moved from hospital to a less acute setting, they got better much more quickly than anyone expected. That is partly due to the psychological impact--people tend to think, "I'm out of hospital, so I must be getting better." Such schemes can really help people's health.
The Government may say that Wiltshire and Swindon have sufficient funding and should be delivering as well as the best across the country. I would respond that if that is so, in what specific respects can we do better? In some cases we can say, "X or Y should have been done," but that probably happens everywhere. I know that the Government are working on best practice across the country, but it would be helpful if we could pass such information back to the people who are working in our constituencies to try to deliver the best that they can for patients. I recognise the hard work that is being done in Swindon and congratulate those who are doing it.
The Government are working to encourage partnerships and to spread best practice. When I was first elected in 1997, the trusts were not communicating and the health authority and social services were not talking the same language--both were defending their own budgets and territories. Now, when I meet them, it is clear that they recognise that they have a shared problem that they are tackling together. That is a huge step forward.
I want to see much more funding for social services, so that we can return to the old-fashioned home help service, which is a good, preventive service. At the moment, we have only the more intensive home care service.
I appeal to the Government to consider increasing partnership grants. That would reward the good partnership work that is taking place and recognise the fact that together the staff are doing all that they can to deliver the best possible care for local people.
Mr. James Gray (North Wiltshire): It is a pleasure, I think, to follow the hon. Member for South Swindon (Ms Drown), although I have to say that I am slightly puzzled by one or two elements of her speech. At one moment she argued that there was a crisis in her local hospital, Princess Margaret hospital in Swindon, and at the next that there was no such crisis and everything was fine. At one moment she argued that social services spending in Swindon and by Wiltshire county council was sufficient, and at the next moment that it should be more. At one moment she argued that it was reasonable that we should rank significantly below the national average for social services spending--because that allows us to spend money on overseas development, for example--but at the next that it is important that we should be spending the same. I fear that some of her speech gave out mixed messages.
I congratulate my right hon. Friend the Member for Devizes (Mr. Ancram) on securing the debate. We entitled it "The bed blocking crisis in Wiltshire" advisedly. This is not a small matter, to be discussed in passing, that might justify a quick local press release, but a significant crisis in our constituencies. That is why my right hon. Friend, who is chairman of the Conservative party and has several other duties to perform, has none the less chosen to give up an hour and a half of his time, plus the time spent in preparing his speech, to come to the Chamber--as have other hon. Friends from the county and, indeed, hon. Members from other parties.
I should like to touch on several aspects of the crisis. As my right hon. Friend said, about 68 beds in the county are blocked, and that has various consequences. It is only the tip of the iceberg, because we believe that about 60 more people are at home and awaiting assessment. They need to be admitted to Cameron ward in Chippenham hospital because, sadly, they have dementia or similar diseases associated with the elderly. They desperately need admission to the ward, but they cannot even obtain an assessment on whether they are suitable for that placement.
There is hidden bed blocking throughout the county and people from other counties, particularly Gloucestershire, are seeking places in Malmesbury and Chippenham hospitals in my constituency but cannot get them. The bed blocking crisis is in fact greater than the figure of 68 that we heard on 19 January, when the most recent census was taken, but I shall focus on that figure.
There is a crisis in local hospitals. It was interesting to hear the hon. Member for South Swindon refer to the Princess Margaret hospital. She referred to it as a Labour achievement, but it was a product of the private finance initiative, which was invented by the Conservatives. The hospital was created and planned by the Conservative Government, although she was right in as much as the new Secretary of State laid the foundation stone, turned up to open it and signed the deal for the PFI. The PFI itself, however, was a Thatcherite invention. The Labour party voted against the whole notion of the PFI for hospitals and was totally and utterly opposed to it for years. When it came to power, it decided to use that Thatcherite invention to build the Princess Margaret hospital in Swindon, among others. I do not accept that it is an achievement of this Government.
The hon. Lady seems to think that everything is fine and has stated that there is no crisis in the national health service. I fear that the Western Daily Press does not agree with her. It stated on 25 January, under the blaring headline "Hospital facing new beds crisis", that the hospital
Will the hon. Gentleman admit that, under the Conservative Administration, the health service was also regularly in crisis--to use his description? If he read the same reports on delayed discharges in hospitals
Mr. Gray : I am grateful for the hon. Lady's clarification. She used the word "also" and said that the crisis under the previous Administration was as bad as the one today, thus admitting that there is a crisis today. Whether the crisis five years ago was the same, better or worse than today's is academic, and I was not a Member of Parliament at the time, but it is clear that she accepts the general point that there is indeed a crisis in local hospitals. To confirm that, on 25 January the excellent Western Daily Press printed another stark headline, "Surgery delayed for 3,000 people by bed blocking". There is indeed a crisis in the national health service in Wiltshire, and I am sorry that she will not openly accept that.
Mrs. Caroline Spelman (Meriden): Does my hon. Friend accept that one of the principal causes of bed blocking is the uncertainty that has arisen as a result of the Government's "Fit for the Future?" regulations? They are a major contributory factor to the closure of nursing home beds.
Mr. Gray : My hon. Friend is right. "Fit for the Future?" may be the result of sensible aims, but it has created an even greater crisis in long-term care. I have mentioned the Princess Margaret hospital and the Cameron ward in Chippenham hospital in my constituency. I am worried about the number of people who are there unnecessarily. The same applies in Malmesbury hospital, where several of my constituents have been affected by the closure of the long-term care home in Minety, one of the three long-term care homes that have closed recently in Wiltshire. Those people are stuck in Malmesbury hospital and are costing the nation a fortune. It is a problem for the hospital, as it is for those who have to stay in a ward where they do not want to be. It is inappropriate that they are there, but they have to be because of the crisis.
My hon. Friend referred to private homes. It is extremely worrying that a large number of first-class private homes are in deep financial difficulties. Many are deregistering as nursing homes. For example, Ferfoot, a former nursing home in Chippenham in my constituency, has now deregistered to become a long-term care home. Many homes have been left with huge numbers of empty beds. The Conifers home in Minety closed recently with tragic consequences for its residents. They received a letter on 20 December by registered mail saying that Conifers was closing down and were asked to find alternative accommodation. Many of its residents are now going into hospital. We have many fine, first-class private homes in Wiltshire and what is happening to them is tragic.
In 1999, there were 295 private residential homes in Wiltshire. We now have only 287, and the number of beds has dropped significantly from 3,141 to 3,079. The position of nursing homes is even worse. The number of
I read the excellent Chippenham Gazette and Herald and The Wiltshire Times, but the Western Daily Press provides more evidence than other newspapers. On 25 January 2001, it carried the blaring headline "Care homes at risk in funds crisis". People are stuck in hospital and care homes cannot continue. They are going out of business and the whole problem is becoming a self-fulfilling prophecy. It is a vicious spiral of the worst sort.
What is happening has particular consequences for the public purse to which my right hon. Friend the Member for Devizes referred. From the point of view of UK plc--the taxpayer--it is extraordinary that we are happy as a nation to pay £1,250 a week to keep 68 people in hospital who need not be there. They could be living in first-class private accommodation with, in many cases, their own bathrooms--one home in my constituency has a swimming pool--for only £250 a week or, if they need long-term care, for only £150 a week. The nation--the taxpayer--is wasting £1,000 per week for each of those 68 people. About £4 million a year is going straight down the drain for no reason other than that health service money comes from one pocket, while social services money comes from another. It is administrative nonsense and an absolute disgrace that taxpayers' money should be wasted in such a way.
Throughout the country, we are wasting hundreds of millions of pounds providing care that people do not need and that is not right for their circumstances. Such people are not in need of acute care. They need long-term care. We are spending hundreds of millions of pounds providing the wrong care. I hope that the Minister will deal with such matters in her response. I suspect that not only the people of Wiltshire but the nation will be interested to hear what she has to say about what the Government intend to do about the problem.
The problem has real consequences. We are discussing not merely numbers--£4 million a year being wasted in Wiltshire--but elderly people being kept in large wards and looked after incorrectly by the wrong sort of people and not enjoying their lives or having an armchair to sit in and look out of the window at the garden. Such people are experiencing deep difficulties, and even worse off than them, it seems, are those who stay at home, often in unsuitable circumstances, around Wiltshire. The home care side has had to be reduced because of the SSA system, which I shall discuss in a moment. Such people sit at home, and their carers, who often suffer in such ludicrous circumstances, are having genuine difficulty in looking after them.
I am keen to leave adequate time for the hon. Member for Exeter (Mr. Bradshaw), who I am sure has a fine speech ready. I see him nodding. We are looking forward to that speech, although it is perhaps not directly relevant to Wiltshire.
I should like to touch on a matter that lies behind the problem. We must differentiate strictly and clearly between the rural Wiltshire county council and the urban Swindon borough council. One of the unfortunate asides in the speech of the hon. Member for South Swindon suggested that she thought it perfectly sensible that the SSA and the revenue support grant in Swindon should have increased while those in rural Wiltshire have decreased. She said that that was a result of Swindon having been part of Wiltshire county council at one time, that Swindon was dreadfully underfunded, which was rotten, especially as Swindon has poverty, single mothers and so on, and that that makes it perfectly reasonable that Swindon should have more money and Wiltshire less. That is clearly what she said, and that is certainly what is happening in the rest of the country, where £30 million pounds has been ripped out of rural SSAs and pumped into urban inner cities. The Labour Government have removed a substantial amount from rural counties--Conservative and Liberal-controlled areas--and pumped it into Labour areas in the inner cities. That was my understanding of what the hon. Lady said a moment ago, but she may want to correct me.
Ms Drown : I was simply saying that Swindon has needs, and I am pleased that the Government have recognised that. We needed the funds, and the Government are right to support us by increasing our SSA over three years by 22 per cent. I am not saying that Wiltshire should receive less support, although the hon. Gentleman's argument seems to be that all the money should go to Wiltshire and none to Swindon. I have a much more responsible attitude to the matter, and I suggest that Wiltshire, too, should get more funds--as, indeed, it has. In 1997-98, the SSA was £48.5 million, and in 2000-01, £53.8 million. That is an increase.
Mr. Gray : One moment the hon. Lady says that Swindon's money has increased, and that that is good, and the next she says that that has not affected Wiltshire's money. The truth is that Wiltshire's money has decreased significantly. The bed blocking crisis is simply the result of that. As I said, we spend £50 a head less in Wiltshire on social services than the national average.
Mr. Gray : That useful and interesting piece of rhetoric ignores the nature of the SSA system. The SSA system involves only one cake. We are not discussing increasing the Government's overall spending on local government.
To answer the hon. Lady's second point, I am not ashamed of the fact that I am not a Minister of the Crown or even a Front-Bench spokesman, although I am an Opposition Whip. I stand here as the Member of Parliament for North Wiltshire to argue the case for more funds for my constituency. I do not have a responsibility for the poor of the nation, or for overseas development, although we would all agree that as much as possible should be spent on that. The purpose of the debate is to talk about bed blocking in north Wiltshire, and I am delighted to have the opportunity to do that. It is not about how much money should go to overseas development. The hon. Lady seems less keen to talk about her constituents than I am.
We must question the Government on the issue. I am glad that the Minister is here, and I know that she has been fully briefed, because she received the same briefing as we did from the excellent Wiltshire health authority and Wiltshire county council social services department. I hope that she is ready to answer the detailed questions that my hon. Friends and I put to her this morning. We seek two things. First, she must speak on behalf of her colleagues in the Department of the Environment, Transport and the Regions with regard to the current review of the SSA system. We need to know whether she believes that the cost adjustment system should remain in place, and why Berkshire and Hampshire receive more than Wiltshire. How can SSAs be reformed to find long-term solutions to the problems that we have mentioned?
Secondly, is Wiltshire in the same position as Hampshire county council, which last year received specific grants to sort out its bed blocking crisis? We look forward to the Minister's announcing whether she will award us specific grants this year to sort out the crisis.
I would also like to hear some longer-term, philosophical thinking from the Minister. The crisis has come about because the money comes out of two pockets--one for the health service and the other for social services. As long as that method of funding is used, the crisis will continue. Will she give some thought about whether it would be possible to amalgamate those sources and take the money from only one pocket? Only then will a final solution come about.
We have heard this morning about a very real crisis in Wiltshire. It is a crisis for nursing homes and hospitals, but, more importantly, it is a crisis for people. I hope that we do not hear a lot of political badinage. I want to
Mr. Robert Key (Salisbury): Thank you, Mrs. Roe. I am grateful to the Minister for her presence this morning, and to my right hon. Friend the Member for Devizes (Mr. Ancram) for initiating this important debate. I hope that the Minister, with her usual charm and courtesy, will find answers for us in her reply to the debate, but I remind her that the system of standard spending asssessments holds no fears for me. As a former Minister responsible for local government finance, I know the ins and outs of it. When I was a Minister, in a different Department from hers, anomalies cropped up and mistakes and statistical errors were made, but it was possible to put things right. I hope that she will be able to do so.
Until 18 months ago, the circumstances in Wiltshire were serious. We had to undergo the consultation on standards in care, and it was clear that that would lead to the closure of homes throughout Wiltshire. Expecting high standards of staffing and physical accommodation is one thing, but damaging over-regulation that leads to closures is quite another.
The Inwood house residential retirement home in my constituency is a fine example of a home that is under great pressure simply because someone decided on the minimum number of square metres required per person and whether that included a loo or a bathroom. Homes are being closed throughout the country on that basis. Assisi house in my constituency closes today, having been home to 20 people for 18 years.
Last year, 700 care homes closed throughout the country, with a loss of 15,000 beds for the elderly and vulnerable. Is it all the fault of the county council in Wiltshire? I think not. It would not be fair to say so. We have all argued for a proper appraisal of the situation, and I pay particular credit to Councillor Mrs. Judy Seager, the chairman of the social services committee, and the director of social services, Dr. Ray Jones, who have worked unceasingly to try to find a solution to this problem. My constituents suffered another body blow today, as we have been told that out of the £52 million announced by the Secretary of State for Education on Monday, Wiltshire will receive just £100,000, and Swindon will receive £460,000. We are among the biggest losers on the transfer of adult education, and have one of the fastest rising school rolls. That is another instance of our county missing out.
Of course there is no problem in Swindon. The hon. Member for South Swindon (Ms Drown) not only lives in another local authority area but on another planet as far as these matters are concerned. Once again, the Government are sucking the tax out of Wiltshire, and stuffing it into Swindon.
Mr. Key : The hon. Lady has only been in the House for five minutes. Indeed, she has only been in Wiltshire for five minutes. Some of us have lived in Wiltshire most of our lives, as well as representing it. She will know that there has been a problem in Wiltshire long before Swindon had its own local authority. I do not want to digress, however, as we are very short of time.
One or two further points need to be made. The county and the health authority are working hard together to find solutions. Let me outline the practical impact on my constituents. Total delayed discharges in Salisbury district hospital are 45, which means 45 bed blockers. Of those, Wiltshire is responsible for 35, Hampshire for five, Dorset for three and others for two. The total number of bed days used by those 45 people is 3,384. The average length of stay is 75 days. General medical average length of stay is four days. Out of those 45 patients, 42 are more than 75 years of age. The mean average age of admission in Salisbury of the over-75 age group is 84 years. We are therefore discussing very elderly and vulnerable people. The delayed discharge rate--the number of people delayed in hospital per 1,000 over 75 years of age, which is a standard health service method of measurement--is 2.5, against a rate of 1.52 for England as a whole. We received news this week that a local deal has been done for lifetime placements, and the local NHS trust and county council social services will find the money for another 10 out of those 45. Therefore, 35 people will still be where they should not be.
The opportunity cost is huge. During the past financial year, bed blockers in my local hospital have meant that 2,920 operations have not been performed. If the county council is forced to continue without any further help, next year there will be 5,840 cancelled operations in my district hospital. That is unacceptable. We must get to the bottom of this problem. My right hon. Friend the Member for Devizes has enumerated some of the available solutions.
I want to stress the impact that the military has on the area. At my end of the county, there is a serious problem. The military are funded by the national health service as well as through defence medical services, but an increasing burden is being put on local services, especially by project Allenby, which will make the local garrisons the biggest garrisons in the country. That has a huge impact on health provision. If accidents happen on the Salisbury plain training area, the casualties do not all go off to the military hospital in Haslar, but to the accident and emergency unit, spinal unit and burns unit at Salisbury district hospital. That is another significant factor.
The crisis is of the Government's own making. As my right hon. Friend so decisively argued, the facts are beyond dispute. There were never such problems under a Conservative Government. The Liberal Democrats in Salisbury have exercised their full intellectual rigour and political clout and suggested that people write to them to complain. A fat lot of use that will be. The issue requires real politics at Westminster.
Mr. Paul Burstow (Sutton and Cheam): The right hon. Member for Devizes (Mr. Ancram) is to be congratulated on securing the debate, which raises serious questions. Perhaps the issues that we have been discussing affecting Wiltshire are a microcosm of the problems confronted every day by directors of social services and the NHS all over the country.
The example that we have heard about shows us a social services department being pressured into overspending its community care budget--at present by £1.5 million, and possibly by up to £5 million by the end of the year. We know, from surveys undertaken by the Association of Directors of Social Services, that the problem of over-commitment is widespread. Seven out of 10 social services departments surveyed last year considered that their budgetary position was worse in the current than the previous financial year. They expected it to be as bad, if not worse, next year.
Wiltshire social services department spends about 18 per cent. more than its standard spending assessment, so talking about increases in the standard spending assessment is deliberately misleading. Until the standard spending assessment is brought up to the right level, increases disappear into existing provision. They do not buy extra services. That is why the hon. Member for South Swindon (Ms Drown) was right when she talked of a history of underfunding. The standard spending assessment locks historical underfunding in place and penalises councils that for one reason or another have been frugal or tight-fisted in the past.
Nationally, most councils spend about 11 per cent. more than their standard spending assessment on social services. As a result, as the Local Government Association found only last week, nearly every social services department in the country expects an outturn overspend this year, totalling £205 million. Those budget pressures--not just in Wiltshire--are causing care gridlock. In Wiltshire the numbers of people over 85 are increasing quite substantially. That is a cause for celebration. It is wonderful that people are living longer. However, that reality is not factored into the equation relating to the funding of long-term care. The consequence is that the number of places that Wiltshire can fund remains the same, while more people need them. That leads to bed blocking, and more people experiencing rationing and being unable to obtain the care that they need.
I hope that the Minister will not tell us that the problems that right hon. and hon. Members have described this morning will be fixed by intermediate care. That is a short-term rehabilitation package to bring about a patient's return home. It should not be somewhere to dump people who need permanent placements in residential nursing homes. If that is to be its function, it is a con that needs to be revealed. We need to make sure that the Government do not propose that. I hope that the Government will not hide behind standard spending assessment figures, but accept that those figures do not reflect true cost pressures on local authorities.
Finally, we need to take into account what might happen if there were a change of Government. We know that the Conservatives want to spend £8 billion less on services. That would reduce funding to social services in Wiltshire by £3 million. Under the proposals of the right hon. Member for Kensington and Chelsea (Mr. Portillo), the situation would become worse, not better. More people would be left in limbo waiting for beds in nursing homes and more nursing homes would close.
Mrs. Caroline Spelman (Meriden): I congratulate my right hon. Friend the Member for Devizes (Mr. Ancram) on securing this debate. He had the good fortune or foresight to realise that this was a good week to debate bed blocking, as at this time there is peak demand for beds in the national health service, so the problem is at its peak. The Minister and I visited City hospital in Birmingham on the same day last week, so she will have seen that accident and emergency departments are not currently coping, due in part to the number of blocked acute beds to which emergency cases need to be admitted.
The debate has shown that there have been three key causes of the bed blocking problem, some of which were avoidable. We have heard about Wiltshire, but it is important to say that its case is not unique. Kent suffers badly from bed blocking. Five nursing homes have closed there, with the loss of 243 beds, and there are 225 blocked beds for the same reasons as in Wiltshire. The picture is the same nearer to me in Worcestershire, so the problem is nationwide. The possible differences and their serious consequences within one county have been thrown sharply into relief by the Wiltshire Members who have spoken.
The avoidable aspect of the bed blocking problem was the imposition of the proposals in the document "Fit for the Future?", which contains onerous regulations for the care home sector. There is some irony in that, as the regulations have resulted in the closure of many care homes and the industry being much less fit for its future. Unsurprisingly, last year the Independent Healthcare Association described them as a piece of "strident bossiness".
The introduction of standard room sizes, wheelchair access to rooms and the reduction of the number of shared rooms to 20 per cent. has had a serious impact on those who have to decide whether they can continue in business under such regulations. I accept that the Government are aware of the extreme concern that the regulations have caused the care home industry. They have climbed down on several issues: they have been prepared to reduce the standard room size for an existing care home from 10 sq m to 9.3 sq m, and have made a distinction between existing and new-build care homes, so that new-build homes will have a standard room size of 12 sq m.
The Government's approach has been ham-fisted, and has led to a huge loss of capacity in the system. I hope that the Government were embarrassed when the hon. Gentleman pointed out that they were unwilling to provide figures on the loss of care home beds. However, they will be aware of last year's Laing and Buisson study, which showed the loss of 25,000 beds in the care home sector. That is an enormous loss of capacity, and one of the key reasons why we are debating the bed blocking crisis today. It is quite separate from the standard spending assessment issue, which has been well elucidated.
The uncertainty caused to the home care industry by the imposition of the regulations is entirely inflicted by the Government. It cannot be attributed to the previous Administration. Moreover, the Government would be wrong to interpret that as meaning that the Conservative party is more worried about the providers of care home places than the users. That is untrue. My right hon. and hon. Friends have made it clear that the problems of those in blocked beds, those who need to go into hospital but cannot, and those in care homes that are being shut are of paramount concern to our party. The Minister will be aware that the mortality rate is exceptionally high among care home residents who have to move out of a home in which they had lived for a long time. Let it not be said that the Conservative party cares more for the providers than for the users.
Care homes throughout the country are underfunded by approximately £50 a week. In order to remain in business, some care homes are turning to the families for top-up funds. That could cause difficulties, because £50 may be a lot of money to people who are rather
There are knock-on consequences of bed blocking. I make no apology for mentioning again my recent visit to the City hospital in Birmingham; I am sure that it is as fresh in the Minister's memory as it is in mine. What I have to say is directly relevant to the bed blocking problem. The Minister and I visited a busy accident and emergency department that is not coping, despite the extra money made available to deal with winter pressures--money that has been allocated also to Wiltshire hospitals. It is no good blaming someone else for the fact that the hospital cannot cope. The hard fact is that the nation's accident and emergency departments cannot cope with a flu epidemic in the middle of winter. That is the Government's responsibility. They said that they would do something about it.
In the middle of February last year, out popped the new term "intermediate care". I asked the City hospital in Birmingham about intermediate care and about step-down bed arrangements, and I was told that it was not a reality for that hospital because it was in the midst of a crisis. Birmingham social services are as overspent as the social services department in Wiltshire--Birmingham is overspent to the tune of £14 million. The overspend in social services departments is one of the main contributory factors to the crisis that faces the NHS. That was well summed up by my hon. Friend the Member for North Wiltshire (Mr. Gray), who graphically described the problem by referring to the two pockets.
The problem has not been solved because the two sources of funding are completely separate, largely because civil servants at the highest level have a silo mentality. They seem unable to talk to each other about how the problem could be solved. It is yet another example of the Government's failure to define the problem correctly and to find an answer. It was this Government who coined the phrase joined-up government, so where is it?
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart) : I congratulate the right hon. Member for Devizes (Mr. Ancram) on securing this morning's debate. There has been considerable confusion among Opposition Members about what is needed. Do they not want us to shift hardship cases to solve the bed problem? The hon. Member for North Wiltshire (Mr. Gray) said that he did not want any political answers, whereas the hon. Member for Salisbury (Mr. Key) was looking forward to the next election. I make no apology for saying that hon. Members cannot have it both ways in such debates. If they want a detailed response from Ministers, they must allow them sufficient time. If the members of the Opposition Front Bench raise wider issues, I shall address them, even if I have to do so outside the Chamber.
The hon. Member for Meriden (Mrs. Spelman) mentioned her visits to Birmingham's City hospital, so she will know that Birmingham social services received an extra £1 million to solve its problems. An extra
The flaw in the Opposition's argument is that they cannot have it both ways. They cannot ask for more money and at the same time accuse us of being reckless. They should not go down the discredited route of saying that we need to do more of the same. There has been a deep recognition that we need to reconfigure the services and work together. Conservative Members complain that the funding streams come from two sources, but that is exactly why we are encouraging social services and the health service to work together.
Ms Stuart : The right hon. Gentleman should allow me to give him an answer. I still have a few minutes in which to do so, although he may not like what I have to say. It is important to recognise that the way forward is for the two services to work together. It is no good criticising and asking about what would happen if this or that were the case. We are changing the way of working. The hon. Member for Sutton and Cheam (Mr. Burstow) expressed doubts about intermediate care, suggesting that it is a quick fix. Far from it: it is part of a whole package.
I refute the hon. Gentleman's allegation that we refuse to publish figures on the loss of beds. The Prime Minister said in Prime Minister's questions on 29 November that although there had been a 15,000 gross loss, the net loss was 8,600. That must be seen in the context of the 20,000 home care packages.
We have made a total commitment to improving public services, which we have matched with funding. Opposition Members, with their talk of crisis everywhere, fail to recognise that we are changing the services and making improvements. I should like to know how they would make improvements in the services while cutting £16 billion under their tax guarantee.
Today we have the opportunity to discuss what happens in Wiltshire. We have a responsibility to put the position in Wiltshire in context. It is no good suggesting that we should not blame the previous Conservative Government. We inherited a system with too few doctors, too few nurses and not enough beds. The hon. Member for North Wiltshire said that he wants more beds. We will provide more beds, but to do so we require extra staff, who need training.
Wiltshire has to be seen in context. We are investing more money throughout the country. From April, Wiltshire health authority will receive £408 million, which is a cash increase of £29.4 million on the previous year, and a staggering increase of £167 million on the figure for April 1997. Hon. Members should remember that that contrasts with the meagre increases in real terms of 0.5 per cent. and 1.4 per cent. that Wiltshire received in the last years of the Tory Government. The allegation that we are ripping money out of Tory rural areas and giving it to Labour urban areas is unfounded and not substantiated by the figures. Bed blocking involves health and social services. [Interruption.] Will the hon. Member for North Wiltshire please allow me to answer his question? I shall be unable to do so if he does not listen.
We are putting investment into not just health, but social services, which are receiving more money. Under the Conservative Government, spending on personal social services rose by an annual average of just 0.1 per cent. in real terms--that is not a misprint or a mispronunciation. Under the Labour Government, spending on personal social services will increase by an average annual rate of 3.4 per cent. in real terms. Conservative Members may not like to hear that, but I am afraid that those are the facts.
Just to make my earlier point clear, for 2001, Wiltshire county council's overall standard spending assessment increased by 5.6 per cent., while Swindon borough council's increased by 4.9 per cent. Both of those increases are above the national average increase of 4.4 per cent. Conservative Members cannot turn this into a debate about rural areas not getting extra money, because the figures do not stack up. In the same year, the personal social services standard spending assessment for Wiltshire increased by 5.8 per cent., and for Swindon by 5.5 per cent. Again, both those increases are greater than the national average. As hon. Members are so exercised about local government spending, I am sure that they will play their part and spend some of their valuable time contributing to this afternoon's debate on local government finance in England.
Investment in the partnership has already begun. The social services and the NHS are working together to support the winter planning preparations in Wiltshire. Additional funding of more than £3.2 million has been provided to the Wiltshire health community. From the £63 million announced in August of last year, Wiltshire received £636,000, which is being used in a wide variety of schemes across the county, such as providing 22 additional beds for discharge and rehabilitation support in Swindon and Ridgeway Downs primary care groups.
The Tories will not match that funding, whether it is the £63 million announced in the summer, the extra allocation in November, or the special grant made to Wiltshire over the past six months. They are committed
Mrs. Spelman : I appreciate that, as I gave the Minister an additional two minutes to accommodate such interventions. I should like to place on the record that the £16 billion in cuts is a figure plucked from the air. She knows full well that we have pledged to match entirely the Government's spending on the NHS.
Ms Stuart : I am grateful for that intervention. Will the hon. Lady clarify whether her party is also committed to matching Labour's social services spending? I would be happy to give way again if she could give me an answer. The core of the debate has been that bed blocking is caused by the NHS and social services not pooling their funding. Unless the Tories match their commitment to NHS funding with a commitment to social services, their promises are empty and worthless.
Mr. Burstow : Will the Minister confirm that, in a parliamentary answer to me, the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), has refused to publish figures showing the number of bed closures in nursing homes? That is a fact, which is on the record. Will she confirm it?
Mr. Ancram : On a point of order, Mrs. Roe. Is it in order for the Minister to refuse to take an intervention from the person who led the debate, but then to take interventions from Conservative and Liberal Democrat Front-Bench Members?
Ms Stuart : I was outlining the whole package, and I was also making the point that the standard spending assessment review is on-going. There is a debate about that this afternoon. However, this debate is about bed blocking, and I am talking about how the NHS and social services work together. The extra packages that have been put in place in Wiltshire have led to the Princess Margaret hospital receiving an additional £408,000 for its modernisation fund. Wiltshire and Swindon are increasing spending on personal social services.
Hon. Members have singularly failed to recognise the progress that has been made. I am not saying that the system is perfect. However, the solutions we propose are extra funding in the short term and a restructuring of services in the long term, which, as the right hon. Gentleman said, is not a matter of shifting hardship, but of solving the underlying problems. It is a 10-year plan, and we are well on the way. Conservative Members have no solutions other than arguing over figures that simply do not add up.