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11.8 pm

The Minister of State, Department of Health (Jacqui Smith): I congratulate the hon. Member for Northavon (Mr. Webb) on obtaining a debate on this important issue. There is not much dispute about the principle of national minimum standards for people living in care homes. The old regulatory system evolved over the years in a rather ramshackle way and is riddled with gaps and anomalies. It is important to set the improvements we are making in that context. Existing standards for care homes are set and administered in inexplicably different ways by different authorities, and some homes are not regulated at all.

The Care Standards Act 2000 allows us to change that. It created the new and independent National Care Standards Commission to regulate care services, and introduced the

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concept of national minimum standards that can be applied consistently to all providers of services in Avon or anywhere else. I will return to the hon. Gentleman's point about the approach that the commission will take to the regulation and inspection process.

The standards put residents' interests at the heart of the regulatory system. I make no apology for that. We should never forget that we are talking about people's homes, where they live, possibly—and we hope—for many years. I certainly share the hon. Gentleman's objective of safeguarding good provision. We must also ensure that inadequate provision is improved through the implementation of our new care standards.

People who need residential personal care are entitled to as many as possible of the comforts of home life that the rest of us take for granted, and that is a big part of what the standards are about. The draft—I emphasise draft—standards for care homes for young adults were issued for consultation. I can assure the hon. Gentleman that the consultation was genuine and we have listened carefully. We talked, we listened and we reviewed the evidence. We consulted a wide range of service groups, carers, providers, purchasers and regulators of the services.

Many of the hon. Gentleman's points echoed what we heard from others. We will publish the final version of the standards within the next few weeks. Without being too cryptic, the final version will not be identical to the draft version. This evening I will go as far as I can to suggest the direction in which we have been moving, but I hope that the hon. Gentleman will understand that, much as I would love to, and despite his view that he may one day be in my position at the Dispatch Box, I cannot give him a sneak preview of the detail.

I will write to the hon. Gentleman about the specific issue of the home with the young man aged 15.

The hon. Gentleman asked about the cost of implementing the standards. We are well aware of the difficulties with which many homes are struggling. That is why earlier this year we set up the strategic commissioning group, which brought together some of the key individuals and organisations involved in commissioning and providing care services for adults, including representatives from the private and voluntary sectors. The group considered local commissioning arrangements and their impact on service users and providers. It published its report last month, supported by £300 million to smooth the flow of patients from hospital to care home. Its work will also help to bring some much needed stability to the sector by encouraging more long-term agreements between local authorities and providers.

We know that meeting the new standards will have cost implications for some homes, and we accept that ultimately they may need to reflect those costs in their fees. This is an issue that should be considered in what in some cases should be a much more participative commissioning process in local areas.

It is worth remembering that we have already raised funding for social services by nearly 18 per cent. in real terms since 1996–97. Next year and the year after we will raise it even more, by an average of 3.5 per cent in each year, giving local authorities some ability to reflect the increased costs in their fee levels.

The hon. Gentleman was concerned about the effect of the standards limiting the overall size of homes and, within homes, the size of the groups of residents sharing

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staff and living areas such as dining rooms. The draft standards suggested that new homes should accommodate up to 16 people in groups of up to eight. Existing larger homes would be expected to organise into groups of eight residents by 2007. I am convinced that the principle behind that standard is right. It can make all the difference between an establishment looking and feeling like a large, anonymous institution and it becoming at least a little more like a family home. I know which I would rather live in, and I expect most people would feel the same.

Most people would sympathise with the principle, but many of those who responded to the consultation exercise felt that we had set the numbers too low. The concern was perhaps felt most acutely, although not only, in the substance misuse sector. Respondents from that sector argued that their residents tended to stay for limited periods of treatment rather than indefinitely, and that some forms of treatment depend on groups of more than 10 residents living and working through their therapy together.

I also recognise the points that the hon. Gentleman made about other care homes for young adults. The concerns were sincerely and persuasively expressed, and I can tell him now that the standard will be modified accordingly while staying true to its guiding principle. The limits will rise, and there will be some extra leeway for shorter-term stays.

The hon. Gentleman also raised the issues of the number of toilets and bathrooms available to residents, and that has generated much debate, both during the official consultation period and since. The draft standards suggested one toilet for each two people and one bathroom for three people, in both cases adjacent to bedrooms. Many people felt that we were aiming unreasonably high. It is an important question of balance. Not many of us—not even Ministers—have completely unlimited access to our own individual, private facilities 24 hours a day. On the other hand, not many of us would be thrilled about constantly using public toilets and baths, even when we were at home. At the risk of repeating myself, we are talking about people's homes, not somewhere they spend the odd night or week.

We believe that we can find a sensible compromise. Many people told us that the requirement for toilets and bathrooms to be next door to bedrooms was not practical, and we have been looking closely at that. Many people told us that one toilet per two people was a higher standard than exists in many private residences, so we have looked closely at that too. We have also been thinking about whether we can give existing homes more time to meet the standards, for some of the reasons that the hon. Gentleman outlined. In other words, we are willing to reconsider when people make a good case, but what still matters most is that service users live in as homely and comfortable an environment as possible.

The hon. Gentleman also raised the issue of single rooms, and the argument about single versus shared bedrooms has been one of the more lively ones. Not many of us would want to share our bedroom with someone we had not chosen to share it with, but it is not hard to see how providing single rooms for all from day one could make life very difficult for some homes.

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The draft standards say that all service users should be offered a single room. Existing shared accommodation is to be phased out by 2004, unless people choose to share. I hope that that covers one of the points that the hon. Gentleman raised. New provision will be built with single rooms.

The objections have not all been financial or technical, although such objections are important and need to be considered. Providers of substance misuse services have argued that service users often need to share with a buddy—someone to discourage regression or self-harm. That seems like common sense. There is no actual evidence to suggest a link between how many people share a bedroom and how successful the outcome of their treatment is, but that is an important issue. Few things are more fundamental to privacy and a genuinely homely atmosphere for adults than having their own space which they share only with those whom they invite to share it.

Different circumstances might arise for special residential colleges for people who need care, and we are looking at that. We are also considering whether the standards could embrace the idea of a clinical need for sharing, as a form of protection for the service user. However, in general, we are clear that new build should be for single occupancy. Existing sharing might have to continue for a few years, but in future people should only share if they want to.

I hope that I have gone some way towards reassuring the hon. Gentleman to some extent, although I guess that he, and others who have expressed concerns, will reserve judgment until they see the final standards. I hope that I have at least convinced him that our consultation was not a cosmetic exercise, and that we valued and listened to all the responses and kept an open mind.

Once the final standards are published the focus will, of course, shift to the National Care Standards Commission, whose job it will be to interpret and use the standards as it inspects and regulates residential care for young adults. When the commission is deciding whether any regulation has been breached, it must take the standards into account, but the standards are not regulations.

The section from my letter that the hon. Gentleman read out still represents the Government's position. It will be important for the commission, as it develops its work, to work with providers, to use the standards and to ensure that the assessed needs of users, which are at the centre both of his approach and of the Government's, are fundamental.

It is right both to issue regulations and to set national minimum standards, because there are homes that are not good enough for users, and it is clear that action needs to be taken. The objective is to ensure, first, that we have a coherent set of regulations and standards across the country wherever such provision is made, and secondly, that we implement those in a way that is both flexible for providers and enables users to—

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