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Debate to be resumed on Friday 25 January.
Residential Care Homes (Essex)
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Stringer.]
2.30 pm
John Cryer (Hornchurch): May I begin by thanking you, Mr. Deputy Speaker, for selecting this subject for debate? I also thank the Under-Secretary of State for Health, my hon. Friend the hon. Member for Salford (Ms Blears), who will respond to the debate. Ministers must feel that they have drawn the short straw when they have to reply to the Friday afternoon Adjournment debate, so I thank my hon. Friend for being here.
My main aim in this debate is to consider the loss of local authority beds, delayed discharge, and high bed occupancy—especially in the acute health economy—in the boroughs of Barking and Dagenham and of Havering, and their relationship to the operation of the national health service throughout our area. I am glad that my hon. Friend the Member for Dagenham (Jon Cruddas) is in the Chamber. This is an enormous issue for the areas that we represent.
I shall quote from the Treasury Minute on the first report of the Public Accounts Committee 2000-01 "Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals". It states:
- "There is a clear relationship between high bed occupancy and the risk of cancelling elective admissions. This risk becomes very pronounced at occupancy levels above 83 per cent. Bed occupancy rates in hospitals ranged from around 50 per cent to 99 per cent in 1997-98. The average across all hospitals was 81 per cent."
- "What you cannot do is provide the optimum levels of emergency care or shorter waiting times in hospital unless outside the hospital you have a social care system that is operating more effectively and in cooperation with the local health service."
- "We have commissioned research from York University which the Committee can see, which indicates that if you get occupancy rates in excess of 82 per cent you start getting a higher level of cancelled operations taking place at the last minute . . . What we have been looking at very closely is what we can then do to get occupancy levels down from around 89 or 90 per cent at the moment across the NHS . . . The problem is that it"—
- "becomes less efficient the more you get above 82 per cent"
That is clear. Occupancy rates of more than 82 per cent. diminish the efficiency of the sector and create other problems across the health economy.
Oldchurch hospital is a big accident and emergency hospital that serves my area, as well as that of my hon. Friend the Member for Dagenham and several other hon. Members. A press release issued recently by Barking, Havering and Redbridge Hospitals NHS trust stated that the bed occupancy rate is currently running at 97 per cent.
Jon Cruddas (Dagenham): Does my hon. Friend agree that the problem affects not only his constituents in Hornchurch and Havering but those in Barking and Dagenham? Recent figures that I have received from the trust show that 54 of the 154 delayed discharges, or
blocked beds, affected Barking and Dagenham constituents. Does he agree that the consequential effects of the problem are so great—the cancelled operations and the implications for the functioning of the accident and emergency centre—that urgent action is needed from the Department of Health, local authorities and the trust itself?
John Cryer: Yes, I agree with my hon. Friend that that is a problem right across the health economy.
Delayed discharges are a problem in our area, partly because its population is, on average, one of the oldest in any Greater London borough. In fact, Havering might have the oldest population of any borough. Barking and Dagenham also has an elderly and ageing population. Barking, Havering and Redbridge Hospitals NHS trust issued a press release on 12 November. It uses the term "bed blocking"—a phrase that I detest. I prefer to use the phrase "delayed discharges", which is far more accurate and sympathetic. Nevertheless, it uses that phrase and says:
- "We currently have 160 beds 'blocked' which means we have 160 people who are medically fit for discharge but cannot return to their own homes. This may be that they are unable to look after themselves or require support to undertake tasks essential for daily living, such as cooking."
I should mention the fact that the Government made £500,000 available to the London borough of Havering so that it could deal with delayed discharges and try to get people back to their homes, or at least into accommodation elsewhere. I pay tribute to the Department of Health for making that money available to the local authority. I have lobbied it for that money in the past, as have other people and bodies. However, that money will not solve the kind of long-term problems that we have in Barking, Havering and Dagenham.
Undoubtedly, we do not have the necessary residential care capacity, either in the public or private sectors. Havering council is presently engaged in a programme of closing care homes in my constituency and throughout the borough. For example, The Grange—a residential care home for elderly people in the Romford constituency—has just closed with the loss of 37 beds. Maybank Lodge is a very fine home in my constituency. The people who live there are very happy, as are those who go to the day centre there, but it is facing closure with the loss of 43 beds. Only two people—Vic and Edie—still live there, and they are determined to stay there as long as they possibly can. They have been to court to try to save the place that they have regarded as their home for some years.
More closures are scheduled. I have always disagreed with the policy of closing local authority care homes. I have campaigned against it and made my views absolutely clear in my constituency, in Havering and on the Floor of the House. One of the key factors in the home closure programme is the appalling level of the standard spending assessment handed out to Havering, year after year. That is not the current Government's fault; it is a historical fact that goes back at least to the fall of the poll tax and actually to the 1950s and 1960s.
In fact, under this Government, the settlements given to the local authority have been much more generous than those given to it when the Conservatives were in power.
Nevertheless, when starting from a low base, even if a borough's settlement is increased by a high percentage, it still does not help a lot because it is continually playing catch-up with neighbouring boroughs. Boroughs with a similar socio-economic mix as Havering tend to get a much better SSA. That plays a key part in the destruction of care homes in the London borough of Havering.There is no evidence—certainly not in our borough—that the private sector has anything like the capacity or ability to provide the necessary care for elderly people. In fact, some private care homes have closed.
I was very pleased that in the trust's recent plans for a new Oldchurch hospital, which will be built on a site opposite the existing hospital, the number of beds was increased by 60, although the original proposal contained a cut in bed numbers. That decision was reversed following a long-standing campaign for a new hospital carried out by myself and others.
The trust is consulting on the provision of 83 intermediate care beds, and I would appreciate it if my hon. Friend could comment on the status and role of those beds. Their provision is comparatively recent—they have come in in the past few years—so how does she see them interplaying with acute beds and other sectors of the local health economy?
However, the increase in the number of acute beds and the introduction of intermediate beds over the next few years will not compensate for the loss of beds in the care sector. In the next few years, Havering could face a crisis in long-term care for the elderly. Will my hon. Friend say something about that?
When we came into office in 1997, we faced an invidious position in respect of long-term care for the elderly. I would argue that probably the first big privatisation post-1979 was that involving long-term care for the elderly. In 1970, long-term care beds in the NHS outnumbered those in the private sector by two to one. By 1990, the position had been reversed: beds in the private sector outnumbered those in the NHS by two to one. By the time that we came to power in 1997, long-term care beds in the NHS had virtually been obliterated. During 18 years of Tory Government, the number of beds overall in the NHS was cut by a third and many of them were in the long-term care sector. We have had to live with that inheritance and we shall have to live with it for some time to come.
Given an ageing population and all the problems in the health sector, many of which we inherited, delayed discharge is clearly a national problem. However, from what I glean, it appears that Barking, Dagenham, Havering and Redbridge—the health authority also covers the London borough of Redbridge—is the worst area in Greater London for delayed discharges.
The key factor is to provide even more resources. Although the Government have provided additional resources for coping with problems in the health economy, we need more resources to go into long-term care for the elderly and into acute and intermediate beds. I hope that my hon. Friend will say something about that.
I also hope that my hon. Friend will say something about the royal commission on long-term care for the elderly. It made some constructive suggestions on how we could resolve the problems, so perhaps she will comment on them.
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