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Mr. Nigel Waterson (Eastbourne): If the hon. Gentleman feels so strongly on this point, can he explain why, during its eight years of running East Sussex county
council, his own party came consistently bottom of the national league table for the rates it paid to care home owners?
Mr. Burstow: Probably for the same reason I gave to the hon. Member for Isle of Wight (Mr. Turner): the council in question was not properly funded in terms of social services. Yet again the hon. Gentleman plays into the hands of the Government by dividing councils and accusing them of failing to deliver, when in fact they have not been given the resources to do the job in the first place.
As a result, care home fees have been driven down so far that we are in a situation where it is impossible to be certain that continuity of provision can be maintained. With figures as low as £225 per week for residential care and £336 for nursing care, how are owners supposed to comply with the new standards, let alone staff their homes and care for the residents?
Mr. Stephen McCabe (Birmingham, Hall Green): I have some sympathy with the points that the hon. Gentleman is making. But how does he reconcile the difficulty that he describes, of new care standards—which he criticises—and of staff whom he describes as McDonald's rejects? Surely if we want the right staff in place, we must have the standards to encourage them.
Mr. Burstow: The hon. Gentleman is quite right to say that standards must be appropriate and that there is a need for extra training. But training is not cost free; it requires money. The problem is that the Government have not recognised that and they appear to be in denial when it comes to the extra costs that are a consequence of compliance with the standards. That is where the problem lies and that is why we are bringing the matter to the House tonight.
On issues of funding, we see that private payers and so-called preserved rights residents are subsidising the shortfalls in state-paid fees. In the case of preserved rights residents, this was in excess of £50 million last year alone. Charities that run care homes are using as much as £185 million of their own funds to plug the gap in state funding for care. That is 19 per cent. up on last year and it is still rising. Money given by the public for charitable purposes is used to prop up state-funded care that is inadequate because it is not properly funded.
On top of that funding shortfall and the staffing crisis in care homes, care homes are also faced with the new care standards coming in this April. Higher standards will mean fewer residents and even less income. Try selling that to a bank manager: "We want to make adaptations and changes to our care home and we need extra capital to pay for that. But we will have less income once we have made the changes". I do not see many bank managers signing up to that.
It is no wonder that, faced with mounting difficulties, care homes are often realising a better rate of return on their capital by selling the property. The victims of this are the frail and vulnerable elderly who are forced to pack their bags and move to another home. The trauma can and does kill. Despite mounting evidence of the extra costs of complying with the new standards, Ministers seem to remain in denial.
Earlier today I was briefed by Leonard Cheshire Homes, which had done some calculations on the costs of complying with the standards for young adults. It found that the weekly cost per resident in one of its homes for disabled adults will rise from £680 to £1,092, a 62 per cent. increase to comply with the training and other standards laid out by the Government. In addition it has estimated that it will need to find an extra 237 nurses to deliver the standards. Where are 237 extra nurses coming from? The NHS? I do not think so. The Government need to spell out where the extra resources are coming from.
Home care fares no better. Under the Government, there has been a 19 per cent. reduction in the number of people receiving home care—93,000 fewer people a year receiving home care in just four years. The Government amendment says that more people are living independently. Perhaps that is what it means—93,000 extra people not being supported in their own homes.
The rules have been rewritten so that only the most frail and dependent are looked after and the rest have to fend for themselves. To make money stretch a little further, care is increasingly being rationed. It is being rationed by denying help to those with moderate care needs or with a carer at home. It is being rationed for those who have high care needs by having them wait in hospital beds or, more likely, having them wait unseen in their own home. It is also being rationed by setting limits either on how much the council is prepared to pay or on the quantity or quality of care to be provided.
According to the LGA, six out of 10 councils have tightened or proposed to tighten the way in which they ration care, as a way of controlling their spending. All we are talking about tonight are things that are not luxuries—help with getting in and out of bed, getting dressed, keeping clean, eating a reasonably balanced diet, having nails cut, using the toilet, having clean laundry, living in a decent environment. We are talking about a person's basic dignity. That is why Liberal Democrats remain committed to the principle that personal care should be free, on the basis of a person's need.
Increasingly, personal care involves services that would have been seen in the past as nursing care, such as changing catheters and dressings, preventing or treating pressure sores and managing medication. That is why Liberal Democrats say that nursing care should be free on the basis of need, not according to who provides it.
The Government's answer to the crisis in the care system is to treat the symptoms and not the causes. The £200 million initiative to tackle bed blocking that was announced last year falls well short of what is needed to tackle the staff shortages, capacity constraints and rationing of the care system that are causing delayed discharges. The £200 million has to be set against a long history of underfunding.
Year by year, the gap between what councils spend and what the Government think needs to be spent on social care has widened. The gap has increased from 3 per cent. in the early 1990s to 8 per cent. in the mid-1990s; in the past three years, it has widened to a gulf of 12 per cent. More than £1 billion has to be found by local councils through council tax to meet statutory duties and respond to yet more Government initiatives and priorities. As a direct consequence, over the past two years three out of four social services departments have overspent their budgets.
How much worse would the problems in the NHS be if councils spent down to the level the Government think is necessary and clamped down on overspending?Against that backdrop, the absence of any extra cash for social care in this year's local government settlement is mind boggling. Social care has been short-changed to the tune of £113 million in the coming year—money that was pencilled in by Ministers in the spending assessment in 2000, but not actually delivered this year. As a consequence, overspending will continue to rise.
Health and social care are two sides of the same coin: underfund one and the other is undermined. It is for that reason that the Government must undertake a whole system review of funding social care. Such a review must go beyond the Government's sticking-plaster solution of cash to tackle delayed discharges. What is needed is long-term, sustained investment in social care, informed by a realistic assessment of what is needed to deliver real improvements.
Social care is stuck in crisis management mode. Those with less acute needs drop off the queue, only for the vicious circle of lack of support, leading to increased dependency and greater calls on high intensity care, to start all over again. That is a false economy that is doing great harm. The true cost of running the system in that way is measured in two ways—in ministerial failure and in human misery.
Madam Deputy Speaker: I call Mr. Hinchliffe. [Interruption.]
Madam Deputy Speaker: I apologise. I thought that the Minister was holding back.
7.33 pm
The Minister of State, Department of Health (Jacqui Smith): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
- "welcomes the Government's strategy for modernising social care services through unprecedented real terms increases in resources, which enables and promotes better joint working between the NHS, social services, and the independent care sectors, develops a national framework for standards and quality and ensures a greater emphasis on users and patients in the design and delivery of services; notes that this has led to more independence for older people, fairer funding of long term care, reduced levels of delayed discharge and greater choice for users; and condemns the Liberal Democrats for their obsession with producer interests over those of users and patients and their failure to recognise that investment must be matched by reform."
The care system plays a vital role in ensuring that vulnerable people of all ages receive the care that they need, and I should like to start by commending the efforts of those social workers and care staff in both the public and independent sectors who, every day of the week, provide support and opportunity to people in need. Incidentally, those staff will not have been impressed by
their description by the hon. Gentleman as rejects from McDonald's. That reference might have been noted outside the House.
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