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7.57 pm
Mr. Simon Burns (West Chelmsford): I certainly welcome this debate, but I must say that listening to the increasingly bitter exchanges between the Minister and the hon. Member for Sutton and Cheam (Mr. Burstow), I began to feel that I was intruding on private grief—it seems that the love affair between the Labour party and the Liberal Democrats is well and truly over if the early stages of the debate are anything to go by. It is amazing to think, Madam Deputy Speaker—and even you can think about it—that there was a great cosy love affair only 18 months ago. Lord Ashdown, the right hon. Member for Berwick-upon-Tweed (Mr. Beith) and the right hon. and learned Member for North-East Fife (Mr. Campbell) were all involved in a Cabinet Sub-Committee—the first time that that has happened since the time of Lloyd George. Tonight, we can well and truly see that that love affair is over. The bitterness of both sides is more than apparent, given the way they were at each other's throat.
Just yesterday, it was widely reported that the elderly in Britain are being penalised by the NHS because of widespread health care bias and discrimination. Although that is deeply alarming, such discrimination is not a wholly new revelation. Indeed, such prejudice towards the elderly has increasingly manifested itself in another aspect of Government policy since 1997—long-term care for the elderly. Between 1998 and 2001, the number of general nursing homes in England fell by 13 per cent. During that relatively short period, nearly 22,000 nursing homes beds
were lost and about the same number of hospital patients had their discharges delayed because there were no places available to look after them properly in the community.Less than one year ago, there were 525,900 places in residential settings for long-stay care for elderly and physically disabled people across all sectors.
Mr. David Hinchliffe (Wakefield): I am a little concerned by the fact that the debate seems to be concentrating on beds when community care should be about preventing people needing beds. How do countries such as Denmark, with a similar proportion of elderly and very elderly people, manage without any care homes whatever?
Mr. Burns: The hon. Gentleman raises an important issue concerning domiciliary care, and I will refer to it in my speech. The simple answer to his question is that the debate has revolved around beds because it is about the crisis in care. Unfortunately, the Government's record on what has happened to the number of beds over the past few years has helped to contribute significantly to the crisis. That is why the issue will be an integral part of the debate. I know that the Government do not like to hear bad news or, in many cases, the truth when it is unpalatable, but they will have to listen to it this evening without the fantasy, the spin or the denial of Ministers.
Mr. Burns: I will give way when I have made some progress.
As I was saying, less than one year ago there were 525,900 places in residential settings for long-term care for the elderly and for physically disabled people across all sectors. That is a drop in capacity of almost 50,000 places since 1996–97. Indeed, 760 care homes were closed in 1999 alone, resulting in the loss of more than 15,000 beds. In anyone's mind—except that of the Minister, who does not seem to think that it is happening—that is an extremely alarming situation.
I do not know about the Minister's constituency, but in mine two care homes have closed in the past 12 months. I suspect that most hon. Members—certainly those on the Opposition Benches —will probably have experienced the same tragic situation. For some reason, it is not obvious to Ministers, who want to perpetuate the myth that everything is fine and that any fact or statistic that suggests otherwise is not true.
Mrs. Humble: I remind the hon. Gentleman that his Government introduced the National Health Service and Community Care Act 1990. When the then Secretary of State for Health announced its introduction, he agreed with Sir Roy Griffiths who had been commissioned by the then Government to produce a report and who said that 25 per cent. of care home beds would be lost as a result of that legislation because it was deliberately designed to move people out of residential care and into a home care setting.
Mr. Burns: The hon. Lady must understand that one of the fundamental principles of community care was to
examine where it was possible to allow people to remain in the familiarity and security of their own homes with domiciliary care packages. If there were a static population, that would lead to the loss of some beds because they would not be needed. The hon. Lady is talking about what happened 10 or 11 years ago and the elderly population has increased significantly since then. For a variety of clinical and funding reasons, many people have not been to able to remain in their homes. In recent years, care homes have closed and beds have been lost not because there is no demand for them, but because it is not viable for a variety of reasons—some financial and some bureaucratic and administrative—for them to be retained.The other problem is that the closure of homes is not taking place where there is spare capacity. More often that not, it is happening in the south-east, the south-west and the eastern region, where there is the greatest demand, and that creates a greater problem. The situation is critical. A survey in May 2001 showed that more than 70,000 pensioners were forced to sell their homes in 1999 to pay for the cost of residential nursing care. That represented a near doubling of the 40,000 pensioners in the same circumstances when a similar survey was carried out in 1995.
Even more worrying is the survey of 104 councils which showed that
- "potentially more than a quarter of a million"
Mr. Burstow: Will the hon. Gentleman give way?
Mr. Burns: I want to make some progress first.
The Government have failed to address the problem for far too long. The average age of this country's population is increasing. Some demographic projections indicate that the provision of nursing home beds needs to expand by around 65 per cent. by 2031 if the population is to be adequately cared for. Yet with the number of beds falling, an even greater expansion—possibly as much as 100 per cent. over the next 30 years—will be needed to meet the target.
Mr. David Drew (Stroud): Will the hon. Gentleman give way?
Mr. Burns: No, I am going to make progress.
The Government can continue to spin the situation, to fiddle the figures and to call it what they like, but the stark fact is that there is a crisis in long-term care. They may refuse to recognise that, but Opposition Members are not the only people who live in the real world and understand what is going on. Frank Ursell, the chief executive of the Registered Nursing Home Association, has commented:
- "The Government can rightly be accused of fiddling while a vitally important part of the health care sector declines before its very eyes. Inaction by the Government, coupled with chronic underfunding of services for older people, could mean that there will be insufficient long-term beds available in the years ahead."
We have to ensure that community care is developed—I strongly support this policy—so that it provides the back-up and the freedom from fear that the elderly deserve in the 21st century. I am afraid that despite some welcome strides forward, such as the raising of standards, more has to be done to address the problem. The knock-on effect of the loss of nursing homes and beds is causing a critical problem with delayed discharge, or bed blocking. A vicious circle is emerging. The increasing number of residential home closures has led to further delays in discharging older people from acute hospital wards. Not only does that prevent them from leaving hospital, but it lengthens the waiting times for patients who want hospital treatment.
The situation is ridiculous. On 9 October last year, the Government claimed that approximately 6,000 beds were blocked by patients who were well enough to be discharged. On 15 October, the Daily Mail revealed that the real number of delayed discharges was 100 times higher. [Interruption.] The Minister says, "It's wrong." It is not. I am worried that a Minister can sit there and, almost ostrich-like, blind herself to the reality of what is going on in the real world.
Although the Minister says that the article was wrong, after the Daily Mail had pointed out that the Government's figures were wrong, the Government admitted that they were wrong: they had referred only to those beds blocked in NHS hospitals on any one day, leaving out the other 364 days in the year. There is no point in the Minister repeating like a parrot, "It's wrong." It is not wrong. The Daily Mail also revealed that Department of Health statistics showed that over the course of the year, there were more than 680,000 elderly bed blockers. The Government insult the country by systematically refusing to accept what is happening. How are we to believe Ministers if whenever they are given information they do not like, they say it is not true?
Last year in inner London, 11 per cent. of acute beds were blocked. In December, in response to a written question tabled by my hon. Friend the Member for Woodspring (Dr. Fox), the Minister acknowledged that 36 per cent. of patients subject to delayed discharge were delayed in hospital for more than 28 days. That equates to almost 245,000 patients. How many patients could have received acute treatment had those beds been available and not blocked by people who had nothing wrong with them but had nowhere else to go?
The Government's policy and the knock-on effect of delayed discharge is having a profound effect throughout health care provision. Insufficient care facilities in the community mean that elderly people are being kept inappropriately in hospital, which in turn prevents those who need hospital treatment getting a bed.
We recognise that hospital is not always the most appropriate environment in which to care for elderly people. Wards tend to be noisy and overcrowded,
with individuals afforded little privacy. The Government have failed to meet their deadline for ending the use of mixed-sex wards. Even more disturbing is the high risk of elderly people in hospital acquiring infections: almost one in 10 of all hospital patients contract an infection during their stay.Although I welcome last October's announcement by the Government that they would release £300 million over two years to tackle delayed discharge, I agree with Sheila Scott of the National Care Homes Association, who described the sum as a "sticking plaster". With 680,000 bed blockers last year, 1,000 extra beds will do little to alleviate the problem that the money is intended to tackle. The vicious circle will continue to revolve until the problem of bed blocking and delayed discharge is brought under control. In the meantime, all care suffers. Under new Labour, we have been put in the ridiculous position whereby one is put on a waiting list both to get into hospital and to get out of hospital.
The Government have failed on another key aspect of health care: free nursing care. Before the last general election—under new Labour, these things always happen just before a general election—the Prime Minister and the Secretary of State promised that there would be free nursing care in England as soon as its introduction was viable. Since then, the implementation of the policy from 1 October has not lived up to the expectations raised by that promise.
Many people feel betrayed because they took the Government's words at face value and believed that everyone would receive free nursing care. They failed to realise that it was the Government who would define nursing care and personal care. Now, a significant number of people who thought they would be entitled to receive free nursing care have been told that they will not get it, because the care they need has been categorised as personal care. Some sufferers from Alzheimer's disease or dementia, for example, may not receive nursing care because it is judged that their care is personal care, and under the new policy personal care is not paid for by the system.
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