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Mr. Burstow: I seek clarification. Is the hon. Gentleman advancing the view that personal care, like nursing care, should be free? Can he explain why his Front-Bench team, who in opposition took that measure through in the last Parliament, did not pick it up and did not deal with the complications of the Government's free nursing care scheme?
Mr. Burns: We fully support the provision of free nursing care, as we did before the last general election.
Dr. Evan Harris: Not personal care?
Mr. Burns: No, free nursing care. Like the Government, we also said at the last general election that we would not give a commitment to free personal care. We fought the last election on that policy, and so did the Government. I know the Liberal Democrats had a different view, but I am stating the policy on which we fought the last general election.
Far too many people feel that they have been let down over the free nursing care promise, which has not lived up to expectations. The Government wring their hands
and will not accept evidence that any constituency MP is more than familiar with, especially if they live in the south-west, the south-east or the eastern region. They see homes closing down and being sold off for other endeavours. Homes are under tremendous financial, bureaucratic and administrative pressures. They are desperately trying to provide the highest standards of care for their residents.We all support the idea of more provision of domiciliary care for people for whom it is a viable and rational option, so that they can remain in the security and familiarity of their own homes. However, there is a crisis, as the title of the debate on the Order Paper shows. It would be far better for the elderly of this country if the Government recognised the arguments and did more to help alleviate the problem, rather than pretend that it does not exist or that it will merely fade away.
8.17 pm
Mr. David Hinchliffe (Wakefield): I welcome the debate. I shall probably break the consensus that has existed so far. I do not subscribe to the view that the success of community care policies can be evaluated on the basis of the number of beds in private care homes. I worked in the care sector for many years, including in care homes. My mother ended up in a care home, and that was the worst experience of my life. I do not want to end up in a care home. I think that we can do a damn sight better for our elderly people than sticking them in institutional care. As the Minister implied, it is about time that we showed vision and courage by moving in a more radical direction.
I felt depressed when I listened to the criticisms of the Government, which were almost wholly based on the decline in the number of care beds. If community care is working, of course there will be a decline in the number of care beds. Reference has been made to people such as Sheila Scott, the chairman of the National Care Homes Association, and others whom I have known for a long time. I probably know more private care home owners than most hon. Members, and I have never known any who have been poor. Someone somewhere is making money out of the sector. I have not seen them walking away from the private care sector.
I want to explore key areas that have not been touched on so far. I was surprised that the hon. Member for Sutton and Cheam (Mr. Burstow) did not mention the structural problems that have occurred as a result of the split between health and social care since the 1940s, which is a major area. I understood that Liberal Democrat policy was to do something radical about that, but perhaps they have moved away from that position.
Somebody mentioned the National Assistance Act 1948, which set out local government services that were to be means-tested. There was also the National Health Service Act 1946, under which care was to be free. Since then, we have had difficulties in matching up the two parallel systems. In 1974, the Conservative Government moved more elements of local government health care into the health service, complicating matters even further. I worked in social services at that time, so I am aware of the difficulties involved in getting the two elements of the care system to work closely together.
We have talked about the royal commission on long-term care, which was proposed by the Labour party when I was a Front-Bench spokesman on community care
policy. I claim no credit for the proposal, because it was the idea of my right hon. Friend the present Home Secretary, who is a good friend. It was right to try to develop a consensus on the direction that the long-term care of the elderly should take. Personally, I believe that the conclusion in the majority report was correct. The split between nursing and social care is unsustainable, and nobody has managed to define the two types of care. At the moment, the definition of nursing care is anything that a nurse does. What absolute nonsense. I think that the definition will be challenged in law; it is impractical and it will not last very long.My Government have made tremendous progress on community care, and I concur with much of what the Minister has said. I fully and actively support many of the Government's reforms, but I do not believe that we yet have the right policy to tackle the divide between personal and nursing care. We will have to revisit that matter. I would go further and tackle the separate structures for health care and for social care. I do not want to rehearse arguments that I have been making for many years about having a common system delivering health and social care, but until we get that we will have problems.
Rev. Martin Smyth (Belfast, South): The hon. Gentleman and I have worked together over the years and I know of and share his concern. However, I must enter a caveat. In Northern Ireland, health and social services work together, but we still have the same problems with the availability of beds. We must deal with the financial structures so that one section is not holding back from another.
Mr. Hinchliffe: I have the greatest respect for the hon. Gentleman, whom I have known a long time. He has had a passionate concern about health and social issues for all the years I have known him. Obviously, he knows the Northern Ireland system far better than I do, but I understand that the problems there arise from the fact that although there is one common organisation, there are still separate budgets.
That brings me to my next point, which relates to the figures on delayed discharges which were given to the Health Committee. In October, we were told that 6,000 beds are blocked on any one day. That was the Government's figure. I do not know whether it is correct, but I have not seen a revised figure. We were also told that the cost of an acute bed averaged out at £120,000 a year, so a quick calculation tells us that blocked beds cost £720 million a year.
I would bet my bottom dollar that for a small proportion of that sum, we could have got those people out into the community and cared for them more cheaply, more effectively and, from their point of view, more happily and in a more settled environment if we had a coherent organisation running the whole show. I make a plea for a common health and personal care organisation—a plea that I have been making in the House for the past 15 years. I hope that by the time my career in this place ends, I will have got somewhere on this issue. I look forward to the Minister tackling that point in her winding-up speech; my hon. Friend is really suffering this week.
I turn now to a point that was not dealt with in great detail by the Liberal Democrats. The difference between the marked and welcome increases in NHS funding under
this Government and the less positive developments in personal and social services funding is having a serious effect on our ability to unblock beds and tackle difficulties in the community. The Government told the Health Committee that the total gross expenditure on the NHS had increased by 8 per cent. in the last financial year. That is an impressive increase, and I welcome it. The budgeted personal social services expenditure for the same year went up by only 1.4 per cent. That is a big difference, and I am sure that the Minister understands the consequences.I was reminded of the consequences at my surgery only last Friday night, when a lady came to see me about her mother, an elderly lady who had been in hospital for a hip operation. She was on an orthopaedic ward and was told, to the surprise of her daughter, that she was fit to be discharged into a private care home. The daughter was told that she had to get on with getting her mother out because she was blocking a bed. The daughter felt that her mother ought to be transferred to a geriatric ward or into intermediate care, but she was told that her mother had to go into a private care home.
The daughter obtained a private care home place for her mother. Interestingly, she was told by the ward sister that because her mother had private resources she could fund her care and there was more pressure on her to leave than there would be on someone who would be funded in that care home by the local authority. I do not know whether that is true or not. If after making local investigations I find that that is happening, I may well draw it to the Minister's attention because I will be concerned; I am certain that she will share my concern.
I differ from Conservative and Liberal Democrat Members on the use of the private market. In a week in which the Government have talked about making more use of the private market, it is important to look at the implications of relying on the private market in care provision. The hon. Member for West Chelmsford (Mr. Burns) appeared to accept no responsibility for the current situation in the care home sector. However, he knows full well that his Government decided in 1981 to allow supplementary benefit payments to top up private care home fees. That unpublicised decision led directly to a massive explosion in private institutional care. As a result, huge numbers of nursing homes and care homes sprung up across the country. Mrs. Thatcher believed in stimulating the market; consequently, we are bogged down in the community care system and locked into the kind of debate that we are having tonight in which we worry about the number of beds that we have.
The huge explosion in private institutional care arises directly from the market's involvement. Figures that I obtained from the Library show that, between 1981 when that decision was taken and 1993 when community care changes were introduced, the Conservative Government spent £10 billion subsidising private care homes. How much could a proportion of that money have done to keep people in their own homes? There was money to put people in institutional care, but not to keep them out.
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