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10.42 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I should like to congratulate the hon. Member for Isle of Wight (Mr. Turner) on securing a debate on a subject about which both he and I care a great deal. He has done an excellent job this evening of bringing to my attention the concerns of his constituents.
Long-term care is a very important subject in all areas of the country, including the constituency of the hon. Member for Isle of Wight. The care system plays a very important role in ensuring that vulnerable people of all ages receive the care that they need. It is important for the Government that we try to create a partnership between commissioners, providers, and local authority social services, to ensure that the needs of local people are met.
We appreciate that the independent care home sector is facing a number of challenges at present. The Government have no intention of denying that there are difficulties in the sector, but we must get the matter in perspective. We must be sure that we are dealing with the facts about care homes. Many figures are bandied about with regard to the numbers of beds that have closed in recent times, but the
study conducted by Laing and Buisson found that the net loss of residential and nursing home beds has totalled about 19,000 since 1997.Capacity problems do not appear everywhere in the country. The national occupancy rate is something like 91 per cent., which indicates spare capacity in some parts of the country. Conditions vary in different parts of the country, and the position in the Isle of Wight is mixed. The island has always had plenty of residential care home beds. A good number of homes were established in the 1970s and 1980s, often using old hotels and guest houses already on the island. In terms of residential care, it is fair to say that there is sufficient capacity, perhaps even overcapacity, in the Isle of Wight. However, we recognise that there is not sufficient residential care for older people with mental health problems who need specialised provision. The number of nursing homes may not be sufficient to meet demand in the Isle of Wight.
It is the Government's policy to promote independence for older people wherever we can and enable them to remain in their own home wherever possible. It is what the people concerned and their families tell us they want. I am encouraged by the figures showing that in the year 2000—the most recent figures we have—228 families received intensive care home packages on the Isle of Wight. That is an increase of about 10 per cent. on the previous year. The number of people receiving intensive domiciliary care in their own home is increasing, and we want to encourage that trend where it meets people's needs. Clearly, some people, too frail and vulnerable even to be supported by an intensive domiciliary care package, will need residential accommodation.
The care home sector can be assured that its services will be required in future and that there is a real need for the authorities to do some long-term, sustainable planning. I accept that short-termism is difficult for providers in the sector. It is important that the commissioners and the local authority have a plan for years to come about how to provide for local people.
About two weeks ago, in a debate on a Liberal Democrat motion about the long-term care system, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said that we should not be judged simply by the number of people in residential care. We must remind ourselves that the policy of care in the community was to ensure that if people could live in their own home with intensive support, we should aim to provide that, balancing it with good, effective, high-quality residential care where necessary. It is a matter of getting the balance right for communities.
The commissioners and providers are equal partners—each needs the other. About three-quarters of residential care provision is provided in the independent sector, so it is vital to get the relationships right. That is why we set up the high-level strategic commissioning group, chaired first by the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and now by the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith). It aims to give greater direction to the way in which we commission these services.
We recently issued an agreement between all the parties in a document entitled "Building Capacity and Partnership in Care". I hope that that document will underpin the relationship for the foreseeable future. It sets out in some
detail the responsibilities and expectations for central Government, local government, commissioners, providers and the national health services. It stresses the need for long-term contracts to ensure that there is planning in the system and that we do not end up with what the hon. Member for Isle of Wight referred to as precipitate closures which can have a damaging effect on the individuals involved.The document also seeks to press the parties involved to be a little more imaginative and think of new ways of providing residential care that can help people to maximise their independence, rather than simply purchasing new places in the existing provision. I am delighted that in the Isle of Wight, social services and the NHS have developed a successful model. They have two independent resource centres for the rehabilitation of older people in the community. Those units have 14 places. During the first six months of their operation, up to March last year, 39 older people passed through the unit when they were discharged from hospital. Only one person was admitted from the unit back to hospital or into a nursing home. The remaining 38 people were rehabilitated back home and remained there for a substantial period. That eased demand for both hospital and nursing home places.
I understand that plans for next year include the expansion of the rehabilitation service. I am delighted, because that is a concrete example of people working hard to come up with an imaginative way of maximising people's independence. It simply is not good enough for people to be discharged from hospital and sent home without the support and care to ensure that they can cope in that setting.
The hon. Gentleman rightly welcomed the additional funding that has been allocated to ease the problem of delayed discharges. Indeed, the Isle of Wight council is one of the 55 councils targeted for extra help over and above the general run of local authorities. It has received extra funding—£326,000 this year. The amount will be almost £700,000 next year. Although about £260,000 of that money will be used to purchase additional residential care places, much of it will be used in imaginative schemes such as the rehabilitation project and also for the funding of intermediate care beds. Hopefully, that will avoid hospital admissions and help people in their convalescence.
Mr. Andrew Turner: Although we welcome the money, the director of social services has pointed out that the problem is that there will not be enough beds to purchase.
Ms Blears: That is why all the partners need to get around the table to discuss whether they need to invest in new build and to create some additional capacity. If the rehabilitation schemes avoid the need for people to be admitted to nursing homes—or at least delay it—and let them have a few more years of healthy independent living, we all welcome them.
As the hon. Gentleman pointed out, we need to stabilise the care home sector. That is also true nationally. We have brought in a range of flexible possibilities through the Health and Social Care Act 2001 so that there can be joint and pooled budgets between the NHS and social services. There will thus be a larger pot to provide some of the longer-term solutions that we might need.
The hon. Gentleman's local authority might want to explore the possibility of setting up a care trust jointly with the NHS to ensure that there is maximum buy-in
from all the organisations in the area. They will then feel that there is a real partnership working to achieve some longer-term solutions.I am pleased to tell the hon. Gentleman that the Government have commissioned research into the supply of residential and nursing care accommodation throughout England. The study will examine future requirements, profitability and closures. We expect the final report to be produced within the next month and I shall ensure that a copy of it is placed in the Library. Such research, undertaking proper exploration of the issues that will undoubtedly face us in the future, will help to inform some of our long-term policy making. The sector has been subject to many rather short-term decisions and that has caused difficulty.
The Government are addressing previous underfunding of social services. We are trying to ensure that local authorities have the resources that they need to purchase care services in the community for people who require them. We have increased social services funding by more than 20 per cent. in real terms since 1997. This year, there has been an average real-terms increase of 3.2 per cent.
The Isle of Wight council has received above-average increases in its personal social services standard spending assessment allocation in each of the past two years. It will also receive an above-average increase next year of 5.8 per cent. The Government are certainly putting in the money to ensure that we provide for people.
The hon. Gentleman expressed the concern of his constituents about care home standards and the National Care Standards Commission. The former regulatory system for care homes was riddled with gaps and anomalies. Different bodies inspected different parts of the system and it was extremely difficult both for commissioners and for providers to find a way through. I understand that some homes were not regulated at all. As the hon. Gentleman said, most responsible care home providers welcome the introduction of national standards. They want to provide a high-quality and excellent service for the people they look after.
The introduction of national minimum standards will also mean that providers are clear about the standards that they have to meet. It will aid long-term planning if there is certainty about standards and about the investment needed to meet them. Users and carers will know what standards they are entitled to expect. There will be a benchmark for the quality of the services on offer.
The National Care Standards Commission will regulate care services in accordance with those standards and will apply them consistently to all providers—to try to ensure that there is a level playing field. Most responsible providers want that level playing field. The hon. Gentleman made the point that he wants the standards to be applied sensitively so that they do not cause undue concern. The phrase "precipitate closures" will stay with me, and I am very conscious indeed of that issue.
I understand that the Minister of State, Department of Health, my hon. Friend the Member for Redditch, will make an announcement very shortly on the precise way in which the National Care Standards Commission will operate. The commission will try to ensure that it works with responsible organisations to provide high-quality services to achieve compliance with the standards, rather
than simply imposing them from on high and acting in a dictatorial manner. Again, that reflects the partnership principle set out in our long-term agreement, and it involves working with the sector in the interests of the people who are cared for.I hope that I have reassured the hon. Gentleman that the National Care Standards Commission will work very closely with providers and have a dialogue with them. He is concerned that, to date, that kind of detailed discussion with the commission has not taken place. Providers need to take part in those discussions so that they can find out what the variations are, what extra work they need to do, what the time scales are and how much leeway they will have in meeting those standards.
I hope that during the next few weeks the hon. Gentleman and his constituents will receive that reassurance and get into that very important dialogue with the commission, but that does not detract from the fact that it is absolutely crucial to set national minimum standards. People in need of residential and nursing home care and their families are entitled to know that they will receive the very best care wherever they are cared for.
Our reforms are intended to be evolutionary, not revolutionary. The commission will focus on working with people to help them meet the standards. If standards are not being met in a few respects, the commission will note that fact in its inspection report, write to the home owner and give reasonable time in which to make the necessary changes. I hope that that will greatly assist people in the sector.
Another important issue is that it has been difficult to recruit residential and nursing home staff. We want to ensure that, in this sector—as in the national health service as a whole and, indeed, in social services—we provide a climate in which people want to work and in which they feel that they receive a decent reward but also a climate in which they receive training so that they feel that their skills are being developed and that working in residential care is a worthwhile experience. That is why we have included in the partnership agreement and in the national minimum standards a core provision for training, with support and funding, to ensure that we make the sector an attractive place for people to work. I am acutely conscious of the fact that we need to draw in the best people to look after some of the most frail and vulnerable people in our communities, so we have to ensure not only that they are attracted, but that they can be retained for a decent period so that we can build up their skills and qualifications. I hope that that will happen in future.
I understand that the hon. Gentleman has specific concerns. Because of the Isle of Wight's geography, it is more difficult to form partnerships with neighbouring local authorities, so there is a need to produce some home-grown solutions. I hope that the extra money that we are providing for social services, together with the money for delayed discharges, will help to reduce the pressure on the NHS. Delayed discharges in the Isle of Wight are now down to about 14—about 4 per cent. of acute capacity—which is extremely good news. I hope that things will continue to get better and that the hon. Gentleman will find that his constituents receive the best possible provision in the future.
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