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Care of the Elderly (Crawley)

1 pm

Laura Moffatt (Crawley): I am delighted to be able to raise this particular issue. I know that, like the hon. Members who spoke in the previous debate, we all feel deeply about it. Many Members say how different the problems are and how important their constituency is, and I shall do the same.

Crawley is a new town and was formed just after the war. People from south London came within five years of each other to settle together with their young families. There was good employment and the town prospered. Few people would deny that Crawley is one of the most successful new towns. Yesterday, I entertained a GP from my constituency, Dr. Roy, who has just completed 40 years working in the health service. He said that he now sees the children of the children of the first generation, so Crawley is a town that has thrived and prospered.

The difference for Crawley, and other new towns, is that everyone came to the town at the same age. They have grown older together and are growing old together. We know that there will be a 51 per cent. increase in the number of over-85s in Crawley by 2011. This debate was designed to examine how we can address that challenge and ensure that we have a decent society. It is a national problem of course, not just one for the south-east and Crawley. People are living longer, and we should applaud that. In 1950, men were not expected to live beyond 67 years old and women not beyond 72 years. In 2002, men are expected to reach the age of 72 and women the age of 81. An average of five years longer in that short time is fantastic, and I hope we improve on that.

There are many reasons for those increased expectations. Ageism is being eliminated from the national health service. I remember when I was a nurse and people over 75 came into hospital requiring complex treatments or expensive drugs. Age was a real issue, but now if people can have a good outcome and are expected to do well from treatments, they are given them. People are treated as individuals, not just as someone who is growing older.

However, that brings huge challenges. A recent article in the Health Statistics Quarterly, produced by the Office for National Statistics, predicted that over the next 30 years 65 per cent. more nursing homes places and a 148 per cent. real-term rise in expenditure on long-term care will be needed. That is scary stuff, and we must face the challenge.

I have spoken a little about the problem in the south-east, but I want to expand on that. Land can be sold in my area and throughout West Sussex for between £500,000 and £1 million an acre—those figures come from West Sussex county council. The value of a terrace property in Crawley is more than £100,000, so hon. Members can imagine how pleased we were when the key workers scheme was introduced to enable people who worked in the care sector, teaching and police to move into our area. We want that scheme to be expanded because it has been enormously successful. However, high land prices have led to nursing home owners being able to make more money from the sale of

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the land to a developer than they could ever make running the property as a going concern, and that problem must be dealt with.

West Sussex county council has a particular and interesting problem. Other boroughs can outbid it for nursing home placements. London boroughs can pay up to £100 a week more, and Kent and Surrey can pay up to £50 a week more. Cash for change made a huge and welcome difference to West Sussex—we received the fifth highest allocation. There was no question that it was needed, and the money was well used. However, we used the money differently from other boroughs by ensuring that everybody placed in a nursing or residential care home had an uprate in the amount being paid. Authorities such as Kent, Surrey and the London boroughs kept the existing price for those in nursing home places and bumped up the new places money, so they can now outbid West Sussex.

Authorities should work together to avoid running into such ludicrous problems. As a result of the outbidding, places are taken by people from London—4.5 per cent. of places in Crawley, for example. That may be good news because people are moving closer to their families, or it may be that there is a shortage of places where they come from. A further 9.7 per cent. of places are taken by people from Kent, Surrey and East Sussex, resulting in a 15 per cent. shortage of what is already a scarce resource. People from London and Kent are coming to Crawley, and Crawley residents are offered nursing home places on the coast. We must do something about that. We have only seven nursing homes in the whole town, in stark contrast to the coastal towns that often have many more.

We must use scarce resources more effectively. It is vital to deal with problems such as delayed discharge. I cannot bear people talking about bed blocking—it is insulting. If I had a loved one in hospital who had a delayed transfer of care and was accused of being a bed blocker, I would be very angry. It used to make me very angry when I was a nurse. We must remember that such language can be insulting to patients.

The problem will be with us for some time, but there is much that we can do to help. Yesterday, in my local hospitals in Crawley and Horsham, 44 patients had a delayed transfer of care. That may sound bad, but it is an enormous improvement on the 70-plus that we suffered for weeks. The cash for change money made a huge difference to the problem, with people working together in better networks and ensuring that people are moved on. Although it seems dire, the situation has greatly improved and I congratulate everyone who worked hard to make that happen.

We must find a no-blame solution. We should get round the table with all those involved in the care of the elderly who deal with delayed discharges and ensure that people have the correct support in their own homes. Before Christmas, I called a seminar at the House of Commons for all those involved—patients, their friends and family, representatives of borough and district councils, social services and the voluntary sector, and general practioners from the primary care trust. We had a useful and productive afternoon looking into better ways of working.

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Without doubt, we all call for more money—that may be the long-term answer because we need to plan. However, it will not produce a single extra space in a couple of weeks, unlike some of the solutions offered by our conference on long-term care. We were delighted that the Minister of State for Health, my hon. Friend the Member for Redditch (Jacqui Smith) was able to visit and give the Government's view on the issue. It was helpful to our deliberations.

I shall describe some of the solutions that we came up with, because we felt that there was much that we could do. There is a lot going on, but we could work much more cohesively to ensure that people have better care. The main recommendation was for improved joint health and social service working. At the conference, a lot of work was explained to us, and it was good that we were all there to share the information. However, there was so much more that could have been done.

As the conference developed, people thought of new ways to work with each other, and they put a face to each other's names. They had usually spoken on telephones but had never seen each other face to face. It was heartening to hear people finding ways of working more cohesively. Of course the issue of increased capacity in the sector came up, but we did not state merely that there should be more nursing home and residential care places. Members of the borough council said that perhaps they had a role to play and could propose parcels of land that could be used for extra care homes.

In one care home in town, which has been superbly successful, elderly people can lock their doors but still have the extra care that keeps them in care places much longer and makes them much happier. We could expand plans for such homes, which prevent people from having to take up nursing home places too soon when they can be maintained in a different setting. That is one of the ways that we would like to pursue our aims locally, and we are actively considering it.

The issue of supporting people in their homes is vital. The fact that people want to stay in their homes tends to get lost in the debate. They want to be with their loved ones, if they have them, and their friends and families. That is why it is unacceptable to take people to the south coast to be put in nursing homes. They need to be in their communities. Crawley borough council should be applauded for its work to develop elderly care homes in the neighbourhood and to encourage people out of their three and four-bedroom houses to allow families to move in. That work is ongoing but could be expanded.

We want more intermediate care packages and greater clarity about the care that people can expect in their homes from local authorities. There was huge support for that, particularly from Age Concern.

Tim Loughton (East Worthing and Shoreham): I congratulate the hon. Lady on bringing up the subject, which is important to hon. Members representing West Sussex. We do not want her problem to be transferred to my part of West Sussex on the coast. We should keep more people in their homes and provide packages for domiciliary care. Does she agree that West Sussex social services and social services departments in the rest of the country have to tighten their criteria because of the

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shortage of funds, so fewer and fewer people are qualifying for the care at home that they so desperately need and that she and I favour?

Laura Moffatt : I thank the hon. Gentleman for his intervention. I understand his point, but I do not agree with the route he takes. West Sussex social services has had a sizeable increase in funds; it is the increase in the numbers of the elderly that is making the problem more acute. The social services department, which was well represented at the meeting, accepts that it has to target its funds much more, and it can think of ways of using them more effectively to keep people in their homes. There is a huge budget for that, which is very important. Of course, funding was an issue, so I take the hon. Gentleman's point.

Recognition of the problems of living and working in the south-east was to the fore. There were further recommendations to improve discharge planning—simple work that needs to be done—and communication with other organisations that assist with the care of the elderly. Improved care and medication for the elderly was also raised. I can well remember elderly people coming into hospital when there was nothing wrong with them other than the fact that they had been on the same medication for too long and had fallen over, or gone off their feet as it is known in the acute sector, and had to be rehabilitated. All that could be avoided.

More respite provision was much welcomed by the caring organisations and the voluntary sector. They said that if more respite care was provided they could care for the elderly at home and would not have to take up the nursing home or residential care option. West Sussex county council is working on that. It is ensuring that information to relatives and friends about supporting the elderly is improved. We are now developing better rehabilitation provisions at Crawley hospital for people who have suffered strokes to enable them to get back to the community as quickly as can be expected. Such good and reasonable options can make a difference. All the money in the world would not improve matters for us over the next few weeks, but changing the way in which we work could make a real difference to the people whom we care about so much.

I am not just shouting for more money. Of course, there is a need for extra resources, but I am talking about working together. The seminar brought people together to work out solutions. No one blamed the Government and said how dreadful they had been. No one said that social services were awful. Members of the seminar genuinely wanted to make a difference. Not only did such discussions improve the relationships of those within the organisations, they made people examine the provision of care in a different way. I hope that the report will make a difference.

1.16 pm

The Minister of State, Department of Health (Mr. John Hutton) : I warmly congratulate my hon. Friend the Member for Crawley (Laura Moffatt) on securing the debate and raising such important issues, and on the way that she has dealt with such significant challenges that face our society as we look to improving

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the health and social care services that are available to elderly people in her constituency and throughout the country.

My hon. Friend was right to draw attention to the significant demographic changes in West Sussex and other parts of England. Meeting the needs of our elderly citizens is one of the biggest health and social care challenges that our country will face in the years ahead. I particularly welcome what she said about the long-term care conference, which she had a leading role in organising in the House before Christmas. If further evidence were needed, the conference confirmed the strong and positive relationships that exist between health and social care organisations in her constituency. She should be congratulated on the work that she has undertaken. I wish to place on record my appreciation of the tremendous efforts of staff in the NHS and West Sussex social services, and those in the voluntary and independent sectors. They are working together to deal with the challenges that she rightly identified.

My hon. Friend was right to say that we should tackle the problem at two different levels. There is a need for the joined-up local working that she described, and we must search for innovation, new solutions and greater efficiency in the use of the available resources. I want to focus the main drift of my remarks on the need for the Government to support the local and better working partnership that she described. There are four particular areas in which we must continue to develop policy and to make further improvements.

My hon. Friend was right to say that resources are important, because they will determine the shape and size of the local services that are available. That point was touched on by the hon. Member for East Worthing and Shoreham (Tim Loughton). That is why the Government are investing significantly more money in social services. Funding for social services increased nationally by more than 20 per cent. in real terms between 1996-97 and 2002-03. That equates to an average real terms increase of more than 3 per cent. per annum, and compares favourably with real terms growth of only 0.1 per cent. in social services spending between 1992 and 1997.

West Sussex has benefited from the extra investment. Central Government support for social services spending in West Sussex is ahead of the national average growth in social services spending. This is the third year in a row that the West Sussex personal social services standard spending assessment has increased by more than the national average. In 1998, West Sussex county council received £106 million from central Government towards the cost of providing social services in the county. By next year, that figure will have risen to £123 million. Those figures do not include the extra special grants that local authorities receive from central Government.

We have been able to do that because we have recognised the real and genuine cost pressures in the south of England, such as land, property, wages and others to which my hon. Friend referred, which differ from those in other parts of the country, such as my

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area. Those higher costs put extra pressures on social services, and it is right to reflect that in funding arrangements when possible.

We are committed to further improving methods of funding local councils with social services responsibilities, in particular to ensure that the allocation system is fair and transparent. My hon. Friend will be aware, as will you, Mr. Deputy Speaker, with your interest in such matters, that we have announced a review of all existing SSA formulas and aim to have an improved system in place for the financial year 2003-04.

I agree with my hon. Friend that we should continue to ensure that investment is maintained, but she acknowledged that that is only one part of the equation. It is not in itself the sufficient and ultimate criterion by which we should judge the success or otherwise of the reforms. It is fundamental, but other things must happen as well.

It was therefore very important that my hon. Friend dwelt on the need to build up capacity in the care system as a whole, in both health and social care services. The Government have an important role to play in supporting local change and development. Central to our plans to reform the care system is the development of new intermediate care services. Those services, which my hon. Friend described, are designed to prevent avoidable admissions to hospital and to allow patients, especially older people, the necessary time and care for rehabilitation. That should enable people to live independently in their own homes for longer when they need care and support from social care services.

I am aware of the need for further development of those services in my hon. Friend's constituency, as she has explained. The NHS plan announced that an additional investment of £900 million would be available annually by 2003-04 for new intermediate care and related services. We have already seen signs of progress in that area. An extra 2,000 intermediate care beds are now available, and 127,000 patients are being helped in their recovery after treatment by specialist intermediate care-related packages.

In Crawley, health and social services are working on a joint intermediate care strategy comprising extra community rehabilitation, supported early discharge schemes, a reablement scheme using beds at Horsham hospital, the use of low dependency nursing home beds and the development of a specialist home care dementia service. Those will be important additions to the services on offer locally. I understand that those and further plans for expansion in intermediate care services in my hon. Friend's constituency are currently under active consideration.

The development of those care packages should not be seen in isolation. The Government have introduced several measures specifically aimed at promoting greater independence, to which my hon. Friend referred and I strongly agree with her views. I think that we would all, were our opinions canvassed, want to remain in our own homes for as long as possible. That is the right place—close to friends and family in an environment with which we are familiar and that we have played an important part in shaping. Of course, there will always be those for whom residential care is the appropriate answer, but our

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overall aim is to enable more people to be helped to live at home supported by home care services, such as the packages to which my hon. Friend referred.

We are providing West Sussex county council with additional resources to make further improvements in services. Schemes are available to prevent unnecessary hospital admissions, provide rehabilitation after hospital treatment and offer non-intensive services to help people to maintain or regain an independent life in the community, such as help with maintaining or entering employment, training or education through the development of seamless services between the NHS, social services and housing. That is the right way forward.

My hon. Friend dealt reasonably and accurately with the problems of delayed transfers of care. The issue of delayed discharges must be addressed, and we must continue to devote additional resources and effort to resolving the problem. It is in everyone's interests to ensure that people do not remain in hospital unnecessarily when they are ready to be discharged.

My hon. Friend was right to draw attention to the slow but steady reduction in delayed discharges from hospital during the past five years. We have made a commitment to reduce delayed transfers of care by a minimum of 20 per cent. by the end of March this year, which equates to freeing 1,000 acute beds by the end of the financial year. To that end, we are giving local councils an additional £300 million over this year and next year to help them tackle those problems. The money has been distributed to every social services department in England, but was targeted specifically on 55 councils that most needed additional resources. West Sussex was one of those and received £2.3 million in the current financial year, with a further £4.8 million in the next financial year. That money has been used to buy an additional 113 residential placements, and for increased expenditure on disability-related equipment and more spot purchasing of care home places by locality planning groups. My hon. Friend was right to say that it has also been used to increase fee rates where supply is particularly short.

The money is already having an effect and the number of blocked beds in West Sussex has fallen steadily from 142 delayed transfers in early September to 71, which is an improvement of 50 per cent. The figure is still too high and there is room for more progress, but we have in place the resources and some of the mechanisms to make a real difference.

We must also make a continuing contribution in our investment in service capacity and staff. We must continue to invest significantly in the training and education of the health and social care work force. A high-quality work force is crucial to ensuring that the country's most vulnerable people receive the best standard of care. Social care workers are a key part of

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delivering the Government's modernisation agenda as they are at the sharp end of many vital public services. We have been investing significantly in the training of social care workers for several years through the training support programme grant. That grant stands at more than £57 million this year, and West Sussex has been allocated almost £540,000 of the grant so far and is entitled to bid for further funds from one of the sub-programmes within the grant.

As my hon. Friend is probably aware, last week my hon. Friend the Minister of State announced further investment in the training and development of the social care work force. That money will help to provide training and development opportunities for a further 26,500 social care staff. It will be used to fund a range of initiatives, including the induction training programme for 6,000 staff and the strengthening of the framework of NVQ qualifications. Investment in capacity and in the work force is being made, and we must find ways of ensuring improvements.

It is important that local authorities such as West Sussex, providers of care and those receiving care packages tackle the problems together and work in the spirit of partnership that my hon. Friend the Member for Crawley described. I believe that what matters most in a modern care system is the quality of care provided, not who owns or operates the individual services. In social care, there has always been a mix of private, voluntary and public sector provision, and that is absolutely right.

We must improve partnerships across the various sectors to ensure that sufficient capacity is available to meet local requirements. The Government are committed to working in partnership with the independent sector and to using capacity and resources to achieve the best possible outcome for users and their carers. My hon. Friend the Minister of State has recently established a new strategic commissioning group to work at national level to give greater direction to the commissioning of care services for adults. We must consider how we can pool resources, staff, land and premises to stabilise and build up capacity. There is a need to consider the role of care trusts and closer partnership working. We have made a good start, but a great deal more needs to be done.

I hope that I have been able to reassure my hon. Friend that the Government are doing everything possible to provide the NHS and social services in her constituency and elsewhere with the necessary resources and opportunities to allow them to do their jobs effectively. The Government will continue to invest more in both the NHS and social services in every part of the country. I hope very much that she will continue to give her support to all those efforts, and that together we can look forward to further improvements in the care provided to her constituents.

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