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(a) any expenditure incurred by the Secretary of State under the Act, and
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided.—[Jim Fitzpatrick.]

Question agreed to.


Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Legal Services Commission

Question agreed to.


Motion made, and Question put forthwith, pursuant to Standing Order No. 119(9) (European Standing Committees),

Food Hygiene

29 Apr 2002 : Column 775

Mr. Speaker: With permission, I shall put together the remaining motions relating to delegated legislation.



New Hereford Hospital

10.27 pm

Mr. Bill Wiggin (Leominster): Having presented more than 20,000 signatures to Downing street last week, it is a great pleasure to present this petition to the House now:

To lie upon the Table.

29 Apr 2002 : Column 776

Social Services (Surrey)

Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

10.28 pm

Sue Doughty (Guildford): I have requested this debate because many of my constituents face problems in getting the care that they need in Surrey. First, however, I pay tribute to the enormous amount of work undertaken on behalf of the people of Surrey by those who work in adult social services, their colleagues in the national health service and those in the care sector.

We are indeed fortunate that, despite the enormously high cost of living in the area, those people work so effectively with the scarce resources that we have, not only to provide the services that they are required to perform, but to ensure that the money is spent as wisely as possible. Their work has already been assessed by the social services inspectorate as making significant progress against Government targets. However, from time to time their best efforts are not enough, and people are badly let down because the needs in Surrey are greater than the resources we have.

It is important that before I go into specific issues, I make the Minister aware of some of the good things that we have been doing in Surrey social services. We have not been allowing a problem to develop in the hope that the Government will bail us out. Far from it: in social services we have secured the country's first and largest private finance initiative contract, with the transfer of 17 former county council homes for older people to Anchor Trust, and seven other homes to Care UK to be developed as specialist centres dealing with mental frailty in older people. Joint developments with district and borough councils have supported developments for older people, and a learning disability partnership board. In my constituency, Guildford borough council provides day centres for older people to relieve Surrey of that load. Guildford has also implemented ground-breaking intermediate care schemes—"step up" and "step down"—to provide temporary sheltered accommodation while changes are made to people's homes, so that they can return after hospitalisation. Time forbids me to mention the many other initiatives on which great progress has been made.

The Minister will recall that I briefly raised this issue in an earlier debate. Although I was pleased with the "cash for change" funding that the county received to reduce the number of delayed discharges, I was concerned that we were not yet out of the wood. The large increase in Surrey county council's taxes had Liberal Democrat support, because we are all concerned about the major funding problems that Surrey faces. The people of Surrey have experienced a staggering 11.4 per cent. increase, 5.4 per cent. of which is for social services alone.

We have no difficulty with the provision of national funding for areas where need is greatest, but our social services funding has fallen below the acceptable level. Care costs are inevitably high in an area where property is expensive. Our unit cost of delivery is high, and we need nursing homes to stay in business. Housing costs are also a major issue, as they contribute to employment costs as well as job vacancies. The Government have allocated money for key worker housing, but demand is massive

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and, understandably, we keep losing staff. Agencies and homes are unable to bring in people from abroad, because the qualification levels needed for many posts are below that for which work permits would be allocated. High land and property costs also contribute to the problem. To build care home capacity, we need business planning. Building new care homes is almost impossible at the moment however, as land owned by the health service is being sold off at commercial rates, out of reach of the care sector. Sadly, in Surrey it is a case of selling off the family silver.

Staff vacancy rates also give us cause for concern. For care managers, the rate is 15 per cent.; for occupational therapists, it is 16.5 per cent.; and for learning disability residential services care staff, it is 34 per cent. The average vacancy rate for residential care staff for older people is 31 per cent., but in some homes it is 51 per cent. In Surrey, domiciliary care assistants work long and hard to do as much for their clients as possible, often finishing off in their own time, rather than leaving someone in distress. However, the average age of those who do such work is rising, despite training efforts at local colleges.

The Minister will be aware that Surrey hospitals have some of the worst problems with delayed discharges in the country, leading, of course, to unacceptable waits in accident and emergency departments, and cancelled operations. The "cash for change" funding has helped with rebuilding capacity, and in the next year Surrey aims to support an additional 120 people who might otherwise have experienced delays in being discharged from hospital. There is much yet to be done, however. Fee levels must be raised if we are to purchase places for those who need nursing home care. Meeting Government targets to reduce delayed discharges is presenting us with a real challenge.

I hope that the Minister can tell me how patients currently funded through "cash for change" will be funded when the scheme ends.

Mr. Philip Hammond (Runnymede and Weybridge): I am most grateful to the hon. Lady for allowing me to intervene. The Government seem to be focusing on areas traditionally regarded as being in greater need than Surrey. However, does she agree that, if people in areas such as Surrey are unable to access good quality public services, the consensus that underpins provision of those services is in danger of breaking down?

Sue Doughty: I thank the hon. Gentleman for making that point. I agree. We have grave concerns about the future of some of those services.

We welcome the additional funding for Surrey that was announced after the Budget, but we are unclear about how much it will really be. The basis of the calculation is 6 per cent., but of which level of funding? Surrey's funding has fallen over the years and to enable wise planning with care providers and the health service, we need to know how much that money will be in real terms. The care business is in crisis in Surrey. We are in competition with London boroughs to get nursing home accommodation, and they have far more money at their disposal. The competition for places with self-funding people is also a constant problem for those who cannot fund themselves.

We share the Government's concern that no one should receive care that falls below acceptable levels, and providers are working hard to meet the new standards.

29 Apr 2002 : Column 778

However, inevitably, prices will need to rise to cover costs and Surrey will need to increase the rates it pays. It is a fact that fees are between 20 per cent. and 100 per cent. more than Surrey can realistically afford to pay, and any increase in fees that the council agrees to pay leads to a reduction in the number of people whom it can support.

Finding places that are accessible for family visits and suitable for the individual is a tortuous process. Improvements have been made through the work done by the Surrey ambulance service, which has developed a website listing homes, vacancies and prices. It helps families through some of the process, but Surrey can only pay fees of £450 a week for residents admitted from 1 April this year and £380 a week for existing residents. On 16 April, the most recent date for which I have figures, there were only four beds in nursing homes at less than £450 a week, but the Royal Surrey county hospital alone has 56 delayed discharges, many of whom are waiting for those beds. We cannot reduce those numbers in this financial climate. We are getting one of the lowest SSA settlements in the country, but facing some of the highest costs.

In the meantime, our acute hospitals are regularly featured at the wrong end of lists of those with delayed discharges and delayed operations. We need to gain a greater understanding of what hospitals will charge social services for having people in beds. At the moment, there is the ludicrous possibility of the Royal Surrey county hospital seeking to recover its costs at £200 a night, when Surrey social services does not have resources to place people in the more expensive nursing homes that nevertheless cost less than the hospital beds. The money runs out, and if it is paid to hospitals it cannot be used for nursing homes. If, through no fault of the hospital, patients cannot be discharged from hospital, will the council be required to pay fines from money that it does not have?

Provision to fund places for those with learning disabilities is also a major issue. Several long-stay hospitals in Surrey have closed, resulting in many people—far more than the national average—living in residential care in the county.

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