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Mr. Michael Jack (Fylde): I am grateful to the Minister for giving way at this early stage. During this debate, she will have heard interventions from the hon. Members for Blackpool, North and Fleetwood (Mrs. Humble) and for Lancaster and Wyre (Mr.
Dawson), and she will be aware of the concern that the hon. Members for Preston (Mr. Hendrick) and for Pendle (Mr. Prentice) and I have about Lancashire county council's proposals to close 35 of its 43 care homes. The Minister said that she would keep in close touch with the county council and monitor that situation. Will she now tell us precisely what she has done, and what comfort she can bring to the elderly people of Lancashire with regard to the actions of this Labour-controlled council?
Jacqui Smith: The right hon. Gentleman is right—my hon. Friends have taken a close interest in care homes in Lancashire. I have, as I said I would, asked the social services inspectorate to keep a close eye on the matter, and the inspectorate has worked with the local authority to secure a better relationship between the independent care sector and the local authority than there had previously been, as was rightly argued for by my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson).
Some people will continue to need and choose residential and nursing care. We need to continue to build a system that translates the needs and choices of older people into the commissioning of a suitable range of both residential and other options for long-term care. This approach puts older people and their choices at the centre of planning. Unfortunately, our long-term care has not always been planned in that way.
Mrs. Jackie Lawrence (Preseli Pembrokeshire): May I draw to my hon. Friend's attention a survey that Age Concern Cymru has just given to me, which illustrates that 40 per cent. of people in residential care suffer from clinical depression? Will she bear in mind, when she talks about choices, what people really want is to be supported in their homes?
Jacqui Smith: My hon. Friend makes an important point about the choice and the independence that we need to provide for older people, and I shall explore that subject later.
As I was saying, we have not, unfortunately, always planned our long-term care by putting older people's needs at the centre. There was a huge expansion in the number of care homes throughout the 1980s, when uncapped budgets from the then Department of Health and Social Security were available for publicly funded people entering residential care. Entry to a care home was not based on need or user choice, but was too often driven by the interests of providers and, more significantly, by Government dogma. Profits were high but the standard of care was too often too low. Indeed, it has already been pointed out that it was the Conservatives—then in power—who, having created this unplanned and uncontrolled growth, sought severely to limit it. As I recall, the National Health Service and Community Care Act 1990 was introduced as much to stem this flow of money as it was to improve the lot of those using public services.
Mr. Hugo Swire (East Devon): If it is true, as the Minister says, that there was an explosion in the number of homes in the 1980s—and, therefore, an explosion in the amount of money following those homes—will she take the time to tell that to her colleague the Under-Secretary, the hon. Member for Tottenham
(Mr. Lammy), who made his first ministerial visit to the west country the other day? When he was confronted with the problems of Devon care homes closing, he replied that that was due to 18 years of chronic underfunding.
Jacqui Smith: My point—and that of my hon. Friend the Under-Secretary—is that decisions were made on the basis of funding streams; they were not made on the basis of investment in assessment and real care for older people, which is what this Government have done.
Fuelled by huge expansion in the 1980s, the care home market peaked in 1996, when there were too many beds to be sustainable in the long term. Indeed, a recent report by the Joseph Rowntree Foundation, written by Mr. William Laing of the independent care consultants Laing and Buisson, states that
- "a decline in care home capacity was to be expected—and, indeed, broadly welcomed."
Jacqui Smith: I was quoting the Joseph Rowntree Foundation, rather than myself. I was, however, going to go on to say that I recognise the concerns that come with managing this change in the care home market. As hon. Members have heard me say on numerous occasions, there has been a small loss of care home beds since 1997—[Interruption.] Some Conservative Members continue—because they lack the sophistication of the hon. Member for West Chelmsford—to chant about 50,000 care beds being lost.
Mr. Patrick McLoughlin (West Derbyshire) rose—
Jacqui Smith: I will give way in a moment.
Although 50,000 beds were deregistered, more than 31,000 beds entered the care home market during the same period, making a loss of just 19,000. That is just 4 per cent. of the stock, which means that there is roughly the same number of care homes today as there was in 1997.
Mr. McLoughlin: If the Minister regards the loss of some 50,000 beds as "small", will she tell us what she regards as large?
Jacqui Smith: If the hon. Gentleman had been a little less excited about jumping up, he would have heard me say that there had not been a loss of 50,000 care beds, but a net loss of 19,000. I also said that I was concerned about that. These are the facts—not according to the Department of Health, but according to Laing and Buisson, which Conservative Members are so keen on quoting.
Conservative Members have proved to me today how difficult it is to get the message over to the Opposition. I have outlined these figures to the hon. Member for West Chelmsford across the Dispatch Box on numerous occasions, and I went through them with him step by step at the Select Committee on Health. Either Conservative
Members are very slow learners, or they have decided not to let the facts get in the way of a political campaign, which is a pretty cheap way of treating the older and vulnerable people who need us to have an informed debate and put forward practical suggestions for improvement.
Mrs. Browning: Does the Minister accept that in rural areas such as my constituency in Devon, geographical spread and availability are important to choice? In many of my larger villages, there is only one residential home. If that home closes, the people in that local community will have to live much further away from their friends and relatives. We are going to end up with Trust House Forte-style care homes with colour co-ordinated bedrooms in urban areas—[Interruption.] It is happening now, and people in rural areas have no choice but to be divorced from their local communities.
Jacqui Smith: I understand the hon. Lady's concerns about care homes in rural areas. As I was about to say, we need to ensure that the fees paid to them reflect their operating costs. I shall come to fees in a moment; I am looking forward to doing so.
Kali Mountford (Colne Valley): On the point made by Conservative Members about delayed discharge, is it not time that we looked at new ways of dealing with that issue? The Moorlands Grange home in Netherton, which my hon. Friend the Minister visited recently, is now an assessment centre. People stay there for a limited period, often a period of their own choosing, while they decide for themselves whether they want to go into a care home or return home with some support. Would that not be a better way of dealing with this problem?
Jacqui Smith: My hon. Friend is right, and I enjoyed my visit to her constituency. That kind of practical suggestion and positive forward thinking will get us so much further than a slanging match about statistics. Of course, any closures that result in people having to move are worrying for those people and their families. I understand that at first hand, not least as a result of a campaign that I ran, before being elected to Parliament in 1997, to prevent the Conservative-controlled Worcestershire county council from closing a home in my constituency. We won that battle, and I was delighted to open the upgraded home just a few weeks ago.
If we are to maintain the necessary care home capacity and provide new services, of course we will need investment. Fees must reflect the costs of residential and nursing care and the improvements that we want.
Mr. McCabe: Issues other than fees may arise in relation to the introduction of new standards in various parts of the country. Tonight's tragedy, however, is that given the tone set by the uninterrupted rant from the hon. Member for West Chelmsford (Mr. Burns), the House has lost any opportunity to recognise the existence of geographical differences—differences relating to fees, but also to how zealously standards are interpreted. There is room for debate about such matters, but that earlier rant has obscured it.
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