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Jacqui Smith: My hon. Friend is right. I was about to deal with the subject of fees.
Mr. Butterfill: Will the Minister give way?
This is tricky territory for Conservative Members. The fees paid by local authorities depend on how much they receive. The amount has risen by more than 3 per cent. a year in real terms since 1997; it rose by only 0.1 per cent. a year under the Conservatives. Moreover, we recognised the concerns of local government last year—
Mr. Butterfill: Will the Minister give way?
Jacqui Smith: No. I have already been far more generous than the hon. Member for West Chelmsford, and I want to make some progress.
As I was saying, we recognised the concerns of local government last year. Over that year and this, we have provided £300 million to help stabilise the care market and cut the number of delayed discharges. I have been asked where the money went. More than 50 per cent. of what councils received was spent on care homes. It is because of those additional funds that local councils have been implementing fee increases. According to independent care consultants, the vast majority of councils recently agreed to fee increases in excess of 3 per cent., and some have agreed to much bigger increases. A third of them have increased fees by more than 10 per cent.
Mr. Michael Jabez Foster (Hastings and Rye): The hon. Member for Bexhill and Battle (Gregory Barker) spoke of problems in East Sussex. My hon. Friend may be interested to learn that while her generosity and that of her colleagues was welcomed by those in East Sussex who received an extra £1.2 million, the Tory county council cut its social services budget by £4 million, thus taking more out than the Government put in.
Jacqui Smith: My hon. Friend has ably illustrated the Conservatives' attitude to investment. I spoke of difficult territory; even more difficult for them to accept is the fact that we are committing resources in the long term. I said that funds for social services were rising by 3 per cent. over inflation each year. As the Chancellor announced in the Budget, from next April we will double that, delivering an average real-terms increase of 6 per cent. a year from 2003–4 to 2005–6. That is very good news for those who need the support of care services—and, as reaction to the Budget has shown, there is overwhelming public support for the extra investment. It is a pity that the Conservatives do not feel the same; it is a pity that they voted against that investment on 1 May. I hope that those who call for higher fees for care homes tonight will also tell us which way they voted on the provision of the necessary funds.
Mr. Simon Thomas (Ceredigion): I have considerable sympathy with the Minister's argument, and I support the Government's aim of improving care home standards. Let me point out, however, that in forthcoming years not private homes but local authority homes will find it most difficult to meet those standards because, for reasons that the Minister has given, they have suffered from underinvestment for many years.
Will the Minister say something about the Welsh Assembly's call for the Government to make personal care freely available in Wales?
Jacqui Smith: I shall deal with the issue of care standards later but, as the hon. Gentleman says, investment is important.
I think that we have made our position clear. We think it important to ensure that there is free nursing care, but also to provide new services by means of the extra investment we are making. Decisions being made in Wales are of course a matter for Wales, and I know the hon. Gentleman takes a close interest in them.
Money is important, but so is better commissioning of care for older people. The ad hoc and distorted relationships of the past are being replaced by partnership at local level between health organisations, social services organisations and the independent and voluntary sector. We have established a new, more positive partnership between the statutory and the independent social, health care and housing sectors at national level. That is being built on locally as authorities implement our agreement, published as "Building Capacity and Partnership in Care".
We need a whole systems approach. The care home sector does not exist in isolation from the overall health and care economy and the reforms that are happening elsewhere. Councils, care home providers and others need to get round the table, listen to what older people say they want in the future and work together to commission and provide it.
Once again, we are focusing on the issue of standards for care homes. Standards in that sector are not new. The system of standards introduced by the present Government replaced a system under which care homes were regulated by about 250 local authorities and health authorities, each applying its own standards. The old regulatory system had been criticised for many years for lacking independence, consistency and coherence. Many people, not least members of care home provider organisations, have been calling for national standards for some time. We responded to those calls: we outlined our proposals in the White Paper "Modernising Social Services", we consulted widely and we debated the proposals at length in Parliament. The Conservative party supported them.
I have spoken to care home owners who are worried about meeting some of the standards. We have already acted on that and will continue to listen. The more challenging environmental standards will not be implemented until 2007 and providers will be given realistic timetables to meet them.
Mr. David Borrow (South Ribble): I am sure that my hon. Friend heard the hon. Member for West Chelmsford (Mr. Burns) criticise the care standards that have been introduced. The hon. Gentleman did not, however, list the standards that he would not implement were he in a position to do so. Has my hon. Friend managed to secure such a list from him, and has she been able to assess the effect on care for the elderly if those standards were not implemented?
Jacqui Smith: My hon. Friend makes an important point, to which I shall return shortly.
In January I issued instructions to the National Care Standards Commission to ensure that inspectors consider whether care homes could fulfil the needs of service users without making environmental changes—for instance, to room sizes, lifts, baths and shared rooms—to meet the standards. I made it clear that failure to meet them should be used as a reason to deregister a home only when services posed a danger to vulnerable people. We believe
that people's safety and well-being is paramount and the new standards will help to ensure that poor quality care is a thing of the past.It is true that only one of the seven categories of standard is environmental. I have mentioned our common-sense approach, but I make no apology for the expectation that those who care for our most vulnerable people should have some training; that those going into homes should have information about terms and conditions and a plan of care; that they should be given regular nutritious meals; and that medicine should be controlled and supervised. If Conservative Members cannot support those standards, I hope that they will explain why to the families of vulnerable people in their constituencies.
Brian Cotter (Weston-super-Mare): May I make a constructive point? It is being said in my area that inspection is being rigorously enforced in some parts of the country, but not in others. Will the Minister pay serious attention to that? It seems that in some regions standards to which the Minister committed herself are being implemented sensibly, while in others, such as mine, they are being implemented too zealously.
Jacqui Smith: The hon. Gentleman makes a sensible point. Of course, we need to continue to work with the National Care Standards Commission to ensure consistency in the way in which inspectors operate.
The emphasis in the standards will be on ensuring people's safety. Of course, there is a balance to be struck. Our aim is to set standards at a level that will improve the quality of life for people whose home is a care home. We will continue to watch developments carefully and—as we have done to date—we will not hesitate to act if we become convinced that the balance is wrong.
Mr. Swire: Will the Minister give way?
Jacqui Smith: No, it is time for me to make some progress.
Long-term care is not just about care homes; increasingly, older people want to be able to choose to stay at home. We are giving them that independence through the development of alternatives such as extra care housing and the provision of more intensive home care packages to keep people in their own homes for longer. Since 1998, the number of intensive home care packages—people supported in their homes, in many cases instead of through residential care—has increased by nearly 16,000. Intermediate care services are making a difference to the independence of, and choices available to, older people. "Hospital at home" teams can give antibiotics to older people with chest infections in their own homes, rather than their having to be admitted to hospital. The other day, I met a lady who thought that she would have to go into a home following a hip replacement, but instead she was receiving intensive rehabilitation in an intermediate care centre that was developed within a care home. She was already making plans to go back to her flat. The plans for intermediate care that are spelt out in the NHS plan are becoming a reality for thousands of people.
New services and investment are achieving results. The issue of delayed discharges was raised, and I am pleased to announce that significant progress has been made in
respect of the serious problems that the Tory Government left us. The rate of delayed discharges for patients aged over 75 stood at 13 per cent. in March 1997. In other words, nearly 7,000 older people were stuck in hospital when they should have been discharged. By March 2002, that figure had fallen to 9.4 per cent.—nearly 2,300 fewer. With investment and reform, we are ensuring that more vulnerable people get the right care in the right place, and at the right time.This evening, we have been treated to the latest incarnation of compassionate conservatism. That is quite a transformation for the hon. Member for West Chelmsford, given his record in government. However, he has also allowed us to see what compassionate conservatism really means. It can be summed up in three easy sentences: "We're sorry that there are social problems and challenges for our public services. We're really sorry that we were responsible for causing them. Sorry, but we're not going to do anything to put them right."
What the people who depend on our care services really need is not Conservative crocodile tears, but a Labour Government who are providing more investment, higher standards, more services, more choice, more independence and more hope for the most vulnerable people in our society. I commend the amendment to the House.
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