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Mr. Dawson rose

Mr. Burstow: I have already taken one intervention from the hon. Gentleman, so I hope that he will forgive me if I do not take another.

Another problem that is causing great anxiety is the massive backlog at the Criminal Records Bureau. Any new member of staff at a care home has to be checked before they can start working. We have been told that that requirement has been put back to 1 August, but what will happen on 2 August to the care home manager or owner who has not been able to have the checks done? Will they go to prison? Will they have to close the home because they do not have the staff to keep it running? What will happen to the people in the home if it has to be shut down temporarily? How will that difficulty be overcome? Many care home owners want to know the answers and would welcome some detail from the Minister tonight.

When I surveyed care homes earlier this year, it is no wonder that I found that seven out of 10 were considering refusing to take on local authority-funded placements and more than half had seriously considered closing their doors and going out of business in the past year. As the cabinet member from Birmingham told the Minister, confidence in the sector has collapsed. It is not only the poor quality homes that are closing but the homes that have invested in making changes to improve the quality of their facilities. They now have to pay more in interest charges to repay their debts and are struggling the most.

The crisis is widening and deepening because of the crisis that is also developing in the home care sector where there are similar financial and staffing strains. Over the past few years, there has been a significant change in who receives home care. To manage their limited resources, social services departments have tightened their eligibility criteria year after year so that they exclude all but the most frail and desperately dependent people from staying in their homes.

The Minister regularly trots out the fact that there are now more high dependency packages, but glosses over the fact that in the past five years, care packages have ceased for 109,900 people or they no longer receive care at home. That is a 22 per cent. reduction. What has happened to those people? Have they miraculously become independent? Do they miraculously no longer need any services? Or is it simply that their local authority has defined them out of eligibility for care? That is what the Government really mean by choice; it is no choice for people who do not quite qualify because their social services department cannot quite afford to provide them with the care that they need.

What has struck me most in all the debates on this issue is that Ministers largely ignored the problem until it started to hit the national health service. When the statistics on delayed hospital discharge began to rise, Ministers became concerned and wanted to do something about it. The announcement last autumn about extra cash

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was not really to deal with stabilising the sector but to do withtackling the Government's concern about the headline delayed discharge figure. It is nothing to do with choice—it is all about Government targets. The Government are concerned only about what they are directly responsible for and quite happy to leave social services to clear up the mess in relation to things that are not their responsibility.

Delayed discharges are just a symptom—the result of the pressure on the care system as a whole. The Minister says that we need a whole system approach, but it is not happening.

In the past two years, we have seen an 18 per cent. rise in emergency readmissions. People are being discharged prematurely because care home packages are no longer available for them. They turn up in accident and emergency departments, needing more care and support.

The Government have failed to take a whole system approach, and the Wanless report, which was published on the day of the Budget, said as much. I hope that in his reply, the Under-Secretary will say that funding is at the root of the problem. Higher standards are not cost free. We were kidded when the regulatory impact assessment to the Care Standards Bill implied that everything could be done on a cost-neutral basis. It was nonsense then, and it is demonstrable nonsense now.

Mr. Andrew Turner (Isle of Wight): Would it surprise the hon. Gentleman to know that the Minister of State admitted last week—only after a question that I tabled in March this year—that the regulatory impact assessment, which she signed off in December last year, was inaccurate in one very substantial measure?

Jacqui Smith: In the annexe.

Mr. Turner: That was part of the assessment, as far as I can tell. The estimated cost was given in the annexe as £52,000 per establishment, whereas in fact it was £52,000 per room.

Mr. Burstow: The hon. Gentleman highlights one of the errors in the regulations relating to disabled people in care homes. The regulations to which I am referring concern care homes for the elderly. However, he is right, and the figures had to be withdrawn as a result of that error. They caused anxiety across the sector when they were published because they did not add up. They did not add up when the Care Standards Act 2000 was implemented and the regulatory impact assessment was published. The figures were partial and did not give a true picture of what would happen after the Bill was implemented.

We could continue to argue how much extra the social services sector does or does not need. The Government say that it is 6 per cent., while the SPAIN—social policy ageing information network—group and others argue for more.

The Government deserve credit for the Wanless report, which studied and analysed the case for extra investment in the health system. We supported the recommendations with our votes when the legislation went through. We believe that there needs to be a Wanless report for social

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care. Indeed, the Wanless report said time and again that there was a need for such an analysis, but it was not within its brief.

Mr. Dawson: Liberal Democrat Members believe that there needs to be such a Wanless report; Wanless himself says so in the report.

Mr. Burstow: I think that that was what I just said, and I am glad that the hon. Gentleman endorses it. I hope that, despite the fact that Ministers have so far rejected that request, they will consider it. What do they have to hide? Why would they be concerned about having a detailed independent assessment of what is needed to provide quality social care?

Dr. John Pugh (Southport): I am sure that my hon. Friend is aware that in 1999 the Government changed the assessment of elderly people in the population from total elderly population to elderly population living in private accommodation. That put undue pressure on authorities with high numbers of residential homes and will continue to do so. While standard spending assessments are under review by the Government, is there not a case for them to take that factor on board?

Mr. Burstow: My hon. Friend makes an important point. My hon. Friend the Member for Bath (Mr. Foster) raised a point of order earlier today in which he said that a consultation document was published today which deals with some of these issues. However, only four copies were lodged in the Library and there was a long queue at the photocopier so that Members could study it properly.

I hope that the Minister will tell us why the Government have set their face against having a detailed independent assessment of the true resource needs to provide social care at the level that we expect.

In the meantime, we believe that we need to strike a different balance in the resources going into the health system. Unless we inject additional resources into home care and care homes, difficulties with delayed discharges and emergency readmission will continue.

Mr. David Drew (Stroud): I do not disagree with the hon. Gentleman's emphasis on funding. However, there is also a systematic failure that I have not heard mentioned in the debate so far—the belief that the private sector alone can pick up the problems of the care sector. We need to look at other forms of organisation, principally mutual organisations, which are growing around the country. That must be emphasised as a solution at the centre of the situation rather than at the margins.

Mr. Burstow: I agree with the hon. Gentleman about considering how to develop new models for the provision of care, such as co-operative and mutual organisations. We want to explore this area, which is an interesting way to ensure that there is a wider choice in the future.

The Minister says that the seeds of today's crisis were planted with the unplanned, unmanaged expansion in the 1980s. However, Ministers today are presiding over yet another unplanned, unmanaged situation, this time a collapse. If they fail to address the concerns that have been brought to the House's attention tonight and in many previous Adjournment debates, they will, by their

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complacency and denial of the facts, show that they are more interested in facilitating the loss of capacity through stealth in this sector and much more concerned about the headline delayed discharge figures than they are about choice, care and the dignity of people in old age.

8.18 pm

Dr. Howard Stoate (Dartford): It gives me great pleasure to be called tonight, because I believe that I am the only Member of the House who carries on any medical practice. It always pleases me greatly to be able to enter into a debate about which I hope I know a certain amount.

How elderly people are looked after is of great importance to doctors. Many of my patients end up in the nursing or care home sector sooner or later, and it is important to me to know that they are being looked after properly. Right hon. and hon. Members may be pleased to know that a number of elderly residents who have moved off my list into care homes still write to me once a year to let me know how they are getting on. It has probably more to do with letting me know that no one has managed to kill them off yet than with any care that I gave them. They certainly seem to want to keep in touch with their former general practitioner, which is pleasing.

The majority of care homes give an excellent quality of service and live up to the expectations of many of their residents.

Nevertheless there are significant problems in the care home sector and we must not underestimate or belittle them. The trouble with tonight's debate is that although the hon. Member for West Chelmsford (Mr. Burns) was long on rhetoric and gave a passionate speech, to which I listened carefully, there was not a word about what his party would do in a similar situation. We heard only how terrible things were; there were lists of the numbers of places closing down and beds lost but not a word about what his party would do to address the situation, let alone to put it right.

On the other hand, the hon. Member for Sutton and Cheam (Mr. Burstow) gave a thoughtful and careful exposition of the problems. I have great sympathy with much of what he said; many of the problems that he raised were entirely correct. At least he had some sensible questions and suggestions as to how we might address them.

The debate is important and the subject is worthy of careful consideration; it should not be trivialised and turned into a party political rant. Sooner or later, many people in this place will probably need care of one sort or another in their old age. It is important to ensure that that care is of good quality.

We have heard that there was a massive expansion of care homes in the 1980s. Indeed there was. I was practising then and an amazing number of care homes opened up all over the place. To paraphrase the slogan from a well-known supermarket, "Pile 'em high, sell 'em cheap", those care homes, under the auspices of the previous Conservative Government, were packing them in and selling them cheap. Many of those homes were providing low quality care, in small and shared rooms, with low staff numbers, inadequate training and poor nutrition. The standards of care in some of those homes were horrifying. The bottom line was profit—massive profit for the owners, but not necessarily good care for the residents.

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That situation was not universal; many homes did a good job even then. However, the Government are trying to ensure that minimum standards are available for all residents, so that they can expect a minimum level of care wherever they go. The only way to do that is to raise standards, but all that we heard from the hon. Member for West Chelmsford was that we must not introduce higher standards too quickly; we must rein them back and dilute them. We never heard which standards he wanted to dilute and rein back or which ones he did not want to introduce. Perhaps he wants to put partitions across rooms to make them smaller. Perhaps he wants to do away with lifts. Perhaps he wants to reduce the quality of food available to the residents. All that we heard from him was how terrible things were and how much bureaucracy there was; neither he nor his party made a suggestion as to how we could address the problem.

The vast majority of people who go into care homes do not actually choose to do so. Over the years, a large number of my patients have gone into care homes and I cannot remember one who said, "I am looking forward to going into a care home." The majority of them went into care because they or their families felt that there was no alternative. That is one of the problems that we have to face.

Many people would much rather have a different type of care. They would prefer to be looked after by their own family in their own home, close to their friends. It is a tribute to the Government that they are at least prepared to address that issue and to try to provide care packages for people in their own home.

As a GP, I think it is a tragedy when I occasionally have to send people to hospital, not because it is the right place for them but because it is the only place for them in the circumstances.

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