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Mr. Swire: Has the person in my right hon. Friend's constituency suffered from the same problem as a care home owner in Exmouth, who contacted me to say that he and his wife, who own the home, and their daughter, the matron, have had a letter from the National Care Standards Commission, inviting them to apply to the Criminal Records Bureau for enhanced clearance. They have been given until 1 August to comply, otherwise they will have to close down, but they have been unable to get through to the bureau.
Sir George Young: We must have sensitive and sympathetic application of the regulations if good people are to stay in the market. In Hampshire, there are homes that are having to remove en suite bathrooms to meet the space requirements, which cannot be right.
The argument that the crisis is less of a crisis because implementation of some regulations has been deferred sounds plausible, but is invalid if we want to achieve a confident care home market. For those who are not going to meet the standards for whatever reason, it simply postpones the day of reckoning and ultimate closure. Those who would like to stay want to know that staying in the market will be worth while and that fees will rise, as the hon. Member for Sutton and Cheam (Mr. Burstow) said.
Many owners need funding to invest, but the banks read the newspapers and are growing more cautious. An inadequate revenue flow will not permit home owners to borrow the necessary capital to fund changes. Earlier this year, at the behest of the Department, the personal social services research unit carried out research into the reasons for closures. It concluded that a number of factors were at work, but describe two as being "decisive" in the owners' decision to close—low prices and the belief that they would not increase sufficiently.
To sum up, there is a clear picture of continued increases in demand led by demography, coupled with a reduction in supply. Costs are rising and are likely to go on rising, driven by higher standards and better treatment of staff and residents. Insufficient funds, however, are being made available to meet market prices. The gap is far wider than the Government seem to recognise. The system survives by low returns on capital; indefensible cross-subsidy; underpaying of staff; moral pressure on families to top up funding; bed blocking; and delays in assessment.
Although the Government pay lip service to the need for a healthy and well-run care sector, they have not done enough to secure it. They should make crystal clear what they expect from the sector in the long term and clarify the role of residential and nursing home care in the overall scheme of community care. They should make it clear
that they want good people to stay in the sector and that they want more good people to invest in it. They should work out the likely level of demand, and then, in discussion with local authorities and the industry, put a price on what that is going to cost. That should then be factored into the SSA so that the resources are made available. In the meantime, the Government should abandon their policy of taking social services departments into the NHS. They are not running the NHS efficiently, and I do not believe that they would do it any better if they took on extra responsibilities for community care.It is legitimate to ask where the money should come from. I would shave it off some of the growth money aimed at the NHS. We simply cannot limp on as we are. That is not fair on owners, residents or staff, so I urge the Government to recognise the scale of the problem that confronts them and to come up with an effective response.
9.15 pm
Mr. Hilton Dawson (Lancaster and Wyre): It is a pleasure to take part in this important debate, not least because I do so under the eyes of 22,000 older constituents and a vigorously active mother, who will no doubt scrutinise every word that I say. I shall speak for only five minutes in order to allow others to get in, but it is a pleasure to take part in a debate which has featured some excellent contributions.
It is worth pointing out that the right hon. Member for North-West Hampshire (Sir George Young) was the first speaker from the Opposition Benches who, in stressing the important issues facing the private sector, started to move the debate along a little and to recognise that health and social care are a system and need to be a partnership, and that all elements of that partnership need to work together. That view has not come over from earlier Opposition speeches, which characterises the Opposition's approach to the matter. They emphasise one part of the system over the other parts and miss the essence of what the debate should be about.
There are huge issues to consider and desperately important issues to resolve. In difficult circumstances, the Government are taking on the matter properly and working along the right lines. We have the national service framework for older people, which emphasises person-centred care, choice and respect for individuals. I believe that residential care can be a positive choice. I take issue with my hon. Friend the Member for Dartford (Dr. Stoate) about that.
The Government have emphasised investment in major resources for health and social care, and high standards across the entire field of care—in people's own homes, in the community, and in residential care, nursing care and hospital. They have emphasised partnership across the various elements of the public sector—health, county and district councils, and the private and voluntary sectors. They have emphasised flexibility in meeting the needs of older people, irrespective of who provides the care.
There are a host of issues involved, but the urgent imperative is to build a partnership culture, moving way beyond the sort of systems that were in place under the previous Government, to develop a robust working relationship between the public, private and voluntary sectors, and above all to place older people, their relatives and carers at the heart of the system, at the forefront of concern and at the centre of the debate.
We have faced a terribly difficult situation in Lancashire over the past few months. Various speakers have referred to that already. It has been a traumatic experience for hundreds of older people in residential care and their families. I hope that we are coming through that now. The clear message that Lancashire county council must have got from listening to older people and from the work of inveterate campaigners, such as Bob and Ann Trafford of Poulton le Fylde in my constituency, is that the public sector services that the council provides are of very good quality and are highly valued by the people who use them.
I hope that the consultation to which Lancashire county council will respond on 25 July will seek to build on those resources, build on partnership, use those resources flexibly and create a continuum of care based in the communities that need them, for the older people who require them. I think that the Government have laid down a very good structure for the future of care, that they are clearly inspecting what is going on and keeping their ears to the ground and that they are concerned to ensure that partnerships grow and develop. The work of the King's Fund, which I mentioned earlier, emphasises that progress is being made.
We are talking about huge cultural change. We need to ensure that local authorities and health services show evidence of progress in terms of sustainable partnerships and improved services that impact on people's lives. I very much hope that my hon. Friend the Minister and her colleagues in the Department of Health will maintain very close scrutiny of what is going on in Lancashire. On the basis of primary care trust areas engaging properly with the private and voluntary sectors, district councils and older people as firm partners, we have the opportunity to develop services and move on, but we need to maintain tight scrutiny of what is going on and to ensure that the system works in future and that it does so very well.
9.21 pm
Mr. Nigel Waterson (Eastbourne): I am delighted to have the opportunity to take part in this important debate.
It is clear that we have twin national crises: the problem of care homes and the interlinked problem of bed blocking. We have heard about almost 50,000 beds being lost nationally, the problems of bed blocking throughout the country and the £1 billion black hole in funding identified by the Joseph Rowntree Foundation, but I should like briefly to consider the local scene in East Sussex and Eastbourne in particular.
Eastbourne has a high proportion of elderly residents, and we have the highest proportion of over-85s in the whole country. We have already been disadvantaged once by the standard spending assessment formula changes to which one hon. Member has referred. It is important to say, although it is almost a footnote in this debate, that care homes and nursing homes are a significant part of the local economy.
The problem has been growing for years and the number of homes closing has grown steadily. As I said earlier, we have been bottom of the league table in East Sussex for many years in terms of our payments to the private sector. At the same time, under the Liberal Democrats, millions of pounds were wasted year after year on the ruinous cost of keeping open homes run by the county council purely for reasons of political dogma.
I have raised that matter over and over again in the House. I first did so in a 1996 debate to which my hon. Friend the Member for West Chelmsford (Mr. Burns) responded as Under-Secretary of State for Health. Most recently, I secured a debate in late 2000 in which I raised many of these issues.We know that the homes have been hit by a triple whammy: the low rates paid by many councils; the funding of new regulations such as the minimum wage and the working time directive; and, of course, the requirements of the Care Standards Act 2000. The direct consequence has been the growth in bed blocking, or delayed discharges. The other day, I saw a press release from the Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith), in which she trilled about how wonderful things were and about how many older people would be able to leave hospital on time. That was not the picture that I saw when I recently visited my local district general hospital. It is doing all the right things; it has opened a medical assessment unit, which is doing very well, and has just officially opened a surgery assessment unit. However, all those efforts to make best use of resources are being distorted by the number of bed blockers in the hospitals.
The very latest figures, which I received only today, show that across the East Sussex Hospitals NHS trust, there are currently no fewer than 131 bed blockers. That is an enormous number, especially in the light of the already stretched resources of the hospitals. In the winter of 1999–2000, there was virtually no bed blocking at all, so it is a relatively recent phenomenon, one entirely presided over by this Government and produced by their policies.
I acknowledge that there has been some extra Government funding but it has not produced the desired effect. I am pleased that, under the leadership of Councillor Keith Glazier and his team, there is now much closer working with social services and other relevant agencies but the problem still shows no sign of improving; it seems to be continually getting worse.
As I have touched on already, the problem we had over some eight years in East Sussex was the Liberal Democrat administration, which, as I have explained, squandered money on its own homes. One that has closed is Parker House in my constituency. Despite the dedication and care provided by the staff there, it was not meeting the old standards, let alone the new ones.
By the time the Liberal Democrats were thrown out of office about a year ago, some 800 people had been assessed as needing care who were not receiving it. God knows how many had not been assessed. Now that figure is less than 200, and it is expected to be zero by the end of this month. For the information of the hon. Member for Sutton and Cheam (Mr. Burstow), who spoke for the Liberal Democrats, the Conservative administration, despite a very tight budget, has increased its payments to the private sector by 8 per cent. above inflation in the current year.
These are not just dry statistics. I remember the case of the elderly lady who contacted me and whose husband was at home dying from cancer. She could get no help at all in looking after him and lifting him; she damaged her own back. I finally managed to get social services to take an interest. I received a very touching letter from the lady
saying that she was grateful for all my help but by the time they had come to talk about a package or putting her husband in residential care, he had sadly passed away. One wonders how many such cases there are of which we are as yet unaware.Only recently, we received the joint report on East Sussex from the Audit Commission and the social services inspectorate, which gave services zero stars. It included damning indictments of the previous Liberal Democrat administration—so damning in fact that a number of leading local politicians, myself included, have called for Councillors Tutt and Rogers to withdraw from public life as they were the ones who presided over that disaster. Typically, we have not received a word of apology or regret from either of those gentlemen. They have shown the same unwillingness to accept responsibility that they showed when they were running social services in East Sussex.
As I have said, it is a matter not just of statistics but of people's lives—cases such as the one to which I have referred and others that we may never hear of. Those are the real reasons why those councillors should go. If they had a shred of decency or responsibility, they would have left by now.
I am pleased to say that the new administration has put more than £4 million extra into the budget to support older people and to tackle hospital discharge, but the question that I still need the Minister to answer is how on earth the Government will tackle the fact that 131 people are still in hospitals in my area with no prospect of being discharged.
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