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Dr. Liam Fox (Woodspring): I am grateful to the Secretary of State for his statement, and for making a copy available in advance. As ever, the statement is strong on rhetoric and well-delivered, but lacking in substance. It is largely a set of re-announcements and U-turns and seems to be timed more to avoid embarrassing headlines
generated by tomorrow's report from the Select Committee on Health than anything else. It is more about managing news than managing patients.The statement is a wish list that rings hollow when compared with the Government's record. It is littered with some real gems. We heard that "Nursing care is now free for older people"; try telling that to our constituents up and down the country. The Government might be making a contribution, but care is anything but free. We were told that "We need to stabilise the care home market"; what an incredible statement from the Secretary of State. We have been telling him that for the past three years. It is his failure to listen not only to the official Opposition and other parties, but to those involved in the care home industry that has led to the loss of more than 60,000 care home places. It is a failure entirely of the Government's own making. As patients are discharged too quickly from our hospitals to relieve the bed-blocking crisis, the number of re-admissions within 28 days is rocketing. It is a revolving-door policy for our elderly people—some dignity or security that provides.
As the number of blocked beds rises, the number of cancelled operations is going up, many of which were intended for elderly patients—some dignity or security. Perhaps the Secretary of State can tell us how many of the 100,000 extra admissions to accident and emergency departments in the past two quarters have been elderly patients denied dignity and security as a result of the Government's failure.
When the Secretary of State has the gall to stand up and say that the size of rooms and doors is important but should not mean good local care homes having to close, I have to ask where he has been for the past three years. It is too late for many homes, which have already closed as a result of the very legislation and regulations that the Government brought in. They are now telling us that they will have another look at the matter and that they will have a more flexible approach. That is too late for many homes. The damage has been done, just as the damage has been done to the security and dignity of many older people in those homes.
It is wonderful what the Secretary of State believes now, but it was not what he believed when the Care Standards Act 2000 was being rammed through both Houses of Parliament. The only word missing today was sorry. Today, he has talked about the quality of care given by care homes, but only recently he was talking about people being "banged up" in care homes. The rhetoric is different today.
We heard the right hon. Gentleman's interesting pledges on equipment, but we have heard them before. When the Audit Commission produced its report on equipment provision in March 2000, the Secretary of State said:
- "It paints a very stark picture of frankly a second-rate service in some parts of the country. What we have to do now is ensure that the Audit Commission's recommendations are actioned in every part of the health service."
- "continue to report long delays for equipment of dubious quality . . . many who could benefit from equipment services are excluded by stringent eligibility criteria . . . waiting times for some equipment is
- up to six years . . . a mood of despondency is common among managers running equipment services . . . no progress has been made in integrating mobility services, leaving the wheelchair and orthotics services marginalised."
What the Government have said about domiciliary care is unbelievable. Of course, Conservative Members welcome the introduction of what will effectively be care vouchers, which the Secretary of State mentioned today. He has, however, a stark reality to confront. When the Government came to office, 479,000 people were receiving domiciliary care. That figure has now plummeted to fewer than 400,000 in the last year. The number of people receiving care has therefore gone down dramatically under the Government's domiciliary care programme, and the shortage of capacity will limit any plans that the Government may have.
Where are all these extra care workers to come from? How will they be employed? Has the Secretary of State actually tried to find a carer for an elderly relative recently? Has he tried to find respite care? Where are these people to come from? Are they to be plucked from the carers' tree, or bought from the carers' supermarket? How are we going to attract people into these jobs? Who will carry out the assessments that the right hon. Gentleman mentioned? How many extra staff will be required for that? Who will initiate the assessments? How will urgency be accommodated within a guaranteed time?
This is certainly not good enough. The Government are making promises yet again, even though they have not kept them in the past. The good points in the proposals are those that abandon Government policy and make U-turns. This is the initiative du jour, and the elderly will see through it for the sham that it is.
Mr. Milburn: I was pleased that the hon. Gentleman was grateful for getting a copy of the statement in advance. I was even more grateful for getting a copy of his press release in advance. In fact, I got a copy of his press release even before he got a copy of my statement. Perhaps it is not surprising that he has remained on the Tory Front Bench, with such extraordinary powers of extra-sensory perception.
The hon. Gentleman said that this was a wish list for older people. It is actually a delivery list for older people. He said that the number of people being delayed from discharge from hospital was rising. That is not true; it is falling. He said that the number of cancelled operations was rising. It is not; it is falling. He said that the number of people being helped to live at home by social services was falling; it is, in fact, rising.
On the issue of community equipment, the hon. Gentleman continually bleats about the lack of provision of services yet he is never prepared to commit the necessary extra resources and earmark them for the purpose for which they are needed. That is precisely what we are doing with community equipment. One of his hon. Friends asked earlier from a sedentary position whether much of this money was earmarked. Yes, it is. Two thirds of this £1 billion package for older people is ring-fenced and earmarked specifically for the purposes that I have outlined today.
The hon. Gentleman is opposed not only to investment but to the earmarking of investment. He wants to see extra resources going in somehow, but I am afraid that the invisible hand of the market will not deliver extra handrails, extra support, extra care home places, more intermediate care, or more domiciliary care. Those are provided only because of the investment that we are making. The hon. Gentleman's problem relates not just to what the Conservatives did when they were in government but to what he is saying while they are in opposition, and to their abject failure to match either our investment or our programme of reform.
Does anyone seriously believe that the Conservatives who landed pensioners with more poverty, VAT on fuel, and charges for eye tests that used to be free, have somehow been regenerated and reborn as today's caring, compassionate Conservatives—the sort of Conservatives you could take home to meet your mother without fear of her being mis-sold a pension? Nobody believes that, not even the hon. Gentleman. We know that public services, social services and elderly care services need both resources and reform, and that is what we are committed to delivering. The problem for the hon. Gentleman is that he cannot commit to either.
Mr. David Hinchliffe (Wakefield): By a strange coincidence, the Health Committee is delivering at midnight a report that has direct relevance to the statement made by my right hon. Friend this afternoon. Obviously, I am precluded from referring to the conclusions of the report, but I can refer to evidence that is in the public arena. I was struck by the evidence from a particular witness, who suggested that the entire debate on the care of older people has been hijacked by the interests of the private care home sector.
I have listened carefully to my right hon. Friend's statement, and he is clearly setting out an agenda to move away from dependence on residential and institutional care. I welcome that, but I would also welcome a commitment that he will work with the private care sector to encourage it to move away from the outdated institutional models of care that countries such as Denmark abandoned many years ago.
Mr. Milburn: As always, I pay heed to what my hon. Friend says—as Chairman of the Select Committee on Health, and as a friend of mine. His comments make perfect sense. It is obvious that, at some point in their lives, some older people may well need residential or nursing care in a care home. Some may require supported or sheltered housing, and others may require intermediate care. However, survey after survey has shown one simple thing about older people's needs and desires: they want to live as independently as possible for as long as possible. Surely, we have got to get the pendulum swinging in the right direction. That means moving away from institutional forms of care, wherever they are provided, towards a new emphasis on more individualised forms of care that support people for as long as possible in their own homes.
A moment or two ago, the hon. Member for Woodspring (Dr. Fox) described these measures as a series of re-announcements, but real money backed by
real reforms means that, for the first time—certainly since my Department has collected such figures—the number of elderly people supported by social services will rise to more than 1 million. The proportion of older people cared for in their own homes will also rise. That is getting the pendulum swinging in precisely the right direction. The hon. Gentleman is right to say that, to deliver these changes and resources, we need to work in concert not just with our friends and colleagues in local government and the voluntary sector, but with the private sector too. That is precisely what we will do, but let there be no doubt: the direction is now firmly towards more individualised care, and less institutionalised care.
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