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Mr. Paul Burstow (Sutton and Cheam): I thank the Secretary of State for giving us an advance copy of today's statement. The Liberal Democrats certainly welcome the extension of direct payments, putting cash into people's hands so that they can buy for themselves the care that they think that they need most. However, will he ensure that those who organise the purchasing of their care in the independent sector do not then find that a VAT bill has been slapped on top, and that the money given therefore goes back to the Treasury? Will he also consider ensuring that direct payments are made to those currently in nursing homes or care homes? They expected a reduction in their fees to reflect the fact that they were receiving free nursing care, but that has not happened. Will he therefore create a direct payment scheme to ensure that they get the money themselves, rather than passing it on through care home owners?
In his statement, the Secretary of State described giving councils a financial responsibility for delayed discharge as if it were some form of new privilege. Is there not a danger that, rather than delivering better care, the culture of mutual blame and buck passing between the NHS and social services will be reinforced, with patients being yet further victimised as they become parcels bundled between the two? Does the Secretary of State share the concern that the Government's over-concentration on delayed discharge is leading to a rise in the numbers discharged prematurely, only to be re-admitted as emergencies? Can he confirm that the targets set for emergency re-admissions in the implementation programme for the NHS plan have been comprehensively missed, and that a growing number of elderly people are turning up in accident and emergency departments just days after their discharge?
Carers are the backbone of our care system. Given that the oldest carers tend to have cared for the longest time—and often at the greatest cost to their own health—will the Secretary of State offer carers a direct payment to enable them to purchase respite care for themselves, rather than running the risk of those payments being held up by social services departments that are ill able to pay for such care? Does he accept the findings of the Rowntree report, "Calculating A Fair Price for Care", which points out that there is a £1 billion black hole in the finances of the care home sector? Given that the latest figures from Laing and Buisson show that a further 13,100 beds have been lost in the last year alone, just when will the free fall in the care market end? When will the Government take the actions that are necessary to stop it?
The Secretary of State made much of the extra places that would be available in care homes. His own Department's figures show that 109,900 fewer people are
receiving home care today than five years ago. Is that because cash-strapped social service departments have been shifting the goal posts, disqualifying the frail elderly and casting them out because they can no longer afford to provide the care that those people need?The Secretary of State has told us that there will be real-terms growth in the future, but in the first three years of the Labour Administration there was a real-terms reduction in funds for social care. There is a huge legacy of underfunding to be made good. Will the Secretary of State say a little more about the baseline for his spending plans? Is he assuming that the extra services he has announced today will receive funds on top of the £1 billion that local authorities already spend in excess of what the Government consider necessary for social services?
The Conservative party has rightly identified over-regulation in the care homes sector as an issue, but the key issue was underfunding of the sector, and today's statement did not address that. What the Government have done is say that they are prepared to trade off the vulnerable young—not to give them the resources necessary for their protection—in return for looking after the elderly better, and giving them dignity. Such a trade-off should not be accepted.
Mr. Milburn: I suppose that that counts as a warm welcome for the package of measures for older people.
It is nonsense to suggest that just because we provide extra support for older people, we cannot provide extra support for working-age adults or indeed children. As I said at the outset, we will announce further measures in due course, and further resources for precisely those groups who need help from social services. The hon. Gentleman will find that for them, too, extra investment is being made and reforms are being introduced. I know that he opposes those reforms, but he will note that the overall volume of care is increasing dramatically.
When the hon. Gentleman spoke of the number of older people being helped to live at home, he was counting a partial figure. He was counting people who receive some form of home help and some form of personal care. He was not counting those who receive, for instance, meals on wheels or community equipment assistance. The hon. Member for East Worthing and Shoreham (Tim Loughton) smiles, but for literally tens of thousands of older people, that means the difference between independence and dependence. The number of people receiving support of that kind from local authorities is not falling but rising, and it is set to go on rising as a consequence of the extra resources being provided.
The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether direct payments would be made to carers. Yes, they will. We will consult in August on changes to regulations on such payments, and we intend the new regulations to be in place by the end of the year. He is welcome to respond to the consultation, and of course we shall listen to what he has to say.
The hon. Gentleman commented on the reform contained in the package. I know what he wants: he wants to snaffle the resources, but he does not want any reform. For older people, that will mean more of the same. Not a single older person whom I have met—and probably not a single older person whom the hon. Gentleman has met—wants more of the same. Older people want change in the
services delivered to them. They want more power, more say, more direct control and a wider spectrum of choice. Of course they want a working partnership between the health service and social services, but partnership is a fudge unless it is clear who takes responsibility for each aspect of an older person's care, and that is precisely what we will make clear.As always, the Liberals bleat nationally about shortages of resources, but the story is rather different when it comes to the position locally. When, before the last local election, I visited Liverpool—whose council was controlled by the Liberal Democrats—what was planned then was not increases in services or resources for vulnerable older people, but cuts in those services and resources.
As always, the Liberal Democrats tell one group of people one thing, and another audience another. In fact, the hon. Member for Oxford, West and Abingdon (Dr. Harris) says different things to the same audience. That is the Liberal Democrats—no more believable than their friends on the Conservative Front Bench.
Mrs. Anne Campbell (Cambridge): I warmly welcome today's statement by my right hon. Friend, and especially those measures that will enable elderly people to stay in their homes longer. However, will he look carefully at areas such as mine, where housing costs are high and unemployment is low? The supermarkets can always afford to pay more than social services departments, which is causing real recruitment problems. That will not change if people try to recruit help through direct payments. Will my right hon. Friend see whether extra help can be made available for areas such as mine?
Mr. Milburn: It is very important to get the resources to the right parts of the country. As my hon. Friend knows, proposals already exist for redistributing resources within local government, and there will soon be proposals for redistributing resources in the NHS. However, pay rates are not a matter for me but for negotiation between local authorities and the trade unions.
Mr. Anthony Steen (Totnes): I have difficulty in understanding how any hon. Member can disagree with the spirit and sentiments of what the Secretary of State has announced. Problems of detail remain, and it is right for my Front-Bench colleagues to mention matters of concern, but the general spirit of the statement must be right.
I draw the Secretary of State's attention to the problem in Devon. There, elderly and frail people who are homebound have a supply of deep-frozen food delivered every month, which they cook in a microwave supplied by the authority. They are like homebound Boy Scouts, or participants in an outward bound scheme. Every 28 days, another crate of deep-frozen food arrives. The idea of hot meals on wheels is disappearing, as are chiropody or home help services. The elderly people involved are going into residential care prematurely.
The Secretary of State says that he will ring-fence the package that he is offering, but is he aware that the Government have ring-fenced rumble strips, road widening and traffic humps, but not social services? As a result, money is going to pay for humps and road widening, but not for hot meals.
Mr. Milburn: I am grateful to the hon. Gentleman for his welcome to the announcement. The £1 billion that will
go into social services for older people is a real-terms figure, not just a cash figure. I think that I am right in saying that, of that, some £650 million will be ring-fenced for specific purposes, with a strong emphasis on ensuring that there are appropriate home-care services for older people. I cannot comment on the position in Devon, but in general it must be right that older people being cared for at home get an appropriate range of services. I hope that the package of measures that I have announced will help people to receive precisely that.
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