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Mr. Peter Pike (Burnley): My right hon. Gentleman has announced a very welcome package this afternoon, but severe problems can arise when elderly disabled people living in two-tier countieswhere there are both shire and district councilsneed adaptations made to their homes. Can we iron out such problems? In Lancashire, there has been a major consultation exercise about care homes, and a decision is imminent. Should not that decision, which is for the county council to finalise, be deferred, so that close consideration can be given to the many important announcements that my right hon. Friend has made today?
Mr. Milburn: My hon. Friend is tempting me astray, and I want to avoid that at all costs. As he said, the decision is the county council's responsibility, but the Minister of State for Health, my hon. Friend the Member for Redditch (Jacqui Smith), is keeping a close eye on the situation in Lancashire.
My hon. Friend the Member for Burnley (Mr. Pike) makes an important point about the relationship between district councils and county councils. I understand the problem, as my area of Darlington suffered from precisely those difficulties before it became a unitary authority. It is incumbent on all parties involved, especially when they are of the same political persuasionand I do not know whether that is the case in Lancashireto sit around a table with their partners in the private and voluntary sectors and work the problems through. In that way they can ensure that no institutional barriers, of any size or shape, stand in the way of older people getting precisely those seamless services that they need.
Mrs. Angela Browning (Tiverton and Honiton): The Secretary of State has announced a range of measures today relating to, for example, equipment, support for carers, support for people at home and for those going into residential care. What plans has he to make any changes to the means-testing that affects all those measures?
Mr. Milburn: As I said in my statement, overall there will not be changes to the means test. I think that the hon. Lady is aware that we issued guidance in November last year about domiciliary care services, suggesting new guidance to local authorities. However, one aspect of the means test is about to disappear altogetheragain, subject to legislationand that is charging for community equipment. The hon. Lady will be aware from her constituency, as I am from mine, that as well as having a long wait for assessment and for getting equipment, older people often face a charge for it. The equipment can be simple, like a pressure mattress, a hoist, a minor ramp or
Let me give the hon. Lady a gentle warning. It is all very well and good for Conservative Back-Bench Members to give long wish lists of improvements they want to see. They cannot have the wish lists unless they are prepared to commit the necessary investment.
Glenda Jackson (Hampstead and Highgate): I congratulate my right hon. Friend and warmly welcome his statement. On direct payments, will individuals be precluded from selecting from whom they wish to buy services? Many of my constituents from the ethnic minorities live in extended families where no one person cares for elderly parents and no one is registered as a carer as such. Will it be possible for them to obtain the direct payment, which would be of enormous benefit?
Mr. Milburn: Yes, in those circumstances, they can. We know that where the direct payment system has been implemented, it has worked. It has not meant that local authorities incur more costs than they do in providing a mainstream service. Disabled people who have a direct payment have chosen to appoint a personal helper from a variety of places and have been able to tailor the care that they need to their own circumstances. That seems to be the right principle.
We are moving towards a care system, I hope in both health and social services, in which the needs of the individual come first. The system is designed around the needs and comforts of the individual rather than the individual always having to fit around the needs of the service.
Dr. Vincent Cable (Twickenham): Since it is essential to maintain public confidence in private care homes, can the Secretary of State explain why his Department is blocking the release of an independent inquiry into Lynde house in my constituency, which is owned by the leading private provider, Westminster Health Care? Given that I wrote to him about that six weeks ago as a matter of urgency, why have I still not had a reply?
Mrs. Ann Cryer (Keighley): I agree with everything that my right hon. Friend has said. The majority of elderly people do not want to go into care if they can manage to stay at home, because home is where their memories and friends are. From what I have seen of my own relatives, sometimes when an elderly person is released from hospital, a care package is set up. Unfortunately, however, social services departments often do not have the time to check that the arrangements are carried out satisfactorily. The service provided could be the delivery of meals or it could be someone getting an elderly person up in the morning and putting her to bed in the evening, doing the cleaning, ironing or laundry. No check is carried out on such arrangements until someone such as myself telephones and moans about something.
Mr. Milburn: My hon. Friend makes an important point. It often happens, day in, day out, that there are good intentions on the part of those concerned, but unfortunately those intentions are not always carried through. That means that we need a better system for assessing need and then implementing the services that arise from that assessment.
None of this stuff is glamorous, but it is hugely important to literally hundreds of thousands of older people. We do not want to have an endless procession of professionalsthe health visitor, the GP, the district nurse, followed by the social worker and otherstrailing to the older person's door. We need one single assessment process, so that the older person's needs are assessed holistically at the point at which they enter the care system, a clear decision is taken as fast as possible, and then the services are put in place. That is what we intend to do.
As my hon. Friend well knows, none of that comes for free. It is useless to pretend that we can reform the system without investing in it, and that is the problem for Conservative Members. What they want, if they would
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I have let the right hon. Gentleman go on to subjects that Mr. Speaker has taken a restrictive view on in the past. The right hon. Gentleman is also lengthening his answers when other hon. Members are trying to speak.
Mr. Andrew Mitchell (Sutton Coldfield): Does the Secretary of State accept that his statement this afternoon will have been listened to with particular interest in Birmingham, and that there is huge cross-party concern that Birmingham's social services are in chaos? Will he give the House an undertaking that he and his Ministers will follow very closely what Birmingham social services do to pursue the laudable objectives that he has set out tonight? If he finds that they do not pursue them in the way that all of us would expect them to, will he and his Ministers intervene directly, either by using the powers that they already have from this House or by taking the additional powers that they need to ensure that Birmingham social services deliver a decent service to elderly and vulnerable people, which they are not doing at the moment?
Mr. Milburn: Yes, of course we will keep under active review our monitoring of social services in Birmingham. That is what we are doing and we shall continue to do it. I think that the hon. Gentleman is aware that, as a consequence of that active monitoring, extra resources have been found for the social services in Birmingham, which I am sure that he will welcome. I do not want to incur your wrath any further, Mr. Deputy Speaker, but the problem for the hon. Gentleman is that he cannot commit to the resources.
James Purnell (Stalybridge and Hyde): May I draw my right hon. Friend's attention to the efforts that have been made in Tameside, where the hospital, the social services and the mental health trust agreed a long time ago to pool staff and resources so as to create a one-stop shop for older people? Will he consider the fact that that has increased and improved services available to older people? Is not that the type of bottom-up reform that we should be trying to encourage, and will he reassure me
Mr. Milburn: My hon. Friend is absolutely right. Throughout the country, the examples are now legion of much-improved co-operation between the health service and social services. That has come about because we have provided the legal vehicles to enable the local authorities that want to co-operate and the health services that want to co-operate to do so, whether they are pooling budgets or establishing care trusts.
My hon. Friend is right that we must ensure that we get the best use of the money by ensuring that there is greater, not less, co-operation between health and social care. Why? For the very simple reason that the older person who by and large needs the health service will very often also need the support of social services or indeed housing services, and we need to see all these public services working together.