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14 Nov 2002 : Column 235—continued
6.4 pm
Angela Watkinson (Upminster): I start by echoing the sentiments expressed by my hon. Friend the Member for Bournemouth, West (Mr. Butterfill). A great opportunity was missed yesterday to address the looming crisis in pensions. It was a notable omission in the Gracious Speech that no mention was made of
pensions, savings or benefit reform, which is needed urgently. The problem has multiple strands. The level of savings is now so low that many people are heading towards an impoverished old age. The withdrawal of pension fund tax credits by the Chancellor to the tune of #25 billion already—that is #5 billion a year over five years, and in fact it is worse than that because that funding would have been invested and would have grown—is the single most damaging contributory factor to the problems that beset both money purchase and defined contribution pension schemes. It is the worst stealth tax of all, with the possible exception of the council tax.The London borough of Havering has historically been underfunded to the tune of #30 million, and last year received a 12.5 per cent. increase. As a result of the long-awaited review, which we all expected would benefit the borough, Havering now faces a worsening situation and another massive hike in council tax rates, possibly in the region of 30 to 40 per cent. Pensioners on fixed incomes will be affected worst.
Add to the withdrawal of pension fund tax credits the #1.5 billion a year shortfall in rebates on contracted-out schemes, and the current regime is unsustainable. People who have been making pension contributions during their working lives now receive pensions on retirement way below former expectations, and their standard of living is not what they had looked forward to or planned for. Add to that the urgent need to simplify the pensions and benefits system, which is far too complicated for most people to understand.
I often have people come to my surgery who have been utterly defeated by 40-page benefit application forms. On one occasion, an elderly couple came with their younger neighbours, who had attempted to assist them. The form had defeated not only the couple in question but their neighbours, and they had filled it in incorrectly. That put my elderly constituents in a worse position than they were in the first place because their application was rejected.
There is also a worryingly high level of personal debt in the country, running to several thousands of pounds per head. Rather than save, many people choose to spend not only the money that they have but money that they do not have. One wonders what prospects some borrowers have of ever becoming free of debt.
I am sorry that the right hon. Member for Tyneside, North (Mr. Byers) is no longer in his seat, because I would have been happy to assure him that there is nothing elite about this Conservative. I was brought up as what used to be quaintly known as respectable working class. I think that the respectable bit referred to not getting into debt, paying one's bills and managing one's budget, however small it was. I remember debt being something that was whispered about. Banks required references when people sought to open a bank account, to ensure that the account holder was of good standing. These days, we are all plagued by unsolicited offers of credit cards and loans, with little or no investigation as to the ability of the person to repay.
There must be countless people who are heading for an impoverished retirement on an inadequate pension, with debts that will have to be settled from their estate, if they have one. The problem of estate values in Upminster may not apply because property values have
rocketed in recent years, but I have many pensioners who are asset rich and cash poor. They have never been rich. Many have earned only modest incomes during their working lives, and they are house owners only as a result of a lifetime of hard work, prudence and making economies—of turning out lights, turning down heating to save on electricity and gas bills and not going to the pub. Home ownership has not come easily to them, but has come from the constant struggle to keep heads above budgetary waters. Many find this struggle difficult to sustain in retirement, as huge increases in council tax hit fixed incomes hardest.Moving house to realise capital is not an attractive option for elderly couples, still less for individuals, who have lived for decades in the same familiar home, of which they are rightly proud.
The number of elderly and disabled people who approach me for advice is increasing all the time. The Department for Work and Pensions does not provide a local pension office; instead it uses local voluntary organisations such as citizens advice bureaux, Age Concern and, in Havering, the Havering Association for People with Disabilities, which runs advice surgeries.
That is a positive step in one sense because it makes venues more accessible in the community, but no funds are available. The Havering association has only #18,000 in core funding. It seems very unfair that small local charities helping their communities should be expected to subsidise the Department. The association loses income by making a room available for an advice surgery that would otherwise have been let to another group at a charge.
I hope that the Department will consider transferring some of the savings made from not running local offices from its petty cash or its paper-clip fund to help small local charities like the association, which are providing services for local people. The Government must take up the challenge this year: they cannot afford further delay. They must now simplify the system, enabling and encouraging more people to provide for a secure old age.
6.11 pm
Dr. Andrew Murrison (Westbury): Let me begin on a positive note, by welcoming the omission from the Queen's Speech of the threatened mental health Bill. I hope very much that the illiberal measures it would have contained will never see the light of day. What a pity that the much-needed overhaul of the Mental Health Act 1983 has been delayed by the Government's disappearance down a rabbit hole of their own making!
The loose definitions in those proposals, the apparent intended role of Ministers, and the misconstruction of detainment as treatment were unhelpful and sinister. We do not summarily detain or disadvantage those in this country who seem odd or unusual on the pretext that they might pose a threat to themselves or others. If I may sound pompous for a moment, let me say that to do so would be distinctly un-British.
I might add that of all the occupational groups I have encountered professionally and socially, ours presents itself as one of the greatest repositories of strange characters and odd behaviour. I am sure, therefore, that other Members joined me yesterday in breathing a sigh of relief.
The community care Bill reminded me of my own Bill to deal with bed blocking, introduced under the ten-minute rule. I am not about to confound the model that I proposed, which was based on a system that had been used quite successfully in Scandinavia. For what this is worth, it also found favour with Wanless.
The concept of cross-charging has merit, provided that it is construed in an administrative rather than a punitive way. At its heart must be a redistribution of resources from hospitals to less glamorous sectors. The reimbursement scheme suggested by Ministers must surely involve the expectation that fines will be levied on social services departments. They cannot Xmagic up" facilities in the community. Such fines will, I suspect, become part of the normal exchange between health and social care departments, and will have to be financed by central Government rather than—as I suspect is the intention—through council tax, at least in part. Otherwise, council tax payers would effectively underwrite, among other things, the loss of nursing home beds over which the Government have presided. The bed-block tax would of course apply unequally, with the south shouldering a particularly heavy burden, given the amount of bed blocking in London and elsewhere in the south.
The Secretary of State's assertion on 18 April that fines imposed on hospitals in the event of emergency readmission would stop them from discharging people too soon was disgraceful. Bureaucrats may think like that, but if the Secretary of State seriously believes that dedicated health care professionals would be motivated by incentives of that kind he gravely misunderstands what motivates those at the coal face of the NHS. My ten-minute Bill has, of course, sunk without trace, but its intention was to keep clinical decision making at arm's length from administration. In the context of reimbursement charges I believe that that is an important safeguard for clinical care—albeit one that looks increasingly naive in the Xcommand" NHS favoured by the Chancellor, if not the Secretary of State.
Ministers might also like to reflect on why emergency readmissions have increased. Could the reason be that people are being inappropriately placed as the number of available nursing home places shrinks? If so, acute units could rightly claim that readmissions were the fault of social services or social service structures, and fining hospitals on the over-simplistic basis that they are wholly responsible would therefore be inappropriate. I urge the Secretary of State to think twice about that incentive.
The Government's proposals include an incentive that health care professionals will willingly observe. It is a perverse incentive that acts in individual patients' best interests. If the quickest way to get a patient the community care that they require is to admit them to a district general hospital, with the consequential imperative for social services to avoid a fine and get cracking, let us be quite sure that GPs will admit them. I believe that that would wind back general practice several decades and that it would no longer enjoy its current position, which we would all celebrate. Once again, district general hospitals would be the nexus of health care provision in this country. That would be highly regrettable both for patients and professionals.
The flip side is that people who were not admitted through district general hospitals, for whatever reason, would be ascribed a lower priority. Effectively, the only gateway to services might become the DGH. I am sure that there are ways of moderating those effects and I would be very interested to hear about Ministers' plans in that regard.
The NHS Confederation is right to point out that the Government's timing is over-ambitious. It is also concerned about the lack of adequate piloting, which means that Ministers are taking a remarkable leap of faith. Unfortunately, Christmas is almost upon us and we are told that the systems that are necessary to implement the reimbursement system must be in place by Easter. I welcome the Government's sense of urgency; bed blocking is a tragedy both for the poor, hapless bed blocker and for the thousands whose admissions are cancelled because of lack of room. However, I believe that the NHS Confederation is right to counsel caution.
The Bill on health and social care reform brings forward grant-maintained or foundation hospitals; one can call them what one likes. They are a nice, if unoriginal, idea, but the devil is in the detail. One of the two DGHs that serve my constituents is unlikely to be in Ministers' sights. The clinically excellent Royal United hospital in Bath is acknowledged as an administrative disaster area. It is on such hospitals that I expect Ministers to focus first and foremost. I would oppose strongly anything that would drag resources and personnel from trouble spots such as Bath. For me, that is the priority and I hope that it is the priority for Ministers too, although I see little evidence of that in yesterday's proceedings. I wonder how the Secretary of State would address the leaching of top staff from, let us say, Bath, to the highly starred and potentially foundation Gloucestershire Royal hospital, given the pay competition that he proposes to introduce into what remains a monopoly sector.
My quest for bias not towards the swept up, but towards the struggling, is not purely parochial. I am pleased to have an unlikely ally in the right hon. Member for Holborn and St. Pancras (Mr. Dobson). I was fascinated to hear that foundation hospitals would have elected representatives on their boards. Having struggled through the National Health Service Reform and Health Care Professions Act 2002 and tried to identify who on earth we would get to volunteer for patients forums, I do not know where the Secretary of State thinks he can get people who will be willing to serve on the boards in the numbers that he expects.
It was remarkable to hear the comments made by many hon. Members about the likely composition of the boards, which will, of course, be middle class. Voluntary organisations throughout the country have middle class members. Indeed, they overwhelmingly populate our voluntary organisations and that will be the case in respect of the new measure, if it is adopted. With respect, however, making such criticisms in the House is a case of the pot calling the kettle black. The House might like to look at itself before criticising volunteers throughout the country who will presumably be called on to serve on the boards of foundation hospitals.
The NHS Confederation is worried that foundation hospitals appear to constitute the Government's flagship health service reforms. It is right to worry. The
organisation shares my view that we should not view health care as bricks, mortar, beds and hospital buildings or even as surgical operations, but refocus on managing chronic disease and the clinical networks necessary to do that. We should be less exercised and constrained by the administrative boundaries that have been the hallmark of the Government's stewardship of the NHS.
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