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28 Nov 2002 : Column 525—continued
Mrs. Humble: The hon. Gentleman may not be aware that in Lancashire occupational therapists are employed by the health authority. If the OT is not there to provide a service, that is not social services' fault, but the fault of the health service. That complicates the situation.
Mr. Burstow: Basically, there are not enough OTs to go round. There is also the spectre of social services and the health service competing for a scarce resource. Until additional OTs are in place, we shall continue to have logjams in the system, as there is a fundamental lack of capacity. Those capacity constraints also apply to home care staff—the latest figures suggest that there is a 10 per cent. vacancy rate. We have serious problems recruiting such staff because they are low paid and undervalued. Unless we tackle that, we shall continue to have problems and will certainly not fulfil the Government's ambition to have more people cared for in their own homes.
Because of rationing, fewer people, as has been said, are receiving home care. The figure may be disputed, but 110,000 fewer home care packages are being delivered. Ministers say that that is because people are getting other services instead, such as meals on wheels, day care and so on. It is clear, however, that the figures for home care support have gone down. People who get such care, however, are getting it for more hours because they are more dependent. The Government's mantra is prevention. In practice, however, when they are judged on the figures, their emphasis is on dealing with crises and the most dependent people, and not prevention.
Capacity has also been lost in the care home sector, and is not being replaced by more care in people's own homes. The loss of 60,000 beds over the past five years has been mentioned but, more importantly, in the past three years closures have exceeded new registrations, which have been flatlining for at least three years.
Andy Burnham (Leigh): The hon. Gentleman has just referred to the loss of 60,000 care home places, as mentioned by the Conservative spokesman, and also referred to the report by the Select Committee on Health on delayed discharges. Has he not seen the part of the report dealing with care home places, which suggests the loss is nothing like 60,000?
Mr. Burstow: I read that and the dissection of the Government's figures. The Committee was fair, and acknowledged that the figure of 19,000, which is regularly trotted out by Ministers, is probably more misleading than the figure of 60,000 cited in Laing and Buisson's report.
Mr. Burns: The hon. Gentleman is absolutely right, whatever Ministers may say. Before he is led astray by the hon. Member for Leigh (Andy Burnham), may I point out that there was not a unanimous decision by the
Health Committee on the number of beds lost? The report was actually rammed through by a majority of aspiring Labour Back Benchers.
Mr. Burstow: I am sure that the hon. Member for Leigh (Andy Burnham) is one of those aspiring Back Benchers.
I want to focus on the figures from Laing and Buisson's report for 2001, which give the net position—the gross figures have given cause for concern. In 2001, 107 new homes, amounting to 3,800 new beds, were registered. During that period, however, 828 homes closed with the loss of 16,600 beds. There is therefore a clear downward trend in the sector, which, in some parts of the country, has contributed to the problem of delayed charge.
The Minister told us in a statement in July that the Government aim to stimulate the care home market to get more care home beds back into the sector. They stated in their document that they want an extra 6,000 beds by 2006, the majority by 2004. I hope that the Minister can tell us how those beds are to be achieved, where they will be provided, and how the barriers posed by the development value of land will be overcome, given the investment costs and the risks involved, and given the fact that the rate of fees has still not gone up sufficiently to bring new players into the market. Why would anyone come into a market where the fee rates are unsustainably low? Work by the Joseph Rowntree Foundation clearly shows a shortfall in the resources going into the sector.
Dr. Stoate: The hon. Gentleman is generous in giving way yet again. He is exercised by the number of care beds in the system, and of course that is important, but is he aware of a recent national audit commissioned by the NHS executive, which found that 17 per cent. of elderly people living in nursing homes no longer needed nursing home care at all? Surely it is more important to make sure that the right people are in the right homes than to worry about the absolute number of beds, given that 17 per cent. of elderly people were apparently in the wrong place.
Mr. Burstow: The hon. Gentleman makes a self-evident but nevertheless valuable point. I am not arguing that care homes are good and anything else is irrelevant but that there is a fundamental problem of capacity, not just in care home places but in home care places. We need more investment upstream to ensure that we can postpone or prevent the onset of the disability and illness that result in admissions in the first place. That ought to be a key priority for investment, but I fear that it will be denied because of the penalties.
My hon. Friend the Member for Guildford (Sue Doughty) has drawn my attention to figures produced in Surrey. I understand that 225 people are experiencing delayed discharge from hospitals in the county, and 120 of them are believed to be the responsibility of the county. Of those 120, 30 are funded but no placement is available because of care home closures and the lack of capacity that I have described, and the other 90 are unfunded.
From next April, the building capacity grant about which the Government have spoken a great deal, and which has been paid for the past one and a half years,
comes to an end. That grant has been used to provide ongoing services, new care packages, the fees paid to care homes and for other purposes. Those are ongoing commitments that arise from a specific grant, and in future years they will have to be funded out of the 6 per cent. real-terms growth. However, the funding commitments that councils have already made will leave little of that new money available for new investment in new services.I shall give an example from Kent county council, which received £2.12 million through that grant in 2001–02. In a full year, the council believes that the cost of its investments amounts to £6.5 million, but in 2002–03 its grant for building capacity was £4.7 million—a gap of £2 million. The gap continues to grow because the people for whom the council is providing services continue to need those services. Why will not the Minister confirm that the penalties system is simply designed to give the Treasury its pound of flesh for giving extra money to social services in the Budget this year? Even that extra money, welcome though it is, leaves social services behind the curve in terms of meeting demand and reducing rationing in the care system.
During the Select Committee hearings on delayed discharge, officials told the Committee that dementia
- Xis a principal cause of delayed discharge because of the complexity that having dementia plus a physical illness produces in terms of developing a good discharge plan."
- Xsuggest that about 70 per cent. of people in nursing homes, not EMI homes but nursing homes, have a level of cognitive impairment that affects their mental function."
The Bill undermines partnership arrangements. It is a recipe for conflict. As the hon. Member for Hampstead and Highgate (Glenda Jackson) said, it is wrong to blame social services as though delayed discharge were their sole responsibility. The Bill turns patients into commodities labelled as bringing in or losing money, depending on one's point of view. The wording of the Bill sounds like a fed-up parent mediating between two scrapping children. It is not surprising that the Local Government Association and the Association of Directors of Social Services oppose the Bill, but it might be surprising that the NHS Confederation does. Those are the managers who will have to live with the consequences of the Bill that the Government are trying to foist upon them.
Why do not the Government instead take forward the ideas suggested by the NHS Confederation for joint local protocols and building on existing partnerships? The Government say that they will aid partnership through the Bill, but it is a strange sort of partnership where one partner is given a stick with which to beat the other. That sounds more like domestic violence than relationship building.
The Bill ignores the patients' and carers' perspective. All the submissions from charities representing older people and carers that I have read oppose the penalty
system. The Bill as drafted makes patients the passive recipients of care, rather than active participants in their own care and recovery—
Mr. Hilton Dawson (Lancaster and Wyre): So what does the patient stuck in NHS provision—it may be an older person or a person with a mental illness—do when, despite all the protocols and all the good intentions, nobody will help them move?
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