Westminster Hall
Thursday 27 March 2003
[Sir Alan Haselhurst in the Chair]
Older People
2.30 pm
Mr. Deputy Speaker : Before we begin this second session of questions in Westminster Hall, I shall make a short statement about the procedure that I intend to follow.
As happens in the House, I will call each Member with a question in turn, and that Member should rise and respond, "Question No. 1," and so on. I will then call a Minister to answer. However, this session is different from questions in the House in that four Ministers from three Departments are present. The House has decided that questions in Westminster Hall should relate to an overall "cross-cutting" theme, which on this occasion is older people.
After the Minister's initial answer, I will call the Member in whose name the question was tabled to ask a supplementary question. One of the other Ministers present may want to answer that supplementary question instead of or in addition to the Minister who gave the original answer. I will then call other Members to ask supplementary questions—including, on some questions, Opposition Front Benchers. I may also call a Member to ask a second supplementary question, if I deem it appropriate.
However, Members should remember that this is a question and answer session rather than a series of mini-debates. There is therefore a premium on brevity in both questions and answers, and I expect there to be a large measure of precision. I hope to achieve a free-flowing exchange to allow us to make good progress through the Order Paper in the hour allotted to questions.
If Divisions take place in the House there is injury time: if there is one Division, we will reconvene within 15 minutes of adjourning, and if there are two successive Divisions, we will reconvene within 25 minutes.
This is still a fairly novel procedure, and I ask for the co-operation of all hon. Members to continue to make it a useful addition to our procedures for holding the Government to account. It is inevitably still experimental. As was the case with the first such session in January, I do not intend any precedents to be set by my rulings, and I will be happy to receive privately any suggestions from colleagues for modifications.
I remind hon. Members that sittings in Westminster Hall are governed by the same conventions on behaviour and mode of address as the main Chamber.
Oral Answers to Questions
The Government were asked—
Community Pharmacy Services
1. Ms Joan Walley (Stoke-on-Trent, North): If the Government will make a statement on the likely impact of the recommendations of the Office of Fair Trading report on pharmacy services in the UK on older people's access to pharmacy services.[104433]
6. Malcolm Bruce (Gordon): What assessment the Government have made of the impact of the Office of Fair Trading report on community pharmacies on older people.[104452]
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy) : We announced yesterday that we will make proposals in response to the Office of Fair Trading report before the summer recess—[Hon. Members: "Oh?"]—and we will publish a progress report at the end of June. We will look at the implications that the report has for access and choice by older people in relation to improved local pharmacy services.
Ms Walley : I thank the Minister for that reply. In a way, I am sorry that only three Departments are represented here today. If we were really going to get responses that do justice to the issues raised in the Office of Fair Trading report, all Departments of Government would need to be present, including the Department of Trade and Industry. [Hon. Members: "Hear, hear!"]
I am concerned about pharmacy services for older people. In Stoke-on-Trent and north Staffordshire, many elderly people rely on having easily accessible pharmacies that are in the high street or near doctors' surgeries. When the Minister responds, he must do what I understand the Scottish Executive and Welsh Assembly have already done: he must reject the Office of Fair Trading proposals outright. I ask him to consult with his colleagues to ensure that the Governments' response puts the health needs of elderly people first and ensures that pharmacies can continue as at present.
Mr. Lammy : I assure my hon. Friend that we in the Department of Health have been consulting not only across Government but with all the representative bodies of pharmacy, the supermarkets, patient groups, consumer groups and others. She is right that community pharmacies play a vital role in our communities. They certainly support older people, not only because older people visit the pharmacies, but because the pharmacies provide delivery services and other things. That is why the Minister, Patricia Hewitt—[Hon. Members: "Who?"]—the Secretary of State for Trade and Industry said in the House last week that the Government do not think that simple deregulation was the answer, and that it is important to consider the role of community pharmacies in examining wider national health service policy objectives.
Malcolm Bruce : I am a little disappointed by the Minister's response. Last week's press reports of what
was said by the Secretary of State for Trade and Industry gave the impression that the Government have rejected the OFT recommendations, yet he is now telling us that the Government have not finally decided and that it will be several months until the Government's position is clear.Does the Minister accept that the issue is causing a great deal of anxiety and uncertainty, especially among older people who are the prime users of local chemists? They want to know that they will not find that their chemist has closed and the service has been moved to a supermarket out of town. They want a developing NHS pharmacy, rather than a free-for-all whereby pharmacies can open and close, leaving people confused and without the guidance and advice that they expect to be able to obtain locally.
Mr. Lammy : In fact, the pharmacy world in the form of the Pharmaceutical Services Negotiating Committee, which represents community pharmacists, said yesterday:
- "We welcome the Government's initial response to the OFT report and their view that any final decision must balance improved quality and access without diminishing the crucial role that pharmacies play."
Pharmacists themselves are happy with what we said yesterday. They understand that we have a clear vision, which we set out for the pharmacy community in our "Pharmacy in the Future" document two years ago. At that time, we also addressed issues of contracts, reimbursement and generics. It must be right that when considering issues of competition, we examine wider NHS objectives and work with colleagues to find the right answer.
Mr. Peter Pike (Burnley): Is it not a factor in considering the wider role that pharmacies have been trying to develop, in line with Government policy, the approach of providing a wider primary care service to people in the community? Does the Minister accept that the large number of petitions and letters that all MPs have received shows that there are strong feelings on this issue throughout the country? We have all received representations from Asda and others, but they are concerned only about profit, not about the poor or elderly people who find it difficult to get to superstores.
Mr. Lammy : My hon. Friend makes a strong point. For me, going through the Lobby in the past few weeks has been like running the gauntlet. Our community pharmacists and many other people, old and young, have petitioned us and written to us with their observations on the report. It is right that we carefully consider those representations. The subject of pharmacy has taken the lion's share of my diary in the past month, and I know that colleagues in the Department of Trade and Industry have also been closely examining the issue.
My hon. Friend is right that community pharmacies play a central role in our national service frameworks. I have just issued a framework document on diabetes. Pharmacies play a key role in diabetes care, and diabetes affects older people disproportionately. Pharmacies have a clear role to play in a range of health care issues
across the NHS, which is why we must consider the OFT report not only in relation to competition in the market, but in relation to wider NHS policy.
Mr. Anthony Steen (Totnes): Is the Minister aware that the simple transfer of responsibility for repeat prescriptions alone could save general practitioners up to 2.74 million hours each year? I told him that during a Westminster Hall debate some weeks ago. In addition, £380 million could be saved if a quarter of patients visited their pharmacist rather than their doctor for minor ailments. In the light of the assurances given last week in the House by the Secretary of State for Trade and Industry that the Government do not believe that wholesale deregulation of the pharmaceutical industry is a good idea and that pharmacists are willing to modernise, what is delaying the Government's getting on with it?
Mr. Lammy : I said that there are ongoing discussions about pharmacists' contracts and the way in which they are reimbursed in respect of generic medicines. The hon. Gentleman is right to point to the benefits connected with repeat prescribing; there are also benefits for pharmacists in prescribing and medicines management. We must consider the matter across the piece, alongside the opening up of the market to more competition. We will reach a conclusion by the summer recess.
Jean Corston (Bristol, East): May I impress on my hon. Friend how important it is that the Office of Fair Trading report is well and truly rejected? I hope that the Government will make an announcement sooner than he said they would. I ask him to remember not only that older people are generally more dependent on pharmacy services, but that if people have ever driven a car, they have generally stopped doing so by the time that they are elderly and they cannot get to a supermarket with their prescriptions. A market is not appropriate in some sectors of the community, and that is certainly the case with pharmacists. They are not just shopkeepers, but health professionals in our community.
Mr. Lammy : I endorse my hon. Friend's comment that pharmacists are not just shopkeepers. They are professionals who want to play a greater role within the NHS. We set out that vision for pharmacists in the "Pharmacy in the Future" document, and we want to support them in that process. Pharmacists are in many communities day in, day out. I am sure that none of us as Members of Parliament have received criticisms of them because of the vital service that they provide. We want to support pharmacists. That is what we said yesterday and what my right hon. Friend the Secretary of State for Trade and Industry said last week when answering questions to her Department. We will make progress at the right pace. I remind my hon. Friend that both the National Pharmaceutical Association and the PSNC support us in that process.
Pensioner Poverty
2. Mr. David Chidgey (Eastleigh): If the Government will make a statement on the level of pensioner poverty.[104448]
The Minister for Pensions (Mr. Ian McCartney) : The Government are committed to tackling pensioner
poverty. Since 1997, our strategy has been to target help on the poorest pensioners. Our priority has always been to focus help on those who need it. That is why we introduced the minimum income guarantee, from which 2 million people are benefiting . The take-up campaign has put an average of £20 a week extra in the pockets of 149,000 people, who would not otherwise have received the money.We are going a step further and are introducing pension credit. It will reward savings, not penalise them. It will be easy to apply for and it will remove the indignity of the intrusive and bureaucratic weekly means test. As a consequence of that change, those eligible for pension credit will receive an average extra income of £400 a year. At last, the savings of those who are just above the minimum income guarantee level are being recognised. The latest HBAI—households below average income—figures show that 400,000 fewer pensioners are living in relatively low income households than were when we came to power.
Mr. Chidgey : I thank the Minister for his reply, but he will recall that the National Audit Office report, "Tackling Pensioner Poverty", which came out last November, highlighted the fact that between one quarter and one third of pensioners failed to claim the minimum income guarantee to which they were entitled. Today's report issued by the Department for Work and Pensions states that the take-up rate is little changed. How can he justify means-testing more than half of all pensioners for the new pension credit scheme in October when he has not tackled the disastrous take-up shortfall that is blighting the Government's efforts through their benefits schemes? [Interruption.]
Mr. Deputy Speaker : Order. I suggest that the Minister defers his reply until after the Division. If there is one Division, we will return in 15 minutes. If there is another, we shall return in 25 minutes.
2.43 pm
Sitting suspended for Divisions in the House.
3.8 pm
Mr. Deputy Speaker : Provided that there are no further interruptions from Divisions, we should be able to continue this questions session until 3.55. Again, I appeal for short questions and answers—we did not get off to a very good start. The Minister for Pensions will now reply.
Mr. McCartney : Thank you, Mr. Deputy Speaker. I am not sure whether you have a squint in your eye or whether you were looking at me when you said that we had not got off to good start.
It seems such a long time since the hon. Member for Eastleigh (Mr. Chidgey) and I last spoke. I am glad that he asked me about the National Audit Office report that was published on 26 March. It boldly stated that the Government had made good progress but that they should build on it. That is absolutely right—we have made fantastic progress. With the introduction of the
pension credit and the other changes that we have made since 1997, there has been a massive £8.6 billion increase in income across the board for Britain's pensioners. That is no mean achievement and I will not apologise for that significant shift in income towards the poorest pensioners in Britain.
David Taylor (North-West Leicestershire): The Government have done a lot to help the aged. Help the Aged recently brought out a report that called on the Government to match their bold commitment to ending child poverty by 2020 with a similar pledge on older people. Does the Minister think that the recommendations that Help the Aged made in the report in relation to benefit take-up, disability and winter deaths are affordable, realistic and achievable, and are the Government aiming to deliver on them? If they were to do so, the country would not collapse and the economy would not crumble, and millions of pensioners' lives would be immeasurably enriched.
Mr. McCartney : I thank my hon. Friend for that question. We think of that organisation as one of our major stakeholders and we work closely with it. We have established a national group of major stakeholder organisations including Help the Aged and Age Concern. I meet regularly with that group, the purpose of which is twofold: first, it engages the stakeholders in long-term strategy and service provision for older people; and, secondly, it involves them in policy development on tackling pensioner poverty.
It is interesting that, despite some differences of opinion in the margins, pensioners' organisations overwhelmingly welcome and work with the Government on the introduction of pension credit. They work with us consistently at both national and international level to deal with pensioner poverty. We have just established a new Pension Service—we are, I think, the first Government in Europe to do so. It is a unique service that will transform the basis of the civil service. Rather than being people who represent Whitehall, we are training civil servants who have a commitment and aptitude. We want advocates for older people to be within the system.
The creation of a national network of local service providers will mean that we will, in the next few years, on a year-by-year basis, challenge and tackle pensioner poverty and make improvements in services. I welcome Help the Aged's involvement in working towards those objectives and targets.
Mr. Paul Burstow (Sutton and Cheam): The Minister talks of progress, but figures published by the Department today show that pensioners are missing out on £1.8 billion in benefits. Up to 270,000 people are missing out on housing benefit, 670,000 on minimum income guarantee, and as many as 1.43 million on council tax benefits. The take-up rates for both the minimum income guarantee and housing benefit have increased by a massive 1 per cent. at a time when record council tax increases are hitting the poorest pensioners across the country, and take-up rates for council tax benefits are falling. What action will the Minister take to ensure that our poorest pensioners do not fall even deeper into poverty as a result?
Mr. McCartney : God help any pensioner living under a Liberal council—[Hon. Members: "Hear, hear!"] I
would not shout too soon—Conservatives are just as bad. I do not want to sound churlish and I would rather that they were not churlish.The hon. Gentleman talks about giving pensioners access to housing benefit and council tax benefit, but it is the changes in pension credit that will ensure that a million extra pensioner households get access to income streams that were not there before. The Liberal Democrats have in the past few weeks come out in opposition to the scheme, and have said that they would scrap pension credit and, with it, access to housing benefit and other benefits. His party cannot have it both ways.
There is massive new investment. I hope for political consensus on that. We should target poverty not on the basis of people's age, but on the basis of their income. What lies behind the hon. Gentleman's question is the fact that he wants to redistribute the Government's resources on pensions and housing benefit and make other changes in favour of those aged 75 or more. That would mean that those on low incomes aged 60 to 75 would lose out completely. I cannot for the life of me understand why the Liberal Democrats think that it would be an effective strategy for tackling or preventing poverty to say, "If you're poor at 60, don't come to us. Wait until you're 75, if you can."
We wholeheartedly reject the strategy that the hon. Gentleman wants to deploy. Our strategy means significant increases in income year after year and access to benefits that would not have been there but for the changes that we made.
Mr. Deputy Speaker : Order. The Minister might like to know that I am looking at him now.
Mr. Jim Cousins (Newcastle upon Tyne, Central): I congratulate the Government on introducing the savings top-up for pensioners in October. I also congratulate them on the changes in council tax benefit that will be introduced in April. They have not had much publicity, but because of the changes in the savings rules, many people will be able to get council tax benefit for the first time.
The problems of take-up are greatest among women who live on their own. I urge the Minister to consider how women pensioners who live on their own could come to understand these good new Government schemes. Such women are often quite isolated, living in difficult circumstances after the death of their partner, with poor survivor benefits through private pension schemes. They are difficult to reach and I urge the Minister to address their problems.
Mr. McCartney : My hon. Friend makes a fair point. That was the purpose of establishing the Pension Service at both national and local level. We are currently doing a great deal of work with older people's organisations on our strategic approach to improve take-up. I will write to my hon. Friend about that and I will place a copy of the letter in the Library.
If we are to target poverty, we must find ways to get to those who are voiceless and powerless in the system. The overwhelming majority of older people who are
poor are women; the biggest beneficiaries of minimum income guarantee and pension credit are women; the biggest beneficiaries of second state pension will be women. The Government understand that it is crucial to tackle the inequalities in the current system that affect women; we must find effective ways to deal with them. My hon. Friend is correct—we are in the same ballpark. I will write to him with further details.
Mr. Julian Brazier (Canterbury): Will the Minister confirm that his Department's HBAI document, which was published earlier this month, shows that the number of pensioners earning less than two fifths of the national average workers' income has risen by 100,000 since the Government took office? Will he confirm that today one pensioner in five lives below the level of that supposed safety net, largely because of the non-take-up of means-tested benefits? Will he further confirm that the proportion of pensioners who are eligible for this increasingly complex set of means-tested benefits is almost three in five? Finally, will he tell us what he means by the local delivery of benefits when we are losing post offices throughout the country and, indeed, pharmacies and other essential services?
Mr. McCartney : That was three questions in one. I will take them in reverse order.
It is a bit rich that the Conservatives, who wanted to privatise the Post Office and close virtually every post office now complain about a multi-billion pound investment in post office services. I have no doubt that we can deal with that during another of the questions.
The HBAI figures show that the incomes of 400,000 of the poorest pensioners have greatly improved because of the measures introduced by the Labour Government. There is, however, much more to do. That is why we are introducing pension credit. I ask the hon. Gentleman, when will the Conservatives get off the fence and tell us whether they will abolish or support it?
Community Pharmacy Services
3. Mr. Edward Davey (Kingston and Surbiton): What proportion of prescriptions dispensed by community pharmacists in the past 12 months were for people of state pensionable age.[104449]
10. Dr Jenny Tonge (Richmond Park): What proportion of prescriptions dispensed by community pharmacists are for people of state pensionable age.[104456]
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy) : In the 12-month period from September 2002, 56 per cent. of prescriptions were dispensed by community pharmacists and appliance contractors to people aged 60 and over.
Mr. Davey : That figure underlines how important community pharmacists and pharmacies are to older people. I have spoken to many pharmacists in Kingston and Surbiton who tell me that most of their customers are pensioners and that such people rely heavily on their community pharmacist. Will the Minister go further than he has done and tell the House that he will seek a much earlier rejection of the OFT proposals? Does he
not realise that the sword of Damocles is hanging over community pharmacies and that it will continue to do so until the Government resolve the issue?
Mr. Lammy : If the sword of Damocles was hanging over community pharmacies, their representative bodies would be unlikely to support the Government. They are supporting the Government because we have been working with them for some time. We have been working with them on their contracts and the way in which they are reimbursed, and on the Office of Fair Trading report. [Interruption.] It is not a question of backing down, it is a question of supporting the NHS and community pharmacies that seek to do more. We will do that according to the timetable outlined yesterday.
Dr. Tonge : I am struggling to say something new, but older people form a high proportion of those cared for by the primary care trust in my constituency and that of my hon. Friend the Member for Twickenham (Dr. Cable)—we share that primary care trust.
Community pharmacists are the friends of older people. They know them well because they know >cf2>their patients. Community pharmacists are also the friends of doctors, as I well know: a pharmacist once corrected me when I was very tired and made an error on a prescription. Doctors rely on pharmacists to check and ensure that they are doing the right thing—
Mr. Deputy Speaker : Order. If the hon. Lady has not got much to say, I would prefer a question rather than a speech.
Dr. Tonge : I am sorry, Mr. Deputy Speaker. Will the Minister ensure that, for the sake of our people, community pharmacists, who are the first access point for the NHS, are there always?
Mr. Lammy : I will ensure that community pharmacists remain for the sake of our people. The hon. Lady is right: community pharmacists on the high street, at the bottom of the road, in rural areas and in towns, know the patients' family history. They come to know people over time and provide a valuable service. That is why there has been concern throughout the House about the OFT report, and why representations have been made throughout the country. We are considering those representations carefully. In "Pharmacy in the Future" we set out a vision for pharmacists that they support.
The OFT report considers only 20 per cent. of the pharmacy business. The other 80 per cent. is NHS business. That is why we need to consider the matter carefully in the context of the needs of the NHS. We must support community pharmacists and I assure the hon. Lady that we are seeking to do that.
Age Discrimination
4. Simon Hughes (Southwark, North and Bermondsey): If the Government will make a statement on the progress they have made in tackling age discrimination in employment.[104450]
The Minister for Lifelong Learning and Higher Education (Margaret Hodge) : We are encouraging
employers to adopt non-ageist employment practices through our age positive campaign, which raises employers' awareness of the business benefits of an age-diverse workforce and encourages a flexible approach to retirement to open up choice and the opportunity for individuals to stay in work longer. Between 1999 and 2001 the number of companies referring to age in recruitment fell from 27 per cent. to 13 per cent. and the number of companies having a policy against employing older workers dropped from 14 per cent. to 7 per cent.
Simon Hughes : The Minister knows that that is not a very encouraging answer, because just before Labour came to power in 1997, her right hon. Friend the Member for Makerfield (Mr. McCartney), now Minister for Pensions, said that the Labour Government would introduce legislation against age discrimination at the earliest opportunity. In the six years since, there have been 18 attempts to introduce such legislation—all blocked by Labour. Will the Minister tell us whether Britain will have to wait until the last minute of the last hour before we are required under European law to implement age discrimination legislation in 2006? What would she say to a relative of mine who reached retirement age in December, asked to stay on and was able and willing to do so, but, like many in that position, was told by the employer, "I'm sorry, but you have to go."?
Margaret Hodge : The Labour Government chose to sign up to article 13 of the treaty of Amsterdam, which will ensure that measures against discrimination on the grounds of age are incorporated into UK legislation. We did so freely and played an extremely active role in ensuring that that article came into being. If such legislation is to work in practice and have an impact on people's lives, it should be developed through consensus among all parties. Working with employers to ensure that we have a framework that is acceptable to everyone is an important part of the process. In my view, legislation simply provides the underpinning framework. What is required in this as in all other aspects of discrimination is a transformation of culture. All parties working together is a much better way of achieving that than simply attempting to confront the issue through legislation.
Ms Candy Atherton (Falmouth and Camborne): I am pleased that the Government are to produce their own legislation, although I, too, would prefer that to happen as quickly as possible. Tackling the issue of goods and services is absolutely critical. If an employer wants to take on an older worker but cannot obtain insurance for that person, the older worker will not be employed. It is critical that we have the same legislation in respect of age as we do in respect of race.
Margaret Hodge : I understand my hon. Friend's point. I am sure that she appreciates that we must ensure that we have a framework in place that is acceptable and that employers will implement according to the spirit, as well as to the letter, of the law. Making the necessary adjustments to enable older people to participate in the workplace will be part of the culture change that we will seek to achieve in the years prior to 2006, when the legislation will finally come into place.
Mr. Nigel Waterson (Eastbourne): Does the Minister agree that we must address cases such as that of my
constituent, Jill Lambard-Brown, who has just been sacked by Liberal Democrat-controlled Eastbourne borough council for no other reason than that she happened to turn 65? The central issue is that, miraculously and in one fell swoop, when people turn 65 they lose all their employment rights.
Margaret Hodge : That is precisely why we freely joined with our colleagues across the European Union to sign up to the directive based on article 13 and to bring that into the framework. It is interesting to hear that the Liberal Democrats are not doing what they urge others to do.
Miss Anne Begg (Aberdeen, South): The Government's pensions Green Paper acknowledges that there is a savings gap. Essentially, the longer people can work, the more they can save into a pension fund and the better their pension will be when they retire. It is important that people are allowed to work and remain in the workplace as long as they possibly can. Far too many employers are still using age as an excuse to offer people early retirement—thereby putting a strain on occupational pension schemes—or not to consider employing people once they have turned 55. Will the Minister engage with employers to ensure that they end age discrimination and that people are allowed to work, pay into pension schemes and make better provision for their old age?
Margaret Hodge : I completely agree that the longer people work, the more they can save and the likelier they are to have a higher standard of living during retirement. I draw the attention of my hon. Friend and other hon. Members to the fact that this is a difficult area of policy, because discrimination on the grounds of age is important in relation to younger people as well as older people. We need to ensure that when we have a framework that enables older people to stay on at work for longer and prevents them from having to retire on the grounds of age, younger people have an equal opportunity to progress into jobs and move up the ladder, so that they, too, can fulfil their potential and contribute to the economy and society.
The Minister for Pensions (Mr. Ian McCartney) : May I advise my hon. Friend the Member for Aberdeen, South (Miss Begg) that the Government have introduced the new deal 50-plus programme, which is specifically designed to get older workers who have been discriminated against or forced out for economic or structural reasons back into the workplace? The programme is having a significant impact on turning around the long-term decline in labour market activity by older workers, especially older men. We have now changed that trend. There is an upward trend in terms of proactively keeping older workers in the work force. Linking the new deal 50-plus programme with our age positive campaign, employers are now giving significant support to proposed legislation on age discrimination and, in the run-up to that, to work with other employers to get them to end their bad practices. That will have a significant impact by 2006.
Digital Hearing Aids
5. Angela Watkinson (Upminster): What action the Government are taking to ensure that digital hearing aids are available to older people who are hard of hearing.[104451]
The Minister of State, Department of Health (Jacqui Smith) : On 7 February, my right hon. Friend the Secretary of State for Health announced an investment of £94 million to support the modernisation of hearing aid services. That will ensure the provision of digital hearing aids on the NHS throughout England by April 2005. Roll-out plans include boosting NHS capacity and improving access for patients by extending public-private partnerships, which will increase access to NHS digital hearing aids on the high street.
Angela Watkinson : What would the Minister say to my elderly constituents who were eagerly awaiting the introduction of digital hearing aids only to have their hopes dashed when they found that funding was available only for new patients and that elderly patients who already had hearing aids were not eligible at this stage? What hope can she extend to them? Arguably they are the people who, with their failing hearing, need such aids the most.
Jacqui Smith : The programme is progressive and it is important that we introduce it in a way that benefits as many people as possible. In such areas as the hon. Lady's—one of the 67 sites that are currently offering digital hearing aids or have been given the training and equipment to start offering them from next April—we have made it clear that people new to hearing aids must be the first to have the benefit of digital, but that people who need their hearing re-assessed or feel that their hearing needs have changed radically can also benefit from digital hearing aids. It will take some time to ensure that the training and equipment are in place, but whereas three years ago no one was getting digital hearing aids on the NHS, we have now issued more than 72,000. We shall ensure by April 2005 that that is an opportunity open to everyone.
David Taylor (North-West Leicestershire): I declare an interest in that I am over 55 and have hearing loss due to chronic tinnitus. There are constituents in Leicestershire, especially North-West Leicestershire, who are very grateful for the steady roll-out of digital hearing aids, which have transformed their lives. However, has my hon. Friend reviewed the patchy provision of audiology clinics and how long many elderly people have to wait to have their need for hearing aids measured more specifically than is currently possible? Finally, please, please will my hon. Friend the Minister look again at public-private partnerships? I sense a disaster in the making there.
Jacqui Smith : My hon. Friend makes an important point. As we make available on the NHS something that has never been available on it before, we see an increase in demand for hearing aids, including from people who had previously had analogue hearing aids but put them into the cupboard because they had realised that they were not suitable for them. That brings to audiology departments the challenge of ensuring that they can
carry out the whole function of fitting digital hearing aids as quickly as possible. It is precisely because of that that we are taking action to recruit more audiologists. The NHS Modernisation Agency is working with audiology departments to ensure that we have in place the programmes and the efficiency that will enable us to get that service delivered as quickly as possible.Perhaps I can reassure my hon. Friend about public-private partnerships. We have carried out two pilots, in Leeds and Shrewsbury. The Institute of Hearing Research has evaluated the pilots and found that the outcomes for the 400 people who went through the process were extremely promising. I know my hon. Friend's concerns about the public-private partnerships, but I think that we can use those means to extend people's opportunity to have a digital hearing aid on the NHS as quickly as possible—an opportunity that never existed before.
Mr. Desmond Swayne (New Forest, West): Will the Minister acknowledge that the real logjam is in gaining access to an audiologist? That could be greatly relieved if licensed hearing aid dispensers in the private sector could access the NHS contract for digital hearing aids. When will that happen?
Jacqui Smith : The real logjam was caused, first, by technology and, secondly, by the willingness of the current Government to invest more than £120 million to ensure that older people could access digital hearing aids on the NHS. The hon. Gentleman must recognise that. His party proposes 20 per cent. cuts, presumably in resources and the staff who are providing NHS hearing aids for older people. It is the policy of the Conservative party to give patients a passport out of the NHS, but it is Labour's policy to ensure that people get on the NHS what they would have to buy under a Conservative Government.
Mr. Tim Boswell (Daventry): Does the Minister appreciate that a characteristic problem of many older people is a subtle but progressive loss of hearing intensity, and that they therefore form a significant part of the national population of some 8 million people who are hearing impaired? Given that, does she accept as a matter of principle that there should be absolutely no discrimination against prescribing digital hearing aids to older people and that any older person who is suitable for such a prescription will be entitled to receive one in due course?
Jacqui Smith : I strongly agree with the hon. Gentleman. I do not know whether he has a particular problem that he wishes to identify, but it is precisely because some 50 per cent. of the over-60s experience some hearing loss that the investment that we are putting into modernising hearing aid services will be so significant to older people. We must ensure that the right processes and suitable equipment and staff are in place to assess people's hearing and to provide that service. I assure the hon. Gentleman that the primary beneficiaries of the policy will be older people, who too often in the past have been discriminated against in the NHS.
I am very pleased that today we have published a report that covers the two years since the introduction of the national service framework for older people, at the
centre of which we put tackling age discrimination. The report shows that significant progress has been made. I am sure that the hon. Gentleman will take the opportunity to read it during the suspension that I suspect is about to start.3.37 pm
Sitting suspended for a Division in the House.
3.50 pm
Mr. Deputy Speaker : We now have until 10 minutes past 4 for the remainder of this question session.
Care Homes
7. Miss Anne McIntosh (Vale of York): How many care home places were available on 1 January (a) 2002 and (b) 2003; and if the Government will make a statement.[104453]
The Minister of State, Department of Health (Jacqui Smith) : The latest data available for 2001 show that there were some 528,000 places in care homes for residential or nursing care in England. In addition to the £300 million building capacity grant in 2001–02 and 2002-03, we are providing record levels of funding for social services. Funding will increase by an average of 6 per cent. in real terms each year for the next three years. Councils can use those resources to stabilise the care home sector and to expand the range of services for older people, including home care and extra care housing.
Miss McIntosh : That is the answer to a question, but not to the question I asked. Since 1997, 60,000 care home places have been lost and there has been a decrease of almost 100,000 in the number of households receiving domiciliary care packages. Does the Minister accept that her Government is to blame, at least in so far as the Care Standards Act 2000 introduced prescriptive standards that led to that large fall in the number of care home places?
Jacqui Smith : As the Select Committee on Health said, 60,000 is a somewhat spurious figure. The latest figures in the Department suggest that between March 2000 and March 2001 there was a decrease of 11,200, and that between 1997 and 2001 43,000 households received intensive home care packages—the equivalent of a care home place. During the past year, there has been an increase in the number of older people receiving support to live in their own home. That is a result of additional investment, but we need to do more to ensure that older people have a choice of care home places, support in their own homes, equipment necessary to enable them to live independently, and extra care housing. My right hon. Friend the Secretary of State announced £1 billion investment over the next three years precisely to develop such services.
Mr. David Drew (Stroud): My hon. Friend is right to concentrate on choice. Does she accept that we should prioritise that in April, with the onset of supporting
people, which is a very good initiative that allows people's homes to be adapted? People often have to return to hospital because their accommodation is totally unsuitable.Another aspect of the problem is that we are disaggregating funding, which makes the position of those who are not in receipt of benefit and are living in sheltered accommodation more stark. Does my hon. Friend accept that it is necessary to look at that, because we must encourage people to live in the accommodation most suitable for them, which for older people is often sheltered accommodation?
Jacqui Smith : I strongly agree that there is greater opportunity for older people. They are able to live in new-style extra care housing or remain in their own home with the contribution of better community equipment services and better adaptations for disabled people. For the first time, the Department of Health is contributing to home improvement agencies to ensure that the necessary changes to older people's homes to enable them to leave hospital and return to their own homes are properly funded. I also agree with my hon. Friend that this is a time of transition as we move to supporting people. We must be careful to ensure that the whole range of support services and benefits are in place to allow older people to have what they want: more independence and more choice.
Chris Grayling (Epsom and Ewell): Will the Minister please address the concerns of both care home owners and care home residents and their families in my constituency? They say that the current system of contributions to nursing care by the NHS is shambolic. Payments are received months after the period that they cover and have to be administered by care home owners, who end up paying money back to families. The result is chaos for everybody involved. Will she re-examine the system?
Jacqui Smith : Certainly, it is unsatisfactory if care home owners are paid late by primary care trusts. If the hon. Gentleman wants to tell me in what specific areas that is happening I shall pursue the matter. We are currently evaluating the free nursing care scheme, and in many areas we are finding that the NHS is being brought, often for the first time, into a much closer relationship with nursing homes. That helps to develop better joint working, better training and a better approach to services, for example, continence services. Although I am willing to tackle problems, in addition to the financial benefits to many older people, there are other significant benefits from bringing the NHS into a closer relationship with nursing homes.
Mr. Simon Burns (West Chelmsford): Will the Minister please come out of her fantasy world and answer specific questions? Has she read the Health Committee's report? I am a member of that Committee. Does she accept that she is being disingenuous in her choice of figures? If she has read the report, she will know from the special work commissioned that just under 65,000 places were lost between 1997 and last
year. That figure includes the loss of local authority places, which she steadfastly refuses to include in her answer.
Jacqui Smith : First, I have read the report. Secondly, the figure that I used in my last answer included local authority places. The hon. Gentleman has a basic difficulty: I have never argued that there has not been a reduction in capacity in care home places. There has been a small reduction since 1997. According to Laing and Buisson independent consultants, the national occupancy rate for care homes is only about 90 per cent. There are capacity problems in some parts of the country, and we have to ask ourselves how we can address them. Care home owners tell me that they want local authorities to be able to pay fees at levels that reflect the quality of care homes. The hon. Gentleman can nod, but until he is willing to support our extra investment in local authorities to enable them, where it is necessary, to raise fees to safeguard capacity, ranting is cheap. He needs to enter the real world and to recognise that the investment, which he is unwilling to support, is necessary to make a difference for older people.
Mr. Burns : If the Minister had read the Health Committee's report properly, she would know that the specific work commissioned on numbers makes it clear that if one includes local authority losses with the private sector, the result is almost in line with the Laing and Buisson figure of just under 65,000 beds lost. The sooner she accepts that, the sooner she will have a greater understanding of the problem in the long-term care sector. In certain parts of the country, people cannot find beds for their parents in their immediate vicinity.
Jacqui Smith : The difference between the hon. Gentleman and me is that I recognise that there is a problem and, unlike him, I am willing to put the Government's money into solving the problem by ensuring that local government has the necessary resources to safeguard capacity in the care home sector. Opposition Members often fail to recognise that although care homes are important, they are not the be all and end all for older people. We need to ensure that the 43,000 increase in the number of older people who can live in their own home, which is a result of the increase in intensive home care packages, continues to grow in the coming years. We must continue to develop opportunities for extra care housing and must ensure that additional community equipment is in place to allow older people a genuine choice. That is what we are committed to. Both reform and investment are required. I will not take the hon. Gentleman's crocodile tears seriously until he is willing to vote the investment to make a difference for older people.
Mr. Paul Burstow (Sutton and Cheam): Does the Minister not accept that the issue is not only safeguarding capacity, but adding capacity? The 90 per cent. figure that she quoted is, as she rightly says, a national figure, but care homes are not a national service. We do not put older people on buses going from one part of the country to another to find spare places for them. Will she tell us what the Government are doing
not only to safeguard capacity, but to add to it and specifically to deal with the chronic shortage of care for people with dementia, for whom the loss of places has become critical?
Jacqui Smith : The hon. Gentleman makes a point that I dealt with in my previous response. Care home capacity is not spread equally across the country. That is why, along with the additional investment, we must allow local authorities to make the right decisions about the balance of placements in their areas. He is also right that we have a particular challenge in providing for mentally ill elderly people. The additional investment going to local authorities has enabled a third of them to increase fees by more than 10 per cent., often for such specialised provision. That is an important way in which we ensure that we safeguard such provision. My right hon. Friend the Minister for Pensions made it clear last summer that the number of supported residents in residential care homes has increased over the past year. Our planning assumption is that local authorities will have the resources to increase the number of care home places that they commission from the independent sector over the next three years.
Post Office Card Accounts
8. Sue Doughty (Guildford): What arrangements have the Government made to promote the take-up of Post Office card accounts among people of pensionable age.[104454]
The Minister for Pensions (Mr. Ian McCartney) : The move to direct payment provides a more secure and efficient method of payment that will make life easier for people. It will also help to prevent crime and fraud. More and more people are already choosing to be paid in this way, and of every 10 new pensioners six do so without prompting. People have more choice: they can use a range of bank or building society accounts at their post office as well as the new Post Office card account. They will not have to carry large amounts of cash, and they will have more choice and flexibility about how much they withdraw and where they withdraw it. They will be able to choose the account that best suits their needs. We will write directly to all pensioners affected by the change, sending them the information that they need to decide which account option is best for them.
Huge numbers are involved, which means phasing in any changes over two years. People do not need to do anything until we have contacted them. In the meantime, we have set up a dedicated helpline so that people can phone if they have questions about the change. The number is 0800 107 2000—just in case someone was going to ask. We are also running an information campaign to support mailings to customers; it will explain the change and the choices that people have. It will include press, radio and television advertising. Press advertising started on 24 March.
Sue Doughty : I thank the Minister for his answer, but I am concerned that people are getting the information late and that it takes time for older people to fill in forms to get the changes made. How does he expect to deal with claimants who do not want a bank account or who cannot run a bank account? They will have real difficulty filling in forms to withdraw cash using the Post Office
card account, but they still want to go to their local post office and withdraw cash—that is the service that they expect to receive.
Mr. McCartney : I thank the hon. Lady for her question and for the manner in which she put it. All of us are acutely aware of the need to be sensitive when introducing change, particularly if that change affects older people. We must ensure that changes are made in co-operation with older people's organisations. The change must also be beneficial to the older people that it affects.
Some 90 per cent. of all pensioners currently have access to a bank or building society account. If we did nothing over 10 years, post offices up and down the country, including those in the hon. Lady's constituency, would have very few pensioners as customers, let alone others. People are choosing to take their income from sources other than post offices because other sources give a better choice. That is why we are investing more than £1 billion in a programme that will provide a platform for additional services to older people and other customers, which will transform the Post Office over the next few years. If we did not make those changes, we would ensure that a major national network slowly bled to death.
I shall send the hon. Lady and other hon. Members a detailed note to keep them in contact with the changes as they are phased in. I want to ensure that all hon. Members have access to the Department for Work and Pensions and to the Post Office. There must be an open process, and we shall deal directly with any problems that hon. Members raise during the transformation period, whether they are connected with the service in general or with specific aspects of the Post Office. If we are serious about maintaining the Post Office network, it is in all our interests to install the system sensitively.
Older people have voted with their feet in the pilots: they have appreciated the opportunity to continue banking with the Post Office for cash and used their building society accounts—with Nationwide, or, indeed, the new Post Office account. I am certain that we shall deal with the matter as sensitively as we can over the next few years to ensure that the needs of older people are met effectively.
Health Service Ombudsman
11. Mr. David Heath (Somerton and Frome): When the Government will issue fresh continuing care guidance arising from the health service ombudsman report.[104457]
The Minister of State, Department of Health (Jacqui Smith) : On 27 February, we reiterated to strategic health authorities that they should report whether the continuing care criteria in use since 1996 are consistent with the Coughlan judgment, and if not, when that was identified and what action was taken. We asked for an estimate of the number of people who might have been wrongly assessed and reiterated to strategic health authorities that they should agree one set of criteria across their area. We expect the results of those considerations to be reported back to the Department of
Health by the end of March. We shall review the existing guidance carefully and consider whether any further action is necessary once that process is complete.
Mr. Heath : It is important that transparent and consistent criteria are applied across the country. Tomorrow is the closing date for strategic health authorities to report back on their reviews of the criteria and the number of people who are likely to be affected. Will the Minister give an assurance that the Department will publish that information, and that an early assessment will be made of the total financial implications? If those implications are significant, how will they be met? Is contingency funding available to the strategic health authorities?
Jacqui Smith : The hon. Gentleman is right that we need first to assess those results and then, as we have said previously, to ensure that strategic health authorities have criteria that cover the whole of their area to ensure greater consistency. On the whole, the guidance that we have issued has ensured that in most areas health bodies have carried out the assessments in line with the legislation. In the light of the urgent action that we took after the issue of the health ombudsman's report, we must carefully consider how to ensure that older people are confident that their needs are properly assessed and that they receive the appropriate support for those needs, whether that is through continuing NHS health care, a contribution to nursing care, or a means-tested contribution elsewhere.
Mr. Mark Francois (Rayleigh): I am sure that the Minister appreciates that the health service ombudsman's ability to deal with any issue is partly conditioned by the resources at her disposal. As complaints about the NHS increase and more cases are referred to the HSO, it is taking longer to get an adjudication. What are the Government doing to increase the resources available to the HSO, so that people who complain about something materially important to them get a quicker and more effective determination?
Jacqui Smith : I am sure that the hon. Gentleman considers it important that the health service ombudsman's considerations are separate from Ministers' decisions.
Jacqui Smith : Well, I do not want to end Question Time on a discordant note, but for Opposition Members to call for more resources at the same time as they propose—[Interruption.] Well, even on the basis of a generous analysis of the proposals, which are about bureaucracy, I am not quite sure where the hon. Gentleman would find the money to resource the NHS or any complaints process related to it. However, I can assure him that the new bodies that we are setting up and
the new legislation that we recently introduced will ensure that patients have the opportunity to voice their concerns about the health service and to have their views properly represented. We will ensure that all the relevant structures—from the complaints process up to the health service ombudsman—are appropriately resourced.
Mr. Paul Burstow (Sutton and Cheam): On a point of order, Mr. Deputy Speaker. I seek your advice on the procedure for notifying Members of cross-cutting Question Times. Only 17 Members submitted questions for the session that we have just concluded, hence the large number of Liberal Democrat colleagues whose names appeared on the Order Paper. Could steps be taken to ensure that more Members table questions for cross-cutting Questions Times?
Mr. Deputy Speaker : A memorandum is published in the Order Paper, and notice of these events should be given at business questions. I hope that Members will get used to the idea and know what to do.
Mr. Tim Boswell (Daventry): On a separate point of order, Mr. Deputy Speaker. You will have noticed that our most intense exchange was about community pharmacies. By way of setting a marker for further consideration in what is an experimental process, may I ask that the House authorities ensure that the distribution of Ministers assigned to respond is coincident with the questions asked? It would have been extremely helpful to everyone had a DTI Minister been here alongside his Department of Health colleague to respond to questions about community pharmacies. Instead, we had the not inelegant spectacle of a Minister of State at the Department for Education and Skills, the hon. Member for Barking (Margaret Hodge), having to answer not a specific question, but one of only general concern to her. None the less, we had no DTI Minister. It was a little like "Hamlet" without the prince.
Mr. Mark Francois (Rayleigh): Further to that point of order, Mr. Deputy Speaker. May I humbly suggest that even Health Ministers might appreciate a DTI Minister being here the next time we have questions about community pharmacies?
Mr. Deputy Speaker : I am sure that Ministers are grateful for that helpful suggestion.
As I said at the beginning, we are still at a very experimental stage with the present procedure. Hon. Members may need to think about the questions that they table, because they will be slightly different from those that they would table for a single-Department answer in the House.
As I said, I am very willing to receive ideas and suggestions, and I am quite sure that Ministers are listening. Indeed, the Parliamentary Secretary, Privy Council Office, listened to a great part of this cross-cutting Question Time and to the previous one as well. We will perhaps find our way through to a system that makes the most of the idea.
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