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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman) indicated dissent.
Mr. Burns: The Minister may laugh, but Department of Health figures show clearly that, although the number of contact hours being provided has increased by 14 per cent.—as the Minister is very fond of saying—the number of households receiving services has fallen by 23 per cent.
Mrs. Angela Browning (Tiverton and Honiton) (Con): I am not surprised by the figures that my hon. Friend has quoted. I have done a lot of case work in this area and I know that the system involves people filling in endless tick boxes. The aim seems to be to stop people receiving anything, and not to make available the small amounts of care that would help them to maintain their independence. It is another example of bureaucracy gone mad.
Mr. Burns: I fear that my hon. Friend's experience is replicated all too often around the country.
Ms Munn: The hon. Gentleman may be aware that I have worked in this area for some considerable time. I was involved in the process of consolidating domiciliary care for those in need of intensive care. The aim was to give people like the constituent to whom I referred earlier the option to go home. That means that much greater care must be devoted to fewer people.
Mr. Burns: I disagree with the last part of the hon. Lady's statement. I fully recognise, as will anyone familiar with domicillary care, that many clients need highly intensive and time-consuming care. The fact is, however, that if, because it is considered more appropriate, we want more people to remain in their own homes rather than going into residential care, we need more domicillary care. Ministers repeat the mantra, "We have increased domicillary care". Yes, their figures show that the number of contact hours has increased, but not the number of people who need the care. That is the nub of the problem.
Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): Will the hon. Gentleman give way?
Mr. Burns: No, I am going to make progress.
The question is why there has been such a contraction in care capacity. Part of the reason has been the policy of social services departments to use their bulk purchasing power to force down the price that they are prepared to pay for beds, as my hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) said. Nowhere, as I told my hon. Friend, has that been more apparent than in Birmingham, where the price paid in the private sector has been forced down to £260 per resident while the price paid in the local authority homes is £525. That has resulted in 96 care homes closing down in the two years to 2002.
In addition, the introduction of more and more bureaucratic regulations, many of which were minimal in raising care standards, has contributed to home closures. Before any Minister tries to misinterpret what I am saying, let me make it quite clear that no Conservative Member opposes in any way the raising of standards so that frail and elderly people can have the highest possible care. What we object to is unnecessary and over-prescriptive regulation. While the Secretary of State continues to mutter from his sedentary position, he should recognise what I am saying. His own Government, before he became Secretary of State, did a U-turn on regulations, recognising the problems that there were.
Laura Moffatt (Crawley) (Lab): Will the hon. Gentleman give way?
In addition, since 1997 we have experienced the Government's over-prescriptive, centrally driven approach, which I believe has contributed to the current crisis in care. In the last two years, we witnessed the Government's ridiculous and unnecessarily prescriptive implementation of some of the national minimum environmental standards. Then the Government had to do a U-turn. We saw the over-zealous and complicated implementation of Criminal Records Bureau checks for care home staff. Then the Government had to climb down. The Government vigorously imposed regulations but then said that they would use a lighter touch, because even they came to understand that their approach had been too officious.
What we have not seen is consistency and a level of regulation that is reasonable to ensure that standards are raised to the levels that we all wish to see. Just last week, we saw the implementation of the Community Care (Delayed Discharges etc.) Act 2003, under which it is intended to fine local authority social services on a daily basis for delayed discharge payments. As I highlighted during the Bill's passage, we remain implacably opposed to what I consider to be a nasty and vindictive piece of legislation that will simply exacerbate a difficult situation and unfairly impose fines on local authorities that are unable, often through no fault of their own, to find places in homes or provide domicillary care packages because of the crisis in long-term care brought about by the Government's indifference.
Mr. David Heathcoat-Amory (Wells) (Con): My hon. Friend has not so far mentioned the cost of regulation. Care homes in Somerset are complaining about a 20 per cent. increase in the regulatory cost from the National Care Standards Commission on top of a similar increase
from the Criminal Records Bureau, which my hon. Friend mentioned. Will he comment on how the squeeze between low fees and rising regulatory costs simply means that fewer people can be cared for? Perhaps that is the root cause of the problem that he is addressing.
Mr. Burns: My right hon. Friend is right. It is, of course, a double whammy in terms of costs. In addition to the significant increase in the costs that care homes have to pay to comply with many standards are the costs of the fees to ensure that they are complying. For example, registrations fees to use the Criminal Records Bureau have increased by 147 per cent. in 18 months, which has a significant impact not only on the larger homes that employ more people, but on small homes, for which it is a disproportionate amount of their costs. As he no doubt finds in Somerset, many of them—especially, although not exclusively, the smaller ones—have thrown in the towel because financially they cannot continue to provide care. They have either sold up or converted the homes into domestic dwellings and left the market. That has contributed to the problems we face.
David Taylor (North-West Leicestershire) (Lab/Co-op): How does the hon. Gentleman justify the actions of his political colleagues in Leicestershire who took control of the authority for the first time for more than 20 years on general election day? They immediately decided to flog off the remaining 14 residential homes that were operated by the county, which had achieved the highest standards of physical and care provision. Is it not disgraceful that the residents of those homes were not even treated as sentient beings, but just as objects to be moved around?
Mr. Burns: I do not share the hon. Gentleman's final analysis. I have no doubt that Leicestershire social services did not treat the clients in their homes as objects.
On the general principle of whether it was wrong for the homes to be sold, it is up to any social service department and local authority to decide whether to continue to provide in-house care or to sell their homes. One reason why I have not opposed local authorities selling their care homes is that for many years those homes were not under the same inspection regime as the private sector. As they did not invest in their homes, for whatever reason, the quality and the fabric of the buildings—not the quality of care—deteriorated. The money was not available to invest in the homes to make them comply with the Government's minimum standards. It would have benefited the people living in those homes if the person who ran and owned them had the money to invest to improve and enhance the buildings and to maintain the highest standards of quality of care.
Mrs. Humble: Will the hon. Gentleman give way?
The Community Care (Delayed Discharges etc.) Act 2003, which came into force on 1 January and into effect this Monday, is illogical and unworkable. It will do nothing to combat the problem of delayed discharges in
our hospitals. Indeed, it has the potential to make the situation dramatically worse. Attempting to resolve the problem of delayed discharge in that manner is bizarre. Fining local authorities will place new burdens on them—
Mr. Hilton Dawson (Lancaster and Wyre) (Lab): Will the hon. Gentleman give way?
The fines will lead to an increase in red tape, damage relationships between local authorities and the NHS, and increase the likelihood of inappropriate discharge decisions. The 2003 Act is a knee-jerk reaction to the serious problem of delayed discharges and is incredibly short-sighted, endeavouring to reduce the levels of delayed discharges by imposing perverse incentives in the form of fines rather than positive long-term solutions.
Kali Mountford (Colne Valley) (Lab) rose—
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