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Dr. Ladyman: Perhaps I can help the hon. Lady with one or two of her questions. The phrase "validated and being processed" means that the forms have been filled in, all the documentation has been received and the matter can be properly investigated; that is different from such people's having been assessed and met the criteria, as she perhaps realises. Frankly, it is a serious problem and at the moment I doubt whether many, if any at all, will meet the standard and be capable of full registration. That is one reason why we introduced the standards and regulations—to drive up the quality of care that such people are providing, and the standards that they are working to—and why we are trying to push them through as rapidly as possible. The hon. Lady and I should be on the same side, fighting the Conservatives, who want to take away all that regulation and checking and return to the old, laissez-faire attitude.

Sandra Gidley: The Minister's answer, although honest, is fairly chilling. He has set great store by this approach. He has admitted that the existing system is failing completely, yet he seems happy to move more and more people into it before the standards are in place. Basically, he has just admitted that an increasing number of old people are being allowed to be subjected to a substandard system. That is totally perverse.

It would seem that the focus on bed blocking and care home places has taken the Government's eye off the ball. We often denigrate targets in this place, but the Government appear, as we heard in a previous debate, to be inordinately fond of them. Is the lack of domiciliary care targets evidence that the Government are paying only lip service to this aspect of care, or do they know the chosen solution has not been thought through and is ultimately bound to fail if nothing is done?

People are staying at home longer, but in some cases an individual's care would continue for longer still were it not for the fact that the carer reaches the end of their tether. Written evidence to the Sutherland report highlighted the fact that respite care has emerged as a main priority, and the report itself also admitted that such care is expensive. The way forward would appear to be to extend respite care not necessarily as a right, but by making it available to those most in need. I concur with that, because I regularly come across constituents who are providing care services, but for whom respite is simply unavailable. Where it is available, it is the occasional hard-won week, with no prospect of anything else to come. One elderly carer told me that if

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she could have a week off every six to eight weeks, she could cope indefinitely. It is the unremitting nature of such care that is affecting her physically and mentally, and in terms of her attitude to her husband.

Hampshire county council pooh-poohed the idea because of a shortage of beds, but a similar scheme is operating on the Isle of Wight. There are regular respite beds, people are on a rota, the home in question gets to know the patients and the system seems to be working well. It is too early to say how cost-effective it is, but the Government should be looking creatively at such a solution. We need more of these places in order to establish a solution.

All the evidence shows that these days when people do enter a nursing home—if they can find one locally—their general state of health is worse than it might have been some years ago. I am not saying that that is necessarily a problem if they have been allowed to stay at home, but it does mean that for many, a nursing care assessment is made and the individual is placed into one of three bands of care. That approach was the Government's alternative to that recommended by the royal commission, and it has been fraught with problems from start to finish. The first problem was the delay in getting through all the assessments. Okay, that is history, but it was a fiasco. The second problem was that this period seemed mysteriously to coincide with many nursing home owners putting up their prices. That may well also be history, but we are still stuck with a system that is bureaucratic, inconsistent and often downright unfair. It is not just me that thinks so, and I quote the royal commissioners again. In a recent statement they cited the general inadequacy of nursing care support levels in comparison to nursing home charges. They described the system as "arbitrary and inconsistent", when people with equal nursing needs receive different financial support rates.

One study showed that in Shropshire 48 per cent. of residents were assessed in the top band whereas in neighbouring Worcestershire it was 12 per cent. That is bad enough, but the overall figures show that the vast majority of patients are placed in the middle band. If that is to continue, it would seem far more sensible to scrap the expense of the assessments—it lies in human resources and high administration costs—and redistribute the money on a flat-rate basis, as in Scotland and Wales. The lack of a proper appeals process is another problem.

There are still further pitfalls. I make no apology for citing a recent constituency case. When a financial package is worked out, the assessment is usually that the patient will be in the middle band for nursing care. That is a fair assumption because, as we have already said, that is the reality for 90 per cent. of people. However, families often have to decide how much they can really afford to top up and then seek a nursing home that will fit those price criteria. In my neck of the woods, nearly everyone has to top up.

In my constituent's case, the home did such a good job that her health improved, so by the time that she was assessed, she was in the lowest banding. That meant that her family had to find the difference of £35 a week in home fees, which was impossible because they had already worked out the maximum that they could afford. It also placed the home owner in a difficult position. No other home placement was available in the

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area and the family was convinced that moving to another home would have made it difficult to visit the mother so often. The mother's health would decline, so she might then be eligible for the middle range of nursing care assistance again. The home owner wrote to me and described the system as providing a perverse disincentive to making sure that a patient's health improved. I am sure that other hon. Members will have similar stories to recount—

Mr. Burns: Not if the hon. Lady keeps on talking!

Sandra Gidley: I do not believe that the Government will take any notice.

The hon. Member for West Chelmsford is being unfair. I have been speaking for a fraction of the time that he was on his feet. [Interruption.]

I have alluded to the difficulty of finding care places and the motion before us today stresses that aspect of the long-term care system. That is why I have concentrated my efforts on other aspects.

There are only so many times that the House can be expected to listen to the Laing and Buisson figures, so I shall spare the Minister a repetition of them. However, I query his selective take on those figures. I am pleased that, for once, he admitted that the number of hotspots was causing problems. As he knows, the report states that that is behind the drive to force local authorities to pay higher fees. The Minister may be complacent because he knows that hard-pressed social services departments throughout the land do not pay the going rate because they cannot pay the going rate. In many areas, top-up fees are the norm.

Rukba, a charity championing independence for older people, highlighted that problem and spent £448,000 in making good the deficit in running its homes. Its assessment is that the funding gap is distorting the balance of supply and demand within the private care sector, and it predicts a major crisis in care provision. It also points out that when care packages are provided, they are retrospective and there is insufficient emphasis on preventing problems. That view is shared by the Association of Directors of Social Services in "All Our Tomorrows", which calls for a broadening approach to prevention and the development of universal services to support it. The Government's approach is far too top-down, and the most recent example is the introduction of a £100 bed-blocking fine, which will be levied—

Mr. Burns: The hon. Lady is, I believe, the Liberal Democrat spokesman on long-term care for elderly people. Is she not aware that elderly people and those who live and work in the long-term care sector find the term "bed blocking" deeply offensive?

Sandra Gidley: Yes, the term is deeply offensive—

Mr. Burns: Then why use it?

Sandra Gidley: The term is still used by many people to describe a particular situation.

Kali Mountford: Before the hon. Lady moves away from the issue of delayed discharge, is she aware that the

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Liberal Democrat local authority in my area has said that, to avoid fines, it is best to invest in rehabilitation? That is what that authority is doing, so should she not encourage other authorities to do the same?

Sandra Gidley: I find that slightly confusing. I have said that I think that preventive care and rehabilitation are the goals towards which we should be moving. In some cases, I have no doubt that the money will be spent wisely, but a recent report by Allyson Pollock stated that, if elderly patients were not moved within two days, local authorities might decide to put them in any home rather than in the home of their choice. That would be at odds with the Government's supposed aim of providing choice in health care. It seems that old people will not be allowed to have that choice, and that is a clear case of discrimination.

If that is the outcome, it would be very disappointing. We will have to wait and see, but there is a growing feeling of disappointment outside the House. A society can be judged by the way in which it treats its old and infirm. At the next election, the Government will be judged accordingly.

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