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5.46 pm

Mr. David Hinchliffe (Wakefield) (Lab): I have long been saddened by the cosy consensus between the three major parties in this House that the way forward for the care of the elderly is to shut up more and more people in care homes. Today, for the first time, I heard a Minister challenge that consensus and say that progress lies in another direction. I have been a Member of Parliament for nearly 17 years, and the speech by my hon. Friend the Under-Secretary of State for Health was the best that I have heard any Minister make in a debate on community care.

I believe in being even-handed in these matters. I shall refer to the Tory motion in some detail, but there is one element with which I agree—its criticism of the Community Care (Delayed Discharges etc.) Act 2003. The Select Committee considered that legislation in some detail. I do not think that it is an appropriate measure, as it addresses the symptoms and not the cause of the problem. If I have time at the end of my contribution, I shall say more about that.

I think that the Tories have displayed what we in the north of England call brass neck in tabling this motion. The previous Conservative Government created the supposed crisis in care. I want to look at that Government's record in this matter, as the problems that everyone accepts now exist are entirely the result of the policies that the Tories pursued when in office—and that includes the time when the hon. Member for West Chelmsford (Mr. Burns) was a Minister.

The background to the current position must be examined so that we can understand where we need to go now. The Tories locked us into a hugely expensive, and outdated, institutional model of care, and they did so in a big way. The previous Conservative Government were right to move children out of children's homes and mentally ill people out of long-stay institutions. Why, then, did they do exactly the opposite in respect of elderly people?

In an intervention earlier, I referred to figures from the House of Commons Library that I received in 1991. They showed that, in the 10 years between 1981 and

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1991—when the Tories were in power—this country's elderly population increased by less than 5 per cent. and that the number of NHS elderly care beds fell by 17 per cent., but that the number of private care and nursing home beds rose by 500 per cent. There was a deliberate stimulation of the institutional care sector. Until the Treasury forced the Tory Government to address the Budget implications of that stimulation, the cost came to more than £10 billion. That money was spent on subsidising private care and nursing homes.

What alternatives to the institutional care sector and to care homes could have been developed with that money? Vast numbers of people who did not need to be there were being sent to care homes without being assessed in any way. The Tories introduced the profit motive into the care of vulnerable and elderly people, and they did so big style. I find that offensive. I find offensive the wholesale privatisation and marketisation that took place under the Thatcher and Major Governments.

The Tory motion deplores closures, but why do most care homes close? They close for the simple reason that owners know they can make more profit through selling them for something else. The property market has moved in a way that lets them make more money. The whole problem, which the Tories harp on about constantly, relates to their own policy of introducing a market into the care of elderly people.

I am appalled that the Tory motion has the cheek to criticise regulation of the care home sector. The Tories' record was to draw into the care of elderly people some profoundly unsuitable people motivated solely by the opportunity to make big money. I was shadow Minister for community care between 1992 and 1995. I met people running care homes—a minority, I admit: I am not over-egging the pudding—whom I would not trust to care for a dog, never mind a vulnerable elderly person. Those were the kind of people attracted into the care home market under the Tory Government. I recall speaking at a care homes conference as shadow Minister, and my right hon. Friend the Minister without Portfolio was present. He applauded something that I said, and he was assaulted by one of the people attending the conference. Those are the kind of people whom the Tory Government attracted into the care home market.

I recall raising in speeches here practices that were being undertaken in care homes. One example that I remember vividly was of 16-year-old youth training scheme students being used to catheterise elderly people in private care homes. That is on the record: it happened in Liverpool. That was the record of the Conservative Government when it came to care of the elderly. The hon. Member for South Suffolk (Mr. Yeo) talked about low politics earlier: low politics is the motion before us, which does not address the quite disgraceful record of the Tory Government on care of the elderly. They resisted—the hon. Member for South Suffolk was responsible for community care—my attempts on several occasions to introduce a Bill regulating domicilliary care to ensure that people who care for folks in their own homes were properly checked on for criminal records and so on. The Tory Government resisted pleas from the social work profession to

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introduce regulation, but thanks to the present Government we now have the General Social Care Council to ensure that people working with the vulnerable and elderly are properly checked. That is right.

The Select Committee on Health is currently looking into elder abuse, which is highly relevant to the debate. We were told a couple of weeks ago that 500,000 or more elderly people are being abused in this country at any one time. The question for the Tories on their proposed deregulation is whether it means the repeal of the Care Standards Act 2000, and the scrapping of the Commission for Social Care Inspection, the General Social Care Council and the national service framework for older people. If it does not mean that, what does it mean? Glib comments about deregulation and over-regulation are unacceptable against a background of serious problems with the care of elderly people.

The Tory motion is clear evidence, as the Minister said, that the Tory party is entirely provider led. It has been hijacked, lock, stock and barrel, by the care home owners. Those owners are writing Tory policy, which is why Tory Back Benchers seem unable to see any possible alternative to care of old people other than sticking them in institutional care.

I have one or two points on which I hope that the Government will reflect. I have made them before and will continue to make them. At some point, I hope, I will succeed in getting across their merits. First, I make a plea for a more radical longer-term agenda for care of the elderly. In both the Ministers present, particularly the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), we have people who are prepared to listen and who understand the need to move in a very different direction.

I may be the only person in the House who is attracted to those countries that have got rid of care homes. My long-term objective, as someone who is 55, is that in 20 years, when I may need some form of care, it will not involve sitting wall to wall with and looking at other, similarly demented, gaga people. Frankly, we can do better than that. My mother ended up in that situation, and I swore that I would do all in my power in politics to ensure that we secure a very different future for elderly people. We are slowly but surely improving the quality of that care. We need to get away from the nonsensical outdated models of institutional care that, frankly, belong not in the 20th century, but with the workhouse in the 19th century.

I want a planned policy of reducing dependence on institutional care with the development of positive alternatives. The Government are moving in the right direction on housing with care and on extra care. We need to follow the model established in other countries, such as Denmark, which have got rid of institutional care. The private, independent and voluntary sectors are gradually going in that direction. The obsession with old people's homes takes us away from the real agenda. Let us get into intensive home care packages and telecare, the type of facilities that we know we can provide to ensure that people remain in their homes.

I end by making my usual plea that the way forward in the longer term is to merge health and social care within common budgets. If that were to happen, we would not need arrangements for fining social services when people are stuck in hospital beds.

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5.55 pm

Mr. John Horam (Orpington) (Con): I pay respect to the passion with which the hon. Member for Wakefield (Mr. Hinchliffe) stated his case. He is long experienced in the subject, which I have appreciated for many years, and he put his case well, although obviously I disagree about the history of the Conservative party.

I also disagree with the Minister about the so-called myth that the Conservative party is in the hands of the providers and that it can talk only about nursing homes and residential homes. We all know that our elderly relatives wish to stay in their own homes as long as possible. I have an aunt who is 97. She gave up driving her car only recently, largely because she could not back it into her garage. She was insistent on staying in her home. Only very recently, in the past month or so, did she take the voluntary decision to go into a residential care home because she could not cope any longer. Most people wish to stay in their homes. If that is the Minister's vision, we share it. I have no doubt about that. Keeping people in their own homes is the vision of the hon. Member for Wakefield and my hon. Friend the Member for West Chelmsford (Mr. Burns). There is no disagreement on that.

I agree with the hon. Member for Wakefield that there are problems across the board. We all accept that there are severe problems. I am privileged to be a parliamentary representative on the Greater London forum for the elderly. We recently held a seminar in the Jubilee Room of the House of Commons. It was attended by a large number of representatives—or at least as many as we could squeeze in—from all over London.

The Minister may be interested to know that we did not simply discuss home care and care homes; a range of issues was raised. The representatives decided that the issue was the erosion of community care in the London area. We discussed chiropody services, the closure of local pharmacies, domiciliary care, NHS dentists and adaptations. I welcome what the Minister said about adaptations, and the representatives were concerned about how quickly they could be provided and whether people could get what they required. That range of issues forms part of the community care package as it is seen by the elderly. My hon. Friends were right to initiate the debate as an across-the-board issue, not just one that relates to care homes.

On care homes—we must not be frightened of talking about them just because the Government say that we are in favour of care homes and nothing else—the Minister said there was a huge surplus of places in Kent. That is not the case in Bromley, which is not far from Kent, as he is well aware. The primary care trust recently had to convert beds in the local community hospital into 44 intermediate care beds. I know that intermediate care is only for six weeks, but it did that because of the great difficulty of finding suitable homes for people who were unable to leave hospital as a consequence of the homes and packages not being available to them. So there is a problem.

The Minister also rightly said—I praise him for this—that he hoped to tour the country, pointing out best practice to local authorities and fixing fees for local care

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home places. I welcome that, but he must be aware that exhortation from Ministers does not always produce results in the detailed way that he would want. The fact is that there is a marketplace, as he acknowledged, and market solutions are determined by local supply and demand. However much Ministers may wish it otherwise, fair and suitable conclusions are not always reached.

Furthermore, local authorities use their muscle-power with adverse effects for local care homes. They drive down prices and, as a consequence, individuals who pay for themselves have to pay much more. There is often a difference of several hundred pounds between what a self-payer pays in a care home and the payment for a person whose local authority is funding their care. People who have provided for themselves for their whole life see that local authority support as highly unfair to them. That is one of the factors that has arisen due to the shortage of supply in places such as Bromley.

Even with the private sector subsidising local authority clients, homes are still closing down, as the Minister acknowledged. They are closing down throughout England but especially in London where the costs and difficulties are greater and where the possibility for making a financial killing is much greater from property development than it is from running a care home. There is no doubt that that is a huge problem in the London area and the Minister must not ignore it. I hope that he will spend some time in London, as well as in the rest of the country, and point out that there are difficulties in the capital, too.

I hope that we all agree about domiciliary care. However, there is a problem that seems to have escaped the Government's attention. I recently received a letter from a lady in my constituency, which states:

That lady has a staff of 16.

I had not realised that the fees for registration with the commission were so high. As the lady cannot afford to register her staff, she has to pay VAT. She serves some of the poorest people in our society, many of whom are on income support, and is competing with larger organisations that do not pay VAT and can make economies of scale. I raised the matter with Age Concern, which replied:

I have only just received that reply from Age Concern, and I shall write to the Minister about the matter as it affects people in our communities who are most in need and I should like him to address the problem. Although

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those people receive domiciliary services, some providers have to compete against larger organisations that are VAT-exempt.

We can all agree about the sort of vision that the Minister outlined, but it is not being delivered. There are many, many problems and the Minister and the Government have still to address them and acknowledge their importance.

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