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6.3 pm
Laura Moffatt (Crawley) (Lab): It is a pleasure to follow the hon. Member for Orpington (Mr. Horam), who clearly has a great interest in care of the elderly—as I do. When I qualified as a nurse, I decided to concentrate on that specialism and I have always remained interested in the care and treatment of the elderly and in new innovations for older people in our community.
The hon. Member for Romsey (Sandra Gidley) referred at length to the royal commission on long-term care for the elderly. In 2001, we held a fantastic conference on that issue in Crawley. Many people, especially the families and friends of people who had to remain in hospital, told us that they could not get access to residential care and that there seemed to be a huge problem. I thought that the best way to deal with the matter was to get everybody around a table at the House of Commons and to have a meeting of all the stakeholders, including the care home sector, so that we could discuss things at length and come to a conclusion about why we believed there was a problem.
Since December 2001 there has been a huge improvement in Crawley, especially in terms of delayed discharges and lack of access to the care home sector. There are many reasons for that. The motion made me cross because it devalued and debased something important by making the spurious assumption that regulation is the main problem for long-term care of the elderly.
I want to say a little about what is being done in my constituency to give older people the care that they deserve. Of course we cannot yet rest on our laurels, but enormous changes have been made. What struck me when I got everyone together—members of social services departments, GPs, people in the care home sector, housing representatives and many other stakeholders—was that few of those people had met before or had an opportunity to discuss how things could be improved. The crucial element that had galvanised them was Government regulation. It was no longer acceptable for 70 out of 400 beds to be inaccessible because of delayed discharges, for instance.
We thought that there was a capacity problem in Crawley. We thought that there were difficulties related to funding, housing and a rapidly growing elderly population. When we began to discuss solutions, however, no one mentioned regulation; it was not an issue for all those who were trying to ensure that care of the elderly was the number one priority. What emerged were issues such as improved joint health and social services activity, and that is where improvement has been particularly evident.
We managed to reduce the 70 delayed discharges to something in the teens, and the number has fallen even more since then. I know that my hon. Friend the
Member for Wakefield (Mr. Hinchliffe)—whose work on the Select Committee I respect enormously—is concerned about the Community Care (Delayed Discharges etc.) Act 2003, but I firmly believe that it has provided the extra lever that was necessary to get people round the table to stop the disgrace of patients being stuck in acute settings inappropriately.We found that when people met regularly to discuss individual cases, it was possible to get the figures down. What struck us most forcefully was that the capacity issue in the care home sector was, in fact, about inappropriate placement. Everyone seemed to think that because elderly people were not well supported at home—because they were having falls, taking drugs for a long time and not being checked often enough— they could not cope any more. Since then, however, there has been a massive intervention by Crawley primary care trust, which now watches older people much more closely. It ensures that they are checked properly to make sure that they are not being poisoned by the drugs they are taking, and are able to support themselves at home.
We also found that it was a good idea to use care homes for intermediate and respite care rather than long-term care, and to set aside six beds to prevent older people from having to go into hospital in the first place. That has proved a tremendous success.
Unlike my hon. Friend the Member for Wakefield, I see a future for the highest-quality residential care; but those who are not prepared to provide such care should not be in business. Therefore, the regulation issues are a complete red herring. If that is making people decide to leave the care home sector, so be it.
We have an extra problem locally. As the hon. Member for Orpington suggested, land prices are incredibly high, particularly in the south-east, so it is very hard to persuade people, especially those who are getting older and have been in the business for a long time, to continue in the business if they are offered perhaps £1.5 million for a piece of land for redevelopment. So we have a difficulty delivering in that sector, especially in the south-east.
None the less, with all the new proposals in place, we are making true headway on ensuring that people have proper choice. To walk into the extra care home in Crawley is an absolute delight for me. More than 90 per cent. of the people who went into that home five years ago are still there. That is a testament to having all sorts of care and not concentrating just on the care home sector, but providing real choice and making it available to all the people about whom we care.
6.10 pm
Mr. Tim Boswell (Daventry) (Con): It is pleasure to follow the hon. Member for Crawley (Laura Moffatt), who sought to introduce an element of balance in the debate on what is an extremely important subject for almost all hon. Members.
I begin by declaring my wife's interest as a non-remunerated trustee of Brackley cottage hospital, which is a charitable trust and was formerly in the NHS, but now provides services both as a registered home and as an agent for the NHS. Perhaps another debate would be
an appropriate occasion to piece together the history of that organisation's attempts to position itself in the right place to deliver intermediate care in the face of constant, serial reorganisation by the NHS. I am now personally involved in a stakeholder group convened by the local PCT to try to find a way forward. I have become very familiar with the situation that the hon. Lady has described in relation to step up, step down, intermediate, terminal and palliative care, as part of the range of provision that may operate and is certainly required.I have been most disappointed by the fact that the Minister tried to characterise the debate as one in which the Government say, "We are in favour of the widest possible range of care at home, and the Tories want to see only residential care." I can assure him that that is not our view. In any case, such care is not always appropriate at any given moment. I am thinking of my elderly mother, who died in July at the age of 93. She had to have spells in hospital and spells of respite care. In fact, she died at home, and we were pleased that she was able to be at home when she died.
There is no simple solution to a complex problem, but I wish to draw on one statistic that came to me as part of the working studies for the local review. It relates to Oxfordshire because Brackley, although part of my constituency, is treated as part of the Oxfordshire health authority for this purpose, as my hon. Friend the Member for Banbury (Tony Baldry), whose constituency neighbours mine, will know. It was reported that 45 per cent. of beds in acute hospitals in the county of Oxfordshire on any one day were inappropriately occupied. I say to the Minister in all seriousness that that shows the extent of the current problem. His intentions to resolve it may be real, but he has not yet been able to discharge that problem.
Mr. Mole: Does the hon. Gentleman accept that the number of people going into hospital inappropriately and interventions such as avoiding slips, trips and falls are needed to address delayed care transfers and that they must be considered as much as the output side of the equation?
Mr. Boswell: I entirely agree—perhaps we are moving into a more constructive discussion. I tell the Minister that the Laing and Buisson study, the figures that have been cited and all my business experience suggests that if capacity is only 102 per cent. of demand, it is difficult to deliver a proper service. Long-term demographics suggest that the numbers will expand anyway. If we are in a situation, as the Minister conceded, in which some people will require residential care—albeit not for the whole time—or step-up, step-down or intermediate care, there will be a need for residential places, although they might evolve over time.
However much the Minister tries to explain things away, there is still a strong element of complacency and wishful thinking in the Government's approach. I referred in an intervention to a study carried out by my local community health council—the situation therefore relates to Northamptonshire—that reported that there had been a 25 per cent. reduction in capacity over 30
months, which might reflect several of the pressures that exist. It is difficult to move to an ideal pattern of care if what is available is reduced at such a rate.Fining local authorities will do nothing to increase capacity. It was put to me recently that one of the interesting elements of the legislation that could apply is that the number of beds that are defined as finable because they are subject to the analysis for delayed discharge, might be refined down by agreement so that the real coverage of the total number of beds in Northampton general hospital, for example, would not come into the equation and thus there would be further massaging of NHS figures—we are perhaps not unfamiliar with that. The Minister might like to reflect or comment on that.
The reality of our local situation is that our local authority's fee offer for the provision of care is unlikely to increase by more than 2 to 3 per cent. due to the state of its budget, yet costs in the sector are ratcheting up. It is inadequate for the Government to take no account of the pressures imposed by bureaucracy. One of my local medium-sized care homes that briefed me for the debate referred to the 20 per cent. increase in registration fees, which means that it is likely to pay some £3,000 in registration fees, let alone compliance requirements. Criminal Records Bureau checks will cost it an additional £1,000. It faces many other pressures because although it pays above the minimum wage, its wages will reflect changes to that rate. It also faces other general pressures from the economy.
It is difficult to envisage even the best care homes keeping in step with the cost pressures that they face, and my experience suggests that it is equally difficult to find immediately available alternatives. I single out for the Minister another local case in which the local authority was unprepared to offer fees at the level that a care home required. The alternative provision suggested was in Wellingborough, but it would not have been fair to move an elderly person some 30 miles because of a row between two public authorities.
The situation is worrying and it is insufficient for Ministers to say that it is not. It would be more sensible for them to say that they need a palette of different provisions, for things to evolve and to work in partnership with providers, but pretending that there is not a problem to start with will not help. Most of us know how the situation works for our constituents.
It will be possible to solve the problem if sufficient resources are made available, but the solution is certainly not more bureaucracy. The danger is that the Government's present attitude might evolve in an unplanned way to address the problem. If what we do is insufficient and what is outlined in the press release on the new piece of eye-catching legislation with no substance is not delivered, there will be evolution—or regression—into a two-tier system. Those who can afford to pay the fees required in the market will continue to use the residential sector at high cost, although they will probably erode their capital or become unable to provide an inheritance for their descendents. People who cannot afford such care will simply fail to find a place, because their only recourse is to social services and it will be uneconomic to offer them one. They will end up bouncing back into hospital, at ruinous cost to us all, or into inadequately supported community care. That is light years away from a
rational and objective discussion of care requirements which, I hope, we all believe should be our starting point. It is sad that the Government have programmed themselves to fail. I do not believe that they can avoid that, but I would be delighted if they do. The burden is on Conservative Front Benchers to introduce the realistic proposals that we all want on the delivery of appropriate care for elderly people.
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