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Kali Mountford (Colne Valley) (Lab): It would not be right, as has been said many times in our debate, to assert that there are no problems in the system. However, to assert that there is a crisis is going much too far. It not only inflicts stress on people who are in the system, as well as their families and other people who are waiting for care, but skews the debate and stops us taking a sensible view of the situation. However, there have been signs of consensus among Members on both sides of the House, especially on domiciliary care. I was pleased to hear from the hon. Member for Orpington (Mr. Horam) that the Conservative party is not denouncing domiciliary care, as appeared to be the case at the beginning of our debate. I hope that I understood him correctly, because domiciliary care is a valuable part of the package that is required.
Domiciliary care is one aspect of care where we certainly cannot say that one size fits all. We all know people in their 90s who are still digging their gardens, sweeping their paths and looking after themselves perfectly well. We also know people in their 60s who are in the early stages of Alzheimer's or dementia. The range of care must therefore fit people's circumstances and respond to their problems. We must consider how we got to where we are now, whether the arrangements work, what we learning and where we are going. I do not want to dwell too long on the Tory years, as they do not bear too much examination. However, I remind the House of Ray Griffiths' report on the care sector, which was commissioned by Lady Thatcher. The report appeared after the privatisation of care homes and examined care in the community. It said that the system was chaotic and more planning and investment were required for care in the community.
The Government are dealing with those requirements. In my own area, people have told me that the measures that we are debating this afternoon were a stimulus for change. All the care in our area has been reviewed and the results have been encouraging, as people believe that the fines for delayed discharges will never apply to them because, in response to the Community Care (Delayed Discharges etc.) Act 2003, they have changed what they do. They invested quite a lot in rehabilitation so that elderly people did not have to go into hospital or, if they did, that there was appropriate care for them on discharge. However, they realised that much more needed to be done and there is now a huge amount of investment enabling that to happen.
People in my constituency have looked at the range of care that needs to be provided. That is a distinctive feature of the mixed market of care homes, and makes it different from other markets. We must plan that market. We cannot wait for market drift to determine how many
I would not be happy with any model that excluded any form of help that could be made available. To assume that any model could be taken out, on the assumption that we all want to be in our homes for ever and a day, would be wrong. It would say to people that even if their family felt that they could not support them properly in their own home with the package of care available, people could not make that choice. That would be wrong.
If the package of care is to be available, it should be properly scrutinised. My own local authority is concerned about the level of scrutiny. It feels not that it is over-regulated, but that the inspections are stringent and sometimes difficult. I have thought carefully about what the local authority says, and I have also looked at the case histories of people who have been to see me. I want to see the evidence for the local authority's view that it is over-inspected. If it is over-inspected, why do I have cases in my surgery where people have had bedsores while they have been in care, where people have not had any stimulation during the day, where they have not received the proper food, or where the water in their water jug has not been changed properly?
Such things, on a day-to-day basis, month in, month out, can change a person's life significantly. A jug of water may not seem much to us, but to an individual who does not have access to the proper drink during the day, it means an awful lot. It means a lot if someone is given milk when they have a milk allergy and the notes have not been checked. It means a lot if staff have not been trained in the proper use of hoists, when they can be used and when they should not be used, so that a person is left dangling uncomfortably, and in one case left dangling uncomfortably as a punishment, because she had been "a very naughty girl". A patient who is suffering from dementia is not a very naughty girl, but someone who needs the highest standard of care.
When such cases are reported to me, that tells me that inspections are necessary and should take place ad hoc, without warning. I have heard from people working in homes that they sometimes have quite a lot of notice and they make sure that the place is spick and span. They make sure that all the proper cleaning equipment, which they often cannot be bothered to use, is used on that day. They make sure that the entrance to and egress from the building are clear, which they do not always bother to do as it is a lot of bother to move trolleys.
I find such features of the system abhorrent. That is not historic information; it comes from people working in the system now. That tells me that we might not yet have the inspection system right, or such things would not happen. We should not loosen the inspection regime. We should work harder and make sure that the standards in our homes are the very best that we can provide.
Only time will tell whether Professor Pollock's concerns about the Community Care (Delayed Discharges etc.) Act 2003 leading to elderly people being put into inappropriate care come true. My concerns about the Act are different. It creates a blame culture and sets social services against health authorities, when they should be working collaboratively together.
In Oxfordshire at present there are 55 people subject to delayed transfers. Only four of those come into the statutory category. The other 51 are waiting to be moved to other NHS facilitiesby far the most common problemor there are disputes with relatives about where they should best be placed. It seems daft to set social services against health providers. I agree with the Chairman of the Select Committee. I do not see why we have two separate budgets. We have five primary care trusts in Oxfordshire, a couple of acute NHS trusts and a huge social services department. I do not think that that involves anything about democratic accountability. To be honest, I do not think that any Members of Parliament or county councillors could say with their hands on their hearts that they knew where all the income streams were coming from and going to. If we are going to tackle delayed discharges and ensure that people get appropriate care, why on earth do we not have a simplified single budget and stop the blame culture in which health authorities and social services blame each other for what is happening?
Next month, to try to get to grips with the problem, rather as Crawley had to do, we in Oxfordshire are having a conference including all the Members of Parliament in the area and county councillors and officials, simply because we need to have everyone in the same room at the same time to discover what on earth is happening. That should not be necessary, and we should have a collaborative approach.
In addition to those who are delayed transfers in acute hospitals, I understand that there are about 46 delayed transfers in community hospitals. Of course we believe in domiciliary provision, but there is also a need for nursing home and residential care provision. Ministers must accept that that provision is not growing, but contracting. Whatever they say at the Dispatch Box, one of the reasons why it is contracting is over-regulation, and one cannot get away from that. In Oxfordshire, we are not seeing new provision coming forward from the private sector, and the public sector seemingly cannot afford to make it either.
We have had a lot of Punch and Judy-style debate this afternoon, but I do not think that that helps anyone at all. Can we not try to ensure that more collaborative work is done? I do not think that the Community Care (Delayed Discharges etc.) Act 2003 will help to achieve that aim. I do not think that attacking nursing home proprietors as profiteers, as Labour Members have done, is helpful. Nursing home proprietors whom I have met in my patch are often concerned clinicians who have been doing a lot of detailed work over many years in dealing with patients with serious Alzheimer's and
I ask the Minister to please see whether we can try to achieve a more collaborative approach. He talked about best practice conferences. I should like to give him an invitation. If he feels that the Oxfordshire health economy or social services are failing in any way, will he please let Oxfordshire Members of Parliament know? Otherwise, can we get away from blame and recognise that all of us have to work together to deal with what will become an increasing problem as we have a larger ageing population, as we will need better care and greater amounts of it? Simply fining or blaming authorities will not miraculously resolve the situation overnight, as the facts clearly demonstrate. We require a collaborative approach, not a confrontational one.