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6.33 pm

Bob Spink (Castle Point) (Con): The long-term care of the elderly is clearly a complicated and very important issue for us all. Many excellent points have been made by colleagues, especially on the Opposition Benches, but also on the Labour Benches. I shall not repeat those points, as I wish to refer to a single example and a specific case study to show how wrong the Minister was to say in his opening remarks that residential care was somehow optional for some people. There is nothing party political in what I am going to say. I shall simply speak honestly for vulnerable people in society, as we must in this place.

First, I should like to pay tribute to the many care home providers. I congratulate their staff at all levels, including the managers and owners, on their care and dedication in an often difficult area of work. Society is indebted to them and they generally do a most excellent caring job.

I wish to raise a specific case in order to illustrate a major problem. Mr. Curran is a constituent of mine whom I have visited several times over the past year in Goldenley care home. It is a very well-run home with excellent, dedicated staff and management—a credit to its community. Mr. Curran is a delightful, dignified gentleman for whom I have the greatest respect, and he is singularly fortunate to have a wonderful, caring wife, Doreen, who has fought to ensure that he gets the very best possible care for his medical conditions.

Sadly, Mr. Curran is very ill—indeed, I have seen him becoming increasingly so over the past six months. He has suffered a number of strokes and the ravages of neuro-degenerative disease. On 17 December 2003, Mrs. Curran wrote to me about her husband's

"considerable health needs which are:


Irreversible brain damage due to many strokes


Epilepsy


Parkinsonism


and just recently arthritis has been diagnosed.


My husband has deteriorated considerably within the last three months and is now mostly in a semi-vegetative state. There is very little response from him now. He cannot communicate; he is unable to move. He is bedridden most of the time. All food, including medication, is now liquid and there is difficulty in feeding as his mouth is rigid and he cannot open his mouth, necessitating the removal of dentures to access his mouth more

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easily. His body is rigid and he cannot move or straighten his legs. His hands are very swollen and it is impossible for him to move them too."

She continues:

"From the outline of my husband's condition you will see that the care he receives is more than social."

Mrs. Curran believes that her husband should qualify for health care funding for the care on which he so obviously depends for his life. I agree with her when she says, as she did in a further letter to me, also dated 17 December, that

"it is grossly unfair for my husband to be forced to pay for care in view of the fact that he is such a very sick and disabled man."

I am pleased to report some recent improvement in Mr. Curran's condition. He is now able to speak a few words—that took place over the Christmas period. I am sure that the whole House will send its very best wishes to Mr. and Mrs. Curran and to everyone at the Goldenley home.

Having set out the background, let me read out the decision reached by the authorities on the funding of Mr. Curran's medical care. In a letter dated 5 December, the strategic health authority states:

"As a result of the hearing the Panel reached the conclusion that the Castle Point and Rochford PCT had acted in accordance with the published eligibility criteria of the Strategic Health Authority in that Mr. Curran's needs for nursing and other clinical care are not more than incidental and ancillary to the accommodation provided."

It seems that the published eligibility criteria of the SHA dictates that Mr. Curran's

"needs for nursing and other clinical care"

are "incidental and ancillary" to the accommodation provided. That is perverse and wrong. If the panel's decision was valid, I suggest that the criteria that it used are wrong. I therefore ask the Minister to look into those criteria and to make any changes that are necessary to reflect what should be a civilised society's response to providing medical care for the elderly.

Home care is not an option for Mr. and Mrs. Curran. He could, of course, be transferred to hospital, where he would get his care completely free of charge, but that would be against his best interests and would reduce his personal quality of life at this time. That would not only be wrong, but against the public interest, because it would be more costly than his residential care home and would block a hospital bed, thereby denying care to other people. The Government clearly need to finesse their policy to prevent that kind of nonsense from taking place and to ensure that appropriate care, and the funding of that care, is provided for people like Mr. Curran, of whom there are many thousands at the moment and will be many more thousands in years to come. I see that the Minister is listening to me carefully, and I thank him for that.

Will the Minister ensure that private residential care providers are encouraged by fair funding to supply what we expect to be an increasing demand on their services from 2005 onwards? Does the Minister also agree that we must break down the rigid barriers between health and social care and integrate funding streams for the NHS and social services? Above all, we must drop the political correctness in social care and become more person or patient committed.

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6.39 pm

Tim Loughton (East Worthing and Shoreham) (Con): We have had a good debate—a bit of Punch and Judy as my hon. Friend the Member for Banbury (Tony Baldry) put it. I shall endeavour to be the peacekeeping policeman before I hand over to the crocodile of a Minister.

There is a sense of déjà vu about this debate. Yet again, we are debating long-term care and the crisis in care for the elderly, whether at home or in residential care, about which we have held numerous debates. Each of those debates has been initiatied not by the Government in Government time, but by the Conservatives in Opposition time.

There were some interesting contributions from Back-Bench Members. The hon. Member for Wakefield (Mr. Hinchliffe) congratulated the Minister excessively on the best speech he had heard in 17 years. It was not the best speech that I had heard from the hon. Gentleman. If anyone has brass neck, it is he, for laying all the blame for the current problems in care at the door of the previous Conservative Government. We were not criticising all regulation but excessive regulation. Frank Ursell, chairman of the Registered Nursing Home Association, said that the regulations make important what is measured, rather than measuring what is important. No one ever died from a small room, but elderly people have died from poor care standards. It does no one a service to rubbish the whole care home sector, as the hon. Gentleman did.

Mr. Hinchliffe: Will the hon. Gentleman give way?

Tim Loughton: No, I want to make progress. The hon. Gentleman suggested that the scandals and misdemeanours of a few in the past represented the whole sector. That is deeply offensive to many people who run good care homes, and to the people who pay good money to stay in them.

Mr. Hinchliffe: On a point of order, Madam Deputy Speaker. I appreciate that the hon. Gentleman will not give way, but I should like to ask your advice about one point. According to the Order Paper, the debate is about the long-term care of elderly people, yet the monitors state that it is about care homes. That is an important point of procedure, and I would welcome your advice, Madam Deputy Speaker, on who is responsible for saying that the debate is about care homes. Perhaps the hon. Gentleman's comments will simply be about care homes, not long-term care for the elderly.

Madam Deputy Speaker (Sylvia Heal): That is not a point of order, although I shall answer the hon. Member's question. The title on the monitor is simply a shorthand version for the terms of the debate.

Tim Loughton: I am surprised that the hon. Gentleman did not blame us for the monitor problem. However, other hon. Members made more measured and positive contributions.

My hon. Friend the Member for Orpington (Mr. Horam) said that homes were suitable for some people and care at home was suitable for others. The hon. Member for Crawley (Laura Moffatt) made positive

7 Jan 2004 : Column 365

comments. I am sure she would have paid tribute to West Sussex social services—an excellent authority—for many of the improvements that they have brought about in the north of the county that we represent. My hon. Friend the Member for Daventry (Mr. Boswell) referred to the use of step-up and step-down roles for care homes. The hon. Member for Colne Valley (Kali Mountford) emphasised that we favour domiciliary care. Of course, most people want to stay in their homes for as long as possible, but that is possible only if we provide the care to support them there. My hon. Friend the Member for Banbury made an important point about the blame culture in the Community Care (Delayed Discharges etc.) Act 2003, which causes so many problems. My hon. Friend the Member for Castle Point (Bob Spink) took up that point.

There is a crisis, which is not improving. There was a crisis when we raised the loss of 40,000 care home beds; there was a crisis when we raised the loss of 61,000 beds, and there is a crisis now, when we have lost 74,000 care home beds since 1996. There is also the crisis caused by the decline in the number of care home packages for vulnerable elderly people, the increasingly high thresholds that have to be achieved to qualify for them and the potentially counter-productive implications of the newly up-and-running delayed discharges measure.

My hon. Friend the Member for West Chelmsford (Mr. Burns) has presented all the stark figures concerning the number of lost beds, including the 13,400 lost beds that account for 745 independent homes that have gone out of business in the 15 months to April 2003. Decline continues in new registration for new homes, and hotspots with acute shortages of supply increase. That applies not only to the south-east and the south-west. The problems place greater strain on GPs and the army of 7 million carers who are increasingly exploited by the Government through stealth.

The demographics over that time are also worsening. I know about demographics; I represent Worthing, where we have some of the oldest people in the country. For the first time, there are now more over-60-year-olds in the country than under-16-year-olds. It is predicted that, by 2015, nearly a quarter of the population will be over 60—an increase of 9 per cent.—and that the number of over-85s, of whom we have the greatest number in Worthing, who need and deserve extra care, will increase from 1.1 million to 1.4 million over that time. Three times as many people over the age of 100 will be living by 2015.

Throughout all this time, the Government's response has been one of denial, confusion, incompetence and caricature. There have been limited U-turns on the over-prescriptive implementation of care standards acts, climb-downs on Criminal Records Bureau checks, claims of using lighter-touch regulation, and a rubbishing of care homes across the board as "banging up" elderly people, as the former Secretary of State put it. Today we have again heard the Minister claim that there is no national crisis in the care sector. He is the "Crisis? What crisis?" Minister, and he spent 33 minutes today rubbishing the care home sector and accusing it of peddling myths, yet he was perfectly happy to quote a report from Christie's—of all people—about what was

7 Jan 2004 : Column 366

going on in the care home sector. He also made a disgraceful criticism of the British Medical Journal for being sloppy in some of its reporting of this matter.

We have heard some interesting innovations, including the claim that the Community Care (Delayed Discharges etc.) Act 2003 was actually a money-spinner for local authorities, and a profit-making exercise. Is this a new turn in Government policy? Are we now going to see an early discharge of pupils Bill to introduce truancy fines, so that education departments can benefit from truancy? Perhaps we could have a Bill to introduce fines on late-running buses to fund local authority transport. This is fantasy island in the extreme. Ministers may come and go, but this problem is set to stay and to get worse. It affects some of the most vulnerable people in our community, and they are being failed by the Government.

The Minister complacently states that we must accept that the sector is contracting, and that that process will go on. He justifies that by saying that more people want to live in their own homes for longer. I am sure that that is right, but this is a matter of horses for courses, and what is needed is real choice: available, quality, serviceable choice. Of course staying at home is an ideal, but only if people are given the support to do so. We are increasingly seeing elderly people living at home, growing older and frailer, while the level of their care package diminishes or, in some cases, is withdrawn altogether. In some cases, there is no package available in the first place. Living at home is not a real choice if a person's quality of life diminishes unreasonably by doing so.

There is an added problem of the shortage—particularly in the south-east of England—of skilled social workers, leading to the greater use of agency staff to service home care packages, often changing quickly and going in and out of homes quickly without building up a relationship with the clients they are looking after. If the clients cannot cope, they then become emergency readmissions to hospital, of which we have seen an enormous increase in numbers. As the Royal United Kingdom Beneficent Association put it, people need independence without isolation in order to have a real choice about remaining at home. That is not happening, despite the best endeavours of social services departments, which are facing a crisis in funding.

Despite all the Minister's bluster, the vast majority of increases to local authorities have been passported to education. West Sussex, my local authority, has left just £400,000 to service social services, transport, highways, the environment and all the other services. We also got another £6,000 recently thanks to the generosity of the Chancellor. This is in a county in which the formula grant per head gives £503 to my constituents, compared with £810 per head in an outer-London borough. It is also in a county in which social services budgets are being stretched between elderly care, child protection and the implications of the Laming report and the forthcoming Children's Bill; these all constitute demands on a dwindling budget.

The pips have long since given up squeaking, and it is the elderly and vulnerable people who are being squeezed the most, whether in three-star, two-star or no-star authorities. This is a double whammy, because increasingly frustrated and abused care home managers

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are being over-regulated, under-recompensed, generally put upon and abused constantly by the Minister and his colleagues. As one care home owner put it recently,

"Everyone is running my business except me."

There is little correlation between the quality of care in a home and the level of inspections and the hoops that it is put through. One doctor who was recently inspected by the National Care Standards Commission said,

"I am perfectly happy to be assessed, provided that I feel we are working on the same side, trying to improve the care of patients."

Far from pursuing a policy of being on the side of those looking after care of the elderly, however, the Government have set themselves on a course of confrontation and bullying with their response in the Community Care (Delayed Discharges Etc.) Act 2003. They are robbing Peter to pay Paul—the antithesis of partnership—undermining years of good work on bringing social services and health care closer together in the interests of patients. Because of the delayed discharges Act, if a patient's first choice of care home is not available, older patients will be offered an interim placement that may be far away from their families and not necessarily appropriate to their care needs. Allyson Pollock, who has been much quoted this evening, has said that that contradicts the Government's pledge to "give genuine individual choices" and that this legislation

"is targeting really vulnerable people and placing them at greater risk."

As with so much in new Labour's health service, far too many of the vulnerable among our communities' sick and elderly people are paying the price of a system dominated by bureaucrats not patients. We make no apology for raising this issue again. We do so not as a mouthpiece for care home owners but as a mouthpiece for many elderly constituents who are suffering from the Government's squeeze on social services departments and their obsession with constantly rubbishing care home owners and treating decent care homes on a par with the Lubyanka from whose clutches people must be saved at all costs. That is why we need this debate today. I urge all Members living in the real world, who recognise the problems that we have set out today, to support the motion in the interests of their elderly constituents before they join their ranks.

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