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Meals on Wheels (Lancashire)
11 am
Mr. Lindsay Hoyle (Chorley) (Lab): May I say what a great event it is to come to this Room for a debate? This is the first time that I have taken part in a debate here, and I am happy to serve under your chairmanship, Mr. Taylor. I am pleased to have secured the debate, because it is on the very important subject of meals on wheels in Lancashire. We are also talking about meals on wheels throughout the country, because the danger is that, when one local authority does something to save money, that is replicated by other authorities for the same reason. I thank my hon. Friend the Minister for giving up his time to respond to the debate. We must ensure that we get on the record the situation in Lancashire.
Meals on wheels is a service that works very well in Lancashire, delivering hot meals to pensioners, and usually vulnerable pensioners at that. It is a crying shame that we have to have this debate because there is a proposal to reduce the county council's costs by £1.2 million by withdrawing the subsidy for meals on wheels. I believe that the service provides good value and I would like to think that the council will reverse the decision and ensure that the subsidy remains.
At present, the cost of delivering a hot meal in Chorley is £2.20. In other areas of the county, it is less than that. Of course the service is not just about receiving a hot meal; it is also about the person delivering the meal taking time out to have a chat with the recipient. That is so important. We are talking about the value not only of the hot meal, but of the visit—the value of being able to talk to someone and that person taking notice of the person to whom they are delivering the meal. The person delivering the meal acts almost as a social worker or health visitor, because they check on the well-being of the recipient and if something is not right, that will be reported.
In a county council meeting, someone said that the meals were delivered on the doorstep. They are not; they have to be delivered to the person in the home. I must clear that up straight away. The service is so important that the cost should not matter. Of course we need value for money but, as I said, we are talking about the most vulnerable members of society. It is the people who are genuinely the poorest, the most vulnerable and the least able to look after themselves who need this valuable service. However, the benefit of meals on wheels is not just the hot meals; there is a social and welfare aspect to the service, too.
The meals in Chorley and throughout Lancashire are delivered in general by the Women's Royal Voluntary Service. Age Concern also delivers meals, but in Chorley it is the WRVS that does so. I should declare an interest: my wife delivers meals on wheels in the Chorley area with the WRVS. The WRVS delivers 100,000 meals a year, with 700 volunteers engaged throughout the county. The volunteers do not simply deliver meals; they act as a point of contact, which is so valuable.
I was dragged in to help on a snowy day when people were struggling to deliver meals and I saw that even those who were not taking a meal enjoyed the visit. The fact that people took time out to have a few words with them mattered so much. I have witnessed at first hand
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the value of such contact. If someone wants their chair pulled up to the table, the person delivering the meal can do that for them and help in many other ways. We can tell that pensioners like that by how they respond to the service. At Christmas, they give the people who deliver the meals chocolates, because they respect what is being done. They value the service so much.
I wonder how on earth the county council has got itself to the point that it has with the proposal that we are discussing. If we consider what the WRVS does, we see that the issue should not be all about financial savings. In fact, we should be asking the WRVS how it does such a good job and how we can enhance the service. Instead, we hear people say, "There is an alternative. We will employ a company to deliver a freezer and people can have seven meals." The price will be more than the price of the hot meal that they are already receiving: it will cost more for a frozen meal than a hot meal and there will be the running costs for the freezer. Heating the meal, which will also involve costs, poses its own dangers. People may struggle to do so. They will have to cook a meal from frozen and ensure that it is cooked properly. We all know the consequences of not getting that right.
Who will go round and check that things are okay? How much will it cost to check on pensioners and the vulnerable? Will that mean more social workers and more home visits? What if someone does not cook a meal properly? What will be the cost of that? We all know what the consequences will be. All the value that people get from a hot meal could disappear and their nutrition could be affected. There will be a reduction in social contact, which could lead to a deterioration in people's well-being and a subsequent reduction in healthiness. Those are real issues that pensioners in Lancashire will face if the proposal is implemented. Who will carry out regular assessments, which are currently done every day? We have not heard anything from the county council about that.
Of course, when a service begins to be withdrawn, it ebbs away continuously. People may say, "There wasn't much uptake of frozen meals," or, "We still offered a hot meal, didn't we?" The fact is that it will be so much dearer for a hot meal to be delivered that pensioners will not be able to afford it. They will be priced out of the market. Therefore, the proposal should not be implemented and certainly not for the most vulnerable.
In a debate some three years ago, we argued against the closure of county care homes. We were told at the time, "You've got this wrong. The view has changed. People do not want care homes any more. We want to support people in their own homes, which will enable them to enjoy a better quality of life." Three years later, that does not ring true, because part of supporting people in their own homes is ensuring that the hot meals service that they are enjoying continues to be provided. In fact, we should perhaps have been considering how to reduce the cost to pensioners of a hot meal. That would have been a better way forward. Care homes in the county have been closed and boarded up. At the same time, pensioners must have begun to wonder what the county council meant about supporting people in their own homes. I certainly wonder.
I have been challenged on the matter in the press by the county council, which is always an interesting experience. The issue is not only hot meals; there have
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been proposals relating to libraries and proposals to reduce the provision of educational psychologists and welfare officers. One of the county councillors challenged me to say where the cuts should be made. I did not think that it was my job to consider the budget of the county council, but if it is serious, I do not mind helping out and having a look at the budget for the council. The challenge is to find something to cut, but I do not believe that we should be cutting front-line services. If £4 million can be spent on consultants, perhaps we ought to prune things there. If we are talking about £1.2 million and we are spending £4 million on consultants, perhaps we should reduce that to £2.8 million. That could be a better way forward.
Mr. Michael Jack (Fylde) (Con): The hon. Gentleman will be aware that, since the unitary authorities of Blackburn and Blackpool were created, county hall has remained the same size and the county council has enhanced its estate by taking on other buildings. Perhaps that is where it should be looking, rather than cutting this vital service.
Mr. Hoyle : We should not be cutting front-line services, which is what is happening.
Not only is there the challenge of looking at the budget and finding the cuts, but the other claim is, "It's the Government's fault. They don't give us enough money." I always agree to campaign to get more money and support grants to the county council. I will always support that. That is not a problem. But we must reflect a little on just what the county council has had. In 2001–02, there was a 5.6 per cent. increase in the grant; in 2002–03, a 3.7 per cent. increase; in 2003–04, a 5.4 per cent. increase; and in 2004–05, a 13 per cent. increase. This year, the increase is 3.1 per cent. We all know that the retail price inflation average has been 2.6 per cent.
There has been a huge increase in Government grants—higher than inflation—yet at the same time, from 2001 to now, we have seen a 22 per cent. increase in council tax. Things do not quite add up. Of course I will support the council's call for more money, but we must reflect on how generous the Government have been, as well as recognising that this is one of the highest county council taxes in the country. If the council is collecting extra money—more money from the Government and from council tax payers—the council tax payers will not expect front-line services to be cut. I find it offensive that vulnerable people—our old age pensioners—have to bear the brunt of the cut. They pay council tax as well, so why should they? If we are lucky, we all get old and we would all like the benefit of a hot meal. All that is being put at risk.
The right hon. Member for Fylde (Mr. Jack) mentioned Blackburn. My understanding is that Blackburn is not going to cut its meals on wheels. We have a doughnut, as my hon. Friend the Member for Hyndburn (Mr. Pope) is here as well. Our constituencies adjoin Blackburn. There will be people who live across the street who have a beneficial service. How do we explain that? We cannot. Has the time now come for us to have a unitary authority, if we cannot get the service that we expect out of the county council? That is one consequence that the county council must consider. People do not feel that they should pay such a high council tax and have front-line services cut. The
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question to ask is: "If you're going to cut the service, why can't we have the benefit that Blackburn has and have a unitary authority?" At least the service would still be provided. The money would be collected locally and the service would be delivered locally. We may have to ask that question.
What can we do? I hope that the county council will reflect on what it has done and drop the proposal as a matter of urgency. In Chorley, I have already arranged for a meeting with the primary care trust and the hospital, because there is a consequence for them as well. Hopefully, social services from the county will come along and we can have a meeting to see whether we can ensure that there will be hot meal provision in Chorley at no extra cost compared with the situation at the moment. I feel that it is not my job to get down to that level, but, if need be, I will always ensure that the pensioners among my constituents do not come second to a decision taken by the county council. I hope that the council reflects on that and will help to fund that service in Chorley. That is so important.
Quite rightly, the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), is going to sum up. There are things that we must ask for and need to ensure, because this will end up being a health issue if we are not careful. First, what does he see as the benefit from meals on wheels? What does he think it does to help elderly people in Lancashire and across the United Kingdom? I have no doubt that the situation is replicated elsewhere. What does it mean when we talk about supporting people in their own homes? I wonder what his views on that will be.
Secondly, I would be grateful for the Minister's comments on the suitability of frozen meals for the elderly, the additional cost involved in checking up on pensioners to ensure that they can cope with the reheating of frozen meals without support, and the effect that that will have on social services.
Mr. Greg Pope (Hyndburn) (Lab): Does my hon. Friend agree that it is important that Lancashire MPs speak with one voice today, across both sides of the Chamber, in asking the county council to reflect on the decision that it has made and to look again at the issue? We are talking about the most vulnerable people in the county. There is a real opportunity for the county council to have a second look at the matter. Perhaps the Minister will join that call in his response.
Mr. Hoyle : I could not agree more with my hon. Friend. The fact that the right hon. Member for Fylde is here as well shows that this is about not scoring political points but being united politically to send a clear message to county hall that we would like the council to reflect, reconsider and not put the more vulnerable at risk.
Thirdly, what impact does the Minister believe that the increased cost will have on the take-up of meals and the future welfare of individuals, whose health may deteriorate as a consequence, and what will be the extra pressure on the NHS? As we know, the system provides an affordable hot meal for the elderly and
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the housebound. The increased cost proposed by Lancashire county council will result in a reduced uptake of meals, which will put an extra cost on social services and a burden on hospitals. I hope that, when we have finished the debate and the Minister has summed up, we can get that message across, that minds at county hall will not be closed, and that the council will reconsider and look to preserving those valuable front-line services.
The county council will say that it is always under the cosh and under attack, but that is not the case. It runs an excellent education system. I am very proud of the schools in Chorley and of the education system that is provided by Lancashire county council. However, when the council provides one valuable service, it should not tarnish other services by proposed cuts.
I look forward to the Minister's response. I am sure that he shares the concerns of Lancashire MPs as we unite to send a clear message to county hall.
11.18 am
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I congratulate my hon. Friend the Member for Chorley (Mr. Hoyle) on securing the debate and thank him, quite profoundly, for giving us the opportunity to discuss this important issue. My view is that we need far more debates such as this in the House, because older people's issues are rising up the agenda, and so they should. We have more people over 60 in this country than under 16. The number of people who are over 85 is forecast to double. That is not just a strategic issue for us as policy makers, but a political issue, because there are four times as many older voters as there are younger.
Meals on wheels is an important component in packages of care that are designed to help people to stay in their own home. Why is that important? It is important because people want to keep their independence for as long as possible and having meals delivered to them at home helps them to do that. There is absolutely no doubt that meals on wheels is an extremely valuable and much needed service. I pay tribute to all those volunteer services in Lancashire, including WRVS and Age Concern, that deliver meals on wheels. They contribute an enormous amount to the fabric of the life of the local community. We would do well to recognise that.
I was thinking about the heart of today's debate and how I could be most helpful to my hon. Friend, so I shall set out two things. First, I shall set out why the issue is important from a policy point of view and then I shall talk about the situation in Lancashire. The policy context begins with the fact that we have made enormous strides in improving health and well-being for older people in this country. We have done that, in part, by tackling age discrimination that once prevented older people from getting health care. We have changed that situation and heart surgery for the over-75s, for example, has now risen from 2 to 10 per cent.—it has increased fivefold. Death rates from diseases that particularly affect older people such as heart disease, strokes and cancer are plummeting. Life expectancy for men and women over 65 is increasing very quickly.
We have done things that have affected the quality of care for older people, such as cutting delayed discharges by two thirds. We have released 1.5 million bed days by
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tackling that issue head on. The policy questions begin with this issue: we have added years to life, but how do we now add life to years? That is the question posed by the World Health Organisation.
I want to draw my hon. Friend's attention to three policy areas to consider as he presents the arguments locally. First, in the White Paper on social care and health, we set out a new direction of travel for national health and social services. At the heart of the White Paper is the question of how we shift services much closer to people's homes, so that care is available not just round the clock, but round the corner. Secondly, how do we ensure that health services work together far better with local authorities? That is extremely important, as he knows from his long experience of campaigning on these issues. Thirdly, and this is particularly relevant to his argument, how do we increase investment in preventive health services? We spend far less in this country than our European neighbours on health care that prevents people from becoming ill in the first place. We set out a clear ambition in our White Paper to increase resources for preventive health care.
One incredibly important policy argument concerns the recent report by the social exclusion unit, which considered the views of older people. If my hon. Friend has not seen that, I shall happily send him a copy because it underlines a lot of the arguments he made today. The report shows that almost one in 10 of those aged 65 and over report feeling lonely often or always. The older people were, the more they reported feeling lonely. About 30 per cent. of people aged over 65 do not see friends at least once a week. That is an incredible number. We know that social isolation and loneliness are connected to inadequacy of social relationships.
Thanks to the social exclusion unit, we now know that people often descend into ill health because of a trigger event, such as the death of a carer or loved one, or when someone has to go into hospital. Often, it is the social exclusion that follows that means people are lonely; they do not access mainstream services and their health begins to decline. The White Paper addresses that issue for older people by saying that the NHS and local authorities need to work closer together to invest more money in preventive health care services, so that we can confront that issue head on.
Another policy area is the importance we attach to delivering more care in the home, and my hon. Friend alluded to that. We know that older people overwhelmingly say that they want to live at home, and we also know that people who are getting older have extremely strong views about that. When the Commission for Social Care Inspection surveyed the under-60s, only between 3 and 11 per cent. expressed the desire to move to a care home. More than 90 per cent. said that they wanted stay in their own home for as long as possible. During the past three years, we have seen a steady increase in the proportion of people receiving intensive help at home. The Department of Health has a target of providing care at home for at least 34 per cent. of those supported. At the moment, 65 local authorities are already achieving that target.
My hon. Friend said that the debate is of national significance and he is absolutely right because the target extends nationally. If we consider inner London, for example, all councils are now hitting that target of 34 per cent. of people being supported at home. In outer
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London, 90 per cent. of councils are hitting that target and we expect the rest of the country to fall in line behind them.
The policy background to this question is a White Paper that says that we must move care closer to home and support people in their home. The social exclusion unit says that tackling social isolation is extremely important, and the direction of travel of policy is to increase the number of people living at home. The question that the local NHS and local authorities have to answer is how those three elements work together.
That brings me to two questions regarding Lancashire county council. First, are we resourcing Lancashire county council sufficiently well, given the agenda that has been set nationally? Secondly, what are the implications for meals on wheels? As my hon. Friend said, we have increased resources for local government significantly. We are in the ninth successive year of real-terms increases in investment in local government. Between 1997 and 2007–08, funding will have increased by nearly 40 per cent. in real terms. In Lancashire, in 2005–06, the adult social services budget was £241 million, which is an increase of about £15 million on the year before. Importantly, there is now a three-year settlement for Lancashire county council, so that it can plan ahead more effectively. In our White Paper, we said that we would ensure that the health service had a three-year budget, so that it is a little easier to make those plans work.
On the issue of Lancashire county council spending on meals on wheels, it is important to say that it has a strong track record of looking after older people. Its social services have received two stars and it has been commended on its performance by CSCI. It has been assessed as excellent by the Centre for Policy on Ageing and it is on track to meet the requirements of a number of public service agreements. I particularly welcome three things: the increase in people receiving direct payments, the increase in the number of extra-care housing tenancies and a 50 per cent. reduction in residential admissions over a five-year period. Clearly, more people are able to stay in their homes, which has big implications for the services supplied to people living at home.
The county council spends just under £1 million a year in providing meals through its in-house service, another £3.2 million in spot-and-block contracts and £2.9 million is then recovered through charges to service users. The council is subsidising provision of meals on wheels to the tune of about £1.3 million a year. The track record is reasonably good because Lancashire provided more meals than any other council in 2004–05 and there are more clients in Lancashire receiving meals on wheels than in any other council area as of 31 March 2005. That is due, in part, to its enormous size—it is an extremely large authority. The Lancashire average is that 22.3 older people per 1,000 receive meals, compared with the English average of 13.6, which is something to be proud of. In addition, as my hon. Friend said, the average cost of the meal is about £2.70, which is quite a way below average. The average cost in England as a whole is £3.30.
I shall write to my hon. Friend on two points of detail relating to costs and assessment. We would expect all assessments of social service clients to take account of whether they can use the meals that they have been given. My hon. Friend is quite right: if we are moving to
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a situation where frozen meals are being delivered, someone cannot just turn up in a truck and give people frozen meals. That is not good enough. We have to ensure that people are assessed on their ability to make use of those meals, which has further implications.
Our direction of travel is to support people in their own homes for longer, in line with their own wishes. We have to be alert to the risks of social isolation, as the social exclusion unit report points out.
David Taylor (in the Chair): Order. Time is up.
Sitting suspended until half-past Two o'clock.
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