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Nursing Homes (Funding)

12.30 pm

Daniel Kawczynski (Shrewsbury and Atcham) (Con): It is the first time I have spoken in a debate with you in the Chair, Mr. Hood, and I am looking forward to it. This week, three independent health watchdogs have highlighted concerns about the treatment of the elderly in our country. This topic is rather current so it is appropriate for us to debate it in the House today.

The objective of any civilised society is to treat the elderly with dignity and respect, but there are examples of the elderly being neglected and patronised in all parts of the country. This represents an ongoing battle that we must pursue and win. The Labour Government have done a great deal to help senior citizens during the last eight or nine years, and this is not an opportunity for me to have a go at the Administration. Rather, it is an opportunity to ask some questions that constituents have put to me because they feel strongly about the issue.

The Government, the national health service, local government and care homes are inextricably linked. They are all interdependent. I shall be interested to hear from the Minister what studies have been done of that link and how greater efficiency and care can be guaranteed. If we provide good care in nursing homes and care homes that gives peace of mind to senior citizens, how much will the NHS save in the long term? Many medical friends of mine confirm that stress can have a great impact on senior citizens and the illnesses that they can have. Providing them with a guarantee of long-term care in a nursing home would go a long way to preventing other illnesses.

I represent Shrewsbury, and many owners of nursing homes and care homes in Shropshire want the Government to listen to them more. They do a very good job of looking after people in Shrewsbury, but believe that the huge amount of regulations and red tape that have been foisted on them are having a major impact on the cost of running their establishments. They have to pass their costs on to their clients. I understand that the Government have a responsibility to set uniform standards across the country, but if the Minister were to come to any care home or nursing home in Shrewsbury, she would find that the standards were extremely high. I wish that we could give the owners and managers of care homes fewer targets and less red tape and allow them to get on with the job of running their establishments. The resulting costs are passed on to their clients, which is part of the problem.

I would like tax breaks for private companies to allow them to develop new care homes and for the training of their staff. Another of their major problems is that they cannot find enough staff to look after patients, so they have to spend a great deal of money on finding people and training them.

Constituents in Shrewsbury have been coming to my surgery in growing numbers to tell me of the financial headaches that they have in relation to this issue. Many of them, such as Mr. Cartwright of Shrewsbury, have had to sell their parents' homes in order to pay for long-term care. Once they have sold their homes, they then have to manage the assets, which are eked out over a certain amount of time to pay for the costs. Many
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constituents feel that such care should be entirely or partly funded by the NHS. This generation feels that the state—the NHS—is responsible and the Government should help.

People genuinely feel that they have paid taxes all their lives and that long-term care should be either partly or totally paid for by the state. That is a frame of mind that many people have and it is difficult to change it in the short term because people have high expectations. Later on, I shall talk about my generation of citizens and how we shall have to deal with the problem, but many of my constituents in Shrewsbury resent selling their homes at the moment.

Many people have worked hard and saved up in order to pass an inheritance on to their children. They come from an era after the war when many worked extremely hard and made huge sacrifices in order to make investments and buy homes that they could then pass on to their children. I am about to become a father for the first time, but I am not thinking about passing on my wealth to my children; I want to enjoy myself while I am still alive. However, the generation before us certainly felt that it wanted to save up and pass on money to the next generation. That is not possible if people have to sell their homes to pay for care.

Rural areas such as Shropshire are underfunded. I pore over all the funding statistics for the police, children in schools and social services. In every single funding table, Shropshire is right at the bottom. I know that it is a long way away from London and that it is a rural area, but as the MP for Shrewsbury, it really concerns me when I see Shropshire at the bottom of all the funding league tables. Ultimately, when there is a lack of funding, the emphasis on looking after the elderly falls on local authorities that simply cannot sustain such levels of expenditure.

I now come to my generation. We have to get people ready to deal with the situation. As a 34-year-old, I cannot totally rely on the state to look after my mother in 20 years' time if she needs care. I very much hope to be able to look after her in my own home, but not everyone can afford to look after their elderly relatives in their home as part of the family. My generation will experience this problem in 20 years' time, when our parents, who are now in their late 50s or early 60s, will be in their 80s. Taxation is going up significantly and young people are not saving as a result; they are also burdened by the high cost of buying their first home. From talking to young people in Shrewsbury, it seems that very few of them are saving at all. They are making little provision for looking after their elderly relatives. When I say this to people of my age, they look at me with a blank expression; it has not even registered that they should be taking out insurance or saving up to look after their parents in the future.

In the House, we tend to look at things as they are now, because we deal with problems that face us today, but I hope that the Government will consider the problem in relation to the future, because it is important that my generation should start to be more accountable.

The Government's role is to incentivise people of my generation to make provision for their parents, who will live much longer than people do now. Some of them
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will live to be 90 or even 100, by which time many will have eked out their savings and downsized their homes. My parents, who have retired, are going to sell their family home and move further away from London in order to release capital to pay for their retirement. When they are older, they will have even less to look after themselves than people do now.

The Government should look to partner people of my age in preparing themselves and their families for the future. I hope that the Minister can tell us what steps the Government are taking to provide tax incentives for people to make such provision. Various insurance companies are starting to do work in this field and to introduce proposals to protect people in the future.

The Government have introduced other major initiatives such as baby bonds. People might ask, "Why is a Tory trying to interfere in this aspect of society? Surely you should leave market forces to deal with it," but I say no. I feel passionately and compassionately about this matter. It is our responsibility to ensure that our parents and other people are looked after, particularly in 20 or 30 years' time, and that there is some form of private insurance in place, or that the state has looked into this matter with a view to providing a solution.

The most important point that I make today is about my constituents, many of whom have come to see me, such as Mr. Cartwright. Many of them—I am going back from my generation to the generation of today—are arguing with the Shropshire and Staffordshire strategic health authority and the ombudsman about who is responsible for paying for their relatives.

Mr. Cartwright's mother died two years ago, but he is, unfortunately, still going through the protracted and painful process of interacting with the local health authority and the ombudsman because he is convinced that his mother should have received free care in her nursing home. She did not. Everything had to be sold; all of her assets went and she was left, on the day she died, with about £250 in her account. Fortunately for her—I hate to say this—she died at the right time, because there was no money left to look after her. I would like the Minister to look into the case of Mr. Cartwright of Telford estate, Monkmoor, Shrewsbury, because he has suffered greatly.

Our fellow citizens—they are more than constituents—are going through an extremely traumatic battle of ping-pong between the ombudsman and their health authority, and they are not getting satisfactory answers to their genuine concerns. I know that the Government have to deal with hundreds of thousands of cases, but one reason why I asked for this debate is because one thing that a Member of Parliament can do is focus the spotlight on constituents who have faced trauma.

12.45 pm

The Parliamentary Under-Secretary of State for Health (Caroline Flint) : I am pleased to take part in this Adjournment debate with you, Mr. Hood, and the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski), whom I congratulate on securing it.

The hon. Gentleman made several interesting points. He is right to draw attention to the shifting issues over a number of generations. When the national health service was introduced by a Labour Government—I am afraid
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that the Conservative party voted against its creation—the health issues faced by politicians and health professionals were different to those faced today. People died a lot younger in 1945 and the following decades than they do in the 21st century. We welcome that, but it brings challenges regarding people planning for their future and the sort of care that they want and need.

The hon. Gentleman will know from his constituency work, as I do from mine, that the needs of older people vary enormously. The other week, I met a woman in her 80s who was active and fit, and lived independently in her own home, but I have also met people in their 70s who do not have her level of fitness and need a variety of care. There is no one-size-fits-all solution.

There has also been a change in the expectations of different generations as they get older. I was a little perturbed to hear someone on the radio use the term "elderly" to describe people aged over 50. That was somewhat ridiculous. The issue of what people expect is important. The expectations of my grandmother—she was born in the first part of the 20th century—and of my mother, who was born at the end of world war two, in relation to their lifestyles, perceptions and needs in their 50s, 60s and 70s, are very different to what I expect for myself and my children.

A good change is that people are less deferent and do not simply accept what they are offered. They now have some say in how services are provided. That is one reason why the Government have tried since 1997 to not only to look at nursing care homes—that very phrase conjures up a particular picture of older people living in those facilities—but to consider how services can be provided nearer to home by health services working with local authorities, and enabling people who choose to do so to live as independently as possible in their own homes or in family homes with others.

There have been dynamic changes in the provision of supported or sheltered housing. Technology has moved on to such an extent that older people can run their own lives knowing that there is someone catering for their needs. I pay tribute to what has been done in the constituency of my hon. Friend the Member for Hartlepool (Mr. Wright) with Housing Hartlepool. I recently visited Richard court, which has a 24/7 service whereby a resident can call a number and someone will be ready to answer their call and assist them with health-related needs, repairs or concerns about intruders or people causing problems in the area. Clearly, steps are being taken to provide various types of assistance such as supported housing and care within a home setting, and to use technology to meet people's needs as they grow older. That is absolutely right.

An estimated one in three women in Britain, and one in five men, will eventually need some form of long-term care. As the hon. Gentleman pointed out, the funding of such care is an issue that will touch many people's lives at some point. We have to deal with people who are in that situation, and with people and their families who are approaching such decisions. We must also consider younger people, who might not think about this issue, and what their needs will be 30, 40 or 50 years down the road.

It would be helpful at this stage to draw out some of the distinctions between nursing care and other support. Nursing care is care by a registered nurse, who provides, plans and supervises a person's health care.
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In 2001, we delivered on the commitment set out in the NHS plan to remove the anomaly that residents of care homes did not automatically receive free nursing care as they would in other care settings. That was an important, positive and progressive decision by the Government and it ensured that 42,000 people now get nursing care free of charge from the NHS, when they would previously have had to fund it themselves. That is a clear change. I welcome the hon. Gentleman's recognition of the positive changes since 1997.

Charging for care is not new. People have always had to pay for or contribute towards the cost of social care. The National Assistance Act 1948 sets out the framework within which local authorities decide what people can afford to contribute. Capital assets and income, including the former home, have always been taken into account in making that assessment. That is nothing new; it was there at the start of the NHS and has influenced policy ever since. However, no one should be forced to sell their home.

Working with local authorities, the Government have recognised the opportunity and local authorities provide an interest-free loan secured against the property. That means that where the arrangements are appropriate, someone can keep their house even if they are in some form of residential care. However, as and when they die the council or the local authority has a claim against the cost of that individual's social care. That is a step forward.

Local authorities means-test whether people have to make a contribution. They have to give a direction of choice, with a variety of providers. When someone chooses not to opt for the local authority choice, there is also provision for them to consider something that suits their needs elsewhere. If they are eligible, the local authority will pay its part of the cost with the option of the person topping up the payments if they want a choice other than those it provides. Efforts have been made to consider how we deliver that.

I am pleased to say that in 2005 Shropshire county council moved from a two-star to a three-star rating for its services for children and adults. I am sure that the hon. Gentleman would agree that it is working to improve its services.

The other support available includes personal care—help to carry out personal activities such as bathing, dressing and undressing, eating and using the lavatory—and continuing health care for people who require the highest degree of support, where the NHS pays the entire cost of care, as it would if their care was being provided in an NHS hospital.

The past two decades have witnessed significant changes. In many respects, there used to be no choice. Care was provided in a long-stay hospital ward or not at all. Now, increasingly, people get intensive support that enables them to live independently in their own home. I think we would all agree that many people would like to have that choice, if it is appropriate.

The shift away from the acute sector has in many respects been positive, not least because it has enabled care to be delivered more appropriately and effectively. It is interesting how different practices are used in different parts of the country. Care has been delivered in a more homely environment, allowing people to maintain their independence.
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As I said before, people have always had to pay for or contribute towards the cost of social care. Removing means-testing for care services would have profound and long-lasting implications. Personal care alone would cost an additional £1.5 billion a year, rising to an estimated £3 billion a year by 2020. Board and lodging would cost many more billions a year. There is a balance to be struck between providing nursing care free, as it would be in an NHS setting, and coming to an arrangement to pay for the personal care towards which someone in a different setting has to contribute. We have tried to consider systems that deal with that as smoothly as possible.

Provision of free personal care could divert resources from services that benefit all older and disabled people. The announcements made in the past year and in the Budget of free transport for older people, for example, have a cost, as does the winter fuel allowance. We have to come up with a package in which the Government play their role and take their responsibilities, but within that there is a challenge for individuals and their families to look at their own lives and plan for their futures.

I cannot answer all the hon. Gentleman's questions about tax incentives, but I shall be happy to pass them on to the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), who is the Minister responsible. I hope that he will be able to write back to the hon. Gentleman.

Eligibility for NHS-funded continuing care has in recent years been the subject of much debate. NHS continuing care eligibility criteria were designed to identify those who have a primary need for ongoing health care, as distinct from help with the daily activities of personal care. That has proved to be problematic, not least for individuals and their families—I think Mr. Cartwright probably falls into this category—who could not understand why similar types of care were sometimes free and sometimes means- tested.

We are aware of the difficulties around the interpretation and application of the criteria and concerns about whether they have been too restrictive in practice. Individual court judgments of which the hon. Gentleman might be aware have provided some clarification of the responsibilities of the NHS and social services for long-term care, including the Coughlan judgment in 1999 and the recent Grogan judgment. We acknowledge that mistaken decisions about individuals' eligibility have been made in the past and we have asked strategic health authorities to review their eligibility criteria again following the Grogan case and to ensure that their eligibility and decision-making processes are lawful in the light of that judgment.

We have already announced plans to develop a national framework for NHS continuing health care to achieve greater clarity, transparency and consistency in making decisions. I will ensure that my hon. Friend the
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Under-Secretary is aware of the comments raised in relation to Mr. Cartwright's case. I cannot say that he will be able to intervene, but I will ask him to consider the case. It is clear from what the hon. Member for Shrewsbury and Atcham said that Mr. Cartwright is pursuing his case through the channels that the Government have set up.

We plan to consult publicly on the national framework soon. It will sit alongside a broader range of measures to improve the quality of care and provide a fairer system. We take the care of our older people seriously and, as the hon. Gentleman will know, this Government published the national service framework for older people in 2001.

One of the central pillars of the framework is the single assessment process, which is meant to ensure that the needs, wishes and perceptions of older people are placed at the heart of the assessment process and that the subsequent planning and delivery of services are informed by that. Linked to the assessment process is the fair access to care services guidance, which was issued to councils in May 2002 and implemented in April 2003. It provides councils with an eligibility framework for adult social care to use when setting and applying their eligibility criteria.

Extra care housing offers independence and choice to individuals to own or rent self-contained flats yet also have access to 24-hour support of the type that is provided in the constituency of my hon. Friend the Member for Hartlepool, as well as other services such as meals, domestic help, and onsite leisure and recreational facilities.

We have also introduced £185 million each year for the carers grant, which provides local authorities with the means to provide respite breaks and services for carers in England. We have introduced a performance indicator, which ensures that councils recognise that support for carers continues to be a priority for the Government. We need to build on that to improve health and well-being so that more people can remain independent in their homes, where appropriate. At the same time, we have to ensure that where that is not possible people in residential care settings are treated with dignity and respect. Not only the individuals but their families should feel fully supported by the care plans.

Such developments are leading to a more flexible pattern of provision of care, which can better respond to the needs and wishes of patients and their families. A record number of people are being supported to live independently and are being offered a choice of care and support when they leave hospital.

The steps that we are taking are improving the situation. We must continue to provide wider choices. This is not a debate that starts and finishes with a general election—

Mr. Jimmy Hood (in the Chair): Order.
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