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Westminster Hall

Tuesday 31 October 2006

[Mr. Edward O’Hara in the Chair]

Nursing Care Homes

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Watts.]

9.30 am

Anne Main (St. Albans) (Con): I thank you for chairing this debate, Mr. O’Hara, and I thank the Minister for attending. I also thank my hon. Friend the Member for Eddisbury (Mr. O'Brien) for attending on behalf of the Conservative Front Bench and the hon. Member for Romsey (Sandra Gidley) for the Liberal Democrats, as well as other hon. Members from throughout the House.

This debate is about care homes for the elderly and the problems that they face, particularly with funding. I acknowledge the excellent work done by the Abbeyfield Society, which celebrated its golden jubilee this year.

In June, in our beautiful cathedral of St. Albans, Abbeyfield residents, volunteer supporters and staff gathered for a service of celebration and thanksgiving for the Abbeyfield Society’s 50th anniversary. The headquarters of that champion for the elderly is in my constituency and it provides a valued service in many hon. Members’ constituencies. The joyful service of celebration was led by the Bishop of St. Albans, theRt. Rev. Christopher Herbert, in the presence of His Royal Highness the Prince of Wales, who is a patron of the Abbeyfield Society. Baroness Bottomley, who is president of the society, also attended and was resplendent in a golden hat. She works tirelessly on behalf of that wonderful organisation, which is valued by hon. Members.

Why was the Abbeyfield community created, what needs pressed it into existence and are those needs being met in care homes everywhere? Abbeyfield began in 1956 because, during a visit to Bermondsey, Richard Carr-Gomm became concerned about the number of sad, elderly faces staring fixedly from windows. He was so moved that he resigned his commission with the Coldstream Guards, moved from Chelsea barracks to a bedsit in Abbeyfield road and became a home help. During his visits as a home help he found that loneliness was a problem, so he spent his Army gratuity on a house and invited four lonely people to join him. By Christmas 1956, he was the first Abbeyfield housekeeper.

Today, Abbeyfield leads the way in care homes for the elderly. It is a major player, with around 500 member societies throughout the United Kingdom and more than 800 houses providing accommodation for more than 8,000 residents, involving 10,000 volunteers and serviced by a small staff in my constituency. It acts as a pretty good barometer of the issues affecting all care homes throughout the country.

The English Community Care Association, of which Abbeyfield is a member, rightly points out that for too long older people have been left off the political agenda. For many older people, moving to a good care
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home can be a hugely positive experience and a means of increasing independence. For older people who do not have family and friends to visit, a knock on the door can be a terrifying experience. Indeed, Hallowe’en tonight will be a source of much worry for many elderly people throughout the United Kingdom.

When struggling to stay in their own home, elderly people sometimes see different domiciliary care workers come and go. Faces change and no one stays around long enough to give real care or, importantly, as Richard Carr-Gomm recognised, companionship. Loneliness, lack of assistance, injuries and poor nutrition are not uncommon for the elderly. The ECCA wants to ensure that no vulnerable people are left alone simply because social services have clocked off. It believes, as I do, that there is no substitute for direct human contact being on offer 24 hours a day, 365 days a year, and that that can be provided by an excellent care home system.

Before I begin the wider debate on how to ensure that a 24-hour, 365-days-a-year excellent care vision is delivered and address the pressing issues facing all care homes for the elderly, I want to thank the staff, board and volunteers at Abbeyfield who work tirelessly for their residents and who, thanks to their founder Richard Carr-Gomm, strive to deliver that vision.

Abbeyfield is a charitable organisation and provides a range of services for older people. It currently offers two main sorts of accommodation for older people—that is often mirrored in other care systems. It offers supported sheltered housing in which the average age is 85-plus and residents, who live in family-type housing, are supported by the “Supporting People” programme. According to the Government’s objectives, that programme, to which I shall return, is supposed to deliver quality of life and to ensure high-quality, strategically planned services. Abbeyfield also offers care homes for residents who need access to 24-hour personal care or nursing care. They often live in relatively small, non-institutional settings and are supported to enable them to retain as much independence as possible. The average age of entry into an Abbeyfield care home is 94-plus. Some residents are self-funding, but others are supported by their local authorities. Funding—and its inadequacies—is an issue that recurs again and again with regard to care for the elderly. It is cited by all providers as a source of deep concern.

If I give some examples of how this issue directly affects the Abbeyfield care system and similar providers, it will become apparent to the Minister how some sectors of our ageing society seem to be perversely disadvantaged by current funding, which can vary hugely from area to area. One example is funding problems in supported sheltered housing. Abbeyfield is not alone in encountering serious issues with the new “Supporting People” contracts, and the viability of its services is seriously threatened, along with the services of many other care home providers. Local authorities, for example, are starting to issue steady state contracts for the provision of “Supporting People” services. The former Office of the Deputy Prime Minister, now the Department for Communities and Local Government, advised authorities that within the contract there should be a clause that prohibits providers from recovering from users any moneys for
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support in excess of the amount agreed within the contract as the price for support. In reality, that means that if the cost of support is greater than the amount that the authority agreed to pay, providers cannot recover those costs from the service user.

Staff costs are the largest part of support costs and it is not possible to reduce those costs and maintain a high-quality service. After all, would anyone advocate using poorly trained staff?

Bob Spink (Castle Point) (Con): I congratulate my hon. Friend on securing this important debate on a matter that has been neglected in the House for too long. Does she agree that when county councils have sold off their residential homes to the private sector, which has then ignored the arrangements under the Transfer of Undertakings (Protection of Employment) Regulations 1981 and sought to reduce the staff pay and conditions by replacing staff with staff from abroad who perhaps do not speak or understand the language well, that has damaged the care of the elderly? Does she agree that we should address that important problem now?

Anne Main: I thank my hon. Friend for that intervention and will touch on the matter later. He is absolutely right. People often refer to Cinderella organisations that attract poorly trained staff or people who would struggle to find a job in any other system and provide a poor service. That is what happens if prices are pushed down too far. Our elderly people deserve better. If the use of poorly trained staff is advocated, residents might be carelessly or even cruelly treated. As my hon. Friend said, we have heard how less scrupulous care homes try to cut costs to the bone not only with poorly trained staff, but by serving bland, poorly nutritious food that fails to tempt the palate, feed the appetite or deliver a balanced diet, sometimes with fatal consequences.

Abbeyfield provides an excellent service but is facing a dilemma because it and similar organisations are unable to pass costs on to service users, sponsors or relatives, so the only alternative is to close houses, which would put vulnerable people at risk, or even worse. Does the Minister agree that our older people deserve excellence and that it is not possible to have excellence on the cheap? I look forward to hearing his views on that.

Mark Williams (Ceredigion) (LD): Does the hon. Lady agree that the problems that she has identified are exacerbated in rural areas where the reality of care home closures means that elderly people and their families must travel vast distances to secure the care that they need? One of the great strengths of Abbeyfield is that it provides strong, localised support for the elderly.

Anne Main: The hon. Gentleman is absolutely right. Richard Carr-Gomm’s vision was that Abbeyfield should provide companionship. A vital part of companionship is that people can visit their families. In my constituency there are no national health service beds for care home provision, so families may have to
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travel long distances to visit their relatives if they are placed with the cheapest possible provider. That can be particularly bad in rural districts.

The advice issued by the DCLG to local authorities is not mandatory, so Abbeyfield and other care home providers are finding huge differences in local interpretation of that advice. I look forward to hearing the Minister’s views on that. Some administering authorities are insisting that Abbeyfield cannot require payment of money for support from residents beyond the amount paid by the local authority—that happens in Telford—whereas other authorities will allow that arrangement. Providers across the spectrum tell me that they need clarity and certainty in funding and I ask the Government to reconsider their advice to local authorities.

The Royal College of Nursing backed up those concerns when it said,

Mr. Anthony Steen (Totnes) (Con): I had the good fortune to meet and know Richard Carr-Gomm and I am sure that my hon. Friend agrees that he would be appalled that although in Scotland care provision—nursing and residential care—is free, it is not free in England and Wales. Will she say something about that, because it is discrimination against the English?

Anne Main: I am sure that the Liberal Democrat Front-Bench spokeswoman, the hon. Member for Romsey, will have something to say about that. I would not use the word “discrimination”, but there is a lack of parity. Scotland has made that decision and we have not, but there is no reason why we should not move matters further forward than we have.

The provision of all care free at the point of use is an ideal that we all aspire to and agree with if it is affordable. However, our provision falls far below that standard, and we must raise our game. The result of self-funders subsidising social service providers is the limited availability of social services places in any one area. Independent providers struggle to keep their costs low, too. The Royal College of Nursing says that it is

There is an uneven playing field, and its results hit particularly hard.

If we do not receive any clarity about funding, the closure of some homes is a possibility. Abbeyfield and other excellent care providers would take such a step with the greatest reluctance, but the Minister must recognise that care providers such as Abbeyfield cannot jeopardise the financial viability of their organisation by planning service delivery without a clearly identified source of funding. I look forward to hearing the Minister’s views on the realistic funding of care homes and on the need for clarity.

If a home is forced to close for financial reasons, it is stressful not only for staff, but for residents. An article in The Daily Telegraph earlier this month included a
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quotation by Professor David Jolley, a consultant psychiatrist specialising in old age, who said that it is

Another psychiatrist, Dr. Peter Jeffreys, rates it as

Care homes face particular funding problems. As the Minister knows, self-financing residents are assessed by the local authority, and if they have more than £21,000 they pay full fees themselves, apart from any nursing element. Many must sell their homes to meet the fees, and that is often the source of much distress to the resident and to their families. Indeed, the Wanless social care review led by Sir Derek Wanless said of the social care services in its 2006 report, “Securing Good Care for Older People: Taking a Long-Term View”:

If the elderly have less than £21,000, they may be eligible for local authority support. Local authorities, however, consistently fail to meet the full fees. The resident is not allowed to make up the shortfall, whether it is £5 or £100 a week. If the local authority is asked to meet the shortfall, a common reply is that there may be a cheaper option, which the hon. Member for Ceredigion (Mark Williams) referred to, and that the resident should move to another home, which is often miles away in a rural district. That is a distressing prospect for all involved, and it can have adverse health implications.

Relatives often have to pay the shortfall or the top-up, but they may be pensioners themselves. Abbeyfield had an 85-year old relative funding the top-up fees for another Abbeyfield resident in care. That cannot be right. Care homes often face contractual constraints. Some authorities may be prepared to meet the shortfall, but others neither meet it nor allow the resident, relative or sponsor to do so, putting the resident and the care home in an impossible position.

Several nationally imposed policies will impact on the costs of running care homes, and local councils and the national health service will have to fund them properly. They must pay particular attention to the minimum wage, proposed increases in statutory annual leave, increases in registration and inspection fees, proposed registration of all care workers, and Criminal Records Bureau and protection of vulnerable adults costs. For example, the 2005 regulatory fees per provider were £1,901, but in 2006 they leapt to £2,186, and registration costs leapt from £518 in 2005 to £596 in 2006. Commission for Social Care Inspection fees increased from £259 to £297, and when we add on increased wages and CRB checks, the bills hugely outstrip an individual home’s ability to cover its costs. I look forward to hearing the Minister’s views about that.

Training is vital to maintaining high quality care services and to recruiting and, importantly, retaining
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capable and caring staff. We need good quality staff in the care industry. For too long, as I have said, it has been considered a Cinderella career that is undertaken by people who have few qualifications and few options. The potential merry-go-round of staff does everybody a disservice, but particularly the residents. Evidence from Laing and Buisson’s study for the Joseph Rowntree Foundation, entitled “A Fair Price for Care”, shows that the income from statutory purchasers, most notably from local authorities, does not cover the costs that an efficient home incurs to meet regulatory standards.

Several local costs-of-care exercises carried out throughout the country support that study. In recent years, the result has been widespread home closures and an increased need for residents to seek top-ups before gaining admission to a care home. The Office of Fair Trading’s May 2005 study of care homes showed that nationally, 35 per cent. of residents have to top up the care payment that they receive from the council. And that may be a low estimate.

The fear is of a renewed spate of care home closures, and with an ageing population, that would be madness. We must invest in our elderly people; otherwise, residents will experience reduced choice and there will be downward pressure on the quality of service. I look forward to hearing the Minister’s assurance that there will be no more care home closures.

We are talking about frail, elderly people in the autumn of their lives. As I said, the average age of entry to a care home is 95. Those people should receive the best appropriate care; they should not be regarded as a throwaway commodity that society can cater for at the lowest possible cost. As a society, we should strive to ensure that the elderly do not miss out, because their voices are not being heard above the clamour of younger voices.

Best value for the taxpayer means that the fee and the quality of care must balance. It would ensure that an individual’s needs were met and not just paid lip service to. If we settle for second-rate or poorly funded care homes, we will let down our elderly people. Councils are slow both to acknowledge the rising costs imposed on care homes and to reflect them in the fees paid to care homes. Care homes should not be caught in the middle of a battle over adequate funding between the Government and councils. The Government should provide councils with adequate advice. I look to the Minister today to provide me with information about the steps that the Government are taking to ensure adequate funding and parity of delivery throughout the country.

If the Government want national policies and the implementation of national standards, they must be correctly funded. Nursing homes often face greater funding problems than care homes. The additional nursing element, which the health authority pays, is prescribed in three bands: high, medium and low. However, it bears no relation to the actual costs of providing person-centred care for individuals in different homes, and it can be widely interpreted, leading to an even greater shortfall in fees. Again, in an attempt to save money, local authorities are sometimes overly restrictive in their interpretation of the criteria.


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Ann Abraham, the health service ombudsman, made that critical point in her February 2003 report, when she said that some local criteria


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