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31 Oct 2006 : Column 7WH—continued

It is a cost-saving exercise at the expense of the elderly people, leaving some financially disadvantaged and struggling to meet the fees.

The restrictive application of the criteria can lead to the distressing situation in which one partner in a married couple has their fees paid for nursing care while the other does not. There are no local NHS-funded nursing care places within St. Albans city and district in my constituency, so in theory, couples can be split up and housed in different homes outside the area, depending on whether they need nursing care.

Spousal liability for fees is also a big issue, and I look forward to hearing the Minister’s reply. If one is married, one may be seriously disadvantaged under the fee system. A local authority may ask a spouse to refund part or all of its expenditure on providing residential accommodation for their husband or wife. A council can negotiate a liable-relative contribution, even if the liable relative does not wish to supply details of his or her resources. Perversely, however, unmarried couples are not legally liable to maintain one another, even though they may live together as husband and wife. It appears that the maxim, “Don’t get married and don’t get old,” is very true in our care system.

Bob Spink: My hon. Friend’s speech on the subject, particularly its financial aspects, has been a tour de force, and we are grateful to her. Will she address the issue whereby many old people do not want to go into a home, but want to stay in their own home for as long as they possibly can? Society can enable that by providing technology and communications. The solution is often cheaper and it provides a better quality of life for everyone. Will she ask the Minister to explain what the Government will do to facilitate it?

Anne Main: That was not going to be the thrust of today’s debate, but my hon. Friend is absolutely right. The age of the people entering the care system indicates that people do not want to go into homes, although, as I have said, it can be a hugely liberating experience for elderly people, particularly if they are rurally isolated and do not have family. We should offer the best system for whatever elderly people want, including facilitating their staying in their own homes with adequate care systems—not just the occasional pop-in visit, being helped into bed at 4.30 in the afternoon because that is the time slot allocated or being given boring meals that are inappropriately timed or inappropriate for them.

I wish to focus today on care homes; I do not want to sidetrack the Minister by speaking about care in the community, which is a wider issue for a future debate. The Department of Health has said that it is

I note that no time frame is mentioned, and in the latest edition of the “Charging for Residential
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Accommodation Guide” the rules continue. I hope that the Minister will update us on the matter today.

In the Abbeyfield Society’s golden jubilee year I want to celebrate its excellent work and hold on to the vision of Richard Carr-Gomm, who recognised the plight of lonely, elderly people struggling to stay in their own homes. More importantly I wish to draw the Minister’s attention to the funding issues faced by those who enter the care homes system. Such problems may be the death-knell for many excellent care homes, including some of those run by the Abbeyfield Society.

9.51 am

Daniel Kawczynski (Shrewsbury and Atcham) (Con): I congratulate my hon. Friend the Member for St. Albans (Anne Main) on securing this important debate. I concur with her sentiment that we speak about nursing homes and care homes far too rarely in the House, so she has brought about an excellent opportunity.

I wish to make a couple of points that are pertinent to my constituency. There is tremendous pressureon care and nursing homes because of the debtat the Royal Shrewsbury hospital, which stands at£34 million. As a result, hard-hitting plans are being made to cut a significant number of beds at both major hospitals in Shropshire. As the representative of that area, I wonder to myself what impact that will have on nursing homes and their capacity to deal with extra people. Many of my constituents are concerned about what will happen to their elderly parents as hospitals are told, more and more, to have a quicker turnaround of patients, treat them more quickly and get them back out into society. That has a huge impact, as hospitals do a tremendous amount of work on improving people’s health, mental health and other attributes.

I am also concerned about the regulations and red tape that are being imposed on nursing homes. I recently went to the Uplands nursing home in Dorrington, a little village just south of Shrewsbury. I spoke to the lady who runs it, Mandy Thorn. She told me that the regulations and red tape that are being foisted on the home by the Government and the European Union mean that the costs are added to the fees. The elderly patients are forced to pay more because of the burden of regulations. While I was there, a new machine arrived. It is a huge, automated machine for cleaning bedpans and it cost more than £10,000. For years the home had had a very professional way of cleaning bedpans manually, and it has excellent star ratings, but the new regulation has forced it to abandon its practices and have an automated system costing an extra £10,000. Of course, Mrs. Thorn asked me, “Where is that extra money going to come from? It will come from extra charges to the people who are staying here.”

She also expressed great concern about the rise in national insurance contributions. For a small business such as the Uplands nursing home, any change to that contribution makes a big impact on the ability to retain staff. Mrs. Thorn said to me, as my hon. Friend has also said, that the work is done not for profit or with a view to making lots of money. The carers do it because they are unique, special people who are prepared to work for little money. Their mentality is that they want
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to work with people and help them. But at the end of the day, it is difficult to retain staff if someone can earn more by packing shelves at Tesco than by working in a nursing home. People such as Mrs. Thorn cannot afford to pay higher wages when the cost of national insurance contributions is going up.

As my hon. Friend mentioned, there should be a level playing field between private care homes and council-run homes. I will be fascinated to hear what the Government’s attitude is on that. Does the Minister believe that in future there should be more council-run and funded care homes, more private care homes or a mix of the two? He looks at me in a bewildered manner, but that is an important question. There is not a level playing field between private care homes and council care homes.

I also ask the Minister about funding for the institutions in question. Shropshire has an ageing population, and it is very rural. As the hon. Member for Ceredigion (Mark Williams), from Plaid Cymru, has said—

Mark Williams (Ceredigion) (LD): Liberal Democrat. Not Plaid.

Daniel Kawczynski: I beg your pardon. The Liberal Democrat Member said that there are costs for councils in caring for people across a rural area. What extra help are the Government considering giving to such rural areas as Shropshire to deal with that problem in an ageing population? There must surely be a Government strategy to examine areas of England with high concentrations of elderly people and an ageing population, and to give councils in those areas more money than others to deal with the problem.

Social care is means-tested, as my hon. Friend the Member for St. Albans stated. I feel strongly and passionately about the matter, and the only real party political point that I wish to make is that the Government are punishing those who have saved. People in Shropshire are not mega-wealthy.

Sandra Gidley (Romsey) (LD): I welcome the new-found indignation from members of the hon. Gentleman’s party and their view that means-testing is a bad thing. I agree with him, but will he at least acknowledge the fact that his party set the system in motion? Will there be a change of policy?

Daniel Kawczynski: The hon. Lady might be bewildered, as might the Minister. They always return to the same Labour-Liberal Democrat theory, “Well, the Tories did it more than 10 years ago.” I must inform the hon. Lady that we have not been in power for more than 10 years. Conservative Members of Parliament of my generation, who are in our 30s and barely remember the Thatcher Governments and others, have the right to set our own agenda for this generation of Conservatives. The hon. Lady cannot keep drawing us back to what happened in the ’70s and ’80s, much as she and the Minister would like to. We are discussing today, 2006, not what happened in 1996.

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I say to the hon. Gentleman that certain things are so structurally inherent to the
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ideological and philosophical system created by his Government that their importance is indisputable. The privatisation of large swathes of the residential and nursing sector was a deliberate philosophical and ideological policy of his party when in government. That is the market that exists in residential and nursing care. Means-testing was at the heart of the system that his Government created and set in stone. He cannot simply pretend that the social care system has been created by this Government; its architecture was actually put in place by the Government that he claims to distance himself from.

Daniel Kawczynski: I would never distance myself from any Conservative Government, as the Minister knows, but the Conservative party has not been in power for 10 years. The reality is that my constituents in Shropshire who have decided to save for their latter years are being penalised by having to pay for their care, whereas those who have not saved receive it for free.

Anne Main: I thank my hon. Friend for giving way, because we do not have very long in this debate. I hope that the Minister does not get sidetracked into debating what happened in 1976.

Mr. Lewis: It happened in the 1990s.

Anne Main: Or whichever date—we are not talking history; we are talking about what is happening for elderly people today. We are talking about why self-funders are perhaps subsidising social care beds within the same home. We need to ensure parity in terms of interpretation of the rules and fair funding for the provision of the social care beds that have been requested. We are not asking for subsidies via the back door from other people who have been prudent and saved. I do not want the Minister to escape from that issue.

Mr. Edward O'Hara (in the Chair): Order. The hon. Lady has already made a considerable contribution.

Daniel Kawczynski: I totally agree with my hon. Friend and I am grateful for her contribution.

I end by saying that care homes and nursing homes are excellent. I have visited many throughout my constituency, and they are clean and well run, with professional and caring staff. I should like to know whether the Minister will meet a delegation from care homes in Shropshire. He thinks that I am biased in some way against him and his Government—which I obviously am—but I would ask him to meet directly the people who provide care in Shropshire and Shrewsbury and to hear at first hand about some of the problems that nursing homes are experiencing and what the staff believe the Government can do to help them provide better care for the elderly in Shropshire in the future.

10.2 am

Peter Bottomley (Worthing, West) (Con): I congratulate my hon. Friend the Member for St. Albans (Anne Main) on introducing this debate. She has already declared my interest in that, in succession
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to Dame Gillian Wagner, my wife is the national president of the Abbeyfield Society. I first visited an Abbeyfield home 30 years ago, in my previous constituency of Woolwich, West—or Eltham, as it is now called. I am delighted that there are Abbeyfield homes in Worthing, West, as well as two in Ferring.

We should view this debate from the perspective of elderly people. They do not set out to live in an Abbeyfield home or a care home. They want to live and have choices. I pay tribute to the great number of people who manage to look after themselves, someone whom they love and live with, or their neighbours. That network of formal and informal relationships matters. That was brought back to me yesterday when I heard about the not unexpected death of my constituent George Philps; he died peacefully at home after 54 years of marriage. The love and support that George and Shirley gave to each other and to their great circle of friends, most of whom they were helping, is normal and natural.

One of the best tributes that can be paid to the Abbeyfield legacy—which will continue to bear dividends, if I can put it that way, albeit no doubt with some adaptations—is that it, too, is natural. I visit people whom I either do not know or knew in their own homes before they became Abbeyfield residents. Their relationships with their direct carers and the trustees who volunteer are also natural relationships.

We ought to see the Abbeyfield society homes in context. If I may be permitted to say a few words about the pattern in my constituency on the south coast, there are some places with dual registration, such as Princess Marina house, which is run by the Royal Air Force benevolent fund, and the St. Bridget’s home, which is one of the great Leonard Cheshire establishments for people with particular challenges. The way in which they face those challenges and overcome them is a living miracle. There are also places such as Rustington hall, which people can move into when they are fully able and which provides a spectrum of care. I pay tribute to the residents, staff and trustees there for carrying on making that investment, which is similar to what happens at Gifford house—the Queen Alexandra hospital home—where elderly people, mainly from the services, live a good, healthy and happy life, even though some of the physical challenges that they face are pretty significant.

So Abbeyfield homes do not operate alone, but are part of the continuum, although they provide more natural settings where the number of people living together is relatively small. They are truly homes, as I have seen going round as the driver during this 50th anniversary year.

Incidentally, I pay tribute to those who organised the cathedral services, which have been marvels to be part of, although I have not been able to go to as many as the golden hatter. The experience has been enjoyable, as was the theatrical performance in the west end of London one Sunday evening, when people came from all over the country to enjoy being together and to raise funds.

The challenges that the Government face are not new and they will not go away. The financial dispute and discussion can continue. I want to confine myself
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to one significant point. When I took a home in my current constituency, there was a man who lived two floors above me and who had helped us to spot the block. He told me, “By the way, I vote Liberal,” to which I replied, “Well, nobody’s perfect.” After about three weeks he told my wife that he was going to help me by voting Labour—in practice, if everyone in my constituency who wanted to vote Labour did so, they would probably drive the Liberals into third place, although that is a separate point. After six months he said that he was going to vote for me, although he would not necessarily vote Conservative. I explained to him that we accepted votes from those who are not political, as well from those who are. We asked why he had decided to vote for me, and he said that he had lived in that block of six flats for six years, but that he had spoken more with Virginia and me in the six months that we had been there than he had with all his other neighbours. Yet we are at Westminster much of the time.

It is that level of isolation that is the worry. It is the isolation of an elderly man with a white stick whom I saw late one winter night wandering around near the A27. I stopped to ask whether he was trying to cross that rather dangerous road and he said no, he was going for a walk, as he did every evening. He said that he wished that he was dead, so I said, “Tell me a bit more about it, if you like.” He told me that his wife had died four years ago, that he was looking after himself and that he really did not think that there was much point in going on. I asked him whether he had served in the forces. He said that he had, so I said, “Are you in touch with your local ex-service association?” He replied, “I don’t think that they’d want me to be with them, because I’m blind and I don’t find it easy to participate.”

It is that withholding of participation and that isolation, which my neighbour also felt, that we need to keep on recognising. It is all right being with those who are in society one way or another—those who go dancing, go to the luncheon clubs or are out and about, so to speak—and with those who still have somebody to care for them. One of the great advantages of the Abbeyfield Society system is that people will notice if somebody else is feeling under the weather or unwell, or if they do not turn up. It is that noticing of humanity that matters as much as the pound notes. It matters as much as the arguments over regulation or over who invented what system and what can be done to improve it.

Of course we must pay tribute to those who provide domiciliary care. Most of us will have experience of that in our extended families and networks of people who receive significant personal support in their own homes. However, in that continuity of provision and width of experience, having someone who notices whether a person is looking cheerful or miserable and who can interact with them can make a difference. My wife once shocked someone by saying to a group of widows and widowers, “I suppose the real thing about being left on your own is that there’s no one you can be rude to.” If one is rude to one’s neighbours, they will not necessarily make it up by supper. It is people sharing those feelings, saying them out loud and recognising that they can build a future together that matters.

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I pay tribute to my hon. Friend the Member forSt. Albans and particularly to the Abbeyfield Society people for the contributions that they have made that have touched the lives of so many people—not just residents, but those who are with them.

10.10 am

Sandra Gidley (Romsey) (LD): I congratulate the hon. Member for St. Albans (Anne Main) on securing this important debate. The fact that I shall probably disagree with her on a couple of things does not diminish my congratulations in any way; she has a real interest and commitment to the issues involved.

I am very honoured to have an Abbeyfield home in my constituency. I must admit that I have never thought of it as a care home, because it strikes me as more of a community. Most of the residents in Romsey Abbeyfield are mobile and do not require any sort of care, but have reached a stage in their lives of needing the company of others, which is provided by the communal nature of the home, and a little bit of looking after such as cooking and cleaning.

In some ways, the daily responsibilities of life are taken away from them, but the residents are all very active. They walk into town and engage with the community; they also provide the best cakes of any home in the constituency. I learned with great sadness that the home’s housekeeper, Pam, had died recently. She was much loved by all the residents in what is a real home from home. The residents are also not averse to getting out the sherry bottle when the local Member of Parliament visits, which is unusual in my experience.

The hon. Member for Worthing, West (Peter Bottomley) made an important point about isolation. My local Abbeyfield provides the company of others. Residents can go to their own rooms, but it is interesting how many of them prefer to interact and mingle in the communal areas. When we get older, choice is very important. I fully agree that the vast majority of older people do not want to go into any sort of home or institutional setting.

However, this debate is not about domiciliary care. Recent research by the Commission for Social Care Inspection—I say “recent”, but it is probably a year old by now—showed that, although the vast majority of older people wanted to stay at home, a significant number thought that a care home was the appropriate place to be at the end of their days. I worry sometimes that there seems to be a mantra that home is good and care home is bad; we need a range of provision for the range of needs out there.

I probably started visiting care homes regularly in about 1997; I was the town mayor and the habit has stuck. One of the things that I have found slightly depressing during those nine years is the significant deterioration that I have noticed in the health of people in care homes. People in care homes who were once fairly mobile now require a lot more personal care, and I would contend that some years ago people now in nursing homes would probably have been in a hospital setting. I do not think that such a setting is necessarily the right place, but there has been a significant shift.

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