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31 Oct 2006 : Column 13WH—continued

Funding has been touched on in this debate. The hon. Member for St. Albans raised the problems with supported sheltered housing, so I shall not repeat them,
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although I fully agree with her. The issue of top-ups is very fraught. Some people are happy to make a choice, so that they go to a local home or one that has the ethos that they prefer. In our multicultural society, it is interesting to see that homes are run by various different faith groups. That is important, because care staff who are not aware of cultural differences can upset or offend older people; such awareness, particularly in areas with less diversity, is not as great as it could be.

There inevitably comes a stage in any person’s or couple’s journey at which there is simply no money left to carry on providing top-ups, and decisions about what will be funded have to be made. Almost invariably, especially in constituencies such as mine, in the south—and, I suspect, those of many hon. Members here today—the cost of nursing homes is much higher than the local authority grants. As has been stated, the individuals themselves are not allowed to top up, although they may have savings and wish to do that.

There are other problems when the threshold at which a person becomes eligible for local authority funding is reached. The individual in the care home may have to move, but the funding also impacts if there is a married partner who does not have an individual pension; a fairly modest house can have substantial outgoings these days. Recently, I have come across a worrying number of people whose partner is in a care home and who simply do not know how they will survive financially. On occasions, we are not good at taking the whole picture into account. However much people in such situations are reassured that they are not going to lose their homes, for those who have always paid their debts and been used to paying their own way, their predicament is very real. That is greatly underestimated.

In the past couple of elections, Liberal Democrats stood on a manifesto of free personal care for the elderly, following the recommendation of the Sutherland commission. The commission made many recommendations. To their credit, the Government acknowledged and honoured most of them, but they ignored the one that I have mentioned, claiming that money was put into the system in other ways and more people were being funded under their system. I am not sure how that works out, because I have not noticed it happening.

In nursing homes, a lot of people have conditions, such as Alzheimer’s, that most regard as health-based. Such people are often doubly incontinent and cannot look after themselves in any shape or form, yet they are described as requiring personal rather than nursing care. People in that situation are often forced into a battle to secure continuing care funding under the NHS programme. To be honest, most people do not have the energy or strength, or an advocate, to fight that battle for them. As has been said, one of the problems is that each local authority has drawn up different criteria. Anybody looking at those criteria would probably be shocked, because they are very subjective. It is very easy to put somebody into a personal care category and deny that they have a health need. I gather that the Government were aware of the problem and that meetings have taken place about
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producing national guidelines. It would be helpful if the Minister updated us on that.

Staffing has been mentioned. The tone was that some staff attracted to work in care homes were of low quality. I am fairly sure that that was not the intention, but I agree that working in a care home has low status. Somebody probably has more kudos in the community if they look after pets in the local veterinary surgery than if they look after older people. It is damning of our society that we do not value or fund roles in care homes. The point that the local authority contribution is so low that it is difficult to fund the staff, provide adequate training and jump through all the other hoops to meet the standards was well made.

Mr. Lewis: May I seek clarification from the hon. Lady? I am not clear about whether it is still Liberal Democrat policy to offer free care. It was at the last two general elections, but is it still her party’s policy?

Sandra Gidley: The Conservative back-out is, “We are reviewing policy,” and that is true in this case for my party, which has a health policy working group. The early signs are that we are committed to keeping the policy, but we are doing more work before we finally announce it. We introduced it in Scotland, where we are in a joint Administration with Labour, and it has worked well. It costs slightly more than anticipated, so we are redoing our sums, as any responsible party would. I hope that the Minister will concede that the policy has been well received and is popular in Scotland.

Peter Bottomley: As we are alluding to Scotland, is it true that the waiting list for assessment and admission to a home where one can get free care is up to two years?

Sandra Gidley: As health care in Scotland is a devolved matter, I am not fully familiar with all the details of what is happening there, but I will find out, as that would be useful information. We are revisiting the Scotland experience to try to iron out some of the problems before we introduce our new policy, and I do not believe that hon. Members would expect us to do anything else.

I was discussing funding. The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) claimed that areas with a high number of older people do not receive adequate funding, and I agree entirely. At the Health Committee a couple of weeks ago, we heard evidence from some academics—they have the time to investigate such matters—that age is not fully taken into account in the funding formula, and areas with a high proportion of older people but relatively low deprivation do not receive a fair amount compared with areas with a relatively young population but more deprivation. I cannot predict what the Select Committee will recommend, but the evidence that we took was persuasive, and I hazard a guess that it will make a strong recommendation on that.

A problematic aspect of care homes that has not been mentioned is managing medication. It is part of
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the national minimum standards, but the Commission for Social Care Inspection stated this year:

In fact, there is a lack of joined-up thinking. The national service framework for older people states that patients over 75 years old taking four or more medicines should have a medication review every six months, and patients on fewer than four medicines should have a review at least once year. There was a chance to enshrine that in the GP contract and ensure that GPs had quality and outcomes framework points for providing the service, but the standard in the contract is different from the standard in the NSF. It would be helpful if the Minister explained why, as I have never managed to obtain an adequate answer on the subject. Is the long-term aim to move to standards that are the same in the NSF and the GPs’ contract, and, if not, why not?

The other aspect of the problem is that pharmacists in the community are now paid for performing medicine use reviews. If medicines management is so poor in care homes, surely there is an opportunity for joining up the two so that medication in care homes is better managed.

Some people could be taking a considerable number of medicines. A survey conducted in 2002 by the Parkinson’s Disease Society showed that, on average, people with Parkinson’s disease took at least five different medicines a day, and some were prescribed 15 or more to be taken three or four times a day. It is difficult for people to keep track of them, and there are bound to be interactions when so many medicines are being taken. I hope that the Minister takes the matter seriously.

I shall draw my remarks to a close. I look forward to hearing the hon. Member for Eddisbury (Mr. O'Brien) explain how the Conservatives will fund their new-found concern about means testing and how their manifesto might change at the next election.

10.26 am

Mr. Stephen O'Brien (Eddisbury) (Con): I beginby congratulating my hon. Friend the Member forSt. Albans (Anne Main) on securing this important and timely debate, and on her outstanding opening speech. It set the tone for what has been an important and good debate. Her comments on the Abbeyfield Society and its care homes were right, and I wish to associate myself and the official Opposition with her remarks. The society’s golden jubilee year has been a wonderful year of celebration, and it was an inspiration to us all to hear how Richard Carr-Gomm had such a driving motivation to care for others and to put others before himself. That is wonderful, particularly in this day and age. My hon. Friend the Member for Worthing, West (Peter Bottomley) highlighted that with the advantages of modern society, it is often easy to overlook the pressures that come of isolation and loneliness.

I have many close family members who have been involved in the sector for many years. Independence, security, dignity and companionship are the four pillars
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upon which we should seek to build policy for our older people. We must be sensitive in those areas on the basis that our society is ageing, and we will have many more people growing into their older years who have a variable set of needs and opportunities.

I know the Abbeyfield well, more particularly in the Lake district through close family connections. It does an outstanding job. I am familiar with its connections in Cheshire, although not in my constituency.

I also take this opportunity to congratulate ny hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on his interesting contribution and on his dedication to the sector. We are discussing people who are at one end of the life spectrum, but he and his wife have recently become the parents of a new baby girl, Alexis. I am sure that the House will join me in congratulating him.

I was also touched by the remarks of my hon. Friend the Member for Worthing, West about the lifetime dedication of George Philps, his constituent who recently passed away. His experience demonstrates what I believe we all aspire to: lifelong companionship and mutual dependence.

In her opening speech, my hon. Friend the Member for St. Albans set the scene well, and now it is incumbent on us to get to the nub of the issue, which is funding—the harder, grungier issue that is always more difficult to discuss than the easier, softer issues—but that is where this debate lies. Whatever the Minister may think about the funding of long-term care, it is clear that the Government have dodged the issue for the 10 years that they have been in office. The Minister and his colleagues have had 10 years to deal with the problem but, despite so obviously and violently despising everything that took place under a previous Government 15 to 20 years ago, it has taken 10 years for him simply to refer to the fact that he does not like what took place all that time ago.

We know that the Prime Minister, just before the 1997 election, bemoaned the fact that people had to sell their homes to fund their long-term care, yet we have not seen any policies brought forward by Government to combat that continuing pressure and problem.

At the last election—it was interesting that the spokesperson for the Liberal Democrats, the hon. Member for Romsey (Sandra Gidley), alluded to this—the Conservative party offered a substantive policy on long-term care funding—the so-called limited liability model. That is something that we are now reviewing carefully and that we were pleased to offer. It is a possibility; I do not know the outcome yet and it would be wrong of me to prejudge it, but we are certainly considering whether the model needs tweaking to move it more to a partnership model, which is now advocated. The Government commissioned Sir Derek Wanless’s admirable report, and we look forward to their response. So far, their response has been to commission another zero-based review.

Interestingly, the Liberal Democrats proposed free personal care, as was confirmed by the hon. Lady. That is of course a policy that hides the reality, which I think is admitted, that an individual still bears the “hotel costs” of accommodation and food. The Government were even more brazen in their manifesto, merely crafting the words that they would

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It has never been disputed that health care in the NHS will remain free under either party in government. The phrase simply begs the question of what on earth they were thinking of that might have been the alternative. Maybe the Minister has an answer to that, but it seemed to me to be a particular non-promise.

Sandra Gidley: Will the hon. Gentleman give way?

Mr. O'Brien: Given the time constraints and the fact that I have not quite finished with the Liberal Democrats anyway, perhaps the hon. Lady would like to wait.

The key is that the manifesto commitments failed to address all the issues of the hotel and social care costs linked to long-term care. We need that sort of understanding.

It has been reported to me, although the hon. Lady might want to suggest that it is a misquote, that at the last Liberal Democrat conference—amazingly, I was not there—the hon. Lady called her party’s policy of free personal care “dishonest”, because people thought that their accommodation costs would also be paid for, which is certainly not the case. In many parts of Scotland, despite the policy as it stands, many local authorities and local NHS organisations have not funded the promise and that is not happening for many elderly and vulnerable people in Scotland. In the coalition in the Scottish Executive, both the Labour party and the Liberal Democrats are increasingly embarrassed and say little about that policy. I hope that the Minister will deal with that and the hon. Lady will do so, too.

Sandra Gidley: The hon. Gentleman has quoted me correctly. I think that we should have been more open about what our policy did. That is how I prefer to do things; it is not how the people who wrote the manifesto try to do things. Will he accept that with the constant battle between health and social care funding, there has been an insidious creep to push funding into social care? It is not clear that the NHS funds that have been diminished have been transferred to the social care budget accordingly.

Mr. O'Brien: I am grateful to have had that exchange, and we now have on the record what I had heard only as a report.

I shall now move on to the health and social care divide. We are far from solving the problem of the division between free at the point of need health care and means-tested social care. As far back as 1998 predecessors of the current Health Ministers talked about the demolition of what they called the Berlin wall that blocks co-operation and encourages turf wars over the treatment of thousands of vulnerable people. The former Health Secretary, the right hon. Member for wherever it is—somewhere in the north-east—

Mr. Lewis: Darlington.

Mr. O'Brien: Thank you. The right hon. Member for Darlington (Mr. Milburn) said:

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It took until 2005 for the hon. Member for Birmingham, Hodge Hill (Mr. Byrne) to announce a joint White Paper designed to deliver integrated health and social care systems, which was merged with the health White Paper to produce “Our Health, Our Care, Our Say”, which contains a paucity of any measures on closing the gap between health and social care funding. As importantly, the initiatives that it does suggest are under threat because of massive NHS deficits. We heard the example of the Royal Shrewsbury hospital.

The temptation to shift costs on to local authorities has been too hard to resist for many PCTs. The County Councils Network, in its response to the White Paper on health and social care, said that

We had, of course, the well-reported story of the NHS’s removing £3 million of Wiltshire county council’s income one day before this financial year started. Those issues are incredibly important and need to be addressed because the budgetary pressures are now having a major distorting effect on the debate about the overall strategy of funding for long-term care.

We also have the issue of continuing care funding. In its response to the health and social care White Paper, the County Councils Network said that concerns about PCT cost shifting

Last week the Government sent to strategic health authorities a document entitled “NHS Continuing Healthcare: Transitional Arrangements Following NHS Reorganisation and Pending National Framework Implementation”. Paragraph 20 states that

That is truly bizarre. The Department of Health is putting together the national framework, and so only it knows what the likelihood and time scale will be. The paragraph goes on to state:

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