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31 Oct 2006 : Column 19WH—continued
Surely that is what the Government have already done in their consultation that was launched on 19 June and is now closed.
We are entitled to ask what on earth is going on. Why is there this stasis? I am sure the Minister will deny it, but is it because everyone is waiting until Gordon gets the job? But will the Minister tell us at least, if not the hard-working NHS staff, when he expects the national framework to be published?
What assurance has the Minister for the House, the public and the councils on whose budgets the burden will fall that the national framework will not be used to raise the bar on eligibility for NHS continuing care? He owes all the participants and patients that assurance.
Finally, I want to draw the Minister’s attention to staffing issues faced by care homes. The first question, because the status issue is so important, is about the registration of domiciliary care workers. My concern is that Ministers are pressuring for registration to take place without recognising the moves forward that have been made in regulation since 1997. The Commission for Social Care Inspection already inspects agencies and homes that employ domiciliary care workers to ensure that they follow minimum standards and there are Criminal Records Bureau checks, referencing, face-to-face interviews and induction training. In addition we have the protection of vulnerable adults—POVA—list. Not only will the move increase bureaucracy in an already overburdened sector, but it will represent a cost that I fear will be passed on to the carer, who might only work a couple of days a week and can ill afford the cost. We must not resort to burdensome regulation, however much we agree that the status of social care workers must be raised. The money would be better spent on training and a recognition of the sector through greater professionalism.
I hope that the Minister says whether he will provide funds for registration of social care workers with the General Social Care Council. I hope that he will address those important and detailed issues as well as the overall strategy for funding.
10.40 am
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I begin by congratulating the hon. Member for St. Albans (Anne Main), not only on securing this debate but on how she presented her case. She spoke genuinely about the needs of older people and the responsibility that a civilised and decent society has to ensure that they have access to choice and quality, and on the whole she resisted making petty party political points.
The only problem, as the hon. Member for Eddisbury (Mr. O'Brien) said, is that although it is good to say incredibly nice, positive and caring things that would unite hon. Members on all sides of the House, some difficult and challenging debates are necessary on the future financing of the social care system, particularly in the context of changing demographics and the rising expectations of older people and their families. We all share the hon. Lady’s passion about our primary duty to ensure that older people receive the kind of dignity and independence that they have a right to expect. At the end of the day,
it is they who built this country; they have made a massive contribution to enabling this country to be as good and successful as it is. We therefore have a serious and solemn duty to ensure that, whatever our political views, we offer older people the kind of support network that they deserve.
I, too, pay tribute to the Abbeyfield Society; its 50th anniversary is a special moment. It is a special organisation given the ethos that underpins the way in which it seeks to offer support to older people. We sometimes pay tribute to organisations simply because they exist; rather, we should pay tribute to those that seek to provide high quality, dignified, responsive and personalised support, particularly for older people. I am happy to endorse Abbeyfield; it is an excellent example.
In my constituency, an organisation called Heathlands provides a similar range of residential and nursing care, with extra care support, for older people. One needs only to visit that establishment to experience a sense of quality, and of family and support. Onecan also sense that people can have autonomy, independence and dignity even in a care setting. Those are the challenges that we face.
I shall not reel off the list of resources that the Government have put in to extra care housing in recent years. It speaks for itself; it is on the record. A tremendous amount of money has been put in, not only by the Department of Health but through the Housing Corporation’s approved development programme, which is a major investment in the extra care housing agenda. We are proud of the work that we have done to reflect the changing needs of older people and changing expectations; the care that we should offer people at the beginning of the 21st century will be very different from what we were offering 10, 15 or perhaps 20 years ago.
I turn to what was said by the hon. Member for Eddisbury—the fun part of the debate, in which we need to talk politics. The rewriting of history on his fantasy island cannot be allowed to stand. I do not disagree with all that the Conservative Government did; in fact, much of the community care legislation that followed the Griffiths report is to be applauded. It said that our modern society needs to recognise that an increasing number of older people will want to stay in their own homes—that they will want to be supported within the community rather than remaining in some form of residential care. That legislation was incredibly important in shifting the balance and in moving resources.
At the heart of that community care legislation was the requirement to assess people before it was determined that they should go into residential care. Basing those assessments on need was an important step forward; if we are honest, in all sorts of cases older people were being put in inappropriate settings because that was what relatives or professionals had decided for them. I welcome many of the principles that underpin the community care changes brought in by the Conservative Government in the early 1990s.
However, we should not forget some of the market realities that were imposed at the same time. One was the requirement that local authorities should spend
between 75 and 80 per cent. of their resources specifically in the independent sector. Why did the Tory Government insist on that? They did it to support their political backers in the private residential and nursing home sector, to ensure that their businesses would not only continue but would take over a greater share of the market.
Anne Main: Where is the evidence?
Mr. Lewis: I shall provide detailed evidence.
The Tory Government created an uneven playing field, so it became financially unviable for most local authorities to continue being in-house providers of residential care to older people. Some local authorities retained an element of in-house provision, which was important as it let them keep some control over market forces. In many other areas, however, we saw the wholesale privatisation of the residential care sector; it was the result of the uneven playing field that the Tory Government deliberately created to support their friends and political supporters in the private residential care sector.
The hon. Member for Castle Point (Bob Spink) raised that question, but he ought to reflect on why we saw the massive privatisation of that market—whether for good or for bad. I have never been ideological about it; I have seen many privately run nursing and residential homes that provide excellent quality care. It is not an ideological statement, but we must not be dishonest about the history of how that market developed.
Anne Main: Mine is a brief intervention, because I want some answers from the Minister. The Verulam House nursing home in St. Albans would love to provide national health nursing home bed care, but it is not allowed to do so because the national health service has bought beds out of the constituency. The private system is complementary. It is not a fight. We can have both systems working together. All we ask is that we have a level playing field on funding.
Mr. Lewis: I agree entirely. We should not be ideological about it, just because a home is in the private sector; many of them provide excellent quality care. My point is that the market was deliberately distorted in the 1990s. As a result, many local authorities could not continue to provide direct residential care; they had no choice but to put it out to the private sector. That was an ideologically driven policy; it was not about the needs of older people. To some extent, the market today reflects that direction of travel. It would be disingenuous of me not to acknowledge that in a debate about the range of providers of residential care.
Bob Spink: The point I was making is that today will be a wasted opportunity if the Minister gets bogged down in backward-looking ideological arguments about ownership—whether private or public. That is not what today’s debate is about. It is about the quality of care and quality of life for elderly residents in care homes, and how we fund it.
Mr. Lewis:
The hon. Gentleman himself raised the matter of the transfer of staff to the private sector and
the protection of their rights. Let us not pretend that I introduced the subject. We cannot consider the nature of the social care market without considering what has happened.
The hon. Member for Eddisbury made a series of political points, and I am entitled to respond to them. The Conservative party presided over and developed a means-tested system and it does not propose changing it. The Tory Government slashed local authority funding. I, as a local Member, spent year after year presiding over damage limitation to deal with those cuts. The Conservative party has given no commitment on additional funding for social care. Indeed, if one considers its rhetoric on tax cuts and the new economic test, billions of pounds less will be available for public services. [Interruption.] As a Minister, I am entitled to raise the dividing lines and the realities of what political parties are saying, and what they are doing and are willing to do, in terms of the care of older people in our society.
On staffing issues, the hon. Member for Eddisbury raised questions about the registration of the wider work force. That says a lot about how he regards the status of some of the people who work in social care.
The hon. Member for Romsey (Sandra Gidley) made a number of very important points. She said that it should not be a choice between staying at home or going into residential care and that we need more choice so that older people have access to a range of provisions. I entirely agree. However, we also have to be honest with the sector and with society. We have moved towards a system where more older people are supported and make the choice to remain in their homes or in a community setting, and as my generation makes that choice, more and more people will want to remain in their homes or in a community setting, which has major implications for the future role of care homes. It does not mean that there will not be a need for care homes—there will always be a need for high quality care homes—but to pretend that the move towards people staying in their own homes for longer periods does not have a significant impact on the residential care market is dishonest. We have to work with residential homes and with the sector to consider what its role will be in the future and in this new world where more and more people will want to remain in their own homes.
Regarding the Derek Wanless report, I say to the hon. Lady that it was not a Government report; it was an independent report and one that I highly respect and welcome—an excellent piece of work by Sir Derek. He rejected the notion of free care and Scottish authorities, as has been said in this debate, are finding it increasingly difficult to sustain the funding model. Most revealingly of all in this debate, the hon. Lady said that, although it is no longer the policy because it is being reviewed, she regrets that her party misled the electorate at the last election by the way that it wrote its manifesto on the question of personal care.
Frankly, I have never heard such an admission in this Chamber involving a Front-Bench spokesperson who, on such a sensitive and emotive issue, acknowledges that at the last election, her party set out to mislead the British people on this issue. I say to the hon. Lady that we will look at their next manifesto with great interest in terms of whether we ought to believe it or not when
the Liberal Democrat Front-Bench team can undermine it and make it clear that people were misled.
The hon. Lady raised the question of the requirement for people to sell their own homes. Actually, this Government have introduced a change to deferred liability that means that no older person has to sell their home to move into care. That was something that the previous Government resisted over many years.
The hon. Members for Eddisbury and for Romsey raised the issue of the national guidance on continuing care. We have conducted a consultation on that and after analysing the responses we have had, will in the near future publish that national guidance.
The hon. Member for Worthing, West (Peter Bottomley)—if he is not right honourable I am sure the new, cuddly, friendly leadership will put it right—made some very sensible points. He drew attention to the role of carers who do a tremendous job in society by looking after the people they love; partners, parents, friends, family members and neighbours. There are millions of carers and as a society we started to realise the need for legislation in the early 1990s, but this Government has moved that forward by recognising the distinct emotional and practical needs of carers as oppose to the people they care for. A lot of progress has been made and we pay tribute to the role of carers.
I say to the hon. Gentleman that our thoughts across the political divide are with the family of George Philps—he was clearly a remarkable man and to be raised in a parliamentary debate he must have had a massive impact on the hon. Gentleman’s experience. We pay tribute to him and our thoughts are with his family. The hon. Gentleman raised the question of isolation and loneliness, as did the hon. Member for Romsey and other hon. Members. I have a strong view on that. The words “independence” and“autonomy” are consistently used in debates on social care, but the word “interdependence” is rarely used. Everybody here is interdependent on their friends, neighbours or family and on contact with each other. In a debate about the future of social care we also need to have regard to the question of interdependence and the dependence that we have on other people. The hon. Gentleman makes a valid point that that is important as well as stressing independence.
The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) made a number of points, particularly on decisions by the NHS to reduce beds and the knock-on effect that has on community services and social care in local authorities. The national health service should not be doing that willy-nilly; it should be consulting and engaging with local authorities before making those decisions and where it is not doing so, it should put that right. It is not for Government to interfere in local decisions made by the national health service to meet the needs of the local health and social care economies, but it is right to put it on record that the NHS should properly engage with and consult local authorities when decisions are made that will have an impact on social care.
The hon. Gentleman also raised the issue of regulation and red tape. The Conservative party has too often taken a blanket negative approach towards the concept of regulation, as though all regulation is bad. Regulation has raised standards and improved quality. It is important to recognise that where there are
unintended consequences of bad regulation, we do something about it. If specific examples of that can be brought to my attention, I am more than happy to raise those directly with the regulator and to investigate whether there is something we can do to change it. However, we should be honest about the benefits that regulation has brought to protecting vulnerable people, raising standards and improving quality in many of our care establishments. The regulatory regime has played an incredibly important part in that.
Mr. O'Brien: Is the Minister saying that the series of four actions that the Government have already taken in seeking to protect vulnerable people are not adequate and that is why we need further registration?
Mr. Lewis: I am not saying that at all—it is part of the process. The hon. Gentleman asked about the registration of the wider social care work force and we are considering that whole issue. It seems that the hon. Gentleman talked about status and I have made specific announcements about what we intend to do to raise the status of social care and those who work in it. Looking at the wider work force, if we say they should be consigned to a second-rate status, that does not give out the right messages in terms of social care.
The hon. Member for Shrewsbury and Atcham fell into the usual trap. He complained about the increases in national insurance and the impact that had on providers of residential care. The increase in national insurance went directly to pay for the massive extra investment that this Government have made in the national health service. We accuse the Conservatives of opposing that and they do not like it. The hon. Gentleman is now moaning that we have put national insurance up so we can massively expand the national health service.
We all aspire towards a system for older people that has personalisation, dignity and independence at the heart of it. There will be an enhanced role for individual budgets as we transfer more power and control from providers to individuals and their families. There are also major challenges, as the Wanless report identified, such as demographics and rising public expectations. We have to address those issues as we seek to create a social system and a system of care for older people that is fit for purpose in the 21st-century. This Government intend to address that massive public challenge.
Reading Recovery Programme
11 am
Mr. Graham Allen (Nottingham, North) (Lab): In my city of Nottingham last year, nearly one in eight 11-year-olds were unable to read the first lesson at secondary school. That is one of the main causes of educational underachievement, exclusions, low attainment, truancy and poor results, yet that social blindness is a wholly preventable disease. The consequences go far wider than education. It may lead to a lifetime of massively expensive antisocial behaviour, ill health, poor skills and job prospects and drug abuse.
I refer hon. Members to the work of Heckman, the Nobel-prize-winning economist, done for the Scottish Executive on the economic return on investment in education at different ages in a child’s life. He shows very clearly that the earlier we invest, the more we get for our money. I am happy to supply hon. Members with more details of that work if necessary.
One study found that a quarter to a third of 10-year-olds who exhibited antisocial behaviour had a specific reading difficulty. Forty-eight per cent. of the prison population read poorly. Twenty-five per cent. of juveniles in custody have a reading age below that of the average seven-year-old, and so on. We are talking about needlessly broken and wasted lives, but the answers cannot be found through educational remedies alone. Incidentally, I welcome the fact that colleagues from all parties are here today. I intend this to be a wholly non-partisan debate; the subject is too serious for point scoring. I am delighted to see those colleagues and I hope that they will chip in to the debate.
The broader causes of the problem have to be addressed by much more effective long-term social policy, focusing on prevention, pre-emption and early intervention. In fact, that is the motto of my local strategic partnership. All the local experts in Nottingham agree. Professor Colin Harrison, who is professor of literacy studies at Nottingham university, states:
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