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Residential Care (Public Funding)

2.30 pm

Daniel Kawczynski (Shrewsbury and Atcham) (Con): It is pleasure to speak in the debate with you in the Chair, Mr. Cummings. I want to raise the issue of Government funding for residential and nursing care because many of my constituents have recently come to see me about it and to voice their concerns. In addition, the Sunday Express has pursued a major campaign, entitled the “Justice for our Elderly” crusade, which I applaud. I hope that it will follow today’s deliberations.

The Express has identified the fact that 70,000 vulnerable people in our country have had to pay for nursing care. A major report, the Wanless report, estimates that £29.5 billion will need to be spent on our ageing society by 2026. That is why the debate is of such interest when we think of the money that will have to be spent on that vital issue over the coming years.

The Government watchdog, the Commission for Social Care Inspection, has warned of a crisis looming for elderly and disabled people. In a damning report, it highlighted how local authorities are cutting back on services for vulnerable older people. That follows similar findings from other influential bodies that include the Government’s health think-tank, the King’s Fund, and the independent charity the Joseph Rowntree Housing Trust.

Age Concern says that it has dealt with increasing numbers of cases in which elderly people have been reassessed as no longer needing care because the local authority eligibility criteria have been tightened to meet only the highest needs. The director general of Age Concern said:

That brings me to an important issue for my constituents, which is means-testing. Any constituent who has more than £20,000 must now pay for nursing and residential care. I find that an absolute scandal in a country that is the fourth wealthiest in the world, with the fourth largest economy. We are always hearing from the Government about the great economic achievements under the Chancellor of the Exchequer and about the so-called advances, yet my constituents have to pay for care. That is an outrage and another Labour stealth tax for those who are unfortunate enough to have relatives who need long-term care.

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Can we be clear for the purposes of the record and the Sunday Express? Income-contingent payments and means-testing have been in place since the social care system was introduced in the late 1940s. When the Conservative Government were in power, social care was provided to citizens on a means-tested basis. Is he now advocating that the state fund social care to 100 per cent. and abolish means-testing?

Daniel Kawczynski: If the Minister is happy for us to be in relatively the same position as we were in the 1940s and as we were 20 years ago, I regret that.


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Mr. Lewis: Is that your position?

Daniel Kawczynski: As a Back Bencher, I can say what I like. I believe that £20,000 is a paltry figure. The Government should strive, if at all possible, to increase that threshold. In Shropshire, many people have more than £20,000 simply because of the huge increase in the value of homes.

Mr. Lewis: So, the hon. Gentleman’s case is that he acknowledges that, as well as a contribution from the state, there will always need to be a contribution from the individual and that under his party the means-testing system would always continue, but that the problem is with the threshold. The campaign is somewhat ambiguous about whether it advocates no charges for citizens. Is he saying that he is after changes in threshold or the abolition of means-testing—

John Cummings (in the Chair): Order. Interventions, by their nature, should be brief.

Daniel Kawczynski: I am being generous to the Minister in giving way—

Mr. Stephen O'Brien (Eddisbury) (Con): Don’t.

Daniel Kawczynski: Don’t indeed. It is slightly unfair of the Minister to pose that question. I am merely a Back-Bench Conservative MP and it is not my responsibility to make the policies up. However, it is my responsibility as a constituency MP to draw out my constituents’ concerns to the Minister and to try to tease out what his policies are and how he will strive to increase the threshold if possible, given the fiscal situation.

Mervyn Kohler of Help the Aged said:

Those words are not mine, but those of a senior director of Help the Aged. I hope that the Minister takes them on board.

I come back to the Minister’s earlier point. I feel that after 10 years of socialism in our country— [Laughter.] It is debateable whether it is real socialism, but I still think of it as socialism. After 10 years of socialism, the elderly should be doing far better than they are. Let me give the Minister another example of my concern.

When the Prime Minister was elected, he said that the priorities of the Labour Government would be “education, education, education”. That is a worrying slogan. It is wonderful theatre and great for getting votes, but how is it possible for a Government to prioritise education over and above the vulnerable elderly and those who need long-term residential and nursing care? The Labour slogans “education, education, education” and “24 hours to save the NHS” took away some of the focus that is so vital in protecting the most vulnerable people who need long-term residential care.

The director of the Wanless report, who used to work for NatWest bank—a senior economist—stated that to provide better care in nursing and residential homes the Government need to come up with an extra £1.7 billion
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a year. That is the figure necessary significantly to improve and sustain better care in nursing and residential settings. So far, the Government have spent more than £5 billion on the war in Iraq, an illegal war that I opposed and will continue to oppose—

Mr. Lewis: That your party supported.

Daniel Kawczynski: It is no good the Minister shouting at me. I was vehemently opposed to the war in Iraq and made numerous statements about it in my local paper, the Shrewsbury Chronicle. It is a disgrace for a socialist Government to waste £5 billion of taxpayers’ money when my constituents and their relatives are being robbed of their life savings purely to pay for something that should be free on the national health service and should be provided for by the Government.

I turn to the specifics in my constituency of Shrewsbury and Atcham. I hope that the Minister will take note of these points because I want him to remember the problems that we have. The number of people over 74 years of age in my constituency has increased by 27.4 per cent. since 1991. That is a staggering increase.

Shropshire is such a beautiful county, so many elderly people from around England go there to retire. The county therefore has a large population of senior citizens. On top of that, the increase in the number of people over the age of 74 is running at a faster rate in Shropshire than in most other counties of England. Shropshire county council has to grapple with that huge problem. I shall be interested to hear the Minister’s comments on what funding the county council receives in that respect—he doubtless has the figures to hand—but I fear that it is far too little to deal with the problem, given the growth in the number of elderly people in the county needing care. I will highlight some specific examples later.

In preparation for the debate, I met four experts from Shrewsbury who run nursing and residential homes. Mrs. Mandy Thorn, a constituent of mine, operates the Uplands nursing home in Dorrington, a little village just south of Shrewsbury. If the Minister has time, I suggest that he engage in correspondence with Mrs. Thorn, Shropshire’s leading light on nursing and residential care. She is an eminent lady from whom the county council and many others seek advice as she is so involved in running various nursing homes. He would do well to speak to her. I use her as my intellectual stable mate on such matters, and I believe that he could learn a thing or two from her.

Shropshire county council is doing well—of course it is; the county is Conservative controlled—but I praise the council and particularly its chief executive, Mrs. Carolyn Downes, and her team. The community services directorate of Shropshire county council has a three-star rating for its adult social services. Despite the lack of Government funding, it does the best it can to ensure that long-term residential and nursing care are properly fulfilled in the county. However, Government funding is insufficient to provide an equitable service in rural areas. Those are not my comments; they are the words of the men and women who run the residential and nursing homes. If the Minister continues to laugh at such points, as he has already, he will be laughing, or even smirking, at those eminent Shropshire people.


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Huge costs are involved in providing care in people’s homes in rural counties such as Shropshire. I was told today by the head of the community services directorate that, in certain cases, the cost of travel to small villages in my constituency such as Snailbeach or Halfway House near the Welsh border is more than the cost of care. Yet the Government, in their great financial models, never take account of the fact that Shropshire is one such rural community, nor of the huge extra costs involved in providing care to the vulnerable in remote villages.

That will obviously be a matter of great concern to the Minister. What do the Government intend to do to help rural areas? Together with an increasing number of frail elderly people, the additional costs incurred in delivering home care services in rural areas is one of the main problems faced by Shropshire.

I am sorry to be party political, but I feel passionate about the matter. Shropshire receives the lowest funding in the country for the police, we are at the bottom of the table for educational provision, and now we are at the bottom of the table for care for the elderly. That smacks of yet another Government policy, which is that the socialists look after their own in the urban areas and in the Labour heartlands, rather than being fair to people in Shropshire and the other rural areas that happen to be represented by the Conservative party.

The increasing costs of service provision have to be passed on to the end user. Those cost pressures include employment costs—we all know how much more expensive it is to employ people—and the huge amount of bureaucracy and regulation emerging from the Government and the European Union. I saw one example of that bureaucracy when I visited the Uplands nursing home. Mrs. Mandy Thorn told me that bedpans have always been washed manually. The home has among the highest health standards in Shropshire, yet the Government have imposed another regulation. The staff are not allowed to wash the bedpans manually, but have to have a special machine to do it—it looks like a dishwasher—at a cost of £7,000. Mrs. Thorn had to buy two machines. That £14,000 goes straight on to the costs of providing care, so either the county council or the relatives of those at the homes will have to stump up the difference.

There is a huge shortage of workers in rural areas, and people such as Mrs. Thorn spend an enormous amount of time trying to find people who can do that work. Better trained and qualified staff obviously require additional pay and better conditions. It is right to have better training. However, it requires additional funds, and the owners of nursing care homes believe that the Government are not taking that into consideration. Although the Government are introducing greater holiday and pension entitlements for those who work in nursing homes—I obviously applaud that—they are not providing the county councils with extra funding to match those increased entitlements.

We are seeing increased fuel costs for home care services, and some of the increases are eye-watering, yet the homes have to take them on board. Inflation stands today at 3 per cent.—a worryingly high figure that will put more pressure on balancing the books. We know also that interest rates are rising. That will contribute to the difficulties faced by people such as Mandy Thorn. Increased inflation and higher interest rates, with more red tape and bureaucracy, will make it more difficult to provide such care.


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I turn to some of the solutions that Mrs. Thorn and her colleagues have suggested. They believe that the funding for adult social care services should be ring-fenced. I would like the Minister to consider that. Why not ring-fence that funding to ensure that county councils cannot use it for any other purpose? Residential care is of such importance to the future of our country that Government funding for such provision should be ring-fenced, and county councils should not be able to dip into it to provide other services. Increased funding for out-of-hospital services, too, should go to local authorities.

I turn to the most important point—one that I am particularly keen for the Minister to answer. Mrs. Thorn told me that we need to increase the registered nursing care contribution in line with inflation and backdate it from October 2006, because the last time that that vital funding mechanism was updated was October 2005. Why has the registered nursing care contribution not been increased? Since October 2005, we have had an inflationary increase in costs of at least 3 per cent., huge increases in energy costs and other cost rises. The fact that the registered nursing care contribution has not increased since October 2005 is a scandal and the issue that Mrs. Thorn and her colleagues believe is putting the greatest strain on providing nursing and residential care in Shropshire.

Mrs. Thorn and I believe that we need properly to fund the additional costs of providing domiciliary care in rural areas—I have alluded to that already. Without proper domiciliary care and the other aspects I have spoken about, the NHS will be on its knees in a matter of days. The work done in residential care homes and nursing homes relieves the NHS of an incredible amount of responsibility and work. However, at the same time, the Royal Shrewsbury hospital is £34 million in debt and there is a major restructuring taking place. There are huge potential cuts to services and the Government do not want to have cancer specialists in Shropshire; they want people to go to Wolverhampton and Stoke. The Government are moving away the services that the elderly desperately need because they do not believe that Shropshire, with a population of 500,000, deserves to have those services and that people should go to Stoke, Wolverhampton or beyond.

There are huge pressures in relation to the lack of financing of residential care homes. I have a document that I will give to the Minister at the end of the debate and that I will be making public. The document describes a model that is roughly based on a 95 per cent. occupancy for a residential home and a nursing home. People in my constituency have produced calculations based on all sorts of expenses: wages, uniforms, food, laundry, medical supplies, bed linen replacement, training, patient activities, electricity, water, water disposal, insurance, council tax, repairs and maintenance, hire and leasing, professional fees, and subscriptions. When all those factors are taken into account, it costs approximately £400.30 to provide one individual in Shropshire with care in a residential home. Yet, at the moment, care homes receive a maximum of £292.15. That is a huge difference.

A residential care home provides a marvellous service, but receives £292 when the actual cost is £400. That is a critical situation and the people involved are
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in a crisis that can only get worse. However, and this is an extremely important point, those people have said to me, “What can we do? We cannot throw the person out.” Can hon. Members imagine the scandal that would be caused by a residential home throwing somebody out? Such a scandal would reverberate around the country. Therefore, care homes are over a barrel. I would like the Minister’s interpretation of how Uplands nursing home can continue to provide a vital service when there is such a huge funding gap.

Lastly, the figure for providing nursing services for a nursing home is £504.62. The maximum that may be received from Shropshire county council is £455.48, which is yet another huge difference. In all candour, I say to the Minister that there is a crisis looming, and I hope he realises that. I would be grateful if he showed some semblance of awareness of the impending crisis that is building up in this area. Can he explain how my nursing and residential care homes can continue to provide their service when there is such a huge disparity in relation to the money that the county council can give them?

I stress that Shropshire county council does a marvellous job, but it does require greater funding from the Government for this vital service.

Several hon. Members rose—

John Cummings (in the Chair): Order. I intend to start the winding-up speeches at 3.30, and there are three hon. Members on their feet. So, if we can keep to that time scale, everyone will have the opportunity to speak.

2.55 pm

Mr. Andrew Smith (Oxford, East) (Lab): This is an important area of provision serving some of the most vulnerable people in our communities, and it is indeed under pressure. I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate.

As the hon. Gentleman said, residential care covers a wide range of important needs, and I want to concentrate my remarks on care for elderly people and, in particular, on those suffering dementia. I will also focus on some of the pressures facing high-cost areas such as Oxfordshire.

We should stress that the growing number of older people in our society represents an opportunity, not a burden. It is a wonderful thing that so many people are living longer and it is a testament to the NHS, better housing and higher living standards. The corollary is that increasing numbers of people are living to the point where they need residential care, and more people need close care as dementia afflicts those who in past generations would have died younger through poorer general physical health or disease.


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