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17 Jan 2007 : Column 321WH—continued
3.17 pm
Mr. Graham Stuart (Beverley and Holderness) (Con): I, too, congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing a debate on this important topic. I do not think that it is going too far to say that my hon. Friend, the right hon. Member for Oxford, East (Mr. Smith) and my right hon. Friend the Member for North-West Hampshire (Sir George Young) have painted a frightening picture of the deterioration in the care of elderly people.
Let me start with the most important point that I want to put to the Minister. Unless Age Concern, all the experts in the field, the Joseph Rowntree Foundation, Members of Parliament and local authorities are all wrong, the current situation is very grave, and there is every likelihood that it will get worse. I therefore ask the Minister please to give us an honest assessment of the position. In my area, in the East Riding of Yorkshire, the number of those over 85 is increasing by more than 500 a year. The impact of that on social care spending is enormous, and I am not sure whether it is factored into any political party’s forward thinking on budgets. I hope that the Minister will address that.
Mr. Lewis: Will the hon. Gentleman give way?
Mr. Stuart: I have given way to the Minister in the past, but, all too often, one gets a very party political approach. I do not think that there is any need for that, because, whoever is in power, things are going to be tough for a few years.
Mr. Lewis: In summing up, I shall certainly give an honest appraisal of the situation. However, can I ask the hon. Gentleman for some honesty too? Does he support the abolition of means-testing for social care? Yes or no? Does he accept that considerable extra investment in social care is likely to require significant increases in taxation? Would he support those increases to justify a significant expansion of investment in social care?
Mr. Stuart: With respect to the Minister, I knew that I would regret giving way to him. Again the narrow partisan approach is being adopted of asking a Back-Bench Member of Parliament about something that there is ample opportunity to debate with those on the Front Bench. I was bringing out the difficulties for any political party—including the Liberal Democrats, who have little likelihood of getting into power but who none the less will, like us, wrestle with such difficulties.
This is a debate, and the Minister’s party is in power. Up to now, no party has been able to find a way to solve what is a really difficult situation. When costs are likely to spiral in coming years—we have talked about numbers and demographics—how is it possible to deal with those costs, without asking people to contribute if they have the resources to do so? If they are asked to contribute, how is that to happen in a way that does not penalise hard-working people with relatively small amounts of wealth built up over a lifetime? How can we avoid creating a disincentive to their saving for the future and a system in which they feel hard done by? The Minister will know that in his constituency, as in mine, people say that they wish they had not saved or put money away, because it is just taken from them. They feel the unfairness.
I do not have an easy, trite solution. I cannot see that we can avoid the requirement for a contribution from those who have assets towards the cost of their care. However, before the general election the Conservative party wrestled with the question and came up with a policy that involved trying to find a form of insurance, so that at least no one would have to pay more than, say, the costs of three years. That was a genuine attempt to cap the requirement and make it reasonable. People are not trying to be unreasonable.
The Minister’s stock-in-trade response, on every occasion on which I have debated with him—which I realise is quite a few now—is to ask Back-Bench MPs about their party’s policy. Perhaps I may take some time now to ask the Minister—as the Conservative party is not in power and neither are the Liberal Democrats, but his party is—not to waste the House’s time in future when we are dealing with a matter of such seriousness and severity. We are not here to make party political points, least of all to a Back Bencher.
The situation is deteriorating. A constituent of mine received a letter from Humberside Independent Care Association, the largest provider of residential care homes in the East Riding of Yorkshire, which told him:
“It is with regret that we are writing to advise you that it is our intention to introduce Third Party Top-ups to all current clients of HICA who are financially supported by their Local Authority.
This year we have been faced with major increases in the national minimum wage, gas, electricity, oil and our annual registration requirements for the Commission for Social Care Inspection. We have raised these issues with your Local Authority, however the fee increases we received were significantly below the level required to cover these costs”.
The letter was sent to the son of a lady of 104 who had lived in the Albemarle home for the past 12 years. He is well into his 70s and the request is for top-ups from him and his brother, who does not live in my constituency and whose 65th birthday is coming up this year. We are asking for pensioners to pay top-up fees for pensioner parents. That is the situation that we are getting into, because the moneys coming through into the care home sector do not reflect the costs.
In the East Riding of Yorkshire, the increase in fees this year to both domiciliary care providers and care home providers was 2 per cent. That is with the minimum wage rising, last year, by more than double that, and by more again this year, and with gas and electricity costs, as the letter mentioned, going through the roof. The East Riding of Yorkshire was unable to provide more than a rise of 2 per cent. When I raised that in writing with the leader of the authority last year, and spoke to the officers concerned, I expected them to tell me—because I am used to dealing with Ministers in the House—that what was happening was the best possible solution. They did not; they said that in their view it was unacceptable and did not properly reflect the costs, but they simply did not have the resources to do so.
Perhaps the East Riding is failing to manage its budgets properly, but, as the Minister may know, after being one of the top three local authorities in the country for its financial management last year, it was this year named as the pre-eminent local authority for getting value for money and stewarding its financial resources for the good of local people. I think that that dismisses any suggestion that the Minister might want to make that the local authority is to blame for not passporting on the sums concerned. The truth is that the East Riding of Yorkshire, the council that is the best run, financially, in the country and which I am proud to say is Conservative-led, was unable to put more than 2 per cent. into the sector this year, and problems have ensued.
The situation is such that when the mother of a constituent of mine moved to the East Riding from the Isle of Wight she found that, although her new residential care home in Driffield cost £450 weekly—over £15 more than the cost of her home in the Isle of Wight—the rate set in the East Riding of Yorkshire per week is £328.80, whereas in the Isle of Wight it is £435. It is an extremely serious situation when homes in East Yorkshire have costs similar to those of homes elsewhere, but do not have the money to provide proper support.
I met representatives of the East Riding preferred providers, Verna Community Care and New Concept Care. Their staff are involved in providing support at home for many vulnerable people, so that they can lead independent lives. The care workers whom they employ work split shifts in all weathers, throughout the year, which often involves cycling between clients. Yet those carers, in the main, receive little more than the minimum
wage. That is the base situation. The providers are unable to see how they can maintain what they do with the expected deterioration in the situation.
The right hon. Member for Oxford, East mentioned an article in The Guardian about the dropping of fees to unsustainably low levels. As that article said:
“Alternatives to residential care are not in much better shape.”
I wonder whether the Minister will comment on another statement from the article:
“Nonetheless, services for older people remain inadequate, are often unreliable and always done on the cheap.”
Does the Minister deny that? Does he see a rosier situation? Are all the experts and commentators wrong? That is the kind of honesty we could do with. The article comments on the Wanless report and its recommendation of a 1 per cent. shift of spending through GDP. That gives rise to all the issues of taxation, including the fact that the Conservatives, and I personally, believe that if tax rates are set too high the tax take eventually goes down, as opposed to the simplistic economics so often used by Ministers which suggest that reducing the tax rate necessarily means less coming in. It is a tough balance to get right.
Mr. Drew: I sympathise with the hon. Gentleman’s argument, but should the service be universal, or should it be capped at a certain income level? It always worried me that when we had free social care we had the ridiculous situation in which millionaires in the Cotswolds received free social care. I thought that that was rather an anomaly. Does the hon. Gentleman agree?
Mr. Stuart: I agree entirely. The current situation, however, as the Minister and the hon. Gentleman will know, creates resentment in people who do not have great means, and who feel that they are penalised for the efforts that they have made during their life to live thriftily, as they were brought up to do, and to stand on their own two feet. With respect to my hon. Friend the Member for Shrewsbury and Atcham, the Government are not really a socialist Government. They claim to be as much on the side of striving, hard-working people, who are doing the right thing, as the Conservative party is. Their behaviour often belies that, but philosophically they are, I think, as attached to that view as we are. Therefore we need to consider the provision of decent funding, in the next few years, within the tight financial situation, so that we can at least meet the current costs of care. We also need to examine the thresholds, to create a fairer system that rewards hard-working people—strivers who made sacrifices and decided not to go on holiday so that they could put money away for the future.
Mr. Stephen O’Brien: For the record my hon. Friend may want to consider—I hope that he will agree—that the difficulty in establishing fairness arises because there are effectively three categories of people: those who do not have the means during their earning lifetime or at any other point to set aside funds for the future, and who need support; those who have had the means to do that and who have made provision, which creates the need for a fair balance; and those who had the chance and chose not to. That is where much of the resentment arises in the debate. As long as we have those three categories in mind we can proceed.
Mr. Stuart: Absolutely. I hope that the Minister will address that because we need a fairer system that provides for those in need. Is there room in the system now? Notwithstanding the long-term difficulties, the wastefulness of this Government is legendary. Never has so much money been spent to so little effect in the history of British government. I imagine that they stand in great comparison with global government. It would be hard to find anyone who has wasted so much—£20 billion on an NHS IT system that does not work.
As for the situation locally, spending on the NHS has doubled—[Interruption.] If the Minister will allow me. Spending on the NHS has doubled, yet in the East Riding of Yorkshire, where there is no funding for domiciliary care or care home provision, NHS beds are being closed. In my constituency, every single NHS bed in community hospitals has been closed. It is proposed that there should be some only in Goole and Bridlington, an hour and a half or two hours’ drive away, which means a round trip of three to four hours. We have a topsy-turvy world in which the Government are not delivering. With efficiency savings and better Ministers, there is ample room within current expenditure to look after older people and provide a better NHS.
3.31 pm
Sandra Gidley (Romsey) (LD): I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing the debate on this important subject, which, sadly, is often neglected by the press and sometimes by this House. Older people, particularly those in residential care, are often forgotten people. The sense of abandonment that those people sometimes feel has depressed me greatly in the past when visiting nursing and residential homes, particularly at Christmas. There is a case for families to have more of a responsibility for looking after their elderly. We need to have an honest debate across parties about the ageing population.
I want to pick up on the point made by the right hon. Member for Oxford, East (Mr. Smith) about poor medication management. That really should not happen. We seem to have gone backwards because many pharmacists used to go into nursing homes, and that should have continued under the new pharmacy contract, but because of other pressures, the PCTs do not seem to have commissioned those services. Will the Minister look into that so that we can have a system that is a bit more joined up? That welcome step would make savings in long-term drug budgets.
The right hon. Member for North-West Hampshire (Sir George Young) gave a solid overview of the situation in Hampshire. I, too, represent a constituency in Hampshire, where the pressures are acute. There are about 440,000 care home residents in England and Wales. The Office of Fair Trading study, in May 2005, showed that 35 per cent. of residents have to pay a top-up payment, which varies from county to county. Social service departments fund at different levels in different counties so top-up rates differ between counties. That is counter to the Government’s agenda for choice: many people feel that they do not have a choice as there is little provision available at the price set by local authorities. That is a concern.
Councils have been slow to acknowledge rising costs and to react to the cost burdens on care homes, which means that, on funding, homes are the piggy in the middle between the Government and councils. They face particular problems, some of which have been highlighted. Although nursing homes receive the registered nursing care contributions, they do not always cover the costs. Although the Government’s measures for better training, regulation and protection for older people are welcome—we cannot argue with those measures—the costs of those changes have increasingly fallen on homes and the social care system, which has been underfunded to an extent.
It is not only homes that are caught in the middle. Individuals and families are also caught in the funding battle between health and social care. Nowhere is that more evident than in the prolonged battles that families have to go through about continuing care criteria. It is a disappointment to many of us that there has been a delay in producing national standards. Previously, we had local criteria, which differed. The biggest problem is that the criteria are very subjective. Families have found decisions difficult to understand and many have been open to challenge in the past—there was the Coughlan case, for example. I have supported families in cases in which the description, on paper, of the person being refused continuing care was exactly the same as that of Ms Coughlan. I do not see how we can continue with a system that allows that to happen.
There was a right of appeal to strategic health authorities, which has been moved and is centrally administered. A gentleman—he asked not to be named—who has chaired those appeals came to see me. He told me that people used to be able to exercise their sense of fair play and common sense and take an overview of the situation, but he is concerned that the procedure has been translated to a tick-box exercise and that there is now no flexibility. He felt that perverse decisions were being made. Why has that system been centralised despite the claims that decisions should be taken more locally?
People cannot understand why somebody frail and elderly suddenly becomes part of the social services system, which is means-tested, rather than the health care system, which is free at the point of delivery. As we move care closer to home, which most people welcome, that problem will increase because people who consider themselves to be ill and in need of health services that would usually be provided in hospital will increasingly be means-tested. Although there has been an increasing amount of money available for care packages, because of their complexity the money has gone to fewer people with greater, complex needs.
I want to discuss the Association of Directors of Social Services and Local Government Association review of social services finance in 2005-06. The report goes into some detail about efficiency savings that have been made and the areas that experience the most pressure. The report highlights that
“older people and physical/sensory services are projecting above budget spending of £18 m and £19 m respectively, with other service areas contributing to meet pressures through efficiencies.”
The report goes on to say that the
“financial challenges facing councils and the real difficulty in achieving a shift in emphasis to prevention when there is increasing demand for intensive social care across all adult services”
has led to an increase in fees above the rate of inflation. It also points out that the
“loss of preserved rights income and residential care allowances are presenting significant cost pressures”
in about a third of councils, and that
“an emerging and growing financial burden is being met by authorities in the form of support to other people ... without access to funds.”
“just under one quarter of authorities are now experiencing a growth in demand for this type of support”,
“46 per cent. of councils have experienced a reduction in Primary Care Trust funding, or a reduced inflationary uplift.”
As services move from the acute sector to social care, the money is not following. I have asked about this locally. Social services departments feel that their burden has increased but their funding has not.
It would help if we could merge health and social care budgets. Welcome moves have been made in that direction but I was concerned by the comment made by the right hon. Member for Oxford, East that councils were withdrawing from this system. As care is being transferred from the NHS to the social care sector, will the Minister tell us how the money is being tracked? How can there be more public scrutiny of the process so that we know that when services are transferred the funding is also being transferred? The money is not there at present and that is a concern. We all know about the pressures on the NHS. The Secretary of State has said that the books will balance next year, but there is not the same focus on social care. Cynics among us probably think that the situation I have mentioned has had something to do with that.
The pressures are affecting other areas of care. As has been mentioned, eligibility criteria are being affected. I shall draw my comments to a close slowly, but I have spoken for only nine minutes.
John Cummings (in the Chair): Order. Will the hon. Lady wind up her comments as two more hon. Members are due to speak?
Sandra Gidley: Seven out of 10 people now receive support only when their needs are substantial or critical. Are the Government happy with that situation? What will be done to ensure that people can receive support at a lower level? Such an approach may prove to be more cost-effective in the long run.
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