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Westminster Hall

Wednesday 21 February 2007

[Mr. David Marshall in the Chair]

Home Care (Elderly People)

Motion made, and Question proposed, That the sitting be now adjourned.—[Liz Blackman.]

9.30 am

Mr. George Mudie (Leeds, East) (Lab): I am delighted to have this debate for two reasons: first, because of the importance of home care for the elderly, but particularly, Mr. Marshall, because it gives me the opportunity to participate in a debate under the benign chairmanship for which you are renowned.

I approach the subject of home care for the elderly with some trepidation. Social care policy is a separate world with a language of its own and, in this Chamber, one tends to leave such subjects to the experts. I got involved when I continued to meet elderly constituents or their relatives who were complaining bitterly about the withdrawal of home care support. One case that stood out was that of Mr. Thomas Place, who is not only a war veteran, but a hero with medals for bravery. Thomas is 93, is in a wheelchair and lives alone. When I met him at a Remembrance day ceremony, I was astonished and angered when he told me that his one-hour-a-fortnight home care support had been withdrawn. There was anger throughout Leeds because, quite rightly, the local paper splashed the story on the front page. A number of people rang in to say that they would take care of his home care personally, such was their anger at the plight of that elderly gentleman.

Initially, I thought that a mistake had clearly been made, until I met other elderly residents—all in different circumstances, but at an advanced age and frail and vulnerable enough to justify support. I met ladies in their late 70s, one with recurring mental health problems, who had all been assessed as not being serious enough cases to need support, despite their backgrounds. Although Thomas Place’s case stood out, it was not the worst that I have come across. I know of an elderly couple, both struggling with ill health and living in bad circumstances, where the man struggled to help his wife, despite his medical condition, and often at great physical cost to himself. That is not an isolated event. The whole business of home care would collapse if it were not for the vast army of unofficial carers, unpaid and unsung, who voluntarily put in many hours daily, looking after relatives and neighbours.

Still thinking that this was a local matter, peculiar to east Leeds, or at best, to the city of Leeds, I made further inquiries and it emerged that the local council is carrying out a review of people receiving the service. Of the 2,471 cases reviewed by January last year, 751 were deemed not to require the service and 406 had their hours reduced. Nearly 50 per cent. of the elderly people reviewed so far had their hours taken away or reduced. On questioning that approach, I was assured by the council that it was all being done at Government diktat
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and was caused by Government cuts in grant. That proved, as the Minister will confirm, not to be the case, but I soon realised that the policy of cuts and reassessment was being replicated throughout the country.

Thanks to the excellent Commission for Social Care Inspection, I discovered that 100 of the 150 main commissioners, who are mainly local authorities, had changed their criteria for home care—that is two thirds of them. As a result, thousands of elderly people had lost their support, and the CSCI gave figures that showed the effect of that. The number of households receiving support fell from 528,000 in 1992 to 354,500 in 2005. My immediate thought was that perhaps the money had been cut after all, but again the CSCI said that the contrary had happened. Although I do not have the figures—I am sure that the Minister will be delighted to produce them at the appropriate time—commentators on the sector accepted that that was the truth, and that resources were actually much higher during the same period.

The agreed explanation seems to be that, as people are living longer in greater numbers, the result is that much more expensive care packages are required by the minority who run into ill health. That is also the result of the effect of the Government’s policy of getting people out of hospital sooner, which is a welcome one, and of trying to keep people independent in their own homes for as long as possible, which is the avenue favoured by most elderly people. The net result is that most councils have more people falling within the substantial and critical categories, and to service those, other categories of need are being ignored. That leaves Thomas Place and those like him bereft of care, and left in what are often difficult and undignified circumstances that cause great distress and can have dangerous consequences, as I shall relate in a moment.

At this point, I should like to break off and talk about a second phenomenon that I have discovered which I thought was a Leeds one: the extent to which the old home help service—now the home care service—has been quietly privatised. Some hon. Members will not complain about that, but to my mind it has been carried out very questionably, and speedily, in an area where customers are vulnerable.

Colin Burgon (Elmet) (Lab): Will my hon. Friend give way?

Mr. Mudie: I will.

Mr. David Marshall (in the Chair): I call Colin Challen.

Colin Burgon: The hon. Member for Morley and Rothwell (Colin Challen) is much better looking.

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I’ll second that.

Colin Burgon: We will put it to a vote.

I am glad that my next-door neighbour, my hon. Friend the Member for Leeds, East (Mr. Mudie), raised the question of home care and privatisation. He has been somewhat reticent about describing the political colour of the council in Leeds. We are weighed down
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by an unholy alliance of Liberals, Conservatives and Greens. In its most recent move, that coalition began the steps towards privatisation and, as my hon. Friend pointed out, it has been quite a disaster for our constituents. Is he aware that it is now hatching a full push towards privatisation? It is claiming that it will save £1 million, but does he agree, based on our experiences with elderly constituents, that that will be £1 million of misery facing them in the years ahead? Will he deal with that coalition in the more aggressive manner with which we have associated him in the past?

Mr. Mudie: I thank my hon. Friend for that contribution. As his next-door neighbour, I shall be looking to him for the support I am describing when I gain a few more years. By the way, I do think that the hon. Member for Morley and Rothwell is much more attractive.

I will touch on some of the problems of privatisation, although it has been a success in some areas. There must be concern about privatisation when we are dealing with vulnerable people. That is not to say that charities, the independent sector or even the private sector cannot perform certain tasks, but such is the vulnerability of the individuals concerned, one must be very careful. Where profit is involved, people might put that before the required proper treatment of the elderly.

In Leeds, the direct home care service is being run down on what are clearly financial grounds, and direct home helpers employed by the council have been left sitting doing nothing while their long-term customers are directed to private providers. One elderly lady in her 90s required help to bathe. She declined the service, because she was tired of the stream of strangers turning up, oblivious to the sensitivity of the task. The service had been handed to a private sector firm, which had consistently sent different people to bathe the old lady. Such was the indignity that she has gone months without a bath and washes herself standing up. She has been put in that disgraceful position because of the insensitive way in which the private home care provider has dealt with her as an individual.

Sandra Gidley (Romsey) (LD): I am sympathetic to the hon. Gentleman’s argument, as there is an acknowledged problem when there is a change of carer. However, one of my local councils discovered that it was paying a lot more for the council service than for the contracted-out service. Does he think that that is necessarily the best use of public money, as some of the contracted-out services are very good?

Mr. Mudie: I do not challenge the latter point, because it is unchallengeable. My hon. Friend the Member for Elmet (Colin Burgon) mentioned the savings, but one wonders where they come about if the contracted-out providers perform a similar task. We know where the savings come about: at the expense of the person delivering the service. Obviously a good employer, such as a council employer, will have good pension and sickness schemes and a good holiday entitlement, but they are normally absent from the staff
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conditions for people in the private sector. Contracted-out providers are able to deliver, but at the expense of the individual carrying out the service.

I was describing the treatment of an elderly lady in my constituency. I found it really cruel for her to be treated in that fashion and for the council to accept that. The move to the private sector is confirmed by the CSCI, which pointed out in a recent report that expenditure on home care nearly doubled between 1992 and 2004, but that most of the expansion went to the private sector. I have no principled objection to a varied service, but when it deals with vulnerable people, it needs to be extended carefully. The CSCI report shows that, in 1992, the independent sector had 2 per cent. of the market, but in 2005, it had 73 per cent. of the market.

Most worryingly, the inspectorate also described the home care sector as having

and pointed to a large amount of movement in the market. In 2005-06, for example, 415 agencies were deregistered and 905 new agencies were registered. Those figures mean little, until one thinks of the effect on the customer—the elderly person. I was a union official in public service before I first came to this place. I have worked with home helps for 30 years and I know the bond that grows between the elderly person and the home care assistant. They get to know and trust each other. Often the duties that the home care person takes on are far in excess of what would be expected, but a relationship forms and that continuity is important.

As I am sure that hon. Members would agree, one of the greatest complaints that elderly people make about home care—if they ever make a complaint—is about their home care being changed. Such change in the market—being forced into market conditions, or the settling down of a market—is damaging to the care, confidence and comfort of the elderly customer.

Mr. Paul Truswell (Pudsey) (Lab): When my hon. Friend started his speech, he said that he came to the issue fairly recently, but in his usual humble way, he did himself a disservice. He was an effective and compassionate leader of Leeds city council, of which I was also privileged to be a member, and he presided over a huge increase in expenditure on social services, against a backdrop of Conservative Government cuts in both capital and revenue funding. The services went from strength to strength. As a council, we also used the independent sector at that time, but primarily voluntary organisations in the not-for-profit sector, such as the Pudsey and Horsforth live-at-home schemes in my constituency, and Aireborough voluntary services for elderly and disabled people. There is no objection to the use of the independent sector, but it needs to be used in the effective way that we have used it as a council in Leeds, much of which comes down to the efforts and the management of my hon. Friend.

Mr. Mudie: Those kind words from my hon. Friend are much appreciated—they are kinder than the words that he used when I was carrying out those very compassionate tasks, but that is history.

What is happening is worrying. I recently had a discussion with some elderly people who were being
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provided a service by a private contractor. They were worried about whether Criminal Records Bureau checks were taking place, given the number of different people arriving and the throughput. Receipts were not being given when carers were asked to do some shopping. Those elderly people were given change without any explanation or receipts. All sorts of issues came through. Also, as one can imagine when a business is being run, if a carer has one hour with one elderly person and another hour with the next customer two miles away, the first elderly person might not get the hour because that individual—not having the public service ethos, but working for a private firm, with private profit as the motive—will have to cut the visit short to get to the next customer on time.

Mr. Stephen O'Brien (Eddisbury) (Con): I have been following the hon. Gentleman’s arguments carefully and congratulate him on presenting a compassionate and sympathetic case. We all have live examples in our constituencies that we can think of as he speaks. However, so that I can understand what the debate centres on, I should like some clarification on whether he is arguing that the CSCI regulatory and inspection regime is falling short, irrespective of whether the provision is public or private sector, or whether he is concerned that there is no way that the private sector can provide the service as he would like it to be delivered, because it has a profit motive?

Mr. Mudie: I shall pay tribute to CSCI, which is proving to be an excellent organisation, but I wonder, first, whether individual inspections are CSCI’s responsibility and, secondly, whether whoever is responsible for them—it is probably the local council, as the client—is carrying them out properly. We are all familiar with what has been happening in residential homes, and that is the problem. Where a customer receives a service but is not in a position to articulate his or her complaints, human nature tells us that corners will often be cut. Those corners are cut at the expense of the individual. I am not being critical of CSCI, because it is doing an excellent job—I notice that the hon. Gentleman knows the language and pronounces it as “See-Sky”.

Although it is important to put that point, which is a personal beef, on the record, my main point is the neglect and indifference being shown to so many of our vulnerable elderly. To give hon. Members some idea of the atmosphere among the professionals who know about the sector in more detail, I shall set out what some of the most prominent feel and have said about the current position. The Disability Rights Commission, talking generally about social care, has said that it is

The recent CSCI annual report painted a bleak picture of increasing demand for support against the backdrop of ever-tightening criteria for receiving it. That excellent organisation, chaired so admirably by Dame Denise Platt, produced an overview of the problems facing the home care sector in a report called “Time to care?” I am raising one of the main points made in that document, but it also raises a number of other important matters that deserve equal attention.

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The Alzheimer’s Society has spelt out social care services’ increasing inability to meet the needs of people in serious need. It points to surveys carried out by the Local Government Association last autumn and Counsel and Care in September last year which show that local councils are tightening eligibility criteria for their social care customers. Both surveys showed in detail that two thirds of councils, as I have mentioned, have criteria in respect of supporting people with substantial or critical needs—that is, two thirds, or 100 of 150 organisations that commission care, have criteria so high that they give care and support only to those with substantial or critical needs. One third have tightened criteria in the past year and 80 per cent. are planning to tighten criteria. Given current trends, nobody with needs defined as lower than substantial or critical will receive support by 2009, two years away.

The Alzheimer’s Society estimates that 680,000 people have dementia and that that will rise to 1 million by 2020. Unless the situation is dealt with, faced up to, funded and resourced—unless the mechanics are worked out—we shall be in a serious situation. The society describes people with dementia being forced into long-term institutionalised care in the absence of good packages of home-based care and carer support services. It claims that people with a lower level of need who would benefit from home care services are not being allowed to access them and that their needs will worsen more quickly and cost more in the long term as a result of subsequent hospital admission, for example. IndependentAge, a national charity, says that there was a 68 per cent. decrease in low-level support from social services departments between 1993 and 2005. However, it states that those are exactly the services that older people say they need to cope and remain living independently.

A grim picture emerges: increased money from the Government is going into the sector, but the majority of the elderly who could benefit are unable to access the resources, which one could rightly say are scarce and needed by the high-risk minority. That minority is cornering those resources and the majority of the elderly who make claims have those denied. It is clear beyond argument that the figures are set to get worse, due to the growing number of people living longer.

Little of that has been contested by the Government; I say that with my fingers crossed, as the Minister is sitting here, although I see little argument about the details. The Minister said on Radio 4 that there needs to be a national debate on the issue, and his Secretary of State has echoed that. In connection with that, welcome and excellent work has been carried out by Derek Wanless on behalf of the King’s Fund. In a year-long project, Mr. Wanless repeated his national health service study with a 20-year look at the problems in trends and resource requirements in social care. He gives options for levels of care and suggests financial mechanisms that would deliver the objectives. The report has been passed to the Government, and it would be interesting to hear whether the Minister has any comment to make on it.

Mr. Stephen O'Brien: Hear, hear!

Mr. Mudie: I see that I have one supporter in the Chamber—[Interruption.] I am being asked to put that to a vote.

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It would be interesting to see whether that report or a departmental document will be the focus of the national debate and decision. However, Mr. Wanless is considering the 20-year projection, and although that is excellent and necessary, it should not obscure the urgency of the current crisis. The situation that I have briefly outlined is serious and demands urgent action. I find it unacceptable that councils should have raised the threshold for help to such a height that it rules out support to people whose quality of life will suffer, if not disappear. That those people are among the most vulnerable makes the actions of the councils indefensible.

The Government have a similar responsibility. No one can deny that they have put large additional resources into the service, but faced with the declared needs and the vulnerability of the elderly, further and prompt action needs to be taken. Remember that the Alzheimer’s Society expects that no one with lower than critical or substantial needs will be supported after 2009. There is, of course, the national debate along the lines of the recent pension exercise, as the Secretary of State suggests. However, that could appear to some cynical people as a method of avoiding facing up to the current problems and cash shortages. The pension debate could be undertaken at a leisurely pace because the real problems were well in the future; however, the social care problems are with us now and, as the Alzheimer’s Society survey suggests, they will immediately get worse.

I have the following questions for the Minister. If he and the Secretary of State are united in wanting a debate, when will it start? As I asked earlier, will the formidable King’s Fund report by Mr. Wanless be the vehicle of that debate? Very pertinently, where does the Treasury stand on that debate? After all, the inescapable fact coming from any examination of the present crisis is that even more money will be required. Is that the real reason why the Secretary of State has called for a national debate but not taken any obvious steps to programme one?

In the industry, the attention is on the comprehensive spending review. Already the pessimistic view is that in light of their toughness, it is unlikely that social care problems will figure high on the Chancellor’s agenda. In other words, if help is to arrive, it will come after 2010. Given the facts outlined, that would be disgraceful and too late. If that pessimism proves to be correct, there will be real hardship and loss of quality of life for hundreds of thousands of our fellow citizens.

In their 2006 pre-Budget report, the Government state that they will consider proposals relating to the future of social care provision, including

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