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21 Feb 2007 : Column 87WH—continued

Mr. Ivan Lewis: May I ask the hon. Lady to be far more helpful to my hon. Friend the Member for Stafford (Mr. Kidney), who has raised this important issue? It is not true that in this Chamber only a matter
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of weeks ago—she is a person of integrity—she said that she regretted that her party misled the British people at the last general election in its manifesto by suggesting that personal care could be free? Will the hon. Lady confirm to my hon. Friend that she said that she regretted the fact that her party had misled the people at the last election, when it suggested that personal care could be free?

Sandra Gidley: The Minister is being rather tedious—he seems to raise that question on every occasion. I suggest that Hansard is a matter of public record, and if people are sufficiently interested they can read my previous words. I have different words to say today, and I hope that the Minister appreciates that.

Returning to local councils, one of the problems is that many would like to increase spending in this area because they recognise the problem, but the capping system allows them very little flexibility for keeping within budget the level of service that they would like, not least because staffing costs have rightly increased. It is not something that we should be getting on the cheap. The number of people requiring services, too, has risen, and we must take that into consideration. However, there is a caveat. Many people want to stay at home, but it is not everyone’s choice, so we must not say that everyone must do it. Dame Denise Platt was mentioned earlier. I remember being quite exercised when I heard her talk; she quoted an elderly lady who had said, “This is no longer my home. It’s their workplace.” A stream of people come in; indeed, the hon. Member for Leeds, East said that it could be different people from the care agency every day. People with complex needs may have various people delivering many different services, which can be quite invasive of someone’s privacy.

There is a protection issue. It is a fact that many older people are unwilling or unable to complain. I was pleased that the CSCI has decided to regulate matters. A lot is made of abuse in care homes, but other workers often provide checks and balances—unless there is an institutional problem, I would suggest that there is a greater chance of problems being found out in care homes. However, we should bear it in mind that most abuse takes place in the person’s home, and it is often committed by someone known to them. With individual workers going into people’s homes, it is only right that they should be supervised initially and that spot checks should be made on their work. Because such workers often work alone, it puts people in a vulnerable position. Many surveys show that workers are not supervised in their early days in the job.

I raise the spectre of Criminal Records Bureau checks. I am told that there are still delays, which are often as long as 16 weeks, in getting approval. If the Minister can do anything to speed it up, it would be welcomed. When workers apply to an agency or a care home, they will already have decided to work in the area and cannot afford to wait until the CRB check is completed. Another complication is that the smaller agencies can no longer administer their own applications for CRB checks, unless they do more than 100 a year. That will put an added cost burden on them, and if the Minister can do anything about that, it would help the sector greatly.

The CSCI report, “Time to Care”, highlighted the problem of performance. It concluded:

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That is shocking. It would be helpful to know what is being done to address the problem. If we are moving towards more people receiving services in their own homes, it seems fundamental to ensure that the problem is not repeated. It has to be tackled before we increase the number of people receiving such care packages.

I turn briefly to carers and the support of others, which the hon. Member for Eddisbury (Mr. O'Brien) has alluded to briefly. I heard on the radio this morning a welcome announcement of money for respite care. It is much needed, and I am sure that those who receive it will be grateful. However, I hope that the Minister will confirm my understanding that the money is for emergency respite care. Unfortunately, my experience from surgeries and from visiting homes is that people would like to be able to plan such care. If they are able to take an occasional break, be themselves and not have to worry, they feel that they can carry on caring for longer. Making a small investment in regular respite care could result in longer-term savings, as individuals would almost voluntarily be undertaking the caring role. A constituent recently highlighted the problem. She was a bit frustrated that she had to book her respite week several weeks in advance—it was difficult to plan anything, but she accepted that only to find that she was frequently messed around when she had made plans. She accepted that others may have had a more acute need, but it highlights the desperate need for better services.

Having mentioned some of the slight problem areas with home workers, it is only fair to put on record the number of complaints to the CSCI about domiciliary care, of which there were 684 in 2005-06. That is 684 too many, but given the large number of people receiving care, it suggests a relatively high level of satisfaction. Indeed, the CSCI found that most older people speak highly of their own care workers, blaming problems on the system. I quote again from “Time to Care”:

Many older people like to plan their lives, because they like a routine. That needs to be considered more carefully.

My final comments are on a key finding, about which I would like to hear the Minister’s comments. The CSCI concluded:

Given that one in two women and one in three men over the age of 65 will be receiving these services, will the Minister say how he sees the future developing, and whether funding, particularly at council level, will be fairer and more equitable, so that more people can receive the services to which they are entitled?

10.29 am

Mr. Stephen O'Brien (Eddisbury) (Con): I congratulate the hon. Member for Leeds, East (Mr. Mudie) on securing this important and timely debate. It is an issue about which he has been exercised over the past few months and has raised a number of times at business questions. He provides an example to us all in the way that he champions his constituents’ interests—in particular, those of Mr. Thomas place, whom we heard about earlier. The hon. Gentleman has been courageous in shining a spotlight on the serious failures in providing health care to the nation that have occurred during the decade of this Government. During a debate on social exclusion on January 11 this year, he said:

It is a shame that the Government are not prepared to address this issue on the Floor of the House, despite the hon. Gentleman’s repeated requests for them to do so.

We have heard the wider failures of the Government on social care rehearsed on a number of occasions in this Chamber. Their response to the Derek Wanless review was to produce a zero-based review, about which the hon. Gentleman quite rightly prompted and chided the Government. We have heard nothing since about that. It is right and timely that we should know whether that national debate will start or whether the Government are attempting to let the long grass to grow around the issue for as long as they can get away with it.

Mr. Ivan Lewis: Does the hon. Gentleman really believe that, in a democracy, it is the job of the Government or the state to start a debate? The debate about the future of social care is raging and that is good for those of us who care passionately about the issue. As I will say shortly, surely it is the Government’s responsibility to come up with solutions, not to stimulate a debate; the debate is well under way.

Mr. O'Brien: The hon. Member for Leeds, East has got his answer from that intervention. Indeed, although the national debate may well be raging, it is important to recognise that the Government have been the architect of suggesting what national debates should be about—for example, new nuclear power. Indeed, the big conversation attempted just that.

Mr. Mudie: Is the hon. Gentleman old enough to remember the Private Eye picture of people snoozing in deck chairs in St. James’s park, under which the heading read, “The great education debate starts”? The
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lack of Members in the Chamber suggests that that debate is not starting or that no debate is taking place along the lines of that on pension arrangements; the country is waiting. Does he agree that, outside the circles of those closely involved in social care, no one—including myself—was aware of the Wanless report or that a national debate was raging?

Mr. O'Brien: There has certainly been a raging debate in the House since Wanless reported. However, the hon. Gentleman raises the serious issue of whether that debate has caught the public imagination in a broader sense or whether it is still a matter discussed only locally, according to local conditions? I suspect that the latter may be true.

This issue also displays the twofold impotence of Department of Health Ministers in the face of the Chancellor’s roadblock to reform. He holds the purse strings, but the double whammy is that the Government are in stasis in terms of policy development until we know whether or not the Chancellor will take prime ministerial office.

The Government’s failure in health and social care extends to home care. I am sure that the Minister will seek to pray in aid the CSCI’s statement that

and that

That marks a shift in resource provision away from those with low-level needs towards those with the most intensive needs—a key point made by the hon. Gentleman. In 2005, 98,240 households received intensive home care, which is an increase of 6 per cent. from 2004. In 1990, home care was provided to 500,000 households and last year 584,000 people were using that home care. I accept that the figures are not directly comparable, but they are close enough to draw the conclusion that little has improved in low-level provision since policies before the last decade—indeed, CSCI seems to suggest a regression from those policies.

Although it is undoubtedly right to give people the choice of remaining in their own home and to work to reduce unplanned emergency episodes through better home care, it is wrong that those with lesser needs should suffer because the resources required by those with greater needs are given priority. As I said in an earlier intervention, such cost shifting is not only unacceptable, but short-sighted. Low-level help and care is just as important in supporting older people as other levels of care. It is also important to keep people at home where that is their choice and it is appropriate to do so.

I praise the dedication of home care workers. We have all met those who are selfless and deeply talented at such work. It takes a very special person to do that work well. However, as a number of charities that are active in this sector have highlighted, there are problems. We must take note that the CSCI reports that

and that there are pockets of very low standards. That mirrors and is broadly connected to the wider failings of the social and, particularly, the home care market.

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The biggest concern about this issue relates to direct payments. Despite having been introduced as far back as 1997 and all the warm words of “Our health, our care, our say”, we must ask whether local authorities have set challenging targets for the take-up of direct payments. What has been the effect of the national awareness campaign that the White Paper said would work

How can it be that direct payments still account only for about £1 in every £100 of social care expenditure by councils in 2004-05? Individual budgets are also moving painfully slowly.

The CSCI notes in its report, “The state of social care in England”, that social care is being hindered by an underdeveloped care market. Collaboration on commissioning is weak, and I hope that the Government will support our amendments to the Local Government and Public Involvement in Health Bill, which aims to support collaboration. It is beyond me why patient and public involvement should be introduced in a Bill from the Department for Communities and Local Government. Does that show a lack of faith in the Department of Health, or a lack of ability or desire to engage in the issues surrounding the crossover of provision between local government and the NHS? As highlighted during this morning’s comments, I suspect that the latter is the case.

In addition, councils often have immature relationships with home care providers and short-sighted, cost-driven approaches to commissioning. Although in some places blame for that might rest with local council politicians and officials, it is more likely to be the result of national policy drives. The CSCI calls for

The continuing disjointedness in health and social care lies entirely at the door of the Government. The Wanless review highlights an innovative funding scheme created, as it happens, by Conservative-controlled Kent county council. The council wanted to research—not instigate—the issue of Government subsidies to encourage contributions to long-term care investment. However, as Wanless despondently puts it:

As usual, faced with the intransigence of the Government, particularly the Treasury, there was no further chance to consider that innovative scheme for general application. That would have potentially provided a serious answer to some of the issues raised by the hon. Gentleman.

Likewise, short-termism in commissioning is born of a financial climate made extremely uncertain by Labour’s continuing mismanagement of our national health service. The CSCI says that

and that they are pulling out of pooled budget arrangements and are nervous about re-entering them.
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The CSCI also notes that people have little control over the services that they use. With such disjunction among users, providers and commissioners, it is unsurprising that the market is having problems. I use the term “market”, as did the hon. Member for Leeds, East, to refer to the overall provision in this area, whosoever may be delivering it.

It is not just those who need care who bear the force of the Government cuts. Where formal care is no longer provided, informal carers often step into the breach. Even with the £33 million that I believe was announced this morning on the “Today” programme—again not in the House, I note—the Government have done too little to support that work force. I am thinking particularly of the point made by the hon. Member for Romsey (Sandra Gidley) about planned respite care, which is probably the most valuable and valued type of respite care for the army of carers in the population. The issue involves not just emergency, plugging-the-gap respite care, although that is unquestionably important. Of course, that funding must be welcomed. This is a very important area, in which policy is being not only rapidly focused on but developed in my party.

I will highlight once more for the record the Government’s failure—the fact that something has not been produced does amount to a failure—to produce the continuing care proposals. When will they be published? Given all that has been debated and even if the Minister can find two minutes to answer the points raised by the hon. Member for Stafford (Mr. Kidney) about his local issues, I hope that the Minister can, if he gives us nothing else in the next 20 minutes, give us at least the long-overdue date for publication of the continuing care proposals

I again congratulate the hon. Member for Leeds, East. He is right to highlight the fact that, as a result of policy, there are a number of areas where the elderly people of this country are being shoddily treated—that was his phrase. It is incumbent on us all—there is a duty on us—to address this live, very important issue of our day. We must get it right; we cannot call ourselves a civilised society if we cannot support and treat with dignity the elderly people of this nation.

10.42 am

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate my hon. Friend the Member for Leeds, East (Mr. Mudie) on securing the debate and on the sensitive, compassionate and well-informed way in which he presented his arguments. I did get a little annoyed and upset a few minutes ago, but he knows that I do not mean it. He talked about social care having a language of its own, and he is right about that. I spent my entire working life before entering Parliament in social care, so for me one of the great things about doing this job in government is now having the opportunity at national level to shape the new policies that are necessary. That is a major privilege. It is a major challenge, too, and I will respond in a moment to the very reasonable and legitimate points that he made.

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