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17 Mar 2009 : Column 199WH—continued

Mr. Burstow: The hon. Gentleman is right to challenge the Minister. I am sure that the Minister will respond by demonstrating that his head is not in the sand, and that he is as anxious as all of us to ensure that we use the
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data that we have to deliver a strategy that bears down on the problem of malnutrition. I hope that he says that.

On the personal expense allowance, I asked a written parliamentary question of the Minister’s predecessor in January 2008 about whether he would undertake a consultation on the level and adequacy of the personal expense allowance, which is paid to people in care homes who are in receipt of a pension that they must forgo because of the rules for determining state support. They are left with £21.15 a week—just £3 a day—to cover the costs of toiletries and food, which are the little things that make the difference between being alive and having a life.

The question is whether the proposed 75p a week increase is sufficient to meet the needs and dignity of 250,000 vulnerable and frail adults who live in care homes throughout the country. I do not think that it is, and Age Concern and many others in the movement campaigning on this issue agree with me. Such groups feel a sense of betrayal, because they were offered a clear undertaking by the previous Minister, which was reaffirmed in June last year, as reported in Hansard, that there would be such a consultation, only to see that snatched away by the Minister who is here today.

The opportunity for the Minister to learn more about the views, experiences and feelings of those who have to live on £21.15 has been denied. I hope that, although it may be too late to address the increase from 1 April, the Minister might use the opportunity in the coming months to embark on that dialogue with people who have been lobbying him on this issue, so that we can have a more meaningful debate, a more meaningful consideration and a proper review of the personal expense allowance.

It is not only me and Age Concern who are concerned. In a report published on 4 March, the Joseph Rowntree Foundation identified the doubling of the personal expenses allowance as a way of giving more dignity to people in care homes supported by local authorities. That is right—it is a small price to pay for dignity. This is an important thing that we should be doing, and it is a great shame that the Minister has not done it. I hope that he will respond positively to that point and the others raised in this debate.

12.1 pm

Greg Mulholland (Leeds, North-West) (LD): I congratulate my hon. Friend the Member for Teignbridge (Richard Younger-Ross) on securing this important and timely debate. How often have we said how important and timely this subject is? It is not only an enormously important subject for hon. Members, but an important and emotive subject for families throughout the country. More than 400,000 people are living in care homes in the United Kingdom. As all hon. Members know, and as has already been mentioned, with almost a quarter of the population estimated to reach pensionable age by 2032, we have to address this matter now.

I shall start by echoing some of the comments made by other hon. Members about the wonderful work that goes on. It is always important to say that. I echo comments made by the hon. Member for Stroud (Mr. Drew) about care homes in his constituency, and comments made by other hon. Members who have made it clear that there are wonderful examples of care homes in the
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public, private and voluntary sectors that are delivering excellent care. It is always important to say that and use those as real examples. Unfortunately, I am sure that I am not the only hon. Member who is sick of having to highlight the fact that too many care homes—perhaps a hard core of care homes—repeatedly fail to meet the basic standards of hygiene and infection control.

Only last week, a freedom of information request to the Commission for Social Care Inspection revealed that 169 homes in England had recorded major failures in unannounced inspections—28 of them on more than one occasion. Inspectors in those cases had found residents forced to wear coats because the homes were so cold and found homes that smelled of faeces and urine. One home had such appalling standards that inspectors issued a notice under the Police and Criminal Evidence Act 1984 to take photographic evidence of, for example, bags of used incontinence pads left outside attracting vermin, dining rooms with food stuck to chairs and walls, commode bowls and urine bottles left to soak in a bath and dirty razors that may have been shared by residents left in bathrooms. The research also uncovered one case where major failings had been noted, but CSCI does not appear to have returned to re-inspect the home for over two years. The inspection process has not been working adequately. Perhaps more worryingly, follow-ups are not necessarily happening. The inspections are identifying problems, but action is not being taken in respect of the follow-up.

I am sure that the Minister agrees that we must, regardless of the effect on the profitability of private homes, have basic minimum standards of care for hygiene, nutrition and malnutrition, as my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) has mentioned—I pay tribute to him for his work leading on that issue—and for dignity and respect. It is vital that we have that. If homes cannot meet that standard, their business model is wrong. I have no qualms in saying that the worst homes should be shut down.

From 1 April, we are moving to the Care Quality Commission, which is currently consulting on standards and, specifically, on how it will enforce them. I am sure that all hon. Members agree that it is vital that the CQC uses the new powers to ensure that those key principles—those minimum standards—are adhered to. I ask the Minister to outline progress on that and what we can expect from 1 April.

My hon. Friend the Member for Teignbridge has already mentioned staff training. I am sure that we all agree that there are concerns that the stipulations on care staff are not adequate. The story today, in terms of the lack of specialist instruction with regard to people with dementia, as the findings of the research show, is that the training is “fragmented and ad hoc”. Clearly, under the remit of the national dementia strategy, which we have all welcomed as an important step forward, we need to move away from training being fragmented and ad hoc. Will the Minister give us his thoughts on that? He has made positive comments about the need for specialist dementia training in particular, but generally how will that lead to a much better national framework of training for people?

My hon. Friend the Member for Sutton and Cheam, who has highlighted this issue powerfully, made the point about the use of anti-psychotic drugs, which is a
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scandal in our care homes. As we thankfully move away from this practice—all hon. Members warmly welcome that direction of travel—we have to face up to the implications of doing so, which mean that there will be a need for better services for people with dementia and therefore for better staff training. That will put the situation in greater focus.

We had much discussion about the human rights loophole, which I am pleased was closed by amendments in the House of Lords that meant that people in private and voluntary care homes providing services to local authorities were covered again by the Human Rights Act 1998. I want to bring to the Minister’s attention self-funders, who are 40 per cent. of people in care homes. Some 115,000 self-funders—27 per cent. of care home residents—are still not covered by the Human Rights Act. The Government have said that that will be dealt with in the equality Bill, but I ask again for reassurance that that is going to happen and for the Minister to say when it will happen.

Funding is important. It is not possible to take this debate forward without a genuine commitment to funding, and we are all on tenterhooks waiting for the Government paper looking at that. I am sure that the Minister accepts the frustration felt by organisations about this having taken so long, because we still do not know what levels of funding we need. The simple reality is that the system is broke and it needs fixing more quickly than is currently suggested by the direction of travel.

The Minister may wish to criticise and make party political points about where money is coming from and realistic levels of funding, but the Liberal Democrats have committed in our manifesto for the next election to £2 billion of investment into the care system to pay for a personal care grant that would give a minimum standard of care—going back to that vital word—for everyone over 65 who is assessed as needing care.

The reality is that, at local authority level, we are seeing the narrowing of criteria and increasing problems with people not getting care that we all agree in principle that they need. I ask the Minister to bear that in mind. We hope that there will be a significant commitment to filling that funding gap.

Immigration is an important issue. One of the problems in care homes is not only recruiting staff, but retaining them. There is an unfortunate issue with the points-based immigration system. I support that system, because it is clearly a sensible way of dealing with immigration and the skill needs of this country, but is there a way to recategorise senior care workers in particular, so that they can work in care homes and plug the gap? That would be a big step forward.

This is an enormously important debate. We agree on an awful lot, and all hon. Members in the Chamber are passionate about people in care homes. I simply ask the Minister to take our points from this debate and to answer our questions. The issue will become even more pressing because of the numbers involved, so will he give as much positive news as possible today, particularly about standards and what will happen on 1 April when the Care Quality Commission comes into being? With only a few weeks to go, it would be great to hear about the positive changes that it will make.

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12.10 pm

Mr. Stephen O'Brien (Eddisbury) (Con): I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on securing this important and timely debate. It has been important and timely for 11 years, and it will continue to be so, particularly when the Government publish their Green Paper. The hon. Gentleman covered the three main areas of funding, quality and work force, and touched on immigration issues. Given the regularity with which we have debated the matter, I will focus my comments on those issues.

We should not have to discuss the matter again today, because the Government have been promising to sort it out for 11 years. As far back as 1997, Tony Blair promised to end the practice of people selling their homes to fund their long-term care, but he rejected the findings of his own royal commission, and the Government have been accused of ducking the issue ever since by putting it in the “too difficult to deal with” box. The former Minister with responsibility for care services, the hon. Member for Bury, South (Mr. Lewis), had the temerity to suggest on 29 March last year that the Government have recognised that problem “belatedly”.

Instead of planning reform, the Government in their 2005 manifesto gave a commitment to continue to provide health care free in care homes. That is what happens anyway, and we all agree with it, so it was interesting to promise in a manifesto to maintain something that is not an issue. The current Prime Minister failed to address the matter in the Government’s latest spending round in 2007, despite the fact, which I acknowledge, that Health Ministers badgered the Treasury and raised expectations of a new settlement, which were later dashed.

The Liberal Democrats—the party of the hon. Gentleman who secured this debate—have not delivered when they have had the opportunity to do so in government in Scotland. It has been shown that their free personal care model from the last election is not without it is problems and costs. It is not free, because it does not cover hotel costs and so on. The hon. Member for Romsey (Sandra Gidley) used the word “dishonest” in this very Chamber; other hon. Members did not dare to use that word—

Greg Mulholland: Will the hon. Gentleman give way?

Mr. O'Brien: No, because the hon. Gentleman knows the point that I am making, and we have discussed it many times. It is vital to put it on the record that the current policy has been dropped, and that the pledge now is for a “care guarantee”, which he suggested would cost £2 billion. [Interruption.]

Mr. Edward O'Hara (in the Chair): Order. The hon. Gentleman has said that he will not give way.

Mr. O'Brien: As has been said, the main point about the care guarantee is that it is important to understand absolutely what might be contained within such a guarantee and how it would interact with a localist agenda. The Minister took a slight intake of breath when that was mentioned. The important question is always where the money will come from, which is why we have these debates. It is a real challenge to find the funding for what we all want to be changed. We must all wrestle
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with that, and I am glad that the Liberal Democrats have moved from saying that it will come from efficiency savings—

Mr. Burstow: Will the hon. Gentleman give way?

Mr. O'Brien: No, I will not give way; I want to make my point. The hon. Member for North Norfolk (Norman Lamb) said last month that funding will come from savings on the identity card scheme, which we would also scrap. It is important to identify clearly and fully where the pots of money will come from to support the guarantee. The hon. Member for Sutton and Cheam (Mr. Burstow) has referred to that, so it is fair to continue to challenge that fundamental area of policy.

We have all hashed out funding models following the Wanless analysis, which is broadly the basis on which most people debate the matter. The debate circles around the partnership model, the limited liability model and the free personal care model from the Wanless report, as well as the national care fund, which the International Longevity Centre has proposed. Work has not been done on what a basic package of care would look like, what it would cost, how it would be flexed and what the overall uptake and cost are likely to be.

I fear that there has been a tactical approach—perhaps even a safety-first approach—by the political think-tanks, and the issues are not even party ones. I hope that the Green Paper will provide the Government with the opportunity to do that work, and I hope that the Minister will take the opportunity to confirm that it is happening.

The paucity of commissioned academic work does not bode well for the Green Paper. I was pleased to discover through parliamentary questions that the Government have

“Inform” is an important and well-scripted word. I hope that the Minister will confirm that those pieces of work, paid for by taxpayers, will be published as soon as they are completed and that they will certainly be published alongside the Green Paper. I hope that that assurance will be forthcoming.

The Minister is aware that we often talk about the need for consensus, and it is important to consider that whether we are discussing a Turner-like model or whatever. I am well aware from informal discussions with my Liberal Democrat counterpart, the hon. Member for North Norfolk, and the Minister that not only should that consensus consist of a shared analysis, but the Opposition parties should be invited to a round table, because the present fear is the introduction of a policy that will put up dividing lines, which are so beloved of the Prime Minister.

On the impact of funding streams on care homes, we are rightly moving to a system in which funding follows the user in the form of individual budgets, direct payments and so on. Care homes will increasingly lose the security,
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and local authorities will increasingly lose the bargaining power, that comes from block purchasing. I hope that the Minister will touch on those issues in his response and certainly in the Green Paper. I have received an e-mail from Anne Marie Morris, of whom the hon. Member for Teignbridge is aware. I have only just realised that, because it says that she is from Newton Abbot, which I gather will be the new name of the hon. Gentleman’s constituency. She has written to say that there are big concerns about the change in the funding formula for care homes, which I think we all agree causes grave difficulty for people in care homes, because so often the service user must pick up the bill.

The hon. Gentleman talked about quality, which causes deep concern with the demise of the Commission for Social Care Inspection. One could rehearse the various arguments about what will happen to CSCI, but we all believe that the challenge for the future will be to ensure that the CQC continues to build on the good work of CSCI and does not let social care and social care inspection become a second-order issue within its overall work.

The hon. Gentleman rightly mentioned immigration and training pressures, the high turnover of staff—that was highlighted in the e-mail—and that the quality of the work force is vital. I hope that Dame Denise Platt’s recommendations, not least from her 2007 review of the status of social care, which have yet to be implemented by the Government, will be a deep influence for action by the Minister in the coming months. The litmus test for him will be to give as much of a clue as he can, in addressing the issues raised by the hon. Member for Teignbridge, about what the Green Paper is intended to cover and whether it will include costed options, so that we can at last have a conversation with the British public on this live and crucial issue.

12.20 pm

The Minister of State, Department of Health (Phil Hope): First, I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on securing the debate. I thank him for raising a very important issue and for putting it on record at the beginning of his speech that external bodies have recognised that the Government are pressing forward with improvements across the board on support and the quality of care. I shall say more about that in a moment. I also thank hon. Members on both sides of the Chamber who have contributed to the debate. Hon. Members come to these debates with a lot of passion, because the subject often affects them, their families and, of course, their constituents. Those experiences inform our desire to do more and go further.

I shall take this opportunity to applaud the great efforts by regulators, such as CSCI, by care home providers, by nursing home providers, by people who provide domiciliary care and by staff, who have done a huge amount to raise standards in social care. I agree that there are still areas that are in need of improvement, but there has been continuous improvement in the quality of care since we introduced new regulatory arrangements in 2002.

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