| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Avebury: My Lords, will the noble Baroness tell us how, if the SADC norms were implemented, they would allow observers to comment on or evaluate the registration process, which comes to an end a week today?
Baroness Amos: My Lords, first, the SADC standards were set by SADC parliamentarians. We have urged acceptance of those standards by SADC governments. Independently of that, we as an international community must be absolutely clear about the norms and standards by which we will judge whether the people of Zimbabwe have had an opportunity to exercise their democratic right in an environment free from harassment and intimidation.
I am conscious of the time, and should like to address all the questions that have been raised.
The Government of Zimbabwe know that they are heading for international isolation if they continue on their unsustainable course. I hope that noble Lords will agree that we act most effectively when we act together. Several noble Lords, including the noble Earl, Lord Caithness, the noble Lord, Lord Avebury, and the noble Viscount, Lord Goschen, talked about the importance of Zimbabwe's economy. Unemployment is at 60 per cent and rising; inflation is at 86 per cent and is expected to reach 100 per cent this year. The Government of Zimbabwe's policies are extremely damaging to business and investor confidence—both within Zimbabwe and across the southern African region.
The noble Lord, Lord Redesdale, asked about smart sanctions and mentioned recent US legislation in particular. That was picked up by several other noble Lords. The US legislation does not mean immediate sanctions. It invites the Administration to consult on and co-ordinate international action against Zimbabwe. As such, it puts significant further pressure on Zimbabwe's ruling party. It means that the Administration can use smart sanctions if they wish to. But the passing of the legislation does not mean an automatic move to smart sanctions.
The noble Lords, Lord Redesdale, Lord St John of Bletso and Lord Wallace of Saltaire, asked about our relationship with the EU and its work. Since March, the EU has tried to conduct a dialogue with the Government of Zimbabwe. Our approach did not work, so we had no option but to consider stronger measures. Article 96 was the logical next step. It is a formal mechanism that sends the Government of
Zimbabwe a clear political signal and gives them 75 days to address EU concerns. Article 96 does not mean sanctions. It provides an implicit threat, but the purpose is to find solutions with Zimbabwe and a return to Cotonou's essential elements: human rights, democracy and the rule of law. A meeting under Article 96 for dialogue with the Government of Zimbabwe is scheduled for 19th December.With respect to general sanctions, we will consider other measures as and when appropriate. We consider concerted international action to be the most effective. UN sanctions binding on all member states are the most effective option, but those would require consensus in the Security Council, which is unrealistic at this stage. However, efforts under way in the Commonwealth and the EU will receive our continued support.
The right reverend Prelate the Bishop of Southwark, the noble Earl, Lord Caithness, the noble Viscount, Lord Goschen, and the noble Lord, Lord Howell of Guildford, all spoke about food shortages and the possibility of a humanitarian crisis. It is already clear that Zimbabwe will be seriously short of staple grains. Those shortages have been made more certain by Zimbabwe's imposition of untenable price controls. The government confirmed to donors on 23rd October that they face a major shortfall in maize and appealed for donor support.
The United Nations Development Programme is preparing a package of measures for consideration by the donor community later this week. The Department for International Development and other donors pre-empted the Government of Zimbabwe's appeal and are providing supplementary feedings through NGOs to children and adults in the worst affected areas. There are obvious concerns that any donor response reaches the needy and will not be used for political purposes.
The noble Baroness, Lady Park, and the noble Lords, Lord Redesdale, Lord Avebury, Lord Wallace of Saltaire and Lord Howell of Guildford, raised the subject of asylum. Members of the MDC have been seeking asylum in the United Kingdom. However, we have received no representations from the MDC on the issue. As far as we know, it is satisfied that our procedures for assessing asylum claims from Zimbabwe is fair. I will write to noble Lords on that subject, as time does not permit me to go into more detail.
The noble Lord, Lord Wallace of Saltaire, spoke about some difficulties facing other countries on the African continent. Noble Lords will know that the Government are committed to working in partnership with leaders in Africa who are committed to reform, to forge a new partnership to support sustainable development on the continent. That will not be easy, but that is our commitment. The comments made by the noble Baroness, Lady Park of Monmouth, about the regional conflict in the Great Lakes region and Zimbabwe's relationship to it, are important to remember.
The noble Lord, Lord Astor of Hever, spoke powerfully about the situation facing journalists. We protested to the Government of Zimbabwe in the strongest possible terms about remarks describing some journalists as terrorists. That is clearly absurd. We will continue to make our views clear, but, in reply to the noble Lord's specific question, I am not aware of the Government of Zimbabwe having blocked access to external broadcasting services with which they do not agree.
The noble Lord, Lord Blaker, asked me if we were considering what we would do if the MDC won the election. Of course, we are considering all possibilities. I thank the noble Lord for his sympathy for my position, but I hope that noble Lords recognise that my shoulders are broad enough to carry the weight of criticism from the Government of Zimbabwe and President Mugabe. As the noble Earl, Lord Sandwich, said in a slightly different context, it is like water off a duck's back.
In a more serious vein, I thank noble Lords for their recognition of the Government's work in seeking to bring about real change in Zimbabwe and their kind words on my role in that work.
In conclusion, let me make our position absolutely clear. The Government have worked tirelessly to build international consensus. We have made our views about violence and intimidation known in the strongest possible terms. The Government have not been apologetic in our handling of relations with the Government of Zimbabwe. I have sought to ensure that Members of this House understand that there are limits to our influence with the Government of Zimbabwe and that is why we have said consistently that it is important that Zimbabwe's neighbours need to make their views known to the government. That is now happening.
Let us not forget that our concern should be for the welfare of all Zimbabweans. The vast majority of the victims of violence are black Zimbabweans. At least 32 have been killed this year. Thousands have been attacked and threatened. Many live in towns and have no connection with the land occupation. Their only interest is a job, enough food to feed their families and the desire for their opinions to count. They are the reason we remain committed to finding long-term solutions to Zimbabwe's problems. I agree with the noble Lord, Lord Carrington, that the people of Zimbabwe must find a solution. They have a right to matter in their own country.
6.1 p.m.
Baroness Park of Monmouth: My Lords, time allows me only most warmly to thank all noble Lords who have spoken, especially my noble friend Lord Carrington, for their interesting and valuable comments. I have only two comments to make. First, I should have declared a double interest. I have family in Zimbabwe but I also have a number of African friends whom I knew in the pre-UDI days and for whom I care.
Secondly, I regard the debate as a message to the people of Zimbabwe, not to Mr Mugabe. I believe that that is worth sending. We are sending it and I hope that they will hear and know when times are better that we were their friends when times were bad. In that context, there can be no possible excuse for not giving asylum, whether or not the MDC has decided we have been fair. We must offer that asylum and give it.
My Lords, I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
Care Homes
6.2 p.m.
Lord Mayhew of Twysden rose to call attention to the state of local authority funding for care home places; and to move for Papers.
The noble and learned Lord said: My Lords, the subject is sadly topical and one could wish that it was not. I am grateful to those who have indicated that they wish to take part in this short debate because there is a wealth of experience in this House.
At the beginning, I want to outline the character of the current financial position in social care at the national level in England. The Local Government Association estimates that between the current level of government support to social services, which fund much of the social care industry, and the true level of expenditure required to meet local need, there is a shortfall of no less than #1 billion.
At local level, where it is all happening, or sometimes not happening, this is a cross-party issue. The Chancellor's recent Budget report elicited much regret and disappointment in the field at the inadequacy of the resources.
To take an example from the South West, local authorities there estimate that the shortfall in their region alone is some #70 million. Throughout the country a similar picture is seen; and that is irrespective of the political composition of the authorities, of whether they are county councils or unitary authorities, and no matter how high-performing or innovative they are.
There are, however, some particular and additional pressures facing authorities in the South East. That is not only because of higher costs, but also because of the purchasing advantages that the London boroughs have over those authorities with boundaries which are contiguous to London.
Those are both matters to which I shall return, but I hope first to illustrate the general situation by drawing on our experience in Kent, where I am lucky enough to live. I suppose I should accordingly declare an interest because although neither I nor my family is likely to be applying for these facilities in the near future, one can never tell.
It is helpful to look at Kent's position because the county council is recognised by the Audit Commission as being at the forefront of innovation. Nevertheless,
its experience, for example, in relation to hospital discharges delayed by bed shortages in care homes is serious enough. In November, 173 beds in National Health Service hospitals were blocked in that way. The regional average for the South East is worse.There is great concern in Kent as to how the authority is to meet the needs of those older people who need support, either to continue to live at home or to return home after an unforeseen admission to hospital, as well as those who need to move permanently into a residential or nursing home. It is not an exaggeration to say that in Kent we are facing a crisis in the social care market.
I speak of a market because, like most local authorities, Kent County Council has to rely heavily on the private sector for the provision of nursing and residential care for people who can no longer look after themselves.
Of the total of about 17,000 beds that the private sector still provides for adults, the county council buys about one-third. Across the country a thriving independent care home sector is pivotal to the effectiveness of the overall healthcare system. A further one-third of those beds is paid for privately. In the South East generally and in Kent in particular, a high proportion of elderly residents are having to pay for their own care. Even when they do receive council support, relatives often have to make up the difference between what homes charge and what local authorities can afford to pay. The remaining one-third is bought by other local authorities or health service bodies from London and the Home Counties.
The trouble can be very simply put. Kent, to continue giving that as an example, is funded for these purposes only to an extent that leaves a substantial shortfall between what the council can afford to pay the homes and what the homes need in order to be commercially viable. The Government's funding formula for residential care of the elderly is lower per head in the South East than anywhere else in England, even though charges are higher in the South East than in any region other than London. That is of course partly because costs there are higher but it is partly because the proportion of standard spending assessment paid, for example, to Kent in grant from central government has fallen by 2 per cent in the past four years. Yet SSAs are intended to measure need to spend and they determine levels of Exchequer support for council spending.
The fact that we are not in the presence of some sellers' ramp may be seen from the number of home providers who have gone out of business in Kent alone. The East Kent Health Authority has suffered a loss of nursing beds of about 25 per cent since 1999. The figure for the West Kent Health Authority is 11 per cent. Between the two authorities, the overall decline is 17 per cent and they cover the greater part of the county. Not all beds that are on offer are available to the county council because they cost more than the council can afford. Therefore the loss of contracted
beds to the county council is of the order of 21 per cent. Nationally, I believe that 50,000 beds have been lost since Labour came into office.Home providers' own rising costs, which have been fuelled by the strength of the economy in the South East, have been added to by the expense of the Government's admirable strict new statutory standards for providers and new obligations placed on employers. However, no additional funding has been made available to pay for those requirements.
Next year will see the transfer to local authorities of responsibility for the care of people who previously had preserved rights to income support. Yet no additional funding is being held out. For residential care, the independent sector calculates that charges of #300 per week are the minimum required to enable homes to stay in business. Yet to bring fees up to that figure from the present average of around #260 per week paid by the county council would cost the authority an additional #6.5 million per year.
For nursing home care the position is even more dire. The average fees presently paid by the county council are #376 per week. The independent sector states that continued viability will require #500 per week. Yet even to increase the present average paid by the authority by #100, to #476 per week, would cost an extra #7 million per year.
The Strategic Director of Social Services for Kent, Mr Peter Gilroy, points to additional costs for the support of independent providers of domiciliary care to enable them to meet the higher standards and the increased expectations of older people. Taken together, those cost pressures mean that Kent County Council will have to find between #16.9 million and #17 million extra.
The story does not stop even there. London boroughs receive SSA typically on a far more generous scale than Kent. This year, for example, SSAs provide for #351 per person per week for residents in Kent aged over 65 years, while the comparable provision in Islington, for example, is #917. While I accept that some of the difference can be attributed to higher levels of deprivation—although Kent itself has too many deprived areas—some of that difference in funding is enabling London boroughs to place their clients in homes in Kent, with obvious consequences for the bargaining position of the less well resourced county council. For example, 1,700 looked-after children have been placed in Kent by other councils.
I suppose that it is hardly surprising that the grievous state of so many hospitals nowadays should be the primary focus for government attention, but the pressure to vacate beds in itself increases the pressure on nursing and residential beds outside the hospitals. When rising pressure is applied to a falling number of beds, the inevitable result will be longer delays before hospital beds can be cleared of patients who no longer need them, but who cannot manage on their own.
As the Continuing Care Conference has stated, it is important that care is provided within an enduring, sustainable and long-term care policy framework, not a series of short-term, politically expedient policies.
The recently announced settlement for social services appears superficially to be generous, as it puts further money into the care of the most frail and vulnerable people in our society. But the difficulty with this additional investment is that much of it is hypothecated to specific new tasks and so still leaves the core services with insufficient money. I am afraid that the expectation is that the recent settlement will lead to further and greater problems in funding social services over the coming year. The chairman of the Local Government Association, Sir Jeremy Beacham, is a well-known Labour supporter. His comments on the Chancellor's Budget Statement illustrate that these are cross-party anxieties.Perhaps I may finish my remarks with a further illustration from Kent. The county council is faced with a stark choice either to make an unacceptably high increase in precept or to make large savings which inevitably will impact on the elderly and the vulnerable. It is no good the Government willing the end in this field if they are not prepared to will the means.
For my part, I hope that the Minister will take advantage of this brief debate to show that the Government have taken on board the grave position in this area and will meet the urgent need with no less urgent action. I beg to move for Papers.
6.5 p.m.
Lord Lipsey: My Lords, the whole House will welcome the timely debate introduced by the noble and learned Lord, Lord Mayhew of Twysden. I think that he is a neophyte to the little gang of noble Lords who congregate on these occasions. After the deliberations last year on the Care Standards Bill, I think that they know each other's views. Having said that, the noble and learned Lord is a most welcome neophyte and we look forward to his continued presence in future debates.
I wish to make a number of brief, sharp points. First, in the care home industry, we need to encourage a flourishing private sector. We need it because between 1996 and 2010 demand for places will grow at the rate of 1 per cent per year. Even on the most optimistic of assumptions, at the point when the time-horizon of the Royal Commission on long-term care expires in 2050 we shall need to double the number of places. We shall need to do so because direct local authority provision is hugely more expensive than that of the private sector. At the time when the Royal Commission reported, on average a local authority place cost #360 per week for residential care, compared with #238 per week in the private sector. The Audit Commission found that the standards of local authority provision were no higher than those of the private sector.
Secondly, this industry—if I may call it that—is faced with a disastrous squeeze. That has been the case for a number of years. Fees have been falling behind costs, which have been and will continue to be greatly elevated by the 11 per cent increase in the national minimum wage recently introduced. The current shortfall in fees for publicly funded residents is
authoritatively estimated by the industry to be running at between #50 and #100 per week per resident—that is the national shortfall; it may be worse in Kent—which translates into a 30 per cent to 50 per cent shortfall.Thirdly, as a result, care homes are resorting to increasingly desperate expedients to remain in business. I shall categorise them. Desperate expedient one concerns the provision of free nursing care so generously introduced by the Government. Many homes are trying to use that money to subsidise the fees, so residents will be no better off. That is not how it was intended the money should be used. Parliament did not vote for that.
Desperate expedient two is to sting the private payer in order to subsidise the public payer. Care providers charge the public sector the marginal cost for care, while the gap between that and the full average cost is met by the private fee payer. An excellent firm which I have looked at recently, Westminster Care, charges the average local authority a fee of #370 but charges #535 for the average self payer.
Fourthly, the desperate expedients I have outlined are not proving sufficient to enable care homes to stay in business. Laing & Buisson, the authoritative source in this area, estimates that 25,000 beds have been lost over the past two years. It believes that a similar number will be lost over the coming five years. Others in the industry think that the situation is even worse, that the crisis is accelerating and that the loss will amount to 5 per cent of all beds over the coming two years. Such losses do not imply only financial costs—on occasion some of those concerned with these matters are accused of being spokesmen for the Treasury. When a care home closes, there is also a human cost. We know that when an older person is moved from one home to another, very often they die shortly thereafter. Thus finance and humanity point in the same direction.
I have come to my fifth point. I regret that Members on the Liberal Democrat Benches will now stop nodding in agreement with my words. I am sure, however, that they anticipate what I shall say. The situation demonstrates the absolute futility and absurdity of the majority recommendation of the Royal Commission, of which I was a member, franked, I am afraid, by noble Lords opposite, that care should be provided free for all. If money is put into that provision, then it will not be available to address the terrible shortfall that ultimately will mean little care available to anyone.
I am very sorry that the noble Lord, Lord Sutherland of Houndwood, who, as chairman of the Royal Commission, has a deep knowledge of these matters, is not in his place to dispute the point with me. I look forward greatly to debating the subject with him one day. However, we have not yet managed to coincide on a platform. Every pound spent on free care is one pound less available to keep the sector thriving, in business and providing decent levels of care. I have in reserve attacks for certain other groups of people. However, there is some good news—I pay tribute to my noble friend here—which is that the Government
have at last noticed that the position is unsustainable. As I remember it, there was a kind of denial phase; then there was a phase of, XYes, we realise that, but we cannot get any money to do anything about it"; and now we are moving into a better and more open phase.There are a number of hopeful signs. One is that the agreement with the private sector, Building Capacity and Partnership in Care, produced in October 2001 by my noble friend's department, sets out better ways of contracting for services which can provide a combination of viability, efficiency and better services.
The second hopeful sign is the hike of 5.4 per cent in the money available for residential and domiciliary care to local authorities contained in the revenue support grant settlement. I have seen all kinds of figures as to what this hike represents. The Government's own document states that the figure is #175.9 million and the figure of #300 million has appeared in some newspapers. Whatever it is, it is a good deal better than the figures we have seen in the past.
To their credit, the Government are now concerned about profitability in the industry and are studying the matter. It is to be hoped that where study starts today, money will flow tomorrow.
I said that I would attack more than one group of people, and here is the bad news. The Government are planning—I use the phrase hoping not to shock any noble Lord—to kick the sector in the goolies with the new standards that they propose to introduce next April. I am a great defender of the British Civil Service, to which we owe a great deal—this House contains many fine examples of that institution—but when the document Fit for the Future first appeared, I simply could not believe my eyes. It was as though a jobsworth at the Department of Health had plucked from a shelf ancient standards based on the days—they were my heydays in politics—when regulation was all. We did not worry about the cost to the private sector nor its effects. The great thing was to have regulations that bureaucrats could impose on private industry. This is a document for the 1970s; it is not a document for the new millennium.
If anyone should think that I am exaggerating, they should look at the suggestions for room sizes for old people and consider how the industry is supposed to economically convert existing homes to provide the new metricated room sizes. They will find their confidence in the British Government shattered because this is a policy to destroy enterprise and standards. In the long run, it will generally reduce standards under the guise of increasing them. These were Bourbons among bureaucrats. They had forgotten nothing from the 1970s and learnt nothing from the 1970s.
I do not know how Ministers allowed this to slip past their eyes—it must have been a momentary inattention in the excitement of the many good things they were doing—but they woke up when MPs signed Early Day Motions as their constituents pointed out to them that they were about to be forced out of business.
This was an all-party matter. My party is sometimes accused of being a regulatory party and the Conservative Party of being a deregulatory party, but people from all sides could see lousy regulation when it was displayed before their eyes.I know that the Government have shifted quite a bit on the issue. I pay tribute to John Hutton, the former Minister, who was very active in bringing about that shift. We no longer have bedroom size, we have recreational facilities size—and that is progress. But there are still ludicrously damaging remnants around. For example, all facilities are supposed to be checked by occupational therapists. That would be all right if there was not such a major national shortage of occupational therapists, with no way of remedying the situation.
Again typical of the numerically-driven rather than practical regulation, there is to be a set ratio of 80:20 of single and shared rooms. That would be absolutely wonderful—I would love everyone to have their own room; I would love everyone to have their own suite of rooms—but if there is no money to pay for it, there will be a bad result because there are simply not enough rooms.
The new regulations are at present out for consultation. I hope that the Government remain in listening mode. The costs of the regulations—on top of the squeeze that has already got the industry into such trouble—are frightening. The banks are starting to say, XWe will not lend money on residential homes. No, you cannot borrow to keep the business going. We do not like the security any more". People are saying increasingly, XI am not going to convert my home. I can sell it for more money as a private home for someone to live in than by staying in business". Some people are, for their pains, criticised as being profiteers. It is a curious situation for the Government to stop someone turning in a decent profit and then complain that they are profiteers when they refuse to go on working their guts out for nothing.
Everything that is being done to help on the local authority side—and I welcome and pay tribute to the tremendous change in attitude—is in danger of being spoilt by these regulations. When they come to the other place, we will find that many Members oppose them. So will many in this House. I say to the Government that many of their most loyal supporters will oppose the regulations unless there is further change. I trust the Government. Therefore I trust that, even at this late hour, they will see sense. If perchance they do not—and no doubt there is room for compromise—I do not believe that this House will shirk its duty to pay true scrutiny to the legislation. If we do not, we will be conniving in a situation which could leave—with the very best intentions, I freely admit—old, frail and vulnerable citizens literally with nowhere to go.
6.27 p.m.
Lord Clement-Jones: My Lords, this is a timely and important debate. Neophyte or not, I congratulate the noble and learned Lord, Lord Mayhew, on initiating
it. I also congratulate him on eliciting a speech from the noble Lord, Lord Lipsey, the first half of which I agreed with wholeheartedly—for a change.It is vital that proper resources are allocated to the residential care of older people, not only to ensure that there is a quality and quantity of residential care available to those who need it, but also in terms of the knock-on effect on the NHS if there are insufficient care places and bed blocking occurs.
As the noble and learned Lord pointed out, the number of care beds is shrinking dramatically. Fifty thousand beds have been lost in the past five years; 30,000 of those in the past three years. In some parts of the country, there has been a continual fall in care beds over the past five years. One in five beds occupied by people over 75 is now blocked because of delays in discharging.
The problem of bed blocking is particularly bad in the South East, as the noble and learned Lord, Lord Mayhew, pointed out. Ten per cent of all acute beds are blocked in the South East region by delayed transfers from hospital. The cost of bed blocking to the NHS has recently been estimated to be as high as #3 billion.
The problem is not only about the numbers of beds. The King's Fund report, Future Imperfect?, published in June 2001, commented on huge problems being experienced by the sector in maintaining quality. There is a major recruitment and retention crisis, together with a worrying picture of inadequate training for care and support workers. The report stated:
- XImmediate action is needed to avoid a catastrophe"—
There has been some acknowledgement of this problem by the Government. They have allocated #300 million to end bed blocking—#100 million this year to local authorities and #200 million next year. Their target is to unblock 1,000 beds this winter and 2,300 by 2002-03. XThis winter" is now upon us. How many beds have been unblocked so far in using this cash? How much of it has actually been spent to date, and to whom is the funding going?
Even if the funding is being spent and if it is going in the right direction, even Labour-supporting local authority leaders such as Sir Jeremy Beecham say that it is too little, as the noble and learned Lord, Lord Mayhew, pointed out. Quite apart from the King's Fund figures, some estimates say that three times that amount is needed to stop the decline in the care sector.
Then there is the issue of personal care and nursing care, and the extent to which they should be funded by government. We have debated this on numerous occasions in this House, not least when the Health and Social Care Bill was before the House. The view on these Benches has always been that it is wholly unjust that people with Alzheimer's and similar chronic conditions are treated differently from those who are regarded as having treatable illnesses.
As part of our partnership agreement with Labour in Scotland, the Scottish Executive, to its enormous credit, took the decision to fund all long-term personal care. The sky has not fallen in, as some Members on the Labour Benches would have us believe. Money for free nursing care is, frankly, inadequate. Depending on a person's condition, nursing care costs—
Next Section
Back to Table of Contents
Lords Hansard Home Page