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Westminster Hall

Tuesday 7 May 2002

[Sylvia Heal in the Chair]

Elderly Care

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

9.30 am

Mr. David Kidney (Stafford): On Sunday, I cycled 30 miles around my constituency in order to raise money for the local hospice, Katherine house. You will therefore understand, Madam Deputy Speaker, why I prefer to stand.

I applied for this Adjournment debate before I took part in that sponsored bike ride, but because hospices such as Katherine house provide care for terminally ill adults, their care for the elderly is relevant to the debate. Katherine house and hospices like it raise a phenomenal amount of money by voluntary means, but it is important that we, the decision makers in charge of spending public money, should properly value the work done by hospices to ensure appropriate support from the public sector as well as from voluntary organisations.

I intend to focus on three issues relevant to the care of the elderly—the well-known problem of delayed discharges from hospital, what help is available for elderly people in their own homes and residential care for the elderly.

It is common ground among politicians that hospital is no place to be once medical treatment has been completed. Social isolation and the absence of purposeful activity are especially harmful for older patients. I regularly receive complaints from elderly constituents—and from their relatives—about the wait for their needs to be assessed before they can be discharged, or about having to wait for the services that have been identified by that assessment of need to be provided or for the funding to pay for that provision.

It is not only patients and their relatives who complain to me—so do hospital managers, who would like to use the beds to help other people with urgent medical needs, and who would very much like those who should not be in hospital to be discharged as soon as possible. It is important to bear in mind that hospital managers are also under pressure to meet targets and deal with the demand for hospital services.

I say well done to the Government for the extra £300 million provided late last year for helping with this problem. Staffordshire's share was £1.7 million last November and another £3.6 million this April. The director of social services in Staffordshire was upbeat about that when I spoke to him, and in the short term at least the money will go a long way to ending the unnecessary delay in people's discharge from hospital in Staffordshire.

In the longer term, we must look for more lasting solutions. One encouraging feature of the final Wanless report, which was published at the time of the Budget,

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was that subsequent to the interim report Derek Wanless had received many representations about the important link between adequate social services and a satisfactory and efficient health service. In his final report, he identified the need for more support for social services. The Chancellor rose to that challenge magnificently in the Budget by announcing a 6 per cent. increase in social services spending for each of the next three years.

Mr. Simon Burns (West Chelmsford): Before the hon. Gentleman gets carried away in his praise of the Government, let me put one point. I presume that he is also aware that directors of social services are concerned about the impact that the increase in national insurance contributions will have on that sector.

Mr. Kidney : I am grateful to the hon. Gentleman for that intervention. I was about to show that I am not carried away by identifying more of the challenges that face directors of social services. I do not minimise the challenge that he mentioned, but I would add several others, which I shall deal with now if he will permit me.

I still hear of many instances of delay in which money is a factor, but working practices cause problems as well. For example, in multi-agency assessments, one professional after another seems to queue to ask the same questions of the same people. The social services department tells relatives to find a residential home placement for a patient in a hospital bed, and then takes months to say what payments it will make towards it. Families are either forced to lose the places that they have found, or put under pressure to pay out of their own pockets to keep the places open until social services funding kicks in.

To answer such problems, could we not have an effective single assessment of a person's needs? Could we not have some up-front assessment of financial eligibility and availability of funding for people while they are in the hospital bed at the outset? I am reminded of the old problem of people looking to rent a home, but being unable to find out whether they would receive housing benefit for the place that they wanted until they were in and running up arrears. Eventually, the Government said that people could have an advance assessment of their housing benefit entitlement, so that they could look with confidence for a place to rent. The issue of people in hospital beds looking for a residential care placement seems similar.

On departure from the hospital bed, short-term intensive care is sometimes helpful for older patients while they get used to being back in their homes and living independently again. However, intensive care packages are a rarity in my part of the country. I suspect that that is true throughout the country, although good work is being done in some places. The professionals involved need to sharpen up their act on that.

The strain is inevitably taken by the army of carers, the relatives and other volunteers who save the state a staggering £57 billion every year, according to Carers UK when it recently launched its new service "Carers Online". There have been some good developments to support carers since 1997, such as the publication of the first national strategy for carers. There has been funding for support, including respite care. Carers grant this

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year is £85 million and will go up to £100 million next year. There have been improvements in social security provision, with an extra £500 million to be put into social security benefit over three years. Perhaps the most glittering prize recently announced was the new state second pension, which gives carers pension credits for the first time. I am pleased to see all those good developments, as carers are, and will remain for the foreseeable future, an integral part of help for elderly people. I hope that we continue to support them with such commitment.

Alongside respite care, intermediate care is extremely valuable to people who try their best to survive in their own homes but need help from time to time. In my constituency, our new primary care trust has managed to put together the basics of a good intermediate care strategy. However, it is run on a shoestring. Obviously, there must be adequate funding if intermediate care is to be a reality for the large numbers of people likely to demand it in future.

People want to stay in their own homes, but older people in particular need help to keep their homes habitable. Sometimes homes need major adaptations such as ramps to the front door, or stairlifts and walk-in showers, and sometimes only minor works of maintenance and repair. I generally find that social services departments are under-resourced for adaptations, which leads to long waits for the simplest tasks. However, care and repair services, where they exist, are extremely flexible and responsive to people's needs. Could we not bring together the two types of service to provide a comprehensive social home care service, so that people can have a speedy response when they need minor help with their homes?

The other great aid to people who live in their own homes with help is domiciliary care. I am not sure how unusual Staffordshire is in relying entirely on private sector provision of domiciliary care. I recently met representatives of providers in my constituency, who warned of the imminent collapse of the service that they provide. They said that fees were too low throughout the system and that there were problems with recruiting and training staff, enabling them to gain qualifications, and paying them good wages.

That very neatly brings me to residential care. The last time that I met representatives of the proprietors of privately owned residential homes in my constituency, they raised exactly the same issues: low fees, training, qualifications and low pay for staff. Raising the pay of those who work in the sector is obviously closely related to the ability of social services departments to raise rates for places in homes and for domiciliary care. Providing training, qualifications and status for care workers is, however, not simply a matter of money. Could there not be closer partnership working between social services departments and private owners to tackle such human resources challenges?

I recently came across a Government announcement about employer training pilots, which combine employee leave for learning with employer compensation for costs and free training. The pilots will cover six geographical areas at a cost of £40 million. Is there any chance of the Department of Health, the Department for Education and Skills and the Learning

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and Skills Council discussing an additional sector-based pilot to cover domiciliary and residential care and to raise training and qualifications issues and the status of those who work in the sector? To quote a famous line, which I cannot attribute, "If you think education is expensive, try ignorance."

Unfortunately, there is a lack of trust between the social services department and private owners in my area, which is, I think, replicated in many parts of the country. I publicly urge both sectors to work more closely together as partners and to keep at the forefront of their minds the fact that they exist to provide a service to vulnerable and valuable members of our society.

I say bluntly that fees must rise; otherwise many residential care home owners will find that it is not worth the candle to run the business.

The other issue that is often raised is national standards for residential homes, and I expect that some hon. Members will mention it. Such standards would be a good thing, but must be enforced sensitively and constructively.

It is a little unrealistic to separate those three issues—hospital discharges, people with help at home, and residential care—in the way that I have done, because, in reality, the challenges involved in tackling them are interrelated. Solutions, of course, require money, but other things, too. For their part, the Government must demonstrate some ownership of the issue and show that they are interested in solving the problems. They have, for example, done good work in developing the national service framework for older people, but on the ground, I still have difficulty identifying older people's champions in local organisations. Furthermore, people tell me that the Government are not committed to the framework, and it would be sad if that became the general view. I therefore urge the Government to take a grip and show that they are concerned about the issue and want to solve the problems.

Last year's King's Fund report on care and support, which was called "Future Imperfect?", identified several national issues that it is important to tackle. The first was the pressure on agencies to contain costs, which cause difficulties when it comes to deciding how to provide services. The report also said that two thirds of the work force lacked a relevant qualification and that there was a problem with low pay and the resulting high staff turnover. It made several recommendations, of which some are relevant to this debate. One was that that there must be funding growth, which was, in part, recognised in the recent Budget. Service users need to be involved and empowered, the national vocational qualifications in care need to be strengthened, skills and standards for all care staff must be improved and the voluntary sector and individual volunteers should be strategically involved.

Those messages were, interestingly, reflected at a conference that I held in my constituency on 19 April to consider care of the elderly in Stafford. The conference attracted 130 people, representing health and social services, private sector providers, housing providers, the voluntary sector and older people and their carers. I had to turn away 40 people because we were full up. A pack was produced for everyone who attended. The keynote speaker, Robin Wendt, a member of the Sutherland commission, made a thought-provoking presentation,

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which caused me to wonder whether we have yet drawn the line between nursing and personal care in the right place. In his view, the commission was right and the Government wrong.

The people representing the many interests in my constituency made a number of points that are relevant to the national debate, the first of which was that good communication is key—that includes listening to older people and their carers. Suggestions were made about challenging existing ways of working, which will be music to the ears of the Minister, who is demanding modernisation for funding. They included more joint working between the agencies; more preventive work, which is music to my ears in terms of keeping people healthy for more years of their lives; higher pensions, which was not an unexpected contribution from many of the older participants; good quality provision, particularly respite care; and a directory of agencies offering help, advice and advocacy. They also provided some action points for health and social services departments including an effective single assessment procedure, more collaboration in order to end delayed discharges, better provision to help individuals to remain in their own homes and better attention to recruitment, retention and recognition of staff.

Other recommendations covered carers, funding and housing providers; I shall not list them all. However, I shall draw attention to the need for rapid response when people need help, with the allied requirement for out-of-hours respite care, and the growing issue of pensioners who are themselves carers and who find that when they become eligible for state retirement pension, they lose invalid care allowance—shortly to become carers allowance—because of the rule about overlapping benefits. The Government are about to make new regulations allowing over-65-year-olds to claim for carers allowance. However, the rule about overlapping benefits will still apply. That is increasingly an issue, and greatly unfair. People provide help that would otherwise cost the state much money, yet they cannot keep the allowance that is provided specifically for caring for another person. I hope that that will be given urgent consideration.

At the end of the conference, I made three commitments: first, that I would produce a conference report and send it to everyone, including the 40 people who were not there; secondly, that I would report the findings to Parliament; and thirdly, that I would meet the heads of the various agencies in my constituency to devise an action plan for Stafford. I am pleased to say that by the end of this debate only the third will remain to be completed. I do not want to boast, but it was a worthwhile exercise in identifying local pressures and getting good ideas from local people about how to solve immediate problems. I commend it to other MPs as an approach for their constituencies, so that we can tackle the problems nationally by contributing to the debate, as well as locally by doing something personally.

It is important to recognise, and give thanks to, all the dedicated workers in that sector. As I have said, the pay is not always great, but the dedication of the workers and the importance of their work is clear. A factsheet sent to me by the Royal College of Nursing called "The health of older people" sets out the demographic change that we can expect in the next 30 years and underlines the challenges posed. Some common themes run

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through everything that I have read, including the King's Fund report, the Royal College of Nursing factsheet, and the work that I did for my own conference, such as getting the funding right, valuing staff and voluntary carers, and putting older people at the centre of the services provided for them. The Budget gave a terrific boost to that work, but plenty more remains to be done. As a society, we do not lack the resources, and the vision of affordable quality services for all older people is exciting and achievable. I look forward to being able to stand in the midst of the community in my constituency and say, "We are all good neighbours now."

9.51 am

Hywel Williams (Caernarfon): I congratulate the hon. Member for Stafford (Mr. Kidney) on securing this interesting and important debate. I shall begin by considering what older people want—which is the same as everyone else: normal care; normal services or, in the jargon of my previous profession, social work, normalised services; to be partners with those who provide the services; and to be seen as contributors, rather than as a burden. They want to give as well as to receive, and they want to be part of society, not a forgotten addition.

I want to address some particular issues, not only those that are peculiar to Wales. Everyone needs good quality information and advice to inform their choices. That advice and information is not always available, either from advice agencies or from social services departments in my constituency or elsewhere. Language is a particular issue in my constituency because, often, in the south and east of Wales, information is not available, face-to-face, in Welsh. In my constituency, and in the north and west of Wales, the majority of people speak Welsh, and services for older people and for others are available in Welsh as a matter of course. However, half the people who speak Welsh live in the south and east, where they form a minority of 5 or 6 per cent., but where those normalised services in the medium of Welsh are not available and older people who need those services, and who are perhaps unable to speak English because of an illness or a stroke, are unable to access them. The 1991 census showed that 23 per cent. of the population of Wales who spoke Welsh were over retirement age; that is 110,000 of 500,000 people.

Older people want services to be provided locally, and the threat to post offices and local council services certainly has a disproportionate effect on older people. They also want improvements in the built environment, in terms of access to buildings and the provision of ramps and lifts, so that they can use buildings in the same way as everyone else. They want adequate community policing and freedom from the fear of crime. That is especially pertinent in rural areas, where crime rates might be lower, but the perception of the danger of crime is as high as elsewhere. Some of those who live in rural areas and visit my surgery are extremely worried about crime.

Those issues affect older people throughout Wales and the United Kingdom. One issue of particular interest to me, given my previous career in teaching, is non-discriminatory access to lifelong learning and recreational activity. At a recent Carers National

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Association meeting, I met a lady in her late 70s who is about to undertake a degree course. She was extremely interested in my work and very capable and lively in her mind but, because she was over 75, she could not get insurance for her car to drive the 10 miles to the local college. That had nothing to do with her condition or abilities—it was an example of structural discrimination against her as an older person.

In Wales, as elsewhere, problems have arisen with providing an integrated public transport system, especially in rural areas. Efforts have been made to counter that, and everyone in Wales will welcome the National Assembly's programme of free transport for older people, which has liberated older people and allowed them to travel when before they could not, or when there were different provisions for different local authorities. That free transport does not extend to the train service, however. People can travel by bus but, in some areas, the train service is the service of choice. If we want an integrated transport system for older people, we should integrate the trains as well as the buses.

I should like to draw the House's attention to some innovative projects. Cyngor Henoed Gwynedd, the Gwynedd Council for the Elderly, is providing a day centre, not on the fringes of a village, in a local authority building or a church hall, but next to the bus station, so that older people can pop in for a cup of tea before they get on the bus. Older people who come along with their carers can find a safe, warm and interesting environment and have a bit of a rest while their carers go off and do some shopping. That sort of innovative project is what we need. There are problems in the provision of such services, which I have discussed with the Council for the Elderly. Inevitably, one of those problems is funding.

Two years ago, I had the privilege of advising the Welsh Affairs Committee in its investigation into social exclusion. Some of the conclusions of the Committee's report are pertinent, including those relating to the funding of community groups. I accept that the same problems affect all sorts of community groups, but they have a particular effect on services for older people. The Committee discovered that short-termism was chronic and that planning by community groups providing services was blighted by the fact that they could not plan more than a year or two ahead. The report also stated that staff felt insecure and that the providers of services were forced to waste time in continual justification of the value of services when applying for extra money. Funding must be secure and long-term and take account of on-costs. In my opinion, five-year rolling funding should be the norm.

The University of Wales Swansea issued a report on domiciliary charging for care services, called "Charging for Care in Wales", which was commissioned by the National Assembly. Unsurprisingly, the report found that there were many difficulties with the charging system. First, and most obviously, there is the postcode lottery, which means that each of the 22 local authorities in Wales has its own system and charges at a different level. People who lived on the border of two local authorities were particularly affected. They might be charged more or provided with a worse service merely because of where they lived, with no regard to their needs. That is the theme of the report.

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The local authorities and user groups in Wales want an all-Wales policy, which is relevant for not only the National Assembly for Wales but the Department of Health. The report noted that guidance was not strong enough and that the bewildering array of charging policies was causing problems. Those charging policies reflect not need but local circumstance, especially in respect of local authority finances.

The report said that there was pressure on local authorities to charge. Of course, they have been allowed to charge since the Health and Social Services and Social Security Adjudications Act 1983 but, significantly, most of them did not charge until they were subject to pressure. I understand that local authorities are pressured to raise 9 per cent. of their funding through charging, irrespective of the wealth or poverty of the area. That is a blunt instrument, considering the variety of poverty and wealth not only in Wales, but throughout the United Kingdom.

The University of Wales Swansea found a powerful case for disregarding disability benefits. It suggested that that would simplify the system of charging and make it fair for all and cheaper to run. Significantly, it found that local authorities with simpler systems also monitored debts more effectively, stating that those


Those authorities tended to encounter fewer users who fell into debt, perhaps because other instruments were not as detailed as individual assessments. Those local authorities took much more notice of the problems caused by the system. There is a lack of clarity about carers' income, certainly in Wales, where most local authorities are reviewing their positions on the matter.

Charging should be a way to develop the service, but the report found that it was not. It stated that the use of charging income to develop new or existing services


Development has been used as a justification for charging, but it is not a good one, so I would be interested in the Minister's response to that.

Many saw charging as effectively a cut in their benefits. During last year's election campaign, I visited many homes for the elderly in my constituency, which was sometimes a sad and sometimes an inspiring experience. I remember asking one gentleman—in Welsh, of course—"What do you want?" Simple questions often give revealing answers. He said, "What you've got," referring to my freedom to walk in and out, the freedom that my wallet and family support give to me, my ability to travel and other such things. That was eloquent testimony of what we need to provide for older people, and what we do not provide at present.

10.2 am

Ms Joan Walley (Stoke-on-Trent, North): I declare an interest as a member of the trade union Unison. I thank my hon. Friend the Member for Stafford (Mr. Kidney) for the way in which he introduced the subject of our debate, which was challenging as well as sensible and constructive. So often, Members of Parliament are not given credit in the House for their work. People in Stafford should be proud of my hon. Friend's huge amount of detailed work on the delivery

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of health care. He may not want to boast about that, but he can be proud of what he has done. It is so important that MPs make a difference on the ground in that way.

We all hope to be elderly one day, and I want to set the debate in the context of inter-generational issues. I hope that when my hon. Friend the Minister replies, she will place her remarks within the context of public health as a whole. Elderly care is not only about care given to people when they become elderly, or hospital care that we may or—we hope—may not need. It is not only about domiciliary care or the social services care that we may need when we get old, but about how we increase life expectancy. We should not do that simply for the sake of it, but so that we can all look forward to a long, happy and healthy life. Emphasis should be on health promotion so that our NHS and other public services, particularly those provided by local government, do what they can to help us to look forward to as healthy a life as possible.

Will the Minister consider the public health context? As vice-president of the Chartered Institute of Environmental Health, I should like to think that we develop policy by linking public health issues with the whole health agenda. The question is not simply about the money spent on hospitals, but about wider issues. None the less, the Government can do a great deal more now that the Chancellor has given a commitment to extra funding for health.

I shall put the debate in a spending context. It is wonderful that we now have extra money for the NHS, but we must address how we spend it to achieve the most efficient delivery services. My hon. Friend the Member for Stafford has already said that we desperately need a reform of the standard spending assessment so that places such as my constituency, which covers Stoke-on-Trent and other parts of Staffordshire, have a fair funding formula. I am pleased that the Government have promised reform in 2003—it cannot come a moment too soon. Between now and then, we must ensure that there is full consultation with local authority leaders and local government associations so that social services, which are integral to full health care for the elderly, are properly funded. In certain parts of the country—usually the parts with deprived populations—the shortfall from the target amount that should be spent to deal with problems is so great that we cannot catch up.

When I first set out in politics, some 20 or so years ago, there was something known as RAWP—the resource allocation working party. In health, that formula helped to raise the areas furthest from the target level and put them on a level playing field; only then would extra money be given. In the review of the SSAs, we must put areas such as Stoke-on-Trent, which has such great deprivation, on a level playing field to allow our social services to invest money that will complement services provided by the NHS, as happens elsewhere.

Another service that is important for keeping elderly people in their homes, when that is where they wish to be, is provided by local social services, and is called Lifeline. In my constituency—I assume that the same applies elsewhere—only people on housing benefit can access that service. If we want people to stay in their own homes rather than in care beds or intermediate care, we must fund the services that all elderly people need to be able to stay at home.

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In her reply, I should like the Minister to consider the fact that elderly people who stay in their own homes desperately need to feel safe and secure. I am aware of that not just because I have been out over the past few weekends for the local election campaign, but because I have regular phone calls and correspondence from constituents throughout my Stoke-on-Trent, North constituency. They say, "Joan, we don't always feel safe." They want local crime partnerships with police. Above all, those who live in council accommodation, which can consist of wonderful bungalows, do not always have the fencing that they need to make them feel secure.

If we had a standing spending assessment that treated our area fairly so that we could invest in council houses, and if we had a level playing field between council houses and other forms of social ownership resulting from transfers, we would be able to provide both the fencing to make elderly people feel secure in their homes and better elderly care.

During the 15 years that I have been in Parliament, I have worked with local people to ensure that we have sufficient continuing care beds for our needs. That campaign came about as a result of the standards, which were not fit for the 20th century let alone the 21st century, at Westcliffe hospital—a former workhouse known locally as the old poorhouse, which is now a large hospital with many continuing care beds. I have been involved with a campaign not to close Westcliffe hospital but to agree a delivery plan to provide sufficient continuing care beds in the context of health care, domiciliary care and intermediate care.

The campaign has had huge success. The Under-Secretary responsible for public health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), set up the Edwards report, which brought together health care professionals, and considered how we can move from putting people into long-stay beds to using all our community resources to provide the ongoing care needed across north Staffordshire. We had various meetings with my hon. Friend, and were given an undertaking that the Edwards report would be implemented. I am happy to report that under the fit for the future programme, considerable progress has been made towards building both a new hospital at the North Staffordshire royal infirmary and a medical school, for which I have waited 40 years, since I was a small child.

Under the fit for the future scheme, there is a proposal called the north Stoke development, which is going to provide us with the continuing care beds that we need. Will my hon. Friend the Minister take time out after the debate to get back to me, and to other north Staffordshire Members of Parliament who are similarly concerned, to give us an update on the progress that has been made? We need to know whether the number of beds that we were promised will be put in place. Are we going to get the development money for those beds? We were given undertakings following a lengthy formal consultation procedure that involved the community health council.

The Edwards report anticipated that a number of beds would be shared between the NHS and independent sectors. The proportion of the beds that would provide continuing care in the independent sector was never properly specified, but it was suggested that it would be about 20 per cent. As I understand it, however,

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as many as 48 per cent. of beds will be provided in the independent sector, although they will be paid for by the NHS.

I want to make sure that the Government are giving their full attention to the community health council in north Staffordshire, which wrote to my hon. Friend on 18 April, as it is particularly concerned that no further public consultation has been undertaken


There is genuine concern that the Edwards proposals, to which we all signed up in good faith and which set out a way forward for continuing care beds, have somehow been superseded by a further consultation, undertaken by the health authority, which looks at the number of intermediate care beds needed. We all recognise the need for intermediate care beds, but there is a suspicion that unless we have full openness and transparency, the wonderful commitment given on intermediate care beds will be at the direct expense of the continuing health care beds to which we all agreed under the Edwards report.

My hon. Friend the Member for Stafford has hosted debates and conferences in Staffordshire. We need the Government to get back to local MPs in north Staffordshire and ensure that we can have full, open and transparent debates on every bit of progress being made on every aspect of the Edwards report. If they can do that, there will be much joy and optimism among all those who care so deeply about providing long-term care for elderly people.

I shall briefly raise one final issue. Encouraging people to get the very best care and continuing health care beds, and also providing intermediate care beds and care in people's homes, raises a point about adaptations, which my hon. Friend the Member for Stafford made graphically. I have been campaigning about wheelchairs for a significant time. The wheelchair service in my constituency is based at Haywood hospital, and people sometimes have to wait for 13 months to get a wheelchair. How can we discharge people from hospital into their own homes if they cannot be mobile?

Two years ago, during the spending round, I went to the then chief executive of the hospital trust responsible for wheelchairs, who is now the chief adviser on the modernisation of the Government's health agenda. I set out for him the importance of increased investment in, and reorganisation and modernisation of, the wheelchair service in north Staffordshire. He as much as gave me an undertaking that that would be dealt with in the service and financial framework round. I heard nothing further and, in good faith, assumed that that spending had increased. As I said, that chief executive now advises the Government on their modernisation policy.

Some months later I realised, with a great shock, that the SAFF round had not agreed the money for increased investment in wheelchairs. It should come as no surprise that I felt it important to campaign to ensure that there was a sufficiently well researched, competent and businesslike plan for wheelchair services in this year's SAFF. Again, I made a point of contacting the

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chairman of the then North Staffordshire health authority and the then chief executive of the hospital trust. I was assured that everything possible would be done about wheelchairs, but, to my deep disappointment, the SAFF round did not agree an increase for the wheelchair service.

Perhaps as a result of my perseverance, and that of others, the silver lining to the tale is that the hospital trust, recognising our points about the wheelchair service, provided extra money to start investment in its long-term business plan for the service. Some one third of the money needed over a three-year period has now been committed, and I am very grateful to the North Staffordshire hospital trust for making that money available.

That story shows that we all have a responsibility to look into joined-up thinking right across NHS services and the different forms of care that need to be provided. The whole system can be completely undermined if one part of it is not right. It is important to get all the pieces of the jigsaw in place so that people in north Staffordshire have the services that they need. I have no doubt that we have an ambitious plan for elderly care in north Staffordshire, but delivery must be open and transparent. I ask the Minister to consider carefully, together with north Staffordshire Members, how we can ensure that our hopes and vision are backed up by delivery of services, so that nobody is without the care that they need.

Several hon. Members rose—

Mr. Deputy Speaker (Mr. Frank Cook) : Order. Perhaps I should remind hon. Members, after one day's holiday, that the three Front-Bench spokespeople routinely commence their winding-up speeches 30 minutes before the termination of the debate.

10.20 am

Mr. Edward Davey (Kingston and Surbiton): I rise to speak because this issue is of huge concern to my constituents. They raise it with me in advice session after advice session in my tours of residential nursing homes in the royal borough, so I felt it right to attend today's debate.

I congratulate the hon. Member for Stafford (Mr. Kidney) not only on his measured and well considered remarks but on the work that he has done in his constituency. I have always regarded him as one of the most impressive Labour Members, and his performance today has only confirmed that judgment. I hope that he will share some of the papers from his conference with me, so that I can see whether I can organise a similar conference in my constituency. I am currently undertaking a survey of care home owners in the royal borough, using a pack produced for me by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), which is producing some interesting results. To follow that up with a conference may be the next step forward and, as with the hon. Member for Stafford, it may be the best service that I can provide for my constituents.

I should declare an interest: I have an elderly grandmother who is recovering in Fordingbridge convalescent hospital because she recently broke her hip

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for the second year running. She was about to come out of care to go back to her warden-controlled flat when she fell over in hospital and broke her left wrist. Family members, including me, are increasingly concerned about the care provision that we make for her in the future. Therefore, the experience that I bring to the debate comes not only from my constituents but from the questions that my family and I are having to ask about my grandmother.

Some basic issues arise when one begins to look at the individual families and their concerns. The first question is: where is my relative to go? Is there a place available for him or her? Because so many care homes have closed down in my constituency, the number of places available is limited. People must wait, either in hospital, like my grandmother, blocking much needed NHS beds, or at home, where the quality of care is not good enough. Neither case is satisfactory, so one of the most important questions concerns the number of places.

It is easy to see why there are so many closures in my constituency. First, the labour market is very tight. The number of qualified people available to nurse and care for the elderly in homes is increasingly limited. It is noticeable when one goes round the care homes that many of the nursing care assistants are from countries such as the Philippines, having been brought over by different agencies to fill the gap. However, that is not an easy or cheap solution, and the pressure of costs on care home owners is increasing because of the tight labour market. I welcome the tight labour market because it helps to drive down unemployment, but it has that knock-on effect, which must be addressed by other areas of Government policy.

The lack of places in my area is also driven by two other factors. First, because of rising property values in areas such as Kingston, many care home owners coming towards the end of their working lives are being offered sizeable sums by property developers. One cannot blame them for wanting a decent pension, but a number of homes are closing for that reason.

Secondly, that desire to cash in on the value of the property is being exacerbated by new regulations. We know that there has been all-party support for those regulations, and I am not undermining the thrust of them, but in an area such as Surbiton where many of the houses were built in the Victorian era, although adaptations have been made, it would be extremely costly for care home owners to make the changes necessary to meet some of the more stringent standards in 2006–07.

There is insufficient help available to make that worth owners' while, so many of them are having to say, "We can't make that room a little bit larger—it's impossible. We can't afford to knock those two rooms into one to meet the standards, either, so we'll have to sell up." The problem is huge. Kingston has some of the most severe pressures in the country on its care sector because of those problems. The borough's senior citizens are suffering as a result, and we have to tackle that quite urgently.

There are other issues that we ask about immediately after finding places for our loved ones, such as the quality of the care. As I go round the residential nursing homes in my constituency I find a high quality of care, and I have seen some very dedicated people, but the

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owners tell me that they have problems in finding qualified staff. The hon. Member for Stafford touched on that during his speech.

Another issue germane to myself and my constituents is that people like their relatives to be near. Often, grandmothers or grandfathers live some way away in a different authority area. They may live in a home or a warden-controlled flat, or benefit from domiciliary care. Then may come the moment when they need to go into residential care. The complexities and difficulties of moving someone from one authority to another are large. If people want their relatives to be near to them when they move to a care home, that can be extremely difficult, given the different financial regimes. Will the Minister comment on that problem?

The Government have slowly been trying to address the problems, and after a lot of pressure and campaigning by my hon. Friend the Member for Sutton and Cheam they have begun to change policies. In the Budget they announced some increases of more than 6 per cent. in real terms for social services over the next three years. The question is whether that is sufficient, particularly if one subtracts from that settlement the extra cost of employers' national insurance contributions. The real-terms increase is significantly less when that extra taxation is taken into account. I am not convinced that the settlement is up to the job. I know that the Minister will not like that, but the extent of the challenge in the sector, and its high relevance to the challenge in the NHS, is such that that sector ought to be getting a better settlement than the NHS.

That sector has been the Cinderella sector, and has been underfunded for many years. The catching up that it needs to do is even greater than that required in the NHS. I found the Budget settlement in that area disappointing. The arguments that the Government rightly used to back the current funding mechanism for the NHS apply in this sector too—in spades. The Chancellor quite rightly argued that a taxpayer-funded health service is needed because in society we should pool risk. We come together as a community and decide that that is the most effective and efficient way of funding that type of service. That argument applies just as much to the care sector—yet people are charged, the quality of service is not sufficient, and the sector has been severely underfunded for a long period. I urge the Minister to press the case for extra funding in future negotiations with her colleagues.

Because the time is approaching the witching hour for Back Benchers I will draw my remarks to a close, Mr. Deputy Speaker—save to say that I can tell the Minister and her colleagues that areas such as mine, which many Government Members believe are prosperous and do not require funding, experience pressures that are as severe as those anywhere in the country, and our budgets and council settlements have not been up to the task of meeting that huge challenge.

10.30 am

Mr. Paul Burstow (Sutton and Cheam): I congratulate the hon. Member for Stafford (Mr. Kidney) on securing the debate and also on the conference that he organised, the information that has come out of it and the work that he is doing. I want to address some of the important issues that he raised.

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Delayed discharge has been the focus of Government anxiety, but all too often the initiatives treat the symptoms but do not tackle the underlying causes. The causes of delayed discharge are a lack of prevention upstream and a lack of capacity downstream in home or residential care. Other speakers have touched on the latter, and I want to focus on prevention, about which we should be doing so much more. The hon. Member for Stoke-on-Trent, North (Ms Walley) rightly identified the need for it to be seen as part of a wider public health agenda, because a little help early on could make an immense difference to an individual's quality of life and could arrest and prevent a downward decline into dependency and a greater need for more intensive support later on in life.

There is a story that is often used to illustrate how powerful a little bit of help can be, and it is about mucky nets. Many people, when they get to a certain age, can no longer climb up a stepladder or on to a chair to take down mucky nets. For many, keeping up appearances is important to mental well-being, which in turn feeds through into their health. If the ability to keep up appearances is lost, the slide down the path of dependency may begin. As the hon. Member for Stoke-on-Trent, North said, feeling safe is also very important. There really is a crying need for services that provide a little bit of help, whether essential gardening services, essential property maintenance, basic do-it-yourself or the auditing of safety, security or energy efficiency.

However, the figures show that the number of people receiving basic care in their own homes has dropped by 109,900 during the past five years. We are told that those people are now living independently, but I suspect that they are the ones who turn up in the accident and emergency departments and end up as the delayed discharge cases in the national health service. They needed a little bit of help, but ended up getting it through the NHS rather than as it should have been given.

The hon. Lady spoke about budgets and resources. One of the measures of the pressure on social services departments is the extent to which rationing is now the norm, such as by denying care and support to those with moderate care needs who have carers—it is a widespread practice in social services departments that those who have carers often do not have access to any care at all. Rationing is also imposed by making those with high care needs wait, whether in hospital beds or in their own homes, hidden out of sight and out of mind, and by limiting the quality or quantity of care provided. Social services departments regularly deploy those tools to try to make their very stretched budgets go just a bit further.

The Secretary of State and the Chancellor recently spoke about the need to do something about delayed discharge by introducing financial incentives or penalties. Not surprisingly, people in local government and many others have expressed their concern, not least because there was no consultation about the proposals. I am very concerned about the introduction of a penalty system, the details of which are still rather vague, because of the potential distortion of priorities that it could produce.

We all know that there are serious pressures on local authority budgets for children's services. Indeed, two thirds of the overspend in social services budgets is on

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children's services. Therefore, a system that imposes more pressure to spend money on elderly people—right though that may be—without putting in extra resources in the first place, could result in yet more pressure on the budgets for children's services. The Wanless report, which was published on Budget day, made the following useful point:


I fear that we are about to see a distortion of resource allocation.

Hon. Members have referred to loss of capacity in the care home sector. As my hon. Friend the Member for Kingston and Surbiton (Mr. Davey) said, there is a real possibility of people not being given the opportunity and choice of residential care in their own communities, and being bussed miles away. Kent comes to mind, because the consequence of a substantial loss of capacity there is that people are bussed miles away from Kent, and from their families and loved ones.

The focus has been on delayed discharge, but there has been an 18 per cent. increase in emergency readmissions during the past two years alone. I understand that there will be a scheme of penalties to deal with that, but the details are much vaguer. Perhaps the Minister will comment on whether the system of penalties will simply recreate the cost shunting that already exists in health and social care. Social services will provide inappropriate packages of care, and when someone comes back into hospital as an emergency readmission, who will pick up the bill?

Hon. Members have spoken about residential care, and I shall touch on the important subject of training. I hope that the Minister will give a positive response to the suggestion by the hon. Member for Stafford for a pilot scheme. There is almost a revolving door in care homes at the moment. Unqualified, ill-equipped, untrained staff come in. They pick up the skills and ability to care for frail, elderly people, acquire NVQs and then leave for better paid jobs in the NHS and the statutory part of the state sector of social care. The same happens with domiciliary care, and the consequence is high levels of staff turnover and many vacancies.

We must consider what can be done about that. I hope that the Minister will tell us today what work she and her Department are doing, particularly in parts of the country where there is a tight labour market, to ensure that we can not only recruit but retain the necessary qualified and quality staff. Some parts of the country, such as Kent, Somerset and elsewhere, have lost a massive number of care home beds. What is being done to identify ways of regenerating the sector? When a home is knocked down or turned into flats, the land is lost and the opportunity is lost. It would be helpful if the Minister could tell us what is being done, in areas where the costs of entry into the market are so much higher than elsewhere, to ensure that the barriers are lowered and capacity can be retrieved.

We have discussed budgets and the need for SSA reform. Amen—we all agree about that. However, that is a holy grail that will deliver only if there is an increase in the size of the cake being distributed. The Budget settlement announced by the Chancellor a little while ago does not address the crying needs in social care

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throughout the country. The Chancellor rightly identified the fact that social services have been a neglected part of the caring services for too long, but it is not clear from the detail—I hope that the Minister can help us with that today—whether social services' extra spending during the next few years will be borne almost entirely by council tax payers forking out more, or whether substantial extra funds will be made available through grant to fund the necessary improvements. When the Local Government Association and others look at the figures they are alarmed that the resources going in are not sufficient to meet the Government's national service framework aspirations or arrest the collapse of confidence in the independent care sector in many parts of the country.

The hon. Member for Stafford referred to his conference, and I was interested to hear that his keynote speaker was Robin Wendt. I agree with him that there is still a debate to be had and a conclusion to be reached about the boundary between personal and social care. It is interesting that Wales is moving in the same direction as Scotland has taken, and I look forward to hearing more details about that.

Finally, I want to ask the Minister about the guidance document "No secrets", which concerns the abuse of older people. When will we have a report from the Department on its implementation, the budgets that will be made available and the staff who will be put in place? What initiatives are being undertaken to ensure that the document, which was published two years ago, is not a worthless set of words but a meaningful mechanism for delivering services on the ground and protecting the elderly?

In conclusion, I repeat that the care of the elderly must be a priority for us, and I congratulate the hon. Member for Stafford on giving us a further opportunity to debate the issue.

10.40 am

Mr. Simon Burns (West Chelmsford): I, too, begin by congratulating the hon. Member for Stafford (Mr. Kidney) on providing us with the opportunity for this useful and opportune debate. Sadly, as we have heard in several speeches, there is a crisis in long-term care and the care of the elderly. The problem is not restricted to particular parts of the country, although there are some in which it is more pronounced.

In the past five years, 50,000 residential care beds have been lost across all sectors. That has put a desperate strain on elderly people who can no longer remain in their homes with domiciliary care. The loss of care home beds has not been uniform, and in some parts of the country, particularly in the south-east and East Anglia, a significant number of beds have been lost as homes are sold and local authorities use their bulk purchasing power to force down the amount that they pay to care for the elderly. The shortage of beds has had a distressing knock-on effect on many people who have been unable to find a home in the area in which they have lived all their lives. As a result, they have had to move ever further from their roots, from family connections and from the communities in which they used to live.

Unfortunately, as many hon. Members have said, we also have a problem with delayed discharge. Figures given in written answers have shown that more than 30

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per cent. of those who are caught up in the delayed discharge system remain in hospital for more than a month. There is no medical or clinical reason for them to do so, but they remain in hospital because no beds are available elsewhere, or because there is no back-up for a domiciliary care package to allow them to return home.

Interestingly, last year's social services inspectorate report noted that 39 per cent. of delayed discharges were caused by delays in public funding, 36 per cent. by people having to wait for residential home placements as a result of the loss of beds and consequent shortage of spaces, and 18 per cent. by delays in the provision of domiciliary care packages. It is staggering that 39 per cent. of delays are due to people having to wait for public funding because there is not enough money in the social services budget to fund a place or domiciliary care, and that the national health service must meet the exorbitant cost of keeping such people in hospital for no clinical reason. That is an utter waste of taxpayers' money, and it is a disgrace that people are languishing in beds that are urgently needed for the acute care of other patients.

Reference has been made to this year's 6 per cent. real-terms increase in social services spending. Of course that is a step forward—it would be churlish to say otherwise. However, we should examine more closely the balance in the NHS funding budget between acute care in the NHS and personal social services.

Since community care was introduced in the early 1980s, there has been a significant increase in PSS funding, in percentage terms. As no doubt the Minister will tell us, the recent Budget contained a significant increase in such funding, although some of the gloss will be removed from that increase next year by the 1 per cent. increase in national insurance contributions, which will have a considerable impact on the NHS budget and place even greater financial burdens on care home owners and those in the care sector. The Department of Health did not examine closely enough the implications of an across-the-board increase in this personal tax and its impact on an area that is already struggling with other problems.

Some 62 per cent. of social services clients being looked after are from the elderly section of our community, but only 47 per cent. of the total funding is spent on social services, so there is a gap. Local government spending is significantly more than the SSA for social services, running at about 8.9 per cent. in 2000–01. It is estimated that for the financial year that has just ended, the difference rose to 9.7 per cent. In personal social services and social care, the amount of money has not increased to keep pace with increased demand and the highly sensitive and difficult nature of the care required by that vulnerable section of our community.

The gap between health and social care funding is inexorably widening. It will continue to do so because of the demographic changes brought about by more people living longer and because the extent and the complexities of the care that many people require will increase year on year. That is producing a vicious circle in which the pressure caused by delayed discharges is passed on from the health sector to the social care sector and then to the care market, where funding pressures affect capacity, leading to another increase in the pressures on the health sector.

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As the hon. Member for Sutton and Cheam (Mr. Burstow) mentioned, there are other pressures involved in getting people out of hospital and into care or domiciliary care packages in their own homes as soon as it is clinically possible. However, I suspect that corners have been cut. Emergency readmission levels have significantly increased—another vicious circle that exacerbates the problems with acute care.

After the Budget, the Secretary of State published a document called "Delivering the NHS Plan", which contains the ludicrous and self-defeating proposal to fine local authority social services departments for delayed discharges. That is an ill-conceived gimmick, which, if it ever sees the light of day, will cause even more problems. The carrot rather than the stick should be used to overcome such problems. The Secretary of State and his successors will rue the day that that proposal was conceived.

We need an urgent and fundamental review of short, medium and long-term financial planning and a proper assessment of the necessary balance between health funding and local authority funding for social care. That will ensure that the problem of funding, which has continued to grow year in, year out as demand rises inexorably, is analysed and rectified to enhance and improve the provision of social care and health care for the most vulnerable, fragile and weak in our society.

10.50 am

The Minister of State, Department of Health (Jacqui Smith) : Like others, I shall start by congratulating my hon. Friend the Member for Stafford (Mr. Kidney) on securing this debate, on his valiant efforts on his bike during the bank holiday and on the good and useful way in which he opened our discussion. I particularly congratulate him on the lessons that he learned from the conference held in his constituency. That was heartening, because we have made it clear that although the Government can set standards and targets, improve funding and offer clear guidance, local action is required to improve services on the ground. The local partnerships and plans that my hon. Friend is leading and contributing to will be important for his constituents.

Importantly, most contributors to the debate have recognised the complexity of the matter. Hon. Members have recognised that it is about more than the number of residential care places and that a range of policies will contribute to the provision of the high quality care that we want for older people.

Many older people lead happy and fulfilled lives with a minimum of assistance from formal services. Many of them make an important and positive contribution to their families and their communities. They do so by giving up their free time to work for voluntary organisations and by working with children in their own families and in schools.

The hon. Member for Caernarfon (Hywel Williams) rightly emphasised the range of older people's needs. We ought to aim to support older people and their families in their choices and lifestyles. We should ensure that, as far as possible, people are not removed from their communities and social networks and we should find

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ways to underpin existing relationships and situations that minimise risk and disruption and maximise continuity, familiarity and social inclusion.

Hon. Members also made the important point that responsibility for that goes across agencies. Local councils, working with partners, have a fundamental role to play, as does the private and independent sector. The voluntary sector also makes an important contribution to the care of older people in our communities.

From talking to older people—my hon. Friend the Member for Stoke-on-Trent, North (Ms Walley) made this point—we know that fears about safety and security are high up on their agenda, as is access to reliable transport, local shops, good leisure facilities and primary health care. It is vital for councils to work with local agencies such as those for health, fire, police, housing, education and social care to make our communities safe and supportive places for older people to live.

My hon. Friend made an important link with the Government's overall public health agenda. Our development of good health throughout our lives will affect us in older age. As a Worcestershire MP I heard, as, I am sure, did my colleagues in the Department for Transport, Local Government and the Regions, her plea for SSA reform. I assure her that there will be consultation with local government throughout the summer as we move towards the implementation of the new regime in the next financial year.

Many hon. Members raised the issue of delayed discharge. I agree that it is bad for the system as a whole; even more significantly, it is bad for individuals. That is why the Government's investment in the system is important—and it is important that it should work.

My hon. Friend the Member for Stafford spoke about the £5.4 million going to Staffordshire. He will be pleased to know that it led to a reduction in delayed discharges in Staffordshire; they were down from 224 in September 2001 to 127 in March 2002, and the target is for a further reduction by March 2003. The investment has allowed extra publicly funded care home places, extra intermediary care beds and more intensive care packages; it has been a successful start in tackling the problem of delayed discharges.

I agree that we need extra investment. I was therefore pleased, as were my hon. Friends—we should not be too surprised that the Liberal Democrats thought that it was not enough—that my right hon. Friend the Chancellor was able to give personal social services a significant annual average real-terms growth of 6 per cent. in 2003–04, rising again in 2005–06. That demonstrates the Government's firm commitment to social care. It contrasts with an average real-terms increase, on a like-for-like basis, of less than 0.5 per cent. a year under the last Conservative Government. That new cash includes resources to cover the cost of hospital beds that are needlessly blocked through delayed discharges.

Councils will be able to use that extra money to expand care at home and to ensure that all older people are able to leave hospital once their treatment is completed. We shall introduce stronger incentives to ensure that people do not have to wait so long before being discharged. Older people and other service users have the right to expect that local services should work

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together as a coherent whole, and that the policy that underpins them should promote joint working rather than letting them act perversely, as sometimes seems to be the case.

The hon. Members for Kingston and Surbiton (Mr. Davey) and for West Chelmsford (Mr. Burns) raised the issue of residential care fees. Once again, we heard the wrong figure for a fall in residential care beds of 50,000; even Laing and Buisson accept that it was a net figure of 19,000. However, we share their concern about residential care placements. As my right hon. Friends the Secretary of State and the Prime Minister have said, higher resources in social services should lead to higher residential care fees. For example, I was glad to see that what Staffordshire received of the £300 million went into increasing residential care fees.

Other hon. Members pointed out the importance that the Government place on promoting independence and allowing people to remain within their own homes. The number of people receiving intensive domiciliary care increased nationally by 6 per cent. to September 2001. That is an important and encouraging trend, and we want to see it continue.

The hon. Member for Caernarfon (Hywel Williams) raised the issue of non-residential care charging. The guidance issued by the Government in England takes an important step in helping to overcome the discrepancies between authorities, and for the local authorities to charge where they choose, which will be much fairer.

My hon. Friend the Member for Stafford and other hon. Members raised the important issue of training, and training support, in residential and domiciliary care. The national minimum standards put in place by the Government will ensure higher levels of training, but we are also matching it through increased investment—for example, through the training organisation for personal social services, which increased from £2 million last year to £15 million this year—to ensure the sort of training that is crucial to recruit and retain staff and to ensure quality in the residential and domiciliary care sector. My hon. Friend's point on how we can take forward that training is important, and I shall certainly consider it.

Several hon. Members made the important link with housing issues. I assure them that my Department is working closely with colleagues across Government to ensure that local authorities recognise those links, and the importance of developing new forms of housing. More extra care at sheltered housing, for example, could play an important role. We are reaching and exceeding our targets on intermediate care. As several hon. Members have said, that is an important bridge between hospital and home, which helps to prevent some admissions to hospital. It is a key part of the national service framework for older people, which remains a high priority for the Government. I shall ensure that my hon. Friend the Member for Stoke-on-Trent, North, receives a reply about the north Staffordshire elderly care strategy.


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