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Mr. Paul Burstow (Sutton and Cheam): I want to begin by referring to some of the evidence—perhaps the Minister did not wish to hear it this evening—on the crisis in the care system. The reality is that the problems from which care homes, home care and the care system in general are suffering have been well documented not just by political parties in this House but by organisations such as Help the Aged. In particular, I want to mention some of the evidence that has been drawn to the Minister's attention time and again by the fair rate for care campaign. There is overwhelming evidence that the care system—not just the care home sector but the home care sector—is reaching a critical point. Indeed, as the Minister herself pointed out, since the care home market peaked in 1996, the number of care home beds has declined. The Prime Minister said during last week's Question Time that we have lost 19,000 beds, but I suspect that, on the evidence from Laing and Buisson, the figure is higher. I shall not get into the semantics of whose figures are most accurate.

The fact is that registrations have plummeted and deregistrations have rocketed in the past five years, which is why we have a serious problem with capacity across the sector. Having listened to today's exchanges across the Dispatch Box and the Minister's response to the Conservative Opposition motion, my feeling is that this remains an issue on which the Government are being remarkably complacent. It is almost as if the Government want a loss of capacity in the care home sector. Ministers cannot be unaware of the concerns that give rise to this debate. Through numerous Adjournment debates in the past two years, Members on both sides of the House have sought to bring to the Government's attention their concerns about the loss of capacity, the closure of care homes and the knock-on effect on the wider local health and social care economy.

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The Minister let the cat out of the bag when she spoke in an Adjournment debate last week. She said that various parts of the country


Indeed, she has restated the point today. That expansion was certainly unplanned and unmanaged, but could not those terms be applied to what is happening now? To a considerable degree, the loss of capacity in the care home sector was completely unforeseen by the Department of Health.

Mr. Dawson: Has the hon. Gentleman seen a recent report by the King's Fund, entitled "Partnerships under pressure", which acknowledges that partnerships are developing the whole systems approaches that the Conservatives failed to recognise at all? Crucial ways of working together to integrate health and social care are beginning to be developed. Is that not the way forward for this sector?

Mr. Burstow: I agree that whole systems are undoubtedly the way forward, and I welcome the work being done to that end by the Local Government Association and the NHS Confederation. However, I regret the fact that the hon. Gentleman's Front-Bench colleagues appear to be pursuing individual quick-fix gimmicks such as the introduction of fines for local authorities that fail to facilitate early discharge from hospital. Such a provision misses the point entirely, and simply treats the symptoms rather than the underlying causes.

Mr. Butterfill: Does the hon. Gentleman realise that, in Royal Bournemouth hospital, for example, at any given time, an entire ward—some 30 or 40 beds—is blocked by this problem? Although we are anxious to have home care as well, that cannot be achieved because this Government have cut the social services budget in Bournemouth—a budget that was designed for this purpose—by £3 million every year since coming to power in 1997. How are we expected to stop bed blocking in the light of such cuts?

Mr. Burstow: The Local Government Association has made a detailed analysis of the implications of the settlement announced in the Budget, about which we will probably get more details in the forthcoming comprehensive spending review. The 6 per cent. real-terms growth—we will have to wait and see how much of that will be passed on to council tax payers, rather than being picked up directly through the Exchequer—will not lead to anything like the improvements that Ministers claim. The reality is that the Government have considerably underestimated the cost of providing care, and I shall discuss in due course the Joseph Rowntree Foundation's report on that subject.

The hon. Gentleman is right: the shortage in social services resources is passed on to the care home sector and to other care providers. Indeed, that is an important reason for the loss of capacity across several different care sector providers. That unsustainable squeeze in fees over at least the last seven years—it predates this Government—has been a serious cause of the reduction in capacity.

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The Minister was right to identify the introduction of the NHS community care legislation in the early 1990s as one of the triggers for the downward pressure by local authorities. The Conservative Government recognised that they had set in train a runaway budget funded through the Department of Social Security—as it then was—and they wanted someone to cap it. Central Government do not like to take responsibility for capping expenditure, so they turned to local authorities to do the dirty work for them. Over the past seven to 10 years, local authorities have been effective at their job, and that is why we see the current problems in the care home sector and well beyond.

Mr. Nigel Waterson (Eastbourne): Does the hon. Gentleman accept that Liberal Democrat-run East Sussex was, year after year, bottom of the national league tables for how much it paid the private sector, while it squandered millions of pounds on paying hundreds of pounds more a week for beds in its own homes?

Mr. Burstow: I hope that, on this occasion, the hon. Gentleman will stay to make his own speech, which he did not when he made that point in an intervention on my speech in January, when we initiated the debate. The answer is the same as it was to the remarks of the hon. Member for Bournemouth, West (Mr. Butterfill). Social services were underfunded by the Conservative Government for far too many years. It is hardly surprising that the hon. Member for Eastbourne (Mr. Waterson) can make that point. The reality is that since the Conservatives returned to power in East Sussex, matters have not significantly improved.

In January, I published evidence of the squeeze in fees. In the charitable care home sector, charities are having to make payments to top up local authority fees to provide decent care. That costs the charitable sector £185 million a year to provide decent pay and conditions for staff and decent quality care for care home residents. A recent letter from a charitable care home provider goes to the heart of the problem and states:


That letter was sent to the Minister in May and is further evidence that the sector is underfunded and undervalued. We are trying to get care for the elderly on the cheap.

Standards are an important part of the equation and the Liberal Democrats were committed to improving them during the passage of the care standards legislation. Indeed, some research into the quality of life in residential and nursing homes gives serious cause for concern. A report last year by the British Medical Journal found that in a six-hour daytime period, in several care homes in both the public and private sectors, residents spent half their time asleep, socially withdrawn or not actively engaged. Only 50 minutes were spent talking or communicating, and fewer than 12 minutes were spent in everyday constructive activities. We must all be concerned that that is the quality of life that far too many suffer in care homes.

Last month, Rowntree published a report by the leading market analyst, William Laing, which found a £1 billion black hole in the funding of the care home sector.

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The Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith), prayed that report in aid but did not say whether she supported the central thrust of its argument that the sector is under-resourced. Perhaps the Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), can say whether the Government will seriously consider the model for costing care in care homes set out in the report, discuss it with the Local Government Association and representatives of the care home sector and start applying it. In that way, we might bridge the gap between what the sector says and what the Government say is needed to fund the sector properly.

Laing and Buisson also produced a local report for Birmingham city council, and I am sure that the Minister will be aware of it. In May, Councillor Susanna McCorry, the Birmingham cabinet member for social services and health, wrote to the Minister saying:


That was in May.

Just last week, I received an e-mail from the Birmingham care consortium that said that more than half the care homes in the city have now declined the contract from the city council. As a consequence, many homes will turn away local authority-funded placements, exacerbating the problems of bed blocking in the city. That is one consequence of the underfunding of the system.

Low pay and morale and poor staff retention are also serious problems. Many people get better paid stacking shelves in Tesco or working in a local IKEA. Providing care is a demanding and stressful job and we are rightly talking about requiring that more staff are trained, with 50 per cent. trained to national vocational qualification level 2 by 2005. But what happens when better trained staff work in a low-paid environment? They take their skills elsewhere, to the NHS or another public sector employer. There is no money in the system to recognise that level of training in the care home sector. What do the Government propose to do about that?

The standards have been the final straw for many care home owners. That is not because they are wrong in principle, or indeed in many aspects of their practice—although my hon. Friend the Member for Weston-super-Mare (Brian Cotter) was right when he asked the Minister about the lack of consistency in the interpretation of standards by inspectors across the country. It would be a serious weakness in the system if we had national arrangements for regulating and inspecting care, only to find that individual inspectors still had far too much latitude in interpreting them on the ground.

The Minister talked about the softly, softly approach that the Government announced at the beginning of the year to try to reassure the care home sector. The later implementation of many of the physical standards is certainly welcome, but removing the need to change room sizes until 2007 does not address the problem that care

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home owners face when they see their bank managers to secure the loan to pay for the changes. It does not alter the fact that care home owners are asking for loans to remodel their homes to reduce the number of beds and therefore to receive less income. Bank managers will laugh in their faces and certainly will not provide the resources to facilitate the changes.


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