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Mr. Swire: The hon. Gentleman is entirely right, but there is a further issue: diet and nutrition. There is evidence to show that a lot of the people who are delivered their meals in advance en bloc simply do not feed themselves regularly during the period that the food is intended to last them. Of course that has long-term effects and probably throws them back into the system.

Dr. Stoate: Again, the hon. Gentleman makes another useful point. What he suggests is sometimes the case, but one hopes that the food provided by social services is of nutritionally good quality. I am sure that most of it is, but the hon. Gentleman makes a fair point: it is important that elderly people get good nutrition because, again, that can make the difference. Some research that I have done certainly suggests that many people—in particular, vulnerable elderly people—suffer from a form of malnutrition. They may not be calorie poor, but they are often nutrient poor, which can make a big difference to their mental and physical functioning and their overall strength and well-being.

Yes, the hon. Gentleman makes a fair point, but we cannot honestly blame the frozen food because many of those meals are of nutritionally good quality, provided that people also supplement them with other food of their own. Nevertheless, that intervention is useful because what matters is looking after people in their own homes and getting people through the hospital sector as quickly as possible and back into their own homes. That is the right way forward.

In Dartford, Darent Valley hospital, which is brand new, has fewer beds than the hospitals that it replaces, so there is greater pressure on those beds. That hospital will

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flourish and provide a good service only if we can reduce bed occupancy lengths and have a faster throughput of patients. Often the problem, as many hon. Members will be aware from their own constituencies, is that too many of those beds are occupied by those whose discharge has been delayed. That effectively holds up the system, slows throughput, increases the mean length of occupancy and therefore causes problems in the acute and casualty end of the system. That is very difficult to manage.

In the modern hospital sector, it is very important that hospitals are used for acute stays, lasting as short a time as possible, and that patients are moved through and into the community as quickly as possible.

I am particularly pleased that my hon. Friend the Member for Gravesham (Mr. Pond), who was in the Chamber earlier, and I have been working on trying to get a step-down, intermediate facility in his constituency that will provide 100 beds for exactly that reason. People can be moved from the acute sector to the intermediate sector for rehabilitation and step-down care before being transferred to a residential home or, preferably, back to their own homes. We need to encourage that sort of initiative, and I am pleased that the Government are supporting that type of project. It is important that we do so because we can take the pressure off the acute sector and the care home sector.

Clearly, we have a problem. I am not trying to diminish the fact that we have to face up to the problem, but it is what we do about it that really matters. I can honestly say that I have heard nothing from Conservative Members about what they would do about it. They have not produced a single solution or said what they would do if they were in this situation. They can rant and rave; they can make a fuss about what we are doing, but none of them has yet produced a sensible proposition. Liberal Democrat Members seem to have a rather more thoughtful approach, and I have been pleased to hear much of what they have said. I hope that they will be able to catch your eye later, Mr. Deputy Speaker.

Mr. Dawson My hon. Friend is praising them too much.

Dr. Stoate: I do not like to butter them up too much. My hon. Friend is right; it has to stop somewhere, but let it be said that we are an inclusive party and, if any Liberal Democrat Member wants to cross the Floor of the House and join us in our endeavours, they will be made very welcome.

The important thing is that society has to face up to the fact that we have a problem. People are getting older. The cost of care is increasing. Thankfully, standards of care are also increasing, which we must surely all applaud. It must be right that those standards increase. It must also be right that the staff are paid and trained better and that the facilities in some of those homes are dramatically better than they were 20 years ago. That has to be the way forward.

Clearly, money must be found and we have to find a way for the system to provide that sort of care. Clearly, we have to balance permanent, long-term care in residential homes with care in the community. All those things must be taken into account. That is why I am so pleased about this debate, and I hope that we can throw around some of those ideas.

Richard Younger-Ross: We have heard a list of things to help reduce the need for people to go into care homes,

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but would there not be less pressure on those relatives and families who are trying to get a relative moved into a care home if there were more support for carers and a greater recognition of their role?

Dr. Stoate: That is an excellent point. We need to give carers more support. The figures that I have seen show that carers save the country many billions of pounds a year because of the care that they provide. Of course that must be recognised. Often carers have given up their own careers, sacrificed their own family life and made huge difficulties for themselves by being carers, but many of them are pleased to have done so.

I agree with the hon. Gentleman that it is important that we recognise the enormous contribution that carers make and that we support them as much as we can. We certainly need to give them all the help that we can. If we are to produce sensible solutions to the long-term care problem, all of us—carers, social services, the health service and the Government—have to work together, so I shall be pleased to hear what my hon. Friend the Minister has to say later in reply to some of my remarks.

Several hon. Members rose

Mr. Deputy Speaker (Sir Michael Lord): Order. Before I call the next hon. Member to speak, may I make a plea for shorter speeches? Many hon. Members are seeking to catch my eye this evening, and I am afraid that an awful lot of them will be disappointed if speeches continue to be so long.

8.37 pm

Mrs. Cheryl Gillan (Chesham and Amersham): It is a great pleasure to follow the hon. Member for Dartford (Dr. Stoate) this evening. He seemed to spend a lot of his speech telling us that the Opposition had no suggestions, but he seemed to spend the other half of his speech agreeing that we were making fair points in our interventions. He can't have his cake and eat it. He seemed to be short on suggestions, but he seemed to understand the problems that were articulated so well by my hon. Friend the Member for West Chelmsford (Mr. Burns) in opening this important debate.

Buckinghamshire is not the sort of place that one thinks of as being in great need. Mention of my constituency conjures up visions of leafy lanes and expensive housing: it is not the first place that springs to mind as having a problem. One would be completely wrong about that, however, since in common with the rest of the country at the moment, my constituency has an enormous problem with the sick and the elderly. Like other constituencies, Chesham and Amersham is suffering from a great crisis in the care homes sector.

In Buckinghamshire, there is an association called the Buckinghamshire Association of Care Homes—BACH. I do not know whether the Minister has come across it, but it has established itself as a very strong voice for the sector. I would like to put on record my gratitude to Peter Hall, Peter Beard, Georgina Rixon, Paul Fletcher, Graham Faulkner and particularly Councillor Hugh Carey, who have briefed me and my colleagues in Buckinghamshire and who accompanied us to see the Minister earlier this

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year about a large catalogue of problems. The Minister was courteous, but, sadly, powerless to stop the disaster that faces us all.

Over the past few years, there have been substantial changes in this sector: mounting labour costs, new standards and regulations, and a lack of confidence in the future viability of the care homes market. Most of those problems can be laid at the feet of Government. If I am generous with my interpretation, I would say that the Government have tried. In reality, however, they do not have the foresight, experience or expertise to realise the unintended consequences that their actions have caused.

The national minimum wage, the working time directive, increases in pay awards to NHS nurses and staff shortages—of nurses, care assistants and domestics—are all wreaking havoc. The other day, a constituent told me that the care home in which her husband now lives starts putting residents to bed at 3 pm, as there are often only two staff to put 16 people to bed. What a humiliating ordeal for people in their final years.

The new standards and regulations, as we have heard, have rolled over the care sector like a smothering blanket—new national minimum standards, codes of practice from the General Social Care Council and European legislation. Individually, they make great sense and afford protection, as many people have acknowledged. Put together over a short period, however, they have had a disastrous effect—forcing local authorities to withdraw from running residential care homes, and closing non-compliant homes that could not cope.

The Minister may be aware that the National Society for Epilepsy is based in my constituency. It has written to me, stating:

Indeed, the NSE has evaluated that it will cost some £15 million to put the establishment in my constituency into the condition now required by the Government. No one can argue with the aims of the new standards—they are highly commendable and have the best interests of clients at their heart. No money has been allocated, however, to enable care homes that are already under financial pressure to undertake the required improvements. As a result, care homes are closing because they do not have sufficient funds to enable them to meet the new standards. Other care homes are having to draw on reserves to enable them to undertake the work, but it is putting them under increasing financial pressure. As far as the National Society for Epilepsy is concerned, the £15 million that it must find will come out of money that could be spent on valuable research.

In addition, the care standards require higher levels of training for care staff. By 2005, 50 per cent. of all staff will be required to have achieved NVQ level 2 or above, or be working towards that qualification—all at a cost to the organisation. That is in addition to a raft of other mandatory training on moving and handling, fire, food and hygiene. Furthermore, all housing managers will in future have to have a registered manager's qualification or equivalent. The Minister must appreciate that the training will be very costly and time-consuming. Again, nobody can argue against the desirability of having those standards. The demands that are being put on the sector, however, are virtually unbearable.

The lack of confidence is only too apparent. Investors and corporates are increasingly viewing the care homes market as financially unstable and offering insufficient

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returns on capital invested. Many voluntary and charity operators are also adopting that view. There have been massive bed losses—whether the loss is 50,000 or a net loss of 19,000 is irrelevant. Not least because of this Government's drive to concrete over the south-east, existing home owners are finding that a higher value is placed on their land than on the business that they operate. Selling for housing development causes less sleepless nights and puts money in the bank. Private and voluntary operators run 85 per cent. of the care home market; if there is little incentive for them not to sell up and withdraw, what will happen?

What has been the effect on the care homes market? Over the past five years, local authority fees have fallen below open market fees. In Buckinghamshire, the usual fee is running at approximately £100 a week down. The budgetary and central Government restraints will not enable our local authorities to purchase bed spaces at levels necessary effectively to reduce delayed discharges in hospital services such as respite and intermediate care.

Many care homes survive because their private-paying clients subsidise the lower fees paid by the state-funded clients. However, voluntary sector and charity operators estimate that they subsidise local authority-funded clients in their homes by about £185 million, and that will prove to be a problem in itself. The Charity Commission has stated that charities such as the National Society for Epilepsy cannot use their funds to finance the care costs of local authority-funded placements.

For many years, the NSE, like many other care providers, has consistently subsidised the provision of care services, because there has been insufficient funding from Government and local authorities and thence to care homes. In the case of the NSE, that has meant subsidies of about £1 million per annum in recent years. The Charity Commission has made it clear that such subsidies constitute an illegal use of funds, and that means that charities cannot use charitable funds to subsidise what is a statutory responsibility of the funding authorities.

That has led the NSE to review its fee structure and, in turn, led to detailed assessments being made of all residents to ensure that individual fees realistically cover the level of care provided. The average increases are about 40 per cent, but I am sad to say that some are much higher. In some instances, 100 per cent. increases have had to be made. Throughout the year, the NSE has negotiated with local authorities across the country to introduce the new fees and it has largely been successful. It has skilled negotiators. However, the negotiations are still going on with some authorities that continue to claim that they are underfunded themselves.

In some instances, the fee increases are for residents who have been at the NSE for many years—some for several decades. Some authorities have threatened to move residents of long standing by saying that they are able to provide care more cheaply elsewhere. But are such decisions being made in the best interests of the clients, or are they being made purely on the ground of funding? I hope that the Minister will answer that question, because some funding authorities appear to be using clients as pawns.

According to the NSE, there is a lack of clarity between health and social services. Up to 70 per cent. of the subsidies made over recent years have been to cover the health needs of individual clients. Fees are currently paid

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by the local authority which, in turn, claims the health component from the NHS via the local primary care trust. However, there are no clear pathways as to how that funding can be acquired. It is evident from feedback from local authorities that there are inconsistencies in the response from the health authorities over what constitutes health care for individual clients. Clarification and clearer pathways are required.

I also wish to mention fairer charging, because my local authority has raised the issue with me. The Government have required that all local authorities review their charging policies to ensure that those people on basic levels of income support plus 25 per cent. are not charged for non-residential services after 1 October 2002. The Government intended that to be cost neutral, but that is patently not the case and no transitional funding is available to help local authorities.

Buckinghamshire county council has put in £1.2 million of local taxpayers' money into the base this year to offset the potential loss of income through implementing fairer charging and I have to tell the Minister that —may well not be enough. As a result, it is likely that some people will pay more than they currently do, and some will pay considerably more. Those on modest incomes will be hit the hardest. Carers may decide that enough is enough and ask social services departments to take over the responsibility for caring. What will happen then? That will add stress to the system, and high costs now may mean that many individuals will have insufficient provision for their old age.

My county council is in crisis. Its standard spending assessment for the past two years was the second lowest in the country. In 1999–2000 and 2000–01, it was the lowest. Even in the year before—1998–99—it was the second lowest. Two nursing homes closed last year in Buckinghamshire—another may close shortly—and we lost 58 places as a result. Laing and Buisson says that by 2010 there will be a 16.9 per cent. increase in the demand for residential nursing places which by 2021 will be 51.8 per cent.

Buckinghamshire has an average number of older people, but that is changing. There is some variation in demand in different parts of the county, but beds for the elderly mentally ill are in short supply across the area. Overall demand for care home places will increase significantly. In 2006, cumulative growth demand since 2001 will be 7.3 per cent., which compares with the estimated figure of 3.3 per cent. for the rest of the United Kingdom. The growth is projected to rise by nearly 20 per cent. by 2011. Despite that, we have the second lowest standard spending assessment allocation. The shortages of beds will be most critical in the Chiltern and Wycombe area.

I could go on about the difficulties in gaining access to beds, their costs, the increasing delays in hospital discharges and the choices of which my constituents are deprived, but it is only fair to let other hon. Members speak. My constituents want dignity for the elderly in our community. The pressures on the county council, the charities, the residential homes and the families in my constituency are almost unbearable. I ask the Minister to halt the crisis and stop it deepening. I ask him to provide practical solutions to the catalogue of problems.

I am a fair woman and will say that perhaps the Government's intentions have been good, but the consequences have been disastrous. Sadly, Ministers

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appear incapable of taking responsibility. I welcome the Under-Secretary of State, the hon. Member for Tottenham (Mr. Lammy), to the Front Bench for the first time tonight. I hope he will not add to the catalogue of shame created by his Government's policies on care homes and will rise above the policies that have been so damaging.

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