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8.52 pm

Laura Moffatt (Crawley): Frankly, the speech by the hon. Member for West Chelmsford (Mr. Burns) was a disgrace. The debate is important and anyone with an interest in care of the elderly would not take his view. When I finished my training as a nurse, I chose care of the elderly as my specialism because it is the most challenging, difficult and fulfilling sector of nursing care. That is also true of ensuring the quality of life for older people in our community, but the Conservatives reduce that to a mere issue. The motion refers to fees and standards, but the hon. Gentleman's speech was only about standards.

Mr. Burns: It was not.

Laura Moffatt: The hon. Gentleman should look at Hansard. I take issue with him on another matter, too. When asked what he would cut from care standards, he said that that was not what he was saying, but he cannot quote such sources and expect people to think that he is arguing for something else. Care homes are important and we need to have a reasonable debate on them. The debate has improved no end since he spoke, and hon. Members need to consider the problem properly.

We are not daft: we know there are difficulties. We participate in and assist our communities by working with Age Concern and nursing homes. There is an increasing number of older people in our communities and we are trying to understand the problems that that creates. I welcome the fact that they have better health care and live longer and happier lives. If this debate had been entitled "The quality of life for older people," we might have heard a slightly better contribution from the hon. Gentleman.

Even if some members of our community are having difficulties, there is another way to approach this debate, which is to be reasonable and honest, as we were in Crawley. We got together everybody in the care sector and talked about how we could improve the quality of life for older people, no matter whether they are in residential care or being cared for in the community. We included GPs and nurses from the primary care trust, representatives from the acute trust, social services, the Alzheimer's Disease Society, ethnic minorities, Health Watchdog, Age Concern and Carers UK, the son of an elderly person in a nursing home, a private care home manager and, to advise on benefits issues, Crawley borough council. I am glad to say that the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), also came to the conference.

Mrs. Gillan: What would the hon. Lady say to the Buckinghamshire Association of Care Homes, whose representatives came with me to see the Minister on 4 December to set out a catalogue of problems they are

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facing, since when not one thing has been done to alleviate any of those problems, which I have also set out today? My hon. Friend the Member for West Chelmsford (Mr. Burns) has expressed very well the depth of anger in this country. The hon. Lady should appreciate that all in the garden is not rosy and people are deeply angry about what is happening.

Laura Moffatt: I thank the hon. Lady for her intervention, I think. I hope that I was demonstrating that there is another way to achieve something better. I achieved something better through that conference, and I should like to explain how its achievements are taking pressure off our care homes. Among other things, the Government gave several million pounds to increase fees in West Sussex, which were a difficulty. We had been campaigning on that issue to ensure that the county council could pay adequately for people's care. There are ways to campaign, and it is not a solution for care home managers simply to say, "I want more money." We have to be a bit more active to achieve what we want in our communities.

Mrs. Browning: Like the hon. Lady, I have regular meetings in my constituency, and have done for the past 10 years, but I agree with my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) that the meetings held in recent years have signalled the crisis in care homes which we are now facing.

If I asked the Minister to come to such a conference in my constituency, would Devon county council receive sums like those given to the hon. Lady's area?

Laura Moffatt: It is for the hon. Lady to make her own representations to Ministers, and I hope that she is able to achieve something different in her community—a more co-operative way of working that I have found helpful. I do not say that it has produced everything that I wanted, but it has certainly ensured that we work together more closely and more effectively.

We looked at our priorities and at specific problems. Nobody is saying that there is no difficulty in the sector; that is precisely why we held the conference in Crawley. We were looking at solutions, not just shouting about the problems. Of course we had to listen to uncomfortable comments, and we talked about money.

Mr. Kevan Jones (North Durham): Does my hon. Friend agree that the root cause of the problem was the previous Conservative Government? I was a councillor 10 years ago, and I saw the effects of their policies on the care sector. They brought in differential charging, which allowed private sector care homes to charge higher fees than local authority homes, and that led to the boom of profiteering at the expense of elderly people and forced local councillors to close residential sectors. Would my hon. Friend like to comment on that?

Laura Moffatt: I thank my hon. Friend for making that point. Anyone who was a state registered nurse at the time could tell us that they were approached by several people saying, "I've got some money to put into this nursing home—would you be keen to head it up?" There would be no investigations into how committed they were—it was just about getting a figurehead so that money could be made. Of course that situation had to end—it was

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ludicrous and inhumane. So we moved on to think about solutions, and we came up with worthwhile proposals to help to reduce the pressure on the care home sector. The pressure is not caused solely by care standards—it comes from our relatives and friends who want to ensure that they are getting the best. Anyone would think that some strange organisation was attempting to put pressure on nursing homes. We want to ensure that our people have the very best in care.

One of the most important comments that the nurse from the acute sector made was that they have too many admissions from older people who have not had their medicines reviewed for a long time. They become unsteady on their feet and fall over, then—as my hon. Friend the Member for Dartford (Dr. Stoate) said—they become disoriented and find it difficult to go back to their homes. A lot of work is going on in Crawley to consider that issue with the PCT. The aim is to have a mobile team that goes around assessing older people in their own homes to ensure that they are on the right sort of medication. That is a practical approach to keeping people out of the care sector and reducing the pressure.

We know from our constituencies about the suffering that is caused by dementia problems. That cannot be cured just by saying, "Everybody must go into residential care." That is not the answer. Carers want to keep their friends and family at home so that they can care for them there. So we considered respite care—using the care home sector for shorter stays, so that the carer could have a holiday while their loved one was cared for by others for a while. Giving carers the proper rest that they need helps to ensure that people can be kept at home. It is important to provide extra care homes—fantastic facilities that give people a front door and allow them to receive the care that they need, such as having a hot meal during the day, being properly bathed and being cared for around the clock. We have one in Crawley and more are to be provided. Having a health partnership manager has proved to be enormously helpful in reducing the number of delayed discharges from care. The post is jointly funded by the trust and west Sussex social services.

All sorts of measures can be taken: improved joint working; increased capacity to deal with the increasing numbers of older people; more intermediate care; sustained funding increases that mean that is possible to predict increased finances, which we could never do in the past; improved discharge planning; and increased medical checks. There is plenty that we can do. Age Concern is setting up a new advice centre to help people to stay in their homes for as long as they possibly can.

I shall sit down now to allow other hon. Members to speak. I hope that the rest of the debate reflects our understanding that there is plenty that can be done and that solutions can be found; we do not have to return to trotting out the line that there is just not enough money in the care sector. If we are imaginative, we can do it, and I hope that other hon. Members are prepared to be so.

9.3 pm

Sir George Young (North-West Hampshire): The House was interested to hear the hon. Member for Crawley (Laura Moffatt) talk about the partnership approach that she helped to promote in her constituency. I am sure that the same is true in many other constituencies. However, I disagree with what she said

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about my hon. Friend the Member for West Chelmsford (Mr. Burns). He made a fine and impassioned speech, and I hope that it is placed in residents' lounges in care homes around the country.

One of the claims made by this Administration was that they would introduce joined-up government, but this area of policy is marked by serious discontinuity. We were told that the comprehensive spending review would introduce stable, generous and confident financial regimes for public sector services, but this area is riddled with one-off payments to meet continuing crises, with no sustainable solution in sight.

We have been told that the way forward is partnership, but the Government have proposed entitling one partner to fine the other, although not the other way round, and have passed a Bill enabling one partner, the NHS, to take over the other partner, social services, at the whim of the Secretary of State. We have seen substantial and welcome increases in the budget of one partner, the NHS, at the same time as we have seen unsustainable settlements for the other, social services departments.

The point where the two systems meet now has a name of its own: DTC—delayed transfer of care, which is an epitaph to policy failure. I want to speak from three perspectives—that of the NHS, social services and care home owners—and then outline a way forward.

First, on the NHS, cash for change has not solved the bed-blocking problem. I shall quote from the minutes of the North Hampshire Hospitals trust of 11 June:


Those minutes concerned Basingstoke hospital, where bed blocking is still an issue. I asked the other major hospital that serves my area, which is run by the Winchester and Eastleigh Healthcare trust, about its experience. Its bed-blocking figures are down from last winter, but at the same level as a year ago, totalling 59. If one looks at the reasons why, one sees that the problem is not going away.

Last year, at the worst, there were 25 cases of bed blocking owing to lack of funding. That number has now gone down to one. However, there are now 17 bed blockers due to there being no vacancy in a nursing home, as against one a year ago. On top of those 18, there are three bed blockers because of no vacancies in residential homes. Thirteen are still looking for suitable placements and 12 self-funders either have no vacancies or are looking for suitable placements.

Cash for change will not solve that strategic problem of undercapacity. A series of one-off payments simply builds up problems for the future. In Southampton, for example, the top-ups that the city paid for discharges from acute beds in 2001–02 out of cash for change produced an ongoing financial commitment into 2002–03, which means that there are no top-ups in the current year. So one blockage—shortage of cash—has been partially and temporarily cleared, but the logjam has simply moved to the next bend in the river: shortage of beds.

That brings me to social services. Hampshire county council has a competent, caring department that is struggling to do its best with the resources available, but it is caught between the rock of the revenue support grant and the market realities of care home provision. I asked Hampshire county council how its expenditure on social services compared with its standard spending assessment.

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In 1988–89, it spent £1 million under its SSA. The next year, it spent £5.1 million over its SSA, and that has gone up ever since until this year, when the budget is £11 million over the SSA.

I know that SSAs are simply a means of distributing grant, but if a council overspends on social services, it must either underspend on education or put up the rates faster than the Government would like. If the Government were open about the matter, they would recognise that they are increasingly vulnerable to the accusation of the Joseph Rowntree Foundation and others that they have got that part of the settlement seriously wrong.

Of course we must develop intermediate care services in order to try to divert demand, and Hampshire county council is doing that. However, that is unlikely to be wholly effective, especially when one takes into account the most dependent and vulnerable older people who need nursing care. The demography time bomb is ticking away; the population of over-65s will increase by 3 per cent. by 2007, and the over-85s by 6 per cent. The demand for nursing home places continues to rise. Over the past three years, the number of publicly supported nursing placements has risen by 9 per cent.

While demand increases, supply is falling. All the underfunding has affected the market. Between April 2001 and March 2002, 252 residential beds and 103 nursing beds net were lost to closures. In the previous year, the numbers lost were 89 and 75 respectively, so the losses are accelerating. Specifically in relation to nursing homes, there has been a reduction of 400 beds over the past three years—about 10 per cent. of total capacity.

That leads me to my final ingredient: care home owners. They feel isolated and vulnerable. That wholly understandable emotion feeds through to their staff—who read the papers and listen to the radio—and of course to the residents and their relatives. There is now a crying need for stability and confidence, to which I shall return in a moment.

I received an e-mail on Saturday from my constituent Mr. Chalmers, who lives in Tadley. He said:


Like other Members, during the election I visited most of the care homes in the constituency and, in preparation for this debate, I returned to one, a well-run, 21-bed home with an owner-manager. To get to the bottom of the figures, I asked her what the costs were. Allowing for no return on capital at all, and allowing the owner-manager £35,000 as salary, the weekly costs are £348 per resident—£273 is paid by Hampshire county council for the residents whom it sponsors, with self-funders paying £375. That is an indefensible cross-subsidy. I have no objection to residents on low incomes who are sponsored by social services being subsidised, but they should be subsidised explicitly from the public purse, not by their fellow residents and their families.

The basic wages in the home are £4.50 an hour, with more for qualified staff. The owner would like to pay more, but she cannot. It is difficult to retain staff, given the buoyant labour market in North-West Hampshire. The owner is grappling with extra costs, such as those incurred

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by complying with new regulations on radiator covers. There are 42 radiators in the home, and she has had quotes of up to £10,500 to cover them. I am sure she will do so, but in the meantime she has had to build a new cupboard and buy more ringbinders to store the growing amount of paper she has to keep—circulars, regulations, staff assessments, residents' assessments and so on. I am sure that other Members have found that some owners are beginning to resent the growing number of better-paid people who check, supervise and monitor them and tell them how to run their business.


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