|Previous Section||Index||Home Page|
Ms Taylor: The hon. Gentleman thinks that this is funny. Good for him. The reality is that local people do not laugh about it. They are very grateful. As I was saying we do not have a bed blocking problem, but we have two people who need places. Where is the crisis? From the perspective of my constituency, my council and local private homes, the Government have achieved an innovative care system that is significantly better financed. It has a structure based on a partnership of equals between the public and private sector. It is a service based on the principle that people's individual needs, not profit, come first. It is also accommodating high standards. The local people know that it will take time for all those characteristics to become evident, but they know that we will persist until they do.
There is little evidence in Stockton of shortage of beds or bed blocking. In fact, there is much evidence that our policies are competent and achieving a much better service. There is no crisis. Unfortunately, in tonight's debate, the Liberal Democrats have been playing to the gallery. The language they have used is also used by my Liberal Democrat colleaguesand they are colleagueson Stockton council. During a council debate, when the homes for life policy was introduced, it was warmly welcomed by the leader of the Liberal Democrats. However, when public opinion began to question the policy and the debate became a little bumpy, the Liberal Democrats immediately decided that a change of mind was the most appropriate response that they could make. I suggest that opportunism is the last thing required when a policy is being developed to respond to the needs of the old, the ill and the vulnerable in our society.
Stockton's approach"Homes for life, a life in your own home"is appropriate. That policy came about because the Government have allowed us to innovate and to challenge a culture; they have allowed us to say not only that we want quality, but that independent, individual lives should be accommodated in the social and health care system.
The test of a civilised society is surely the way that it cares for its older people. Although I agree with the hon. Members for Stockton, South (Ms Taylor) and for Wakefield (Mr. Hinchliffe) that we should facilitate independent living wherever possible, it is not appropriate for everybody. Ideally, there will always be a place for residential care in a mix of provision.
At present, the vast majority of people who go into residential care go into the private independent sector, so the state of that sector should be of concern to us all. Despite the paradise in Stockton, that sector is in a state of developing crisis and I shall explain why.
The sector has suffered underfunding for many years. In Norfolk, year-on-year fee increases are below the rate of inflation. Last year, the Labour-Liberal Democrat council budgeted for social services spending of £13 million above the standard spending assessment, but it still overspent by £1 million.
The competing demands faced by social services departments put those departments in an impossible positionfor example, as regards their child protection work. In Norfolk, we experienced the awful and desperately sad death of Lauren Wright. Part of the problem is that there are insufficient social workers. I pay tribute to the work they do, but there are not enough of them. Furthermore, there is not enough money to pay for an adequate number as well as providing sufficient funds for the care of elderly people.
In addition to the underfunding in fees from social services, the costs incurred by care homes over the years have continued to rise. They have had to cope with the minimum wage and the introduction of holiday pay. I fully support both those things, but they must be funded. The increases have not been enough to fund those extra costs.
On top of that, there are the new care standards. I repeat the comments already made by my colleagues on the Liberal Democrat Benches. We support national care standards. They are important, but it is essential that they do not act as a straitjacket that makes it impossible for inadequately financed care homes to meet them, with the result that the homes become unviable and have to close.
The effect of all those measures is that a substantial number of homes have already closed35,000 beds have been lost nationally during the past three yearsand there has been a dramatic drop in the number of new registrations. We have also heard about the knock-on effect for the NHS where blocked beds inevitably result in cancelled operationsdespite the situation in Stocktonand longer waiting lists.
The homes that are most affected are those that rely on social services-funded residents, so the most disadvantaged residents lose out most as a result of the current inadequate funding. Furthermore, those residents also lose out owing to the problems in the underfunded NHSproblems such as cancelled operations. They are unable to opt out as people with more money are able to do.
Finally, I shall comment on the situation facing care homes for younger adultsresidents with learning difficulties. That sector is the real Cinderella service. Recently, I visited an impressive home called Abbottswood lodge, which is situated in Swanton Abbott in north Norfolk. It is highly regarded locally and has received very good reports from social services inspection teams, but staff there are very worried about the impact of the new care standards on the home. They are especially concerned about the limits on the size of units and rooms in the home. They feel that the overly prescriptive approach will have a severe impact on their ability to continue to operate as a care home for younger adults.
The home is wonderful, an old vicarage with delightful grounds. However, the extent of the grounds cannot be taken into account in the prescriptive rules of the new care standards. The introduction of the national care standards requires sensitivity and flexibility.
It is time for some joined-up Government thinking, to quote a new Labour phrase. There needs to be a whole-systems review, so that we can judge the impact on the health service and on the care sector. It is time too that the whole system received proper and sustained funding.
The problem with the debate is that it is stuck in the past, whereas we should be looking to the future. However, I am not going to live in denial: there are problems in Gloucestershire. Recently, I met care home representatives from my constituency. Homes have closed there for a whole range of reasons, some of which have been noted already.
Yesterday, Lord Sutherland, Baroness Greengross and Ian Philp from the national service framework for older people addressed different meetings. Their various perspectives on the matter allowed hon. Members who attended the meetings to see the good things that are happening, as well as some of the problems with which we are all familiar.
My main aim in this debate is to make it clear that I think the mistakes that have been made are not necessarily the fault of this Government, or even of their predecessors. Although we could do some things better, the problem is that many previous Governments have failed to overcome the barrier between social care and health care. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) made that point very clearly.
The Conservative Government may not have been responsible for that mistake but, as I noted in an intervention, it was made worse by the way in which they tried to reallocate funds to personal social services as a result of the Griffiths report. As a result, the NHS was removed from the equation to too great an extent, and there was a failure to understand that it was not a mixed economy of care.
Moreover, that period saw the beginning of the end of county-led provision, certainly in my county. I believe that that was wrong. There was also a failure to realise the opportunities for the mutual sector. I hope that that matter will be looked at again. There is a role for mutuality in this sector, as it overcomes some of the distrust that people feel for the private sector.
I do not want to belittle the private sector. Some of my friends run care homes, and they are open about the fact that they want to make a profit. However, the private sector is not the only solution. We must give credence to mutuality, which is something from which we could gain considerable benefit.
The debate has already touched on various geographical and historical problems. Interestingly, the latest figures from Laing and Bouisson show that demand has not continued to rise exponentially, but has been capped. Perhaps that is a result of the way the funding mechanism operates, but alternatives are already being sought. Demand may grow as the population increases, but we must take demand into account as well as supply. The problem is not merely one of capacity: we must take account of what people want and where they want to go.
There is also a difference in expenditure. Again, I understand from House of Commons figures, drawing on Laing and Buisson's work, that approximately £9 billion is spent in the residential nursing sector, compared with just over £1 billion in the domiciliary care sector. Is that the right balance? Many hon. Members would argue that it is not, and we need to find a difference balance.
In trying to find some solutions, I would argue that the NHS has already moved too far out of the personal care sector. The NHS is invaluable precisely because it is the most trusted of organisations. Despite its various problems, it has a notion of how to deal with people, and we must ensure that that is carried into the personal care sector.
As I have said before in the Chamber and in Westminster Hall, there are different ways in which we can ensure that people are properly accounted for when they enter the system. In the United States, systems called minimum data sets provide a much better understanding of how people in the system can be moved more effectively. I hope that the Government will consider some of the pilot work that has been done in the Bristol area and try to roll it forward towards a national system. That involves using information technology effectively, but if that can be done people will not be lost but will be funded appropriately and they will feel that they are being listened to much more.
Another concept worthy of mention is that of supporting people, which has not been mentioned at all in this debate. It is important because for the first time it genuinely locks housing into social care and health provision. People often want to go home when they leave hospitalthey do not want or need to go into the residential or nursing home sectorbut perhaps cannot do so for the simple reason that their homes have not been adapted, and we must highlight that problem. I have done a lot of work locally and nationally with Care and Repair, and through other home improvement agencies it can lock into that exciting debate.
A final issue is that of intermediate care. I shall not try to define it here tonight; the Government have much cleverer people than me working on that, but we could consider the way in which the NHS and others can provide the appropriate facilities for older people and the other groups mentionedthe vulnerable peopleby pursuing intermediate care.
To give it a quick plug, Standish hospital will no longer be used for acute provision after 2004, so it could be considered for use as an intermediate care centre. In the years to come, I shall write to Ministers to advocate that solution, but that much-loved institution should be considered properly. If such things happen in the NHS, some of the pressure will be taken off the care sector, and we shall ensure that we do not view the solution as lying entirely in private provision. That would be neither fair nor realistic to the private sector; nor would it represent an appropriate use of state resourcespeople's resourcesand we could have a much better system accordingly.