|Previous Section||Index||Home Page|
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.
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
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.
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 communitya 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 homewould you be keen to head it up?" There would be no investigations into how committed they wereit was just about getting a figurehead so that money could be made. Of course that situation had to endit was
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, thenas my hon. Friend the Member for Dartford (Dr. Stoate) saidthey 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 careusing 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 homesfantastic 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.
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
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: DTCdelayed transfer of care, which is an epitaph to policy failure. I want to speak from three perspectivesthat of the NHS, social services and care home ownersand then outline a way forward.
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 200102 out of cash for change produced an ongoing financial commitment into 200203, which means that there are no top-ups in the current year. So one blockageshortage of cashhas 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.
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 yearsabout 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 staffwho read the papers and listen to the radioand 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.
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