HC Deb 27 March 1986 vol 94 cc1131-6

2.2 pm

Mr. Willie W. Hamilton (Fife, Central)

Although I am a Scottish Member of Parliament, most of my speech will be devoted to the problem of residential care for the elderly in England.

However, I shall first comment briefly on the situation in Scotland. Recent statistics from the House of Commons Library show that the regulation system in Scotland is not as sophisticated as that in England. The regularly produced statistics do not distinguish private homes from other non-local authority homes. They imply that the expansion of the private sector has not been as marked in Scotland as it has been in England. In 1979, there were 176 such private homes, whereas in 1984, the latest year for which figures are available, there were 193. That is a 10 per cent. increase. I do not know the reasons for that. In the same period, the increase in England was 100 per cent. My hon. Friend the Member for Aberdeen, North (Mr. Hughes) has just informed me that the Tory-controlled Grampian regional authority has decided that it will build no further homes for the elderly in Scotland.

Generally, elderly people are more dependent than others on social services such as the National Health Service and community services provided by local councils such as home helps and sheltered housing. Most retirement pensioners have to struggle for existence with the help of supplementary benefit because the basic pension is so inadequate.

One basic requirement for elderly people is clean, comfortable and warm living accommodation at rents or charges they can pay without financial worry. Most old folk prefer their own independent accommodation where they can enjoy privacy and the possession of their own furniture and objects of sentimental value. The next best is sheltered housing provided, in the main, by the local council, with qualified staff, attendants, constant supervision and provision for privacy. I have had an exciting and moving experience of such provision in my constituency. It is organised by the Labour-controlled Fife authority.

Throughout the country there is a mix of provision by local councils—which are non-profit making—voluntary bodies and private, profit-making institutions. The community at large has an obligation to ensure that old folk and other vulnerable people, such as the mentally or physically disabled, are properly cared for by the community, paid for by the community. The private, profit-making sector has only a limited role.

I shall put some facts and figures on the record. Written answers to questions tabled by my hon. Friend the Member for Burnley (Mr. Pike) on 2 March 1984, and by my hon. Friend the Member for Peckham (Ms. Harman) on 26 July 1984, indicate the trend. My hon. Friend the Member for Burnley asked for information on the provision of private and voluntary homes for the elderly since 1979 in the various regions in England and Wales. I shall not put all the figures on record, but I think that I should mention a few.

The figures cover a geographical stretch from the northeast of England to Devon. In 1979, Tyne and Wear had 32 privately run homes; in 1983, it had 39. West Yorkshire had 57 such homes in 1979, and 96 in 1983. Merseyside had 55 in 1979, and 101 in 1983. The west midlands had 25 in 1979 and 59 in 1983. Lincolnshire had 20 in 1979, and 44 in 1983. Norfolk had 41 in 1979 and 88 in 1983.

In the south of England the attractions are obvious. It has a milder climate, and a more desirable environment in many other ways. Dorset had 117 private residential homes in 1979 and 196 in 1983. East and West Sussex together had 294 in 1979 and 447 in 1983. Avon had 52 in 1979 and 96 in 1983. Devon had 217 in 1979 and 371 in 1983. If one adds up the figures for all those regions the total number of private residential homes was 910 in 1979 and 1,537 in 1983.

My hon. Friend the Member for Peckham, in a parliamentary question, asked for the local authority provision for March 1984. The total in England showed that there were 2,673 local authority homes, 4,090 in the private sector and 1,152 in the voluntary sector. Roughly half of the homes were provided by local authorities and slightly half the places available were local authority places.

It is worth noting that, in Dorset, which is predominantly Tory-controlled, there are only 37 local authority homes as compared with 215 private homes. In Hampshire, also predominantly Tory-controlled, there are 66 local authority homes and 233 private homes. In the Isle of Wight there are six local authority homes and 42 private homes. In Wiltshire there are 25 local authority homes and 66 private homes and in Somerset there are 27 local authority homes and 73 private homes.

In a written answer on 28 January the Minister said that the number of registered private residential homes in England for the elderly and disabled in March 1983 were 4,509, in March 1984 5,222, and in March 1985 6,443. That is a provisional figure.

On 12 March the hon. Member for Southampton, Itchen (Mr. Chope) initiated a debate on these matters. He made a quite extraordinary claim that the Government have an excellent record on extending care in the community."—[Official Report, 12 March 1986; Vol. 93, c. 1056.] The hon. Member cited as evidence the expansion in the national network of private profit-making homes for the old. The hon. Member proceeded to enumerate the many financial problems that inevitably arise from the clash between the desires of the proprietors of these private homes to make profits and the inadequacy of the means of the residents, subsisting, as many do as pensioners, on supplementary benefits.

The Under-Secretary of State for Health and Social Security the hon. Member for Huntingdon (Mr. Major) who replied to that debate sought to make the best of a bad job. He welcomed the rapid growth in the private industry but then stated that, in 1978, 7,000 old folks had been helped by supplementary benefit to pay their fees. In other words the Government augmented the profits of the private owners.

In 1978 the cost to the Exchequer was £6 million. The Under-Secretary went on to state that in 1984 the situation had got out of hand and the cost was £190 million. The Government were pouring public money into the coffers of the private owners. The Minister admitted as much. He admitted that the scheme was open to exploitation and abuse.

An article in the journal Community Care, on 8 March this year, gave examples and stated: According to one estimate, if you get yourself a property and fill it with 12 elderly residents you have a guaranteed income of £60,000 a year. The same journal referred later to an organisation called

Care Concern, founded by David Rattray, former deputy director of Denbighshire SSD, whose homes for emotionally disturbed adolescents and the mentally handicapped bring him well over £1 million a year. When my hon. Friend the Member for Peckham spoke in a debate on these matters on 13 March, she, too, gave examples of what can happen in those private homes. She cited the Inglehurst nursing home in Blackpool, where

the owners engaged in twice-daily drinking sprees, failed to administer drugs safely and fed their residents inadequately, and where there was inadequate staffing and residents were kept in squalor."—[Official Report, 13 March 1986; Vol. 93, c. 1149. ] Mainly as a result of my hon. Friend's representations, that home was eventually closed, but not before getting £50,000 a year from the DHSS—in other words, £50,000 of taxpayers' money. My hon. Friend also mentioned two cases of fraud by private homes in Kent. She raised those matters with the Government, but to date, apparently, there has been no action.

In the article in Community Care to which I referred, Mr. Dick Clough of the Social Care Association was reported to be worried by the fact that the market in old folks' needs is one ripe for profit making". That view was eagerly shared by a private company called Associated Nursing Services Ltd. It was planning to buy Stewart lodge, belonging to Hammersmith and Fulham council, along with the 29 residents whose average age was 88. Only the imminence of a by-election in that area stopped that.

Incidentally, the proposed sale was to have gone through with the support of the Tory and Liberal councillors in that area, and only in the past few days have those people reneged on that because they saw the great disaster that could befall them politically if they went through with that sale. That was an unbelievable act of social irresponsibility. Only public outrage and the imminence of the by-election stopped it.

Another organisation has shown that it fully understands the enormous profits that can be made out of the old folk. A brochure issued by the Investment and Pensions Advisory Service was quoted by my hon. Friend the Member for Peckham in the debate to which I referred. It refers to investment in old folks' homes as a

lucrative, long-term opportunity for large-scale capital growth. Under the Government's business expansion scheme, people can get grants of taxpayers' money to engage in that practice. I should be interested to know how much public money has been given out under that scheme to foster that private industry.

The Government have shown clearly that they believe in the private system and in the solution of the problem by private enterprise and privately financed homes; by leaving the problem increasingly to what the Prime Minister describes as caring capitalism, the magic of the market. We should leave it all to the market and the profit motive, and the old people's problems will be solved. There is massive evidence that the Government believe in the increased privatisation of the services, especially the accommodation requirements of our old people.

Handsome profits are being made at the expense of the old, and the taxpayers too, because the Government have admitted that the DHSS—the taxpayers—were paying £10 million a year to private homes in 1979 and £190 million in 1984. God knows what the figure will be now.

The DHSS coughs up as much as £180 per person per week in a private profit-making home. Therefore, a wee 10-bed home can received £1,800 a week or a little Less than £100,000 a year of taxpayers' money to look after those people. The local authority is responsible for examination and inspection to see that the homes are up to the mark.

While all that has been going on, the local councils have been directed and bullied into spending less and less on residential care and other services such as home helps, which helps to drive the old folks into the private profit-making sector. It is not many years since Professor Galbraith wrote an eloquent book on that philosophy entitled "Public Squalor and Private Affluence". It is interesting that the Minister grins at that. "Private Affluence and Public Squalor" describes what is happening in this area now. By treating all public expenditure, public investment and public services as inefficient, wasteful and bad, hence justifying the curbing of all that is public, the Government are driving people into the private, profit-making sector, whether it be housing, health, education, pensions, social security or, as in this case, old folk's homes.

The social services as we have known them since the war are being strangled by the Government and the Social Security Bill currently before the House underlines that fact. That is why millions of people up and down the country are full of foreboding for the future of the services as we have known them for the past 40 years.

2.22 pm
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I am grateful to the hon. Member for Fife, Central (Mr. Hamilton) for raising this subject. I am particularly grateful to him for suggesting that he would like to put some facts and figures on record. We have not had any so far and I should like to offer some.

He talked about the social service being strangled. Never, in real terms, has more been spent on personal social services than is being spent today. He talked about the social security budget being destroyed, or whatever words he used. Never, in real terms, has more been spent. Indeed, there has been an increase of over 20 per cent. in real terms, and most of that has gone on an increased number of beneficiaries, including about 800,000 pensioners and increased rates of benefit paid under the social security system.

The hon. Member for Fife, Central spoke about pensioners. He knows, but perhaps as a member of the Opposition he is not prepared to admit, that the state retirement pension is 10 percentage points higher than it was when we came into office. I wonder whether the hon. Gentleman is aware that a pensioner couple on a supplementary pension now receive £2.96 a week more than they would have done when the hon. Gentleman and his party were in government. That is the measure of the so-called stranglehold of personal social services and retirement pensions to which the hon. Gentleman has referred. They are the facts and figures which must be put on record.

The hon. Gentleman is happy that apparently in Scotland his constituents are denied the choice that is available in England between local authority provision, voluntary home provision or private provision. He smiles at that, just as I smiled when he quoted Professor Galbraith. It would be difficult to find anyone more exploded as an economic theorist than Professor Galbraith, other than Mr. Marx, to whom the hon. Gentleman may also pay some tribute.

It may have escaped the hon. Gentleman's notice that most people in this country—including I would imagine, the hon. Gentleman's constituents in Fife, Central—prefer a choice. If they have to go into a home, they prefer an opportunity to choose which sort of home they should go into. The hon. Gentleman seems to object to the fact that the Government are prepared to pay, through supplementary benefit, the scale of fees that are available. For those who live in homes for the elderly, we are prepared to pay £120 a week. For those in nursing homes who are physically disabled and below pensionable age, we are prepared to pay £230 a week.

To the hon. Gentleman that is an outrage. It is something that he condemns. However, the great majority of people, not only the elderly but their relatives, welcome and applaud it. The great majority of people recognise that there has to be a limit. They realise that there has been an explosion in numbers. In 1978, 7,000 people were receiving residential care fees. In 1984, that figure had risen to 42,000. I should have thought that the hon. Gentleman would welcome that increase in the provision made by the state to a particularly vulnerable section of the community, but he does not. He condemns it.

He does so because so many of these people have the effrontery to seek, in co-operation with the social security budget of the Department of Health and Social Security, entry into private nursing homes. The hon. Gentleman wants them to go into local authority homes. He has picked out some bad private homes. We must continue to seek out the bad private residential homes and nursing homes. That is precisely why an inspection system was introduced two years ago to supervise home care provision and the registration fee system, to which I shall refer in a moment.

Does the hon. Gentleman say that there are no bad local authority homes? Let him discuss that question with his hon. Friend the Member for Peckham (Ms. Harman). He should discuss with her what happened in Southwark at the appropriately named Aneurin Bevan home. Let him discuss with her whether those old people would prefer to be in an adequately inspected, properly run voluntary residential or private residential home or nursing home or in a local authority home in Southwark. The hon. Gentleman knows the answer to that question.

The Government recognise the importance of residential care for the elderly. That is why so large a part of our national resources has been devoted to it, why fees have been increased to the levels that I have already mentioned, why we are conducting a study to make sure that fees are kept in line with inflation and why the problems confronting particular categories are examined carefully and kept under careful review.

I have no doubt that the mix that we have achieved, and that we shall continue to maintain and improve, of local authority statutory provision and voluntary and private sector provision is the right way to go. We do not share the hon. Gentleman's vision that that percentage of our community—happily a small percentage—who need residential accommodation should be accommodated willy-nilly, without choice, in local authority homes. Of course there are good local authority homes, and we applaud and support them. But there are also good voluntary and private residential homes. That is a mix, which implies individual choice, freedom and responsibility, that most people welcome.

The hon. Gentleman finds it reprehensible that there were 910 homes in 1979 and that that figure has increased to 1,537 by 1983. I do not find that figure dismaying. I find it something to be pleased about. It means that our elderly population have a greater choice and that the support that the Government are able to offer to them through the social security system, which is constantly kept under review, can be deployed throughout the whole sector of community care.

The hon. Member for Fife, Central has a deep-rooted antagonism to private enterprise and to the operation of the market. I suggest—perhaps I would be wasting my time if I tried to make this suggestion to the hon. Gentleman—that most people consider that, having more homes in the market and more competition, obtaining better value for money, whether private or public, must be in the interests of society and of elderly people. We know that it is a great deal of public money.

Of course, standards must be maintained and that is precisely why we have taken such care in our activities with local authorities in terms of registration and inspection of these homes. Recently, we announced a substantial increase in the registration fee for private homes, from £100 to £500. To put it mildly, that measure was not welcomed by owners of residential homes. We did that because we attached great importance to the proper inspection of these homes to ensure that standards are adequate to meet the needs of our elderly people and to ensure that local authorities do not face additional burdens.

We are proud of our achievements in the promotion and preservation of residential care for the elderly. Happily, only a small minority need this accommodation. The objective must be, as the hon. Gentleman recognised, for the majority of elderly people to stay in their own homes. That is why I am glad that personal social services, the number of home helps and our spending generally on the elderly, including retirement pensioners, are at record levels.