Residential Homes

HC Deb 10 December 1991 vol 200 cc751-86

Motion made, and Question proposed, That a further sum not exceeding £1,680,076,000 be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1992 for expenditure by the Department of Social Security on non-contributory retirement pensions, Christmas bonus payments to pensioners, pensions etc., for disablement or death arising out of war or service in the armed forces after 2nd September 1939 and on sundry other services, on attendance allowances, invalid care allowance, severe disablement allowance, mobility allowance; on pensions gratuities and sundry allowances for disablement and specified deaths arising from industrial causes; on income support, transitional payment, child benefit, one parent benefit, family credit, and on the vaccine damage payment scheme.:[Miss Widdecombe.]

4.35 pm

Mr. Frank Field (Birkenhead)

It is my privilege to open the debate on the report of the Select Committee on Social Services into the financing of private residential and nursing home fees. It gives me the opportunity not only of placing on the official record the Committee's thanks to its staff for their work, not only of drawing to the attention of the House what I think is the first debate on community care to be initiated in the Chamber which is not part of a debate on another measure, but also of drawing attention to the number of firsts that we score with this report and debate.

This is the first joint report to be submitted to the House by the Select Committees on Social Security and on Health. This is the first time, speaking in this capacity, that I have welcomed my hon. Friend the Member for Manchester, Withington (Mr. Bradley) to the Opposition Front Bench. Anyone who knows my hon. Friend's track record before he became a Member of the House will know how well deserved that promotion is.

This is also the first time that the Under-Secretary of State, the hon. Member for Maidstone (Miss Widdecombe), has been allowed out to speak from the Treasury Bench in the Chamber. We heard from the hon. Lady several times in Committee, but the Secretary of State for Social Services has kept her firmly muzzled on other occasions. Hon. Members can draw an important lesson from the hon. Lady's rise to office as a junior Minister in the Department. She got the post because she proved such a thorn in the Government's side on this very issue. Those hon. Members who are told by the Whips that their loyalty, obedience and voting record will all be taken into account may rest assured that those things are, indeed, taken into account, but in a totally different way from what one is led to believe if one wants to speak in the House from either Front Bench.

With those introductory remarks, I hope that I have drawn attention to the firsts that we celebrate in this debate, but although those matters are important, matters of far greater importance form the substance of our debate. I refer to what has been, is and will be happening to the financing of some of the most frail and vulnerable members of our community who live in residential or nursing homes.

I know that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) wishes to contribute to the debate if he is able to catch your eye, Mr. Speaker. From the many written questions that my hon. Friend has tabled on this matter, I note not only that the numbers of people in residential and nursing care have increased substantially, as we all know, but also the surprising fact that there has been only a modest fall in the numbers of people in local authority care. I had thought that there had been a really massive shift from what one might call the public sector into the private sector. Although there has been a slight fall in the numbers of people in local authority care in the past 10 years, there has been a remarkable increase in the numbers of people cared for in what is described as the private sector—in the homes run as nursing or residential care homes.

I know that criticisms will be made as a proper part of our deliberations today about whether that is the best use of the money. My hon. Friend the Member for Wakefield raised such criticisms in Committee and may well do so again later. However, on behalf of many of my constituents—I am sure that this is true for many other people around the country—I should like to stress that, although none of us thought in 1979 that we would be discussing this situation today, as a result of it many of our constituents have received a quality of life far superior to that which they might otherwise have had.

I certainly recall visiting residential and nursing homes in my constituency of which one could genuinely say that one would be pleased to be a member of that community. We are called upon to make such statements in all sorts of circumstances in our constituencies and sometimes we do it slightly with tongue in cheek, but I can genuinely make such a statement about many homes. I do not want any criticisms that we may have of some home owners or some trends to detract from that important fact.

We all agree, however, that there are some real problems with the current provision. Many of us share some deeply felt worries about what will happen under the current procedures until the changeover takes place in 1993. While our minds may boggle at the difficulties which exist now, goodness knows what the scene will be after 1993. We welcome to our debate the Minister for Health, who is in her place on the Treasury Bench.

First and foremost, there has been a remarkable and outstanding growth in the social security budget for residential care. This is one of the few occasions in the House when I can say that many hon. Members on both sides of the House told the Government that that would happen if the Government allowed the policy to develop in the way it has. Hon. Members made a plea in the early stages of the 1979 Parliament that the Government should allow local authorities to appoint gatekeepers who would judge whether people qualified on not only income grounds but more general medical needs grounds for the care that they sought.

Every time hon. Members put that point to the Treasury Bench, the Government knocked it aside. One of the consequences of that is a high level of provision, from which many of our constituents benefit. But if some of our constituents had been offered other options, they would not have chosen residential or nursing care.

It is because the Government would not allow local authorities to appoint a couple of gatekeepers that we face a bill probably in the region of £1.9 billion. Undoubtedly, the Under-Secretary of State will bring us up to date on that. I think that it is fair to say that, if hon. Members on either side of the House had realised 10 years ago that we would be debating a sum of almost £2 billion, none of us would have recommended the one-track community care solution that has been adopted. To some extent, that is water under the bridge.

I do not say that to score a cheap point. It is not a party point but a House of Commons point against the Treasury Bench. I make the point because, in the report that we are debating, we make several recommendations and we wish the Government to take them more seriously than those that we made in the past. The fact that the Government disregarded our recommendations largely accounts for the debate that we are having today.

The next problem that the Government face is the fear of evictions. If I were the Secretary of State for Social Security, which I am not, my nightmare would be the early morning phone call from the Department's press office saying that an eviction is taking place that day, that the media and particularly the television cameras will be there and asking whether I would be there and what were the Government's comments. It is because that fear exists that some home owners know perfectly well that they have the Government over a barrel. When they want to see fees generally jacked up, we get talk of impending evictions.

The Under-Secretary of State said in her discussions with the Select Committee that she did not have any examples of evictions, yet the Association of Metropolitan Authorities told us that 24 per cent. of its members had reported evictions to it. It added a phrase so extraordinary that I quote it directly: although these were felt to be isolated incidents. All that I can say is, thank God that they were isolated incidents. Even so, a quarter of the authorities reported to their central body that such incidents had taken place. It is a real worry that evictions might take place.

It is because we wish to strengthen the Government's hand against a fairly well organised industry which seeks universal general increases that we make a series of recommendations in the report, to which I shall come in a moment. The Government are vulnerable at any time, but especially in the run-up to a general election, to the prospect of evictions of people who are no longer able to pay the full fees for which the home owner calls.

The Committee has highlighted two other problems. When the policy was first implemented, there was no question but that those who were then on supplementary benefit and are now on income support gained a first-class service from the homes. Indeed, many of the homes said that the fees from supplementary benefit were so adequate that the people who came in on that ticket were given some of the best accommodation in the establishment. That is not so now. There is not only a form of filtering within homes of the rooms offered to those on income support, but homes sometimes put up a bar against those whose only contribution is up to the ceiling laid down by the Government. Within homes, a two-tier system is developing.

More importantly, a different tier system is developing in different parts of the country. I see the hon. Member for Chislehurst (Mr. Sims) in his place and I know that he hopes to catch your eye, Mr. Deputy Speaker. He is a member of the Select Committee on Health and played an enormously valuable part in our proceedings. We were given evidence by Age Concern England. It quoted a Health Advisory Service report on Bromley, which said: Frail, elderly people face exile in private residential homes far from Bromley". In other words, the rates that the Government lay down are such that one must be extraordinarily lucky in Bromley and many other places to obtain a place near one's home. It gives a new and cruel twist to community care that people may have to be shipped perhaps as far as Birkenhead to find a community home. That provision will cut a person off from all that he or she most values—family and friends. That is the background to some of the problems that the report has highlighted.

I come quickly to our recommendations. I stress that we have made them in the most constructive vein possible. I sought to score points earlier on the cavalier way in which previous Ministers dismissed the suggestions from the then Select Committee, by which we sought to limit the rate of increase in the residential care part of the Government's budget. We did so not because we did not want money spent on community care, but because we did not necessarily believe that a one-track policy was the best way to ensure the ideal form of care. We want the Government to think carefully and respond positively to our recommendations, because we are anxious that the rate of increase in the Budget from now on should not be jacked up by the powerful lobby of the industry and the influence that it can exert on the Government.

Therefore, our recommendations were tailored to some selective targeted measures which the Government could implement to avoid conceding increases across the board. We emphasise in our report that we do not see those measures as a way of dealing with the shortfall. We are interested in how to make good that shortfall. That is what our recommendations are about, but we also aim to help the Government to limit the rate of increase in the budget.

I wish to touch on three proposals. First, the Secretary of State told the Committee and the House that the new form of community care, which will be run by local authorities, would have the extraordinary advantage that people in the locality who knew the scene would make the decisions. Why cannot that proposal be brought forward, so that the local offices of the Department of Social Security could make the decision about topping-up arrangements?

Secondly, as new residents in homes will be able to claim housing benefit under the new proposals, why cannot housing benefit be claimed as a way of helping to make good the shortfall? Thirdly, as the Government are turning a blind eye to many of the disregards being allowed for people on income support and in residential and nursing care, could that be codified and made safe for all forms of disregard?

We hope that the Government will respond to other priorities and suggestions in the report, which I shall list as headings because I know that other hon. Members wish to speak and will doubtless develop many of those arguments. We are worried about the date on which local authorities will know the size of their budget. Will the Government issue clear guidance on which responsibilities will fall to health authorities and which to social services? How far down towards the locality will the decision on housing benefit be made

? One more issue, which I often return to from these Benches, although I hope that before long I shall be able to support those on the Treasury Bench from the other side of the House—

Mr. John Marshall (Hendon, South)

Is the hon. Gentleman crossing the Floor?

Mr. Field

When I am ready for residential care, I may totter over to that side of the House, but until then I am happy to stay on this side.

Finally, on the proposals in our report about extending freedom, many of us fear that, after the changeover, people's freedom will be limited under the Government's proposal, although so much of their rhetoric suggests the opposite. We have three proposals. First, as we wish to encourage carers and strengthen families—even the extended family—if a person who is caring for someone loses them to a home, the person's home should not have to go on the market to meet the cost of fees.

We are not saying that taxpayers should not be able to claw back some of the costs at a later stage, but the carer's position should be protected. Under the new system, we want people to have rights to choose the sort of care that they receive, rather than be directed to it. We all have too much experience of what it is like for council tenants trying to exercise their supposed freedom for us to lie easily with the Government's assurances on that matter.

The most important issue regarding freedom is that we fear that, far from more people being given control over their lives, when the new system comes into play, fewer people will have control. Our plea to the Government is that they take a leaf out of their own book on the independent living fund, which was set up in haste and has played a role that it was never meant to play. It has been a noble role, as it has allowed people grants and cash to fix the level of care that they want. They have been in control. Under the new system, we want an increasing proportion of the budget to go into a pot of cash, which local authorities will be able to give out. That cannot happen in year one, but as the years went by, it would enable people to build their own packages of care rather than having to take care designed by others for them off the shelf, as in a supermarket.

As I have emphasised three times, the previous Select Committee on Health and Social Services made a number of pleas to the Government not to get us into the position that we are in now. I am being polite about the way in which the Government have behaved when I say that they have dealt with our recommendations in a cavalier fashion. When the Under-Secretary of State responds, I hope that we will know that the joint recommendations from the Select Committee on Health and the Select Committee on Social Services will be taken more seriously than previous recommendations.

4.54 pm

Mr. Nicholas Winterton (Macclesfield)

My contribution will be brief. I support everything said by the Chairman of the Select Committee on Social Services, the hon. Member for Birkenhead (Mr. Field). I am sure that all those who participated in the report—in his Committee or in my Select Committee on Health—endorse the responsibile recommendations and conclusions in the report.

The hon. Gentleman presented the case for the Committee and introduced the debate in a measured and responsible way. Like him, I welcome my hon. Friend the Under-Secretary of State for Social Security to the Front Bench to respond to this important debate. As the hon. Gentleman said, she made a substantial reputation for herself by the stand that she took in seeking to represent the best interests of the elderly and others who would he looked after in private residential or nursing homes.

Having endorsed—on behalf of the Health Committee —all the recommendations made by the Social Services Committee, I wondered precisely what my contribution to the debate could be. I need not have worried. Following the appearance that I made with the hon. Member for Birkenhead on a Channel 4 programme, which generated quite a volume of correspondence, I received a letter from the proprietor of a private nursing home in Chesterfield. The letter precisely sums up the remarks that I would have wished to make in this debate.

The gentleman concerned—the proprietor—decided to establish the home after he had cared for his father-in-law in his own home until he died. He described that as a traumatic and difficult experience, following which he and his wife pledged to find a better way to look after the elderly and people who need residential or nursing care.

In his compassionate letter, he advised me that, after 12 years research and work, they opened their present nursing home. He told me that they have about 50 residents, cared for in a purpose-built home by about 100 staff. That is a measure of the cost of looking after the elderly and those who need residential and nursing care properly. The 100 staff include 25 state registered nurses.

Like the hon. Member for Birkenhead, I have taken considerable time during the years that I have represented Macclesfield in the House to visit private residential and nursing homes and part III county homes in my constituency. I have not given notification but have dropped in.

The proprietor says in the letter that the facilities that he is able to provide are a better way to look after people who are among the most vulnerable in our society. The kernel of the argument is that, because of the costs he incurs by running a highly staffed, well-motivated and caring establishment, he has to limit the number of income-supported residents that he can accommodate. The fees that he can get back from the Department of Social Security are inadequate to cover the costs that he incurs.

In his letter, he gives one or two examples: May I give Margaret as an example of costs. This lovely lady has suffered extreme arthritis for many years, and her skeleton is crumbling away. Three of my staff take 1 hour to wash and dress her, morning and night—cost £210.00 per week. Treatment, laundry, food, room and other overheads raise the true cost of her care to £400.00 per week. Income support for this lady is £255.00 per week, or £1.55 per hour. The cost of £210 is the fee that he currently charges the lady.

He asks me to consider another case whose Christian name is Jennie: This delightful lady is frail and confused, requiring a lot of care and attention. At night her bed linen is changed 6 times to keep her warm, dry and comfortable. her bedroom carpet has been shampooed daily for the past 2 years. Yet Jennie is charming, retaining dignity and pride, and is loved by all of us. Not one of our residents could live on their own now. Many have spent years in their own homes, coping with frailty, loneliness, poor diets, falls, fear, burns and hypothermia. Perhaps the most serious of those is loneliness. Sadly today, the extended family is not as caring and is perhaps too extended to enable them to take care of their elderly relatives.

The gentleman who runs the home advises me that the only alternative environment for the residents would be a hospital. Of course, that would not be so homely or comfortable and it would go entirely against the policy of successive Governments, which is to have these people looked after in a much more caring way, hopefully within the community. In addition, the cost of a hospital bed is extremely high.

The proprietor of the home in Chesterfield says that they cannot reduce costs. He thinks that the Government's regulations are reasonable, but says that they demand only minimum standards, while he seeks to establish standards which are higher than the minimum. He says that his charges are well below those of local hotels which do not offer skills to reduce the pain, or reassurance and a cuddle when you are afraid. He continues: Recently I spoke to a chairman of a health authority, who confirmed that substantial economies are being made by closing 'Grannie beds' and transferring patients to private nursing homes. We all know that that is happening. I am making no announcement that is not well known to the Government. If the Minister of State and the Parliamentary Under-Secretary are determined that community care should work and that the more vulnerable groups within society should have a better life in their declining years, they will ensure that the level of income support for those who need to rely upon it is as high as is necessary to enable them to be looked after in a private residential or nursing home which can provide the proper quality of care that the House would wish them to receive.

Those examples are not untypical of what is happening throughout the country. I have not mentioned Southfield Manor, just outside my constituency, which I brought up during our deliberations in Committee, where Mr. McCabe looks after 94 infirm, confused, mentally ill and mentally handicapped patients with serious behavioural problems. That nursing home requires a high level of qualified staffing. He may have to close at the end of the year unless many of the patients, most of whom rely upon income support, have an increase in their benefit.

I take the examples of top-up and housing benefit recommended in the report by the hon. Member for Birkenhead. If something like that is done, we can stagger through to 1 April 1993, but a very serious position will develop then. I hope that the Government of the day—my own Government, I trust—will pay serious attention to the matter and make better plans.

5.4 pm

Mr. Clifford Forsythe (Antrim, South)

In 1982, as mayor of Newtownabbey, I took the opportunity to visit all the residential and nursing homes, in addition to the hospitals, in the borough. Since then, I have visited many homes in the rest of my constituency. But it was the visits that I made as mayor in 1982 that gave me my first insight into the running of such establishments. I saw at first hand the facilities which were being offered to the disabled and elderly residents.

I should explain to the House that most of the homes were under the control of the Department of Health and Social Services, because in Northern Ireland the local government set-up means that district councils have no function in the delivery of social services to their ratepayers. The position remains the same today for the public provision of care, and many private residential and nursing homes now exist in the Province.

Returning to 1982, I was generally pleased with the lay-out and surroundings of most of the homes; unfortunately, some fell far short of the standards of comfort and homeliness that many people, including the residents, would have liked. What impressed me greatly in all the homes was the dedication, hard work and helpfulness of all the staff, each working to overcome, in a minority of homes, adverse conditions of overcrowding and unsuitable, ancient buildings, in order to ensure that the residents were kept comfortable and contented.

I was made aware by those in charge of the homes that, because of better health provision and the demographic trend, a large rise in demand for places in residential and nursing homes was inevitable and that major changes would occur as a result. I am sure that those staff members, like me, have been startled by the huge increase, not only in the number of residents in the homes but in the vastly increased number of homes, particularly private homes.

It is revealing to compare the figures for 1982 and 1990. In 1982, residential homes in Northern Ireland totalled 246; in 1990, the number was 337, a rise of 37 per cent. In 1982, there were 12 nursing homes; in 1990, the number was 164, a rise of 1,250 per cent. Recently, I asked the Secretary of State for Northern Ireland to supply me with up-to-date figures for residents. The total number of residents in all homes in 1987 was 2,382; in 1990, it had grown to 4,489, a rise of 85 per cent. in just three years.

The figures for different categories are interesting. Residential homes had 85 mentally ill and 1,321 other residents over 60 years of age; 41 mentally ill and 203 other residents were under 60. The nursing homes had 80 mentally ill residents and 2,533 other residents over the age of 60, seven mentally ill residents and 219 other residents under the age of 60.

All those residents received income support. That means that, according to the 1991 benefit rates, approximately £1 million per week is paid in Northern Ireland for those in residential homes and nursing homes. That figure does not reveal how many of those residents are supported by their relatives, who cover the real cost of the residential care in many homes.

The principal demographic change in the 1990s will be a rapid expansion in the number of pensioners over the age of 85. By 2001, the proportion of elderly folk living alone in the United Kingdom will have increased by 600,000 over the number living alone in 1986. We are already aware that living alone is the second greatest demographic risk factor, other than age, that necessitates admission to hospital or to residential or nursing care homes.

Those figures put into context the conclusions and recommendations contained in the report of the Select Committee on Social Security. They reinforce the vital importance of agreeing on an effective policy for such specialist care.

I support the report, and commend it to the House. I am not a member of either major political party, and I was impressed by all my Committee colleagues, under the excellent chairmanship of the hon. Member for Birkenhead (Mr. Field). I have been impressed by their industry and obvious concern when investigating this important subject. I was also impressed by the manner in which they laid aside party preferences—except on one occasion—to arrive at conclusions aimed to be beneficial to residents and fair to people who have taken on the task of caring for those who are no longer able to manage in their own homes. We must not forget those who undertake that work.

I welcome the extra finance that will be provided by the Secretary of State for Social Security next April. However, I wonder whether various hidden expenses in running a home have been taken into account. In Northern Ireland, it appears that the Rates Amendment (Northern Ireland) Order could lead to some residential and nursing homes being rated by the valuation department. It also appears that, as a result of the new council tax, some of those homes will have to pay that tax. I do not believe that that hidden expense has been taken into account when deciding on the finance to be provided next April.

I sympathise with, and understand, the argument of those asking for a general uprating. However, I also sincerely believe that that would create a situation in which fees could be raised to absorb that extra cash. I am also concerned that, on occasions, a resident's personal allowance is used to top up their care home fees. The personal allowance belongs to the individual, and it must remain his property.

Recommendation (x) in the report asks that residents' homes should be exempt from consideration as capital assets in connection with Income Support claims in those cases where a carer remains living in the home or where there may be a reasonable possibility of the resident returning to live at home. It also states that, should the resident's spouse sell the home to raise extra money, that money should be excluded from the calculations of income support entitlement.

I should like that concession extended to family smallholdings or farms where a similar problem can arise, with the result that land that has been in a family's hands for centuries is sold to pay for the former owner's residential or nursing home fees. That deprives his spouse not only of her home, but her livelihood. Such a sale places the land and the house in the hands of speculators who care nothing for history, tradition, or, indeed, farming.

In the future, we face the prospect of more and more pensioners taking on the responsibility of looking after their even older parents, as well as themselves, on a fixed and, in many cases, inadequate income. Therefore, it is obvious that we have a short time only in which to resolve the problem. It is up to us to ensure that those who created the wealth of the nation in the past are properly looked after without the pressures, tensions and worry to which many are unfortunately subject now.

5.16 pm

Mr. Roger Sims (Chislehurst)

The House is indebted, not for the first time, to the hon. Member for Birkenhead (Mr. Field) for the manner in which he chairs the Select Committee on Social Security and for the way in which he introduced the debate today. The report from the Select Committee is a valuable one on an important subject. As the hon. Member for Birkenhead mentioned, the report also creates a precedent by being as near as possible a joint report of two Committees, the Select Committee on Social Security and the Select Committee on Health, of which I am a member.

Government is divided into different Departments, but life is not. There are bound to be overlaps in the work of different Departments, and therefore of different Select Committees. There are circumstances in which it is useful to conduct joint inquiries. I hope that it will be possible to amend the Standing Orders to produce joint reports, instead of having to follow the rather odd procedures which we did.

People are expected, not unreasonably, to try to make some provision for their old age, but some are better able to do so than others. Some are able to live in their own homes and look after themselves, with or without help from relatives, literally until their dying day. Others— none of us know what the future holds—need to go into residential homes or nursing homes to receive care. In both cases, the costs can be substantial, but they are especially great in the case of nursing homes. Where such costs can be met from a person's resources, it is right that that should be done. When that is difficult or impossible, the state, through the payment of social security benefits, should step in.

I recall a case in my constituency of a lady who had to go into a home. Her son wrote to me from an address that suggested that he was not too badly placed. He protested that his mother's application for income support had been refused because she owned a home. He said that that meant that he would have to sell that home and therefore deprive himself of his inheritance. I am afraid that he got a rather dusty answer from me, because I did not see why the taxpayer should pay to support his mother when there was such a property in the family.

Any benefit system involves rules and regulations which are almost bound to produce anomalies. Some people will be covered, others not. Some will get benefit who perhaps should not have it. We must try to build in some flexibility and consider cases on their merits. That, without going into a detailed argument, is a feature of the social fund.

Income support for people in homes is not flexible. The rules specify the circumstances in which it shall be allowed, and the sums are fixed. On the Minister's admission, income support is not intended to meet the full cost of fees of residential and nursing homes. So how is the gap to be filled between the fees charged and the income support provided? Sometimes it is met by relatives, and that is not unreasonable if they are people of means. Sometimes charities are asked for assistance to fill the gap. But some people do not have relatives, while others have relatives who do not have the means to help.

Many examples were quoted to the Committee and are recorded in the evidence. They include a letter which I received about a 102-year-old lady in a modest residential home in my constituency for whom the difference between income support and fees is met by her son, aged 80, from his pension. That cannot be right. Similarly, there is the case of a lady in a nursing home in my constituency who receives retirement pension, war widow's pension, attendance allowance and a grant from the Soldiers, Sailors and Airmen's Families Association, her husband having fought in two world wars, plus income support. But that is still not sufficient to pay the nursing home fees. The difference must be paid by her son, an ex-POW pensioner turned 70.

I urge the Minister seriously to consider the recommendations in our report, which would enable local offices to top up in individual cases, thus providing the flexibility that I have advocated. The arguments against a general increase in income support levels are rehearsed in the report, but I suggest that the alternative, of individual top-ups, would be less costly and a far more effective use of resources.

Reference has been made to carers. I cite the case of a lady in my constituency who, since her father died in 1975, has lived with her mother, sharing household costs and maintenance, and latterly has combined a full-time job with looking after the mother in failing health. The mother is now 82, her Alzheimer's disease has reached the stage where she needs 24-hour care, and she has moved into a nursing home. The daughter's entire net salary, plus the mother's pension, are insufficient to meet the nursing home fees, so an application has been made for income support. That benefit will be issued for six months, but not for longer, because the house was in the names of the father and mother and since the death of the father has been in the name of the mother only. So she is not eligible for income support after six months, the period which is given to enable her to dispose of the house.

That means that the daughter, now aged 52—she does not fall within the bracket of being either disabled or over 60—will be obliged to sell the roof over her own head. She is, in effect, being penalised for spending those years caring for her mother by having to sell her home of 20 years, on the proceeds of which she will apparently have no claim. The irony is that if, on the father's death, the home had been transferred not to the mother but to the daughter, there would have been no problem for the mother or daughter.

I urge the Minister sympathetically to consider our recommendation that in those circumstances the Government should exempt homes from consideration as a capital asset. I invite the Minister to look at the practicability of the ingenious solution mentioned by the Chairman of the Committee, by which social security might have a claim at a subsequent date on the estate or on the estate of the carer.

Some of those problems will cease to arise when the new community care schemes are introduced in 1993, and I emphasise the importance of the Government transferring sufficient funds to local authorities to enable needs to be met in full. We recommend that some research be undertaken to ascertain what the figure is likely to be. I suspect that, when assessment gets under way, we shall find much of what might be described as hidden need.

While, as I say, the problems should cease to arise, the existing problems will remain, because those at present on income support, and on support in April 1993, will continue under that system and at the rates then applying. We could therefore find after 1993 that in the same home will be people receiving income support because they were there before April and others who were put in the home at a later date by the local authority having their costs met in full.

The impact on residential and nursing homes of the new council tax is causing concern. It seems clear from the Local Government Finance Bill that a person will be exempt from the council tax if his/her sole or main residence is in a residential care home, nursing home, mental nursing home in England and Wales, and is receiving care or treatment in the home. Miss Sheila Scott, secretary of the National Care Homes Association, sought clarification from the Department of the Environment, which said in a recent letter to her: The Government proposes that the landlord or the owner of a residential care home should be liable to pay the council tax. It will he for that person to decide whether to seek a contribution from residents through fees and charges as he would with any other overhead". Rather confusingly, the letter went on Occupants of residential care homes will give rise to a discount. A maximum of two discounts will apply if there are no liable adults resident in the home. While people on income support will not be liable, in any event, to the council tax, there is concern about what the implications will be for owners of residential and nursing homes, for if those charges are substantial—and in the past the rates did not apply—and if now a substantial, council tax is to be imposed, the tax will have to be passed on to the residents and will increase fees even more.

I hope that the Minister, either when replying to the debate or by letter, will clarify the misunderstanding, if it is a misunderstanding, because it would be unfortunate if life were made unnecessarily more difficult for people in residential and nursing homes whose position our report endeavours to assist.

5.29 pm

Mr. David Hinchliffe (Wakefield)

Having served on the Select Committee on Health and been involved in the joint inquiry, I endorse the report's conclusions and recommendations. I pay tribute to my hon. Friend the Member for Birkenhead (Mr. Field) for his role in engineering the joint working of the Social Security Select Committee and the Health Select Committee, and to the Chairman of the Health Select Committee, the hon. Member for Macclesfield (Mr. Winterton), for his role in the process. It was a useful exercise and we all have a right to feel proud of the end result—the content of the report.

There has been a broad consensus in the debate so far, but I hope that I can break it as I take a different view from some of those that have been expressed. Some would say that my view is more politically partisan. I apologise for the fact that my argument may be familiar to most hon. Members present. The two Ministers present have certainly heard me take this line before, and my hon. Friends and most Back Benchers have heard it on a number of occasions. Furthermore, any similarity between the speech that I made to the Doncaster trades and Labour club a couple of weeks ago, when you, Mr. Deputy Speaker, were in the Chair, and the speech that I shall make tonight, is purely coincidental.

We have heard comments about the Government's community care programme and have debated the matter in the House on numerous occasions. None of us would argue with the broad political consensus that community care is desirable, and we all support the processes in which successive Governments have been engaged in the past 20 or more years. We all support the break-up of the large old lunatic asylums and the movement of people from geriatric wards into the community, but we may raise questions about how those changes were handled. The number of children who have been introduced into institutional care has also been reduced, and community schools have been broken up. Anyone who knows people who have lived in such institutions will support such measures. Alongside that process, however, there has been an alarming growth in the movement towards private institutional care. We have now reached a stage where community care is in a horrific mess and we have to unravel it. The report that we are discussing tonight is one contribution toward unravelling the mess that—let there be no mistake—has arisen because of the Government's policies alone.

The hon. Member for Antrim, South (Mr. Forsythe) spoke of the huge explosion in the number of care homes in his part of the world. The official figures provided by the Library show that, in the past decade or so, the number of places in local authority care homes have been reduced by some 4 per cent., while the number of private residential care beds has been increased by 316 per cent. It is not possible to obtain reliable estimates of the number of private nursing home beds, but I am reliably informed that, in my area of Yorkshire, the increase in the past decade has been some 1,000 per cent. That is a massive increase in the number of people in private nursing home care.

It may be argued that the reason for that is the explosion in the number of elderly people, but the figures provided by the Library show that that simply does not justify the explosion in the number of people in private nursing home care. The increase in the number of elderly in the same period is 9.5 per cent., and the increase in the number of very elderly who might be expected to end up in care is only some 20 per cent. Therefore, the actual increase in the number of elderly people in society in no way justifies the increase in the number of private care beds in the nursing home and residential care sectors.

The Government's policies have pushed into residential care people who do not need to be in such care. I say that not just because of what I see when I visit care homes in the public and private sectors in my constituency, as I frequently do. The Audit Commission said recently that 25 per cent. of the people whom it saw in care homes could have been cared for in the community and had no need to be in institutional care. That point was picked up by the previous Social Services Select Committee.

The Health Select Committee recently took evidence from directors of social services who said that their registered care homes officers reported that 50 per cent. of the people whom they saw in private care homes in their areas need not have been in those homes but could have been accommodated in the community. That is an indictment of the Government's policy in the past decade, and we must do something about it. Because of the Government's policy, people who do not need to be in institutional care are being placed in it. Whatever Government are in power, that is wrong, and I hope that the report will be a starting point for a change in direction.

The reasons for a revival in the institutional model of care are clear. The Government have pursued policies that have directly led to people being forced into accepting— they have no doubt had a resigned attitude—the need to enter care because the preventive services have sometimes been pulled from under their feet.

We can argue all day whether the Government have funded the national health service properly. There is plenty of objective evidence that there has been large-scale cumulative underfunding since the Government have been in power. However, I have seen cases in my area—I have mentioned them in the Chamber before—of people who have had basic services such as bath nurses withdrawn, resulting in their having to be forced to leave their homes, to give up the ghost, and to enter care. If the Minister wants details, I can name cases in my area where that has happened.

The Government are committed to a reduction in public spending, which has affected the availability of preventive, caring services—alternatives to institutional care. It is ironic that, although the Government are committed to reducing public spending, huge amounts of money—some £1.7 billion in the current financial year—have been thrown willy-nilly at the private care sector. If one looks at that in detail, one finds that it is a gross and highly irresponsible misuse of huge amounts of public money, which could be used far more effectively elsewhere.

My local authority has experienced major difficulties in attempting to provide the basic services that are required by people who did not want to enter care but wanted to remain independent and who had carers prepared to support them, with a little help from outside and from local authorities. Yesterday, I received a note from the deputy director of my local authority about its present financial position. I asked about the position of the local authority with regard to its standard spending assessment in the next financial year. He said that the local authority had experienced problems in the past few years and added: For 1992–93 the Standard Spending Assessment for Wakefield District Social Services, excluding specific grants is £26.3m. Current expenditure plus inflation, if carried forward into 1992–93, will be £28.6m. The SSA is therefore £2.3m less than we need to maintain current expenditure plus inflation. However, the letter from the Department of Health dated 26.11.91 giving details of the Standard Spending Assessments for the personal Social Services states that 'In setting the 1992–93 figure the Government has taken account of demography and inflation and has allowed for the implications of Community Care and the Children Act 1989. Also included are the revenue consequences of the specific grants'. Mr. Cullinan, the deputy director, then said: In round terms I would estimate that we need an extra £2m to allow for the minimum implications of the Community Care Act, Children Act and the revenue consequences of the specific grants. This means a shortfall of £4.3m between the Standard Spending Assessment and what we need as an absolute minimum in 1992–93 to meet legislative requirements. This is the reality for my constituents who want assistance with home care and the variety of levels of provision such as day care and respite support, which enable people to remain independent or semi-independent.

In the period since the Government came to power, the pattern of expenditure on personal social services has been changed. By virtue of the Government having reduced the rate support grant, they have taken some £6 billion out of the budget of personal social services. That money should have been spent on preventing people from having to enter the hugely costly care programmes that we are discussing today. I do not want to expand that point, but it is important for the Government to accept that their local government policies have greatly damaged the prospects of people who genuinely wanted to remain, and could have remained, in the community. It will cost the Government more to adopt those policies than if they had allowed people to remain independent or semi-independent if they wished.

The role of housing in relation to community care is absolutely vital. Last year was the first year since the 1920s when no new council houses were built in my district. No one is making the sort of provision we need to enable people to remain semi-independent by moving into sheltered housing when they can no longer remain in their own homes. The voluntary sector and housing associations have simply been unable to expand the provision in the way needed during a period when there has been an increase in the number of elderly.

Alongside those policies, we have seen a clear effort by the Government to make it easier for people to enter private institutional care. There was a change in 1981 in the supplementary benefit system. People have told me that they have struggled to try to get telephones, day and home care facilities, but their local authorities have genuinely not been in a position to assist them because they did not have the resources. However, as soon as the decision was made for those people to give up the ghost and go into institutional care, the money flowed.

The money is available, but not where it is actually needed. It is not used to allow people to remain independent or semi-independent. It is not used on basic services such as home care and facilities that would allow people to remain in their own homes, which is tragic. I have met many people who have been affected by those policies, and I believe that the Government have made regrettable decisions.

It is also important to mention the way in which a market experiment in the private care sector has, with substantial public support and money, had a bearing on the type and range of services now available. Provision in the private sector is unplanned. If it is planned, it is done purely and simply by entrepreneurs who realise that they can make money by providing establishments in a particular district.

Perhaps because there are not many large Victorian mansions in Wakefield, vast numbers of people who have lived all their lives in that district have had to move away to live—often for the rest of their lives—many miles from where they were brought up. Provision for people in need has not been available where those people live, and they have had to move to the facilities. If there were proper planning of community care provision, those people would have been granted the necessary facilities in their homes.

Mr. Nicholas Winterton

I am surprised that the hon. Gentleman is making such a strong argument. In my short speech, I spoke of a private proprietor who had built a purpose-built nursing home for the infirm and those who could not operate within the community from their own flats or houses. I hope that the hon. Gentleman will be prepared to admit that, if special accommodation is not provided by the county council social services or through the old geriatric hospital wards, it must come from another source. The private sector can fill and is filling an important vacuum.

Mr. Hinchliffe

I understand the hon. Gentleman's point. I certainly do not disagree that, where provision is specialised and limited—as it might be for young disabled people—it might be necessary for the person requiring that care to travel some distance from where he or she lives. However, I am not talking about people with specific needs, but about elderly people who simply need elements of care that are not provided in their communities.

I know of a number of examples where individuals have been discharged from NHS geriatric care and have been told that they must move into private care as there is nowhere else for them. As private care is not available in their local authority district, those people have had to travel to find accommodation outside their local authority area. They have ended up in the private care of another local authority. After some time, they have applied to that local authority for funds to return to their own local authority district where they have lived all their lives. They are then told that the authority is not prepared to support them because they are ordinary residents.

They have to live out the rest of their lives in a district many miles from their own homes where they have lived all their lives. I know of a number of such deplorable cases. As private care is largely unplanned, it is often not in the interests of the many residents who have to move from the district where they have lived all their lives and where they have their friends—[Interruption.]

Having been given a nod by the Whips, I shall come to my central theme, although I should have liked to go on for at least another half an hour. Private sector provision comes primarily in one form: institutional provision, which is the easiest way to make money. I do not believe that institutional provision should be the only facility available to the elderly or disabled. There are other forms of provision which could be available to people in their own homes.

People keep plugging the fact that the new legislation will introduce assessments. Hopefully, the assessment scheme will be introduced in the 1993 legislation, but assessment alone will not cure the problem. A social worker can assess a person, but only on the basis of the services available at any one time. If there are no alternatives to institutional care, assessment is nonsense. It would be wrong to assume that assessment will cure the problem.

I shall briefly summarise the points that should come out of the debate, and I hope that the Government will take note. The Government have engineered a deliberate redirection of public resources away from preventive domiciliary supportive services in the community towards institutional care in the private sector. It is ironic that, up to the last financial year, the amount of money spent on institutional care in the private sector through income support provisions—previously, supplementary benefit—was about £6 billion. That sum was provided to people entering private care since 1981. The amount of money taken out of local authority preventive services budget was about the same—£6 billion. That is what the Government have achieved during their period in office.

The incoming Labour Government will have a huge challenge: to engineer a complete transformation of residential care. No one has referred during the debate to the quality of care available in homes. The Government have commissioned various reports; the report analysing the costs of care did not mention quality. I agree with Lady Wagner who said that local authority homes should be progressively adapted to provide fewer residents with better accommodation on the model of very sheltered housing. That is the policy that we should adopt for residential care. We should not simply put people into Victorian houses miles away from where they have lived and forget about them, as happens at present.

I know that my hon. Friend the Member for Manchester, Withington (Mr. Bradley) agrees that, when we are in government, we must urgently implement a substantial redirection of public resources away from residential care towards supportive services in the community, whether in the voluntary or local authority sectors or elsewhere. We shall thus enable people who choose to live independently to remain in the community with the support facilities which they require and which, in many cases, have been removed by the Government.

5.49 pm

Mr. Patrick Nicholls (Teignbridge)

Although the hon. Member for Wakefield (Mr. Hinchliffe) may have thought he was introducing a contentious note, only in the closing seconds of his speech did I find much to disagree with. It was the second time that I have heard that speech, but it was well worth a second airing and there was a great deal in it with which I would agree.

The hon. Member for Wakefield fairly pointed out that the amount of money spent on residential care is massive. Our report notes that since 1979 the amount spent on income support for people in residential care and nursing homes has risen by about 160 times—a massive increase. Without wishing to spoil the atmosphere of consensus, I must point out that, although the hon. Gentleman said that the money could have been spent in better ways, I have a strong suspicion that, had it not been increased by this amount, he might have said that it should have been increased by more. That sums up the nature of the dilemma that he identified.

It is common ground between us that residential care of the standard that we expect for our fellow citizens is not a cheap option. Whatever else divides us, that statement cannot. It is an expensive option, and so it should be. The chances are that it is the most expensive option of all, so on social, pragmatic and financial grounds, I am sure that the hon. Gentleman was right to draw our attention to the fact that there may be better ways of spending this much money.

I do not, however, see the spending of money in this way as inhibiting our reaching a more attractive regime. It is a necessary step on the way there. We are getting away from the institutionalised Victorian establishment to something which approximates more closely to the sort of conditions that people enjoyed or wanted to enjoy when they were still independent enough to live in their own homes. The type of home with which all hon. Members will be familiar, operating at its best, is a step in the direction of the right sort of care.

We owe the hon. Member for Wakefield a debt. The last recommendation in our report is that the Government should undertake a study into the types of service that should be made available as alternatives to residential or nursing home care. That recommendation was included to satisfy the point made by the hon. Member, and it makes the report all the better.

In a sense, however, we need the evidence to back up the hon. Gentleman's suspicions. I am sure that he is right to say that we could be more creative, that we could keep certain people in their own homes either for ever, or at least for longer. That is only common sense. I must sound a note of caution to the effect that the evidence does not yet exist. I share the hon. Gentleman's strong suspicions, but quantifying them will depend on the evidence. If the recommendation in the report is taken up, we may well gain the evidence that would carry the hon. Gentleman's suggestion further ahead.

The recommendations in the report would not have been made without the highly skilled chairmanship provided by the hon. Member for Birkenhead (Mr. Field), who shows us where consensus lies and who makes it clear that the easiest options of all are not available. Many people who take an interest in these matters might say I hat all that is necessary is to spend more money. This above all others must be an example of a problem on which expenditure of money would do the trick. As the hon. Member for Wakefield and I would agree, however, there is more to it than that. Our acknowledgement of that lends our report credibility and makes it harder for the Minister not to follow at least some of our recommendations.

The first recommendation contains the following statement: We do not recommend a general uprating of the Income Support level, other than the normal annual uprating. We welcome the increases to be made in the 1992 uprating, particularly the additional £15 a week rise … We understand and sympathise with those who have asked for a general uprating, but we believe that in all probability it would simply push fees up further and actually exacerbate the problem. That says it all. The hon. Member for Birkenhead, with his customary fairness which makes it so difficult to attack the parts of his presentation with which one does not agree, said that a general uprating would merely put the Government, the Treasury, the taxpayer and the system over a barrel. So the message should not go forth that this is just a question of spending more money and then the problem will be solved.

The recommendations can be divided into three categories. Recommendation (xvi), which I have already mentioned, falls into the first. It is valuable and free-standing. The next category discusses specific ways in which money might be spent to deal with a problem that was always bound to exist before community care was finally implemented—but it does so in a targeted way that would not amount to a general uprating. The third category I will refer to in a moment.

The difficulty with which the Government have to wrestle—I can say this in a debate in which there has been far more agreement than disagreement—is that, although we have pointed out the dangers of a general uprating and done our level best to come up with a package of recommendations that do not amount to a general uprating, it may be hard to implement the recommendations in their entirety in such a way that they would not amount to a general uprating, thus having the precise effect that the Committee did not want.

We Back Benchers do not have to wrestle with these problems; we have done our part by pointing out responsibly how to deal with the problem. But we would do our own credibility no good and we would not serve those with an interest in this debate if we did riot acknowledge that, unless we are careful about our solutions, we shall bring about precisely what we do not want to achieve.

Finally, I arrive at the third category of recommendations, which includes action that can be taken that will not require expenditure. Recommendations (vii) and (viii) amount to much the same thing. The Committee was given clear evidence that some health authorities indulge in what can only be described as sharp practice, either by passing on to the social security budget or by passing on to relatives obligations that the authority is supposed by law to fulfil. The recommendations try to rectify that; the practice must be stopped.

Health authorities may reply that they want more money, but then they would, wouldn't they? Times do not change; that is a respectable pressure to bring to bear on the Government of the day. But first things first: if authorities have an obligation in law, they must discharge it. Whatever else may cause the Minister difficulty when she sums up, I cannot imagine that she will not be able willingly to clasp to herself those two recommendations. She can do that without embarrassment or fear of comparison with past speeches.

My hon. Friend the Member for Chislehurst (Mr. Sims) alluded to recommendation (x)—the consideration of capital assets in connection with income support cases when one carer is present and one is not. This recommendation combines compassion, common sense and—although we do not have the evidence to assess this—good solid fiscal sense. For that reason, if for no other, it should be adopted.

The report does not underestimate the problems; it tries to deal constructively with them, and it responsibly points up the fact that we must be careful lest, by implementing the recommendations in their entirety, we bring about what we do not want to achieve. Mercifully, we Back Benchers do not have to wrestle with that.

5.59 pm

Mr. David Bellotti (Eastbourne)

First, I thank the Chairman, the hon. Member for Birkenhead (Mr. Field), and all the Members of the Select Committee who worked hard to produce the report and the excellent recommendations which are contained therein.

The report is simply a look at the current situation which will grow more serious as time goes on. The United Kingdom has 10 million retired people, about 18 per cent. of the population, but that figure will increase considerably in the decade to come. By the year 2030, although the overall population will rise by about 7 per cent., the rise in the 60 to 74-year-old age range will be about 36 per cent. and the rise in the over-75 age range will be more than 44 per cent. Those figures show that we must consider the report's recommendations seriously, because, unless we act properly on them, the situation will be more difficult to deal with as time goes on.

First, we must determine our principles for care in the community. There should be a mixed economy of care. It is for the House to ensure that all three sectors, public, private and voluntary, have the opportunity to develop and grow during the challenging years ahead. We should try to maintain high standards in all three sectors because that will lead to an element of choice for the client or the customer, help us to ensure that we obtain value for money and, to some extent, maintain standards, because only by rigorous inspection and comparison between the three sectors can standards be maintained.

In the real world, however, local authority public sector provision for residential care is in difficulty. Sussex is no different from many other areas of the country. There, the local authority is having to reduce the number of places available and to close existing residential homes in order to find the money to bring the remaining homes up to the standard which should exist across the three sectors to which I have referred. Therefore, the number of places in the public sector is being reduced.

The voluntary homes are also in difficulty because of recent changes in the financing of many of those which are registered as housing associations. Many of them are finding it difficult to balance their books, and relatively few are looking forward to developing new projects in the next 10 years. Their development plans are few and far between.

The third sector, the private residential and nursing home sector, has suffered because of the gap which has been created between income support and the real cost of delivering care. I was extremely pleased to see that one of the report's major recommendations was that the Government should immediately commission research to provide information about the shortfall between income support and fees paid, so that the funds to be transferred from the Department of Social Security to local authorities in 1993 can be accurately determined, because, if a problem exists now, it will be much worse then. That is important because, if funds are not there, standards of care will decline.

Slightly less important, but nevertheless important to homes that I visit, is recommendation (ix), which has not yet been referred to, requesting the Department of Social Security to ensure that high priority is given to assessing and paying claims for income support in care homes. I have visited many residential homes in Eastbourne where the proprietors are concerned about the time that it takes for those receiving income support to obtain it. That causes initial problems at the very moment when confidence in the system is needed.

The 7.7 per cent. increase in social services spending in the recently announced standard spending assessment has been referred to by the Association of Metropolitan Authorities as "absolutely devastating". The Association of County Councils has also expressed strong concern. The problem with that figure which gives local authorities cause for concern in the public sector is that it is not a 7.7 per cent. increase above their spending last year but above the SSA, which is what the Government thought that they should have spent. Therefore, the real increase in the funds available to social services departments next year will not be at the level above inflation which would meet the existing problems. Many social services departments throughout Britain are already spending well above their SSAs.

An example of where that is not only occurring but is leading to delay is in the provision of a much needed facility by the Key housing association in Kilmarnock. Because Strathclyde region cannot be sure about next year's funding, it is unable to give the sort of encouragement that such a proposal has so far received, and there could well be a delay in the provision of residential accommodation as a result of those delays and uncertainties. It is important that not only the right figure is arrived at through the SSA, but a figure that will give people confidence to move forward.

In evidence to the Committee, widespread concern was expressed about the gap which is emerging. The Royal National Institute for the Blind, which I quote not least because one of its residential homes is in my constituency, said that, from April 1991, its fees were £262 per week, whereas its real average costs were about £300 per week. It concluded that there was an urgent need for the weekly limits to be raised so as to ensure that visually impaired people received the care they needed.

I am sure that the Minister is aware that that concern is shared by other voluntary providers and by the private sector providers. In addition, private providers tell hon. Members that, unless the gap can be reduced or some other solution arrived at, they are particularly worried about the future. The British Federation of Care Home Proprietors says: As the gap between income support and real costs continues to widen, choice, a major concern of the Government"— something to which, as I said at the beginning, I too am committed— will be restricted and a two-tier system of residential care may be the inevitable and regrettable consequence. I think that all hon. Members will accept that we do not want to support anything that would lead to the evolution of a two-tier system of care. The report contains many examples of concern expressed on that front. Given the comparison of the fees, of which we had much evidence, it is not surprising that concern has been expressed from so many quarters.

Another report dated 7 May 1991 comparing the income support for 1991–92 with two surveys one from Price Waterhouse and one from Laing, it is easy to see why that concern is so widespread. For residential care running costs, income support for the present financial year was £160. The Price Waterhouse survey concluded that the real cost was £187 and Laing concluded that it was £204. In nursing homes, the comparative figure for income support was £255. Price Waterhouse concluded that the real cost was £293 and Laing, £287.

Those figures will be well known to the Minister, but they illustrate and add to the views being expressed from so many quarters. One way of providing residential care is often for individuals to sell their properties when they retire and to use the capital to purchase their care. Unfortunately, it is becoming more difficult to do that. Apart from the problems of selling property at this time, the average house realises only £66,000. Even if the whole of that sum is invested, the income thus produced is unlikely to be sufficient to support someone living to a very old age. An extremely helpful booklet produced by Pearl Assurance states: Many people use the proceeds from the sale of a house to help finance the fees. Even large amounts of capital do not last forever, so it is a good idea to get professional advice well in advance of the time you anticipate moving into a home. Given the large number of people who are likely to enjoy a quality of life into old age, consideration must be given to how they can be financially supported, because that cannot be done only by the sale of their property. Price Waterhouse points out that average residential care and nursing home costs in London and the south-east are 15 per cent. higher than in the rest of the country.

Current uncertainty means that developments such as that in Kilmarnock which I mentioned are not proceeding as we would wish, and it is affecting individuals who are receiving care but who are not properly funded. I know that the director of nursing at one Sussex establishment has written to the Secretary of State and to a number of other right hon. and hon. Members, pointing out that his home has provided places to ex-hospital patients, but that they have not been awarded the income support to which they are entitled.

On 24 September, the National Association of Mental Health legal director successfully represented 12 of the ex-hospital patients in that home before a social security tribunal, which awarded them income support. However, the Benefits Agency decided to appeal against that decision to the social security commissioner. While that process continues, those individuals are left without any income. The Minister should give consideration to such cases, which place enormous pressures on the establishments concerned, and which could arise even after "Care in the Community" has been implemented.

In all this, we want also to protect the carers. At some stage, they could become the very people who need financial help for residential care. If we mortgage their future on behalf of those for whom they care, we shall not be providing for their own care in due course. Clearly, income support levels are not high enough, and the Government must address the alternative solutions available to them. Funding must also be reassessed—and I am sure that if we put our minds to that task, we could all do better.

6.13 pm

Mr. David Shaw (Dover)

I pay tribute to the Chairmen of the Social Security Select Committee and of the Health Select Committee, who have found a way around the difficulties of operating together and have produced a more interesting report as a result. Having been through that process once, the Social Security Committee is clearly interested in other areas. When problems such as those created by the Maxwell affair, for example, come to light, that Committee and the Department of Trade and Industry could operate together.

The report therefore establishes an important precedent: it means that Government policy will not always be departmentalised but will he seen in the round. The problem with Select Committees is that they are sometimes compelled to take a narrow view, rather than the broader view that is reflected by the report.

The report gives further evidence that residential and nursing homes are an enormously important and valuable source of care for the elderly. The Government have made significant improvements in that regard. I am sure that my hon. Friend the Under-Secretary of State must be delighted that she will be summing up in a debate that concerns an area of activity in which expenditure has increased 160 times under this Government. Even given the expenditure that the Government have devoted to the public sector, there cannot be many Ministers who find themselves in such a favourable position.

The number of claimants has increased from 12,000 in 1979 to 220,000. There were 9.5 million old age pensioners in 1979, but there are now some 10.5 million. Those extra I million pensioners must account for many of the additional claimants. The frail or very elderly account for an increasing number of pensioners, and that emphasises the importance of nursing home and residential care.

The evidence to the Select Committee suggests that the private sector has not only expanded well in terms of growing numbers and additional services, but of maintaining its assets. There was, however, evidence that public sector homes have been poorly maintained and that councils had spent their money elsewhere. Councils have had an enormous amount of money through their hands, and have spent it in an equally enormous number of areas over the past 12 years.

Mrs. Alice Mahon (Halifax)

A recent report named my local authority of Calderdale as the second most efficient metropolitan council in the country. Because of the threat of poll tax capping this year, it was compelled to cut £5 million from its budget. I do not think that even the hon. Member for Dover (Mr. Shaw) could accuse that authority of being profligate, but those cuts will affect the care of the elderly in Calderdale.

Mr. Shaw

The hon. Lady ought to examine local authority budgets. I was on a local council for some years that thought it was well run, but we still found it possible to get rid of a tier of management. It is always possible to do that, and to use elsewhere the money saved. Many councils have employed too many staff over the years, have been too inefficient, and have not maintained their homes for the elderly and residential care homes as well as they should have done.

The Committee was told of a backlog of maintenance. That is because councils do not keep proper accounts or records. One of the problems in the public sector is that no one keeps a balance sheet, so there is no proper record of maintenance costs and of depreciating assets—whereas the business man or woman who manages a private care home is alive to the importance of maintenance, and of protecting the value of that asset.

The Government made a good move in calling in Price Waterhouse, because clearly there was concern among residential care home owners about their funding through the income support mechanism. We welcome the Government's commitment to keeping finance and income support levels under review; the Committee will examine the position from time to time, and ensure that the levels remain reasonable.

As the Committee's Chairman pointed out, the Government must maintain a fine balance. They must be careful not to make income support too generous, thus causing the taxpayer to lose out and causing funds to be taken from other provision for the elderly and disabled. The Government must exercise the wisdom of Solomon: although they must not put too much money into that sector, if they put in too little, the owners of care homes will tend to withdraw the little extra facilities that are so enjoyed by the elderly people.

As the report points out, resources must be made available to those who enter residential care with no resources of their own for those "little extras". Their spouses may not have been able to save much during their lives; they may have had low-paid jobs. Thank goodness, the current pensions policy is improving the position: many more people will retire with second pensions. Many others, however, will have retired some time ago, and will not have sufficient resources. The Government should consider setting up a scheme to provide top-up money when residents' families cannot provide it themselves.

The question of evictions is open to misconception. The evidence of such evictions is very weak; I felt that the evidence presented to the Committee was based more on political considerations than on hard numbers. One organisation suggested, however, that—although no actual evictions had taken place—some people had been discouraged from going into homes because of the cost involved. We recognise that some homes are more expensive than others, and that some provide more facilities than others; we must ensure, however, that no one falls through the net because basic income support is not available.

The report makes a recommendation about the assessment of claims for income support, and the payment of such support. We are led to believe that there are administrative problems. As we know, all Government Departments have such problems, but a review of administration might be helpful.

In my constituency, a care home owner admitted an elderly person over a weekend after that person had suffered a fall in her own home. The home owner had not waited for the bureaucratic processes to be completed; she had acted out of the goodness of her heart. Rather than being rewarded by the social security system, that home owner suffered a disadvantage. Payment of income support is related to pension payment days, and she was not remunerated for the first five days of the elderly person's occupation. The home owner had to pay herself. It is clear that legitimate and reasonable owners of residential care homes are suffering. The less money is given to such homes, the less is available for the "little extras" to which I have referred.

The hon. Member for Wakefield (Mr. Hinchliffe) mentioned alternatives to residential or nursing home care. Although I disagreed with some of what he said, I agree that we should consider whether more people can stay in their own homes. As I have said, there has been a substantial increase in the number of pensioners, but surely new technology and the availability of volunteers could enable more people to stay at home for longer. We should take a radical approach to the position of elderly people beyond the year 2000, and consider whether technology can allow them to enjoy a better standard of living and to rely less on residential and nursing homes. Surely, in the early years after retirement, fewer people will need to go into such homes.

I commend the report. I believe that many of its recommendations deserve wider and deeper consideration, and I hope that the Government will take them on board.

6.25 pm

Mrs. Alice Mahon (Halifax)

I congratulate my hon. Friend the Member for Birkenhead (Mr. Field) on his excellent chairmanship of the Committee; I also congratulate the hon. Member for Macclesfield (Mr. Winterton), who played an important role. I welcome the recommendations in the report.

The report addresses itself very well to a specific "client group", the elderly and sick. Over the past decade, the care of that group has been privatised: the hon. Member for Macclesfield illustrated the process very clearly when he referred to an excellent nursing home in his constituency, a fairly large institution containing trained nurses. The taxpayer financed the training of those nurses: there is a hidden bonus for the owner of that home, and for the owners of many others.

In the Select Committee, the hon. Member for Teignbridge (Mr. Nicholls), who is not in the Chamber now, moved to amend paragraph 88 of the report. I am sad about that. The paragraph clearly spelled out the story of supplementary benefits and income support payments to fund care in residential and nursing homes, saying that it was a telling example of what could happen if change was made in an ad hoc way.

The section that was deleted struck me as very important. It pointed out: no overt decision had been made to phase out geriatric wards; the practice grew as health authorities saw the opportunity to transfer costs to the budget of another Government Department by transferring one aspect of care to the voluntary and private sector. That practice has now brought about a major change in the NHS. A service free at the point of delivery is being changed, for some, to one in which they or their relatives are asked to make what is often a considerable weekly contribution. When Opposition Members talk of creeping privatisation, that is exactly what we mean. I am sorry that an excellent paragraph was amended, effectively to blame carers—or their neighbours or female relatives—for neglecting to do their unpaid duty.

Paragraph 94 expresses dismay that the funding of nursing home care should be private, and that health authority managers should draw a distinction between the elderly and others who need care. I hope that the Minister will take note of that important paragraph. I have argued with my district health authority for many years I know that many hon. Members have done the same with theirs —because it has for various reasons shifted the problem of elderly sick people to the private sector. It is increasingly difficult for the relatives of the elderly sick to obtain even respite care in many hospitals when they themselves need a rest. The crisis has occurred because of the Government's policy—which, whether or not it was deliberate, has been disastrous, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said. We have ended up in a mess.

The hon. Member for Dover (Mr. Shaw) attacked local authorities, but that will not wash. It is no good knocking local authorities—we have only to consider the figures to see the massive amount that has been removed from rate support grant while the number of elderly people has increased. If the local authorities had been given the money that has been poured into the private sector to be spent on domiciliary packages, more home helps, special care attendance and occupational budgets to provide aids and adaptations for people in their own homes, we could have saved the Government and the country millions of pounds. My local authority of Calderdale spent responsibly, and a Government Department patted it on the back, saying that it was the second most efficient metropolitan authority in the country.

I think that my hon. Friend the Member for Wakefield said that £1.7 billion has gone into the private sector in the current year. With that money, we could have provided what the people wanted and real choice. I imagine that, for 90 per cent. of the elderly sick, the choice would be to receive nursing home treatment under the national health service or the care packages which would enable them to stay in their own homes. If local authorities and councillors had wasted the money in the way that many of us believe the Government have done, they would have been surcharged and hounded out of office. It is a disgrace that Government Departments are not subjected to the same scrutiny and punishments.

I do not want to criticise those who provide private care, because I recognise that there is as much good care in the private sector as there is bad. However, I criticise the trend towards not having highly paid and experienced staff. Many of the private homes are pretty, Laura Ashley, chintzy places, but do they have rehabilitation programmer or free therapy for their residents? Do they have the orientation programmes which I have seen in many of the local authority homes that I have visited in my constituency?

The crux of the report is funding, and the growing gap between income support and what it now costs to keep people in either nursing homes or elderly residential homes. The growing gap now means that the elderly people or their relatives must find that difference. When the Under-Secretary of State for Social Security, the hon. Member for Maidstone (Miss Widdecombe), was in a less exalted position, I remember listening to her make a clear and, I thought, slightly emotional but honest contribution to a debate in the House. She talked about Florence Smith, an elderly constituent of hers, and how she was caught in such a gap.

Since she became Under-Secretary, I have written to the hon. Lady about such gaps experienced by many of my constituents. I am afraid that her reply was not as sympathetic as the contribution that she made as a Back Bencher when talking about Florence Smith. She also told me that there had been no evidence of evictions, but, however hon. Members interpret it, the evidence given to the Select Committee by Mr. Harris of the Association of Metropolitan Authorities was clear. He said: about 24 per cent. of our member authorities are saying to us that they have recorded instances of eviction.

Mr. David Shaw

rose—

Mrs. Mahon

I shall finish this point, and then I shall give way.

A constituent of mine was on the verge of being evicted. Fortunately, her relatives were able to move her to another home which was cheaper: that is an increasingly common practice. Elderly residents are being downgraded and sometimes have to share rooms, and that situation will get worse. I am concerned that that will happen long before the community care changes come into force.

I want to draw the House's attention to recommendations (vii) and (viii), which are important. They deal with hospital discharge procedures and state that district health authorities should obey circulars. We need to know how the recommendations will apply in the new internal market for health care. We know that circulars that go to trusts are sent for the purpose of information, not action. If the recommendations are shortly to be accepted by the House, we want to know specifically whether the opted-out hospitals will be excused from obeying that recommendation. If so, there is not much point in us debating the issue. The report is excellent, and I hope that its recommendations will be carried out.

I finish where I started, by saying that the report confirms absolutely that there has been a wholesale privatisation of care for the sick and elderly. That is unfair, and it is also slightly sinister to say that, when somebody reaches a certain age, he can no longer receive care under the NHS. I welcome the fact that that has been exposed and, despite the amended paragraph 88, I welcome the recommendations as a whole.

6.36 pm

Mr. Michael J. Martin (Glasgow, Springburn)

I shall be brief, as I understand that the Opposition Front-Bench spokesman and the Minister want to reply to the debate. I also wish to put on record my congratulations to the Select Committee and its Chairman for their hard work.

I hope that we never reach the position that I have sometimes, although not often, met in my constituency, when I have received a phone call from a private home to the effect that it could no longer keep a patient who had perhaps become doubly incontinent. If the relatives could not pick the patient up, he would be lodged in the casualty department of the local hospital. It is scandalous that elderly patients should be treated in that way.

I repeat what the hon. Member for Antrim, South (Mr. Forsythe) said about patients' private needs payments. It has been brought to my attention that that money, which patients regard as pocket money, is sometimes taken from them by private residential homes to be used as payment.

I take issue with some Conservative Members who spoke of second pensions solving the problems of the elderly in our communities. I ask them to visit some of the communities that I represent, from which industry has disappeared and in which it is not only the person approaching pensionable age who is unemployed and in receipt of social security benefit, but the caring young people in the family who want to do the best for their relatives. I do not see how those people can accrue a second pension. To get a second pension, a person needs a job, and the jobs are just not there.

I have no objection to private residential care for those who can afford it, but the Minister must admit that local authorities do an excellent job in terms of residential care and that there should be more local authority residential care places. The Minister must know that, when Conservative Members attack local authorities, they are attacking—sometimes unconsciously—dedicated men and women who have fought for years to get first-class old folk's homes.

If we mean business in looking after our elderly—and not just the elderly, as young and middle-aged people may be stroke victims or have other problems which mean that they need residential care—local authorities should be encouraged to build more places. I hope that the Minister will encourage local authorities which do an excellent job in terms of residential care.

6.40 pm

Mr. Keith Bradley (Manchester, Withington)

It gives me great pleasure to commend to the House the fourth report by the Select Committee on Social Security. It is a model of detail and clarity in reporting on private residential and nursing homes. It is of great credit to the Committee that it describes the situation so clearly and that it points out many of the problems that have come about as a result of Government policy towards private residential care over the past few years.

I thank my hon. Friend the Member for Birkenhead (Mr. Field) for his kind comments in his introduction to the debate. No one has more expertise or knowledge of these matters, and it is to the credit of the House that he brings those qualities to bear in our debates. He has always been a source of inspiration to me and I hope that he will take it as a compliment when I say that, from the days when I was a student, he has been an inspiration to me.

I intend to reinforce and highlight some of the recommendations that have been mentioned in many thoughtful contributions this afternoon and I will pose a series of questions to the Minister, whom I welcome to her first estimates debate. I hope that, in the short time available, she will be able to answer those questions.

I support my hon. Friends the Members for Wakefield (Mr. Hinchliffe) and for Halifax (Mrs. Mahon) in their general comments on the broad area of policy on residential and community care. Many people who care or who are cared for find it difficult to understand why they cannot get the resources for that care when such vast amounts go towards people who are in residential care. Such people have been disappointed, to say the least, that the Government postponed the community care programme by two years because they saw it as an opportunity for the balance of resources between residential care and community care to be readdressed. They also saw it as an opportunity to get the packages of care that they sought implemented as early as possible.

My hon. Friend the Member for Halifax made the point that the rundown of long-stay care for the elderly in our health service and the move towards the elderly having the opportunity to go only into private nursing care is to be deprecated. I am not in favour of long-term institutional care in hospitals, but the balance between the opportunity for decent health care for the elderly in our hospital services and the opportunity for other care has gone much too far. In my local hospital in Withington, the number of beds for the elderly has decreased in the past few years from 140 beds to barely 20.

I was informed today that elderly people who are trying to get into hospital are being put on to wards in which the nursing staff have not been designated specifically for the care of the elderly. They are put into such wards because there are not sufficient resources in the health service to open up other wards that have been closed because of the general lack of resources in the health service. We must consider clearly the balance between health care provision in the national health service and health care provision in private nursing homes.

We must also examine the way in which the run-down of resources through personal social services and housing, as my hon. Friend the Member for Wakefield pointed out, has led to local authorities having to suspend many innovations. Cities such as Sheffield and Manchester have been at the forefront of examining alternatives to residential health care to ensure that people can live happily in the community. I commend the programme of the development of elderly persons' resource centres in those cities.

In Withington, we have such a centre, which provides domiciliary care, meals, laundry services, recreation services, shopping facilities and companionship. The people who attend those centres can still live in their own homes because of the support staff who work from those resource centres. The number of people in the catchment area of the resource centre who now seek residential care has dropped dramatically. Few now seek residential care because of that support in the community.

I hope that the Government will re-examine the funding of such developments in local authorities in conjunction with their community care programme so that local authorities and others can again consider a flexible response to ensure that we do not only seek residential care, but that we look forward to proper community care and support in the home.

My hon. Friends have highlighted some of the report's recommendations. The report is clear that there is substantial evidence from many organisations such as the citizen's advice bureaux, the Association of Metropolitan Authorities, Mencap and MIND—the National Association for Mental Health—that the level of income support does not match the costs in private residential care and that there is a threat, although Conservative Members may doubt it. People in such homes are anxious that, because of the gap between income support and charges, there is a threat of eviction. Indeed, there are cases of eviction. They may be few and far between, but they cause worry to elderly people who fear that the gap may lead to them being put in the same position.

An AMA survey in September 1990 showed that 24 per cent. of local authorities gave evidence of evictions. It is a particular problem in the south-east, where there are escalating costs. There have been examples in local councils in the south-east—Hertfordshire springs to mind —of evictions taking place. We must study the gap closely and we must realise that, in many of the homes that have come on to the market, on which there has been significant capital outlay by people moving into the private sector, the costs have escalated because of the massive increase in interest rates. Those costs have been passed on to the residents, so the gap has widened.

We have heard today that the gap has had to be filled by resources from relatives, from charitable organisations and, most appalling, from the meagre personal allowance available to people in residential homes. They cannot then use that small amount for the few personal items that they may want to buy when they are in residential homes. We must ensure that the gap does not lead to anxiety about possible eviction. We must also ensure that the escalation of costs does not lead to elderly people having to move from a single-bedded room to shared accommodation, which would be a lowering of standards in their residential home—and it is their home. We must ensure that those problems in the south-east are addressed.

I support the recommendation—I hope that the Under-Secretary will do likewise—that the extra allowance that is given in the Greater London area should be extended to out-of-area boroughs that have similar high charges. Her Department should act on the recommendation that local officers should be able to top up that gap for claimants if no other resources are available. There should be local flexibility through income support benefits to meet the different charges around the country.

I also support the suggestion that has been made by the National Association of Citizens Advice Bureaux about housing benefit continuing to be paid until the new system commences in 1993. I am pleased to see the Secretary of State for Social Security in his place, because he has said that the decision in January 1991 to stop such payments was taken because It has never been the intention, nor is it sensible, that in the generality of cases Housing Benefit should be available as an alternative to income support". After 1993, the finance to meet the charges will come from income support, housing benefit and local authority community care budgets. Therefore, would it not be sensible to reintroduce the housing benefit element now to ensure that that gap can be met?

I strongly urge the Under-Secretary to look closely at the recommendation that the personal allowance should not be used as a contribution to bridge the gap between the charges and the benefits. The personal allowance must be ring-fenced to ensure that people in residential care can have a small amount of money for their personal needs.

Several hon. Members have highlighted the position of carers who may be disadvantaged because of the capital rules on income support. Their position was well summed up by the Carers National Association, which has stated that the current rules could have "disastrous consequences" for the family and friends of the claimant who may have moved into the home to take on the caring responsibilities. We must not do anything to discourage people from taking on that caring role. People often give up their own home to move into the home of the person for whom they will be caring but may lose that home as a result of the income support capital rules.

Although a spouse may be protected if he or she stays in the home, if the partner goes into permanent residential care, the spouse may want to move into smaller and more appropriate accommodation. In that case, the spouse must forgo 50 per cent. of the proceeds of the sale of the property, which means that his or her opportunity to purchase something more appropriate is diminished. I urge the Minister to comment on that and to look at the way in which capital is treated for income support purposes to ensure that such disadvantages do not continue.

Perhaps the most crucial recommendation is that relating to the funding that will be available for community care after April 1993. The report highlights three issues: the amount of money to be transferred from the budget of the Department of Social Security; the way in which housing benefit will be calculated after 1993; and the division of responsibility between the health authorities and the local social service departments.

The first issue is the amount of money that will be transferred in income support from the social security budget into the community care budget. The Association of Metropolitan Authorities estimated in its evidence to the Committee that there would be a £300 million shortfall in that provision. Although the Secretary of Slate questioned that figure in his evidence, he did not say what he believed the shortfall would be. However, there is irrefutable evidence that there will be a shortfall, and if we do not ensure that that gap is identified and ascertain where the resources to meet that gap will come from, not only will the people who are currently seeking community care be disadvantaged, but, more importantly, future generations who might seek care in the community will not receive the resources that at present they believe that they will get.

I should be grateful if the Under-Secretary could comment on the way in which housing benefit is calculated. I hope that the Government do not intend to set a national figure that will apply throughout the country. Without regional and local variations, a further gap will be created. We must ensure that there is local flexibility when assessing housing benefit so that it is sufficient to meet the charges that are imposed locally and to ensure that the gap does not widen.

We must also ensure that the Department of Social Security and of Health reach a clear understanding about the way in which the community care system will operate in future. From my reading of the evidence, it appears that there is a certain amount of buck-passing between the Ministers in the two Departments about who will identify the gap, where the resources will come from and who will come clean about the budget that will be set for community care provision. The local authorities need to know now how the standard spending assessments will be calculated so that they can make definite financial plans. Such planning is crucial if our hopes for community care are to be realised after 1993. The local authorities need to know where the resources will come from and how they will be allocated between the different areas of the country.

I end with some final thoughts for the Under-Secretary. Many questions have been posed and many recommendations highlighted in this debate. The Opposition commend them all, and I hope that the Minister will say that she will implement them. More crucially, however, will she tell the House how the Government will meet the identified shortfall in community care funding? If they do not meet that shortfall, there will be a sorry start to the future system of community care.

6.56 pm

The Parliamentary Under-Secretary of State for Social Security (Miss Ann Widdecombe)

I begin by joining in the congratulations paid by hon. Members of all parties to the hon. Member for Birkenhead (Mr. Field) on the production of an excellent report, and to my hon. Friend the Member for Macclesfield (Mr. Winterton) who chaired the Select Committee on Health, which was also involved.

I welcome the hon. Member for Manchester, Withington (Mr. Bradley) to the Opposition Front Bench and look forward to many a debate with him. I look forward especially to a future opportunity to develop his views on the desirability of keeping national insurance contributions as low as possible and of working out exactly how that fits in with the policies of some of his right hon. and hon. Friends, but that is for another occasion, Madam Deputy Speaker.

Before turning to the detail of the debate, my hon. Friend the Minister of State for Health, who has been present for most of the debate, has asked me to apologise to the House on her behalf for the fact that she could not stay throughout.

The hon. Members for Birkenhead and for Halifax (Mrs. Mahon) and my hon. Friend the Member for Macclesfield referred to my part in the events of 1990. It could scarcely be more vivid in their memories than it is in mine, but what is also vivid in my memory is the aftermath of those events, which was the Government's sensible accommodation of the fears and anxieties that had been expressed.

I refer not only to the substantial amount of money that was made available, resulting in a £45 per week rise for nursing homes, which cost us a total of £225 million, but to the amendment that allowed the Secretary of State, after community care had been in place for some time, to take account of the local authorities' assessments of reasonable rates and of their experiences in general. I will not say that much of this debate has been irrelevant, because that sounds as if I am dismissing what has been said, which I am not, but it is irrelevant in the context of 1993, because the advent of the new system will answer many of the problems that have been identified.

The fact that we can examine what local authorities are doing has been comprehensively ignored, yet it could have an effect on many of the points that were raise.

The hon. Members for Birkenhead and for Withington raised the problem of evictions. They seemed to be selective in the evidence that they quoted. I was particularly surprised to hear the hon. Member for Withington home in on Hertfordshire, because, among those giving evidence to the Select Committee was a Mr. Herbert Laming, the director of social services in Hertfordshire. He said: there is no statistical evidence that is known to me at the present time … of people who are actually being discharged from the private sector … We do not have evidence … to bring to you … of a substantial number of people who have been discharged against their will from the private sector. We must take into account that evidence, as well as the other evidence, which seems to point the other way but has not been statistically upheld and has never been put before us in any form that we could check or examine.

Mr. Hinchliffe

Will the Minister accept that I have an example? A private care home in my constituency accepted an elderly lady for respite care. Her son and daughter who cared for her were going abroad for a fortnight's holiday. After a period, the home evicted the woman, put her in a taxi and sent her to the local police station. Is that an eviction? Is that responsible behaviour by the private sector? Does the Minister accept such behaviour? It is happening elsewhere to my knowledge. It is not merely anecdotal evidence. There is clear evidence.

Miss Widdecombe

The hon. Gentleman said that it was happening elsewhere to his knowledge. Perhaps he could produce chapter and verse evidence of such incidents.

Mr. Hinchliffe

rose—

Miss Widdecombe

May I finish, please?

If the hon. Gentleman sends the evidence, we will examine it to see what happened in that case, and whether it is evidence of a larger problem. There will always be homes, local authority as well as private sector, which do not always behave as well as they should within the rules. That is not evidence of a general trend. The hon. Gentleman has not produced evidence of a general trend.

The problem of carers was sensibly raised by my hon. Friend the Member for Chislehurst (Mr. Sims) and by several other hon. Members, including the hon. Members for Withington and for Birkenhead. We already make exceptions to the capital rule where homes are occupied by a spouse, a relative over the age of 60 or a relative who is incapacitated. We have considered whether any further easement is possible. Although I cannot give the House any good news on that score tonight, I can say that we are considering the matter.

We have to consider factors other than merely resources. Opposition Members seemed to suggest that the hold-up was resources, but there are other factors, not least the fact, that, if we needed primary legislation, it would come on stream in about 1993, when the responsibility for assessment and the decision about what to pay passes to local authorities. No new cases would come on stream for us to deal with. There seems to be a slight practical difficulty there.

Furthermore, we would have to devise fairly tight rules. Yes, the cases quoted are clear ones, in which carers have been in the home for a long time, but obviously we would wish to avoid a position in which the carer was in the home for a short time in the expectation that he or she would then be allowed to stay there. All those factors are being taken on board.

The hon. Member for Antrim, South (Mr. Forsythe) raised the problem of the personal allowance, as did several hon. Members. My right hon. Friend the Secretary of State alluded to the problem when he was giving evidence to the Select Committee. It is my understanding that, after 1993, the personal allowances will have to be given to the individual, but we have a problem. The personal allowance belongs to the individual. It is for the individual to do what he or she likes with it. We cannot forbid individuals to use that allowance in whole or in part to pay fees for their care. So that is another problem. Opposition Members want us to forbid the use of that personal allowance, if only in part, for a particular purpose.

My hon. Friend the Member for Chislehurst said that, on Ministers' own admission, we no longer paid the full rate of fees. That is not true. We have said that we have never been committed—it is not something new—to paying the full fees, however high. In many instances, the income support rates cover the fees.

Mr. Frank Field

The Minister asked my hon. Friend the Member for Wakefield (Mr. Hinchliffe) to give her more evidence of evictions. May we ask her for evidence? History seems to be being rewritten. Could she give us just a handful of examples of people who were moved from geriatric beds into the private sector in the early stages of the development of the policy and were given the assurance that she says was publicly given that the Government had no intention of meeting fees, however high? Is not the truth that practically everyone was told, "Don't worry—social security is picking up the bill."

Miss Widdecombe

Social security has always been committed to meeting a reasonable rate. The hon. Gentleman has acknowledged, indeed it is in his report, that, by simply increasing the income support rate, all that we do is cause the fees to rise behind it. That point has been made consistently. That is the point that we have addressed in saying that we will not meet fees, however high. I do not believe that we ever said to anyone in geriatric care or anyone who entered a home for any other reason, "Don't worry—social security will pick up the bill, however reasonable or however high." The hon. Gentleman challenged me, but I challenge the hon. Gentleman to provide the examples of where we said that.

The hon. Member for Wakefield (Mr. Hinchliffe) made an interesting speech. He seemed to suggest that the problems with the policy had largely been caused by the Government withdrawing funding from local government for domiciliary and other services, thus forcing people into residential care. I do not know how he reconciles that with the 59 per cent. increase in spending on local authority care services since 1979.

The hon. Member for Wakefield said that he did not like private institutional care. May I draw his attention to comments in the recent issue of "Community Care" by the hon. Member for Birmingham, Perry Barr (Mr. Rooker) The hon. Member for Perry Barr is not an apologist for the Government, but he said that the Labour party was committed to a mixed economy. I welcome his commitment. That also means a commitment to private residential care as much as to local authority residential care.

Mr. Hinchliffe

rose—

Miss Widdecombe

I would like to make progress, because the hon. Member for Birkenhead wishes to reply to the debate.

Mr. Hinchliffe

Will the Minister give way?

Miss Widdecombe

For the last time.

Mr. Hinchliffe

I said that I did not like institutional care, whether private or public. We have more of it in Britain than in any other country in Europe, and it is wrong.

Miss Widdecombe

The hon. Gentleman said that private residential care was effectively institutional care, and went on to say that he did not like institutional care. By the application of simple logic, anyone can work out that that means that he does not like private residential care.

The hon. Member for Eastbourne (Mr. Bellotti) was the only hon. Member to refer to recommendation (ix). I shall turn to the other recommendations in a moment. Recommendation (ix) calls upon local offices and the Department of Social Security to give higher priority to those entering residential care to to make sure that their claims for income support are processed in good time so that people do not have weeks of worry or possibly weeks in a home without paying.

I was grateful to the hon. Gentleman for raising that, because it is not often realised that such claims can be made up to three months before the person enters care, although I am aware that the circumstances do not always allow that. Few people enter care on the spur of the moment as a result of a catastrophe. For most people, it is a planned exercise. Therefore, I welcome the opportunity to exhort people who are considering the option of residential care to make inquiries as early as possible with the social security department.

Of course, there are national targets for all categories of claim. The target for income support is five days. Obviously, there will be difficult cases, especially where there is perhaps a house or capital to be considered. However, we will take on board the recommendation and try to ensure that people are not kept waiting on any appreciable scale. I am grateful to the hon. Member for Eastbourne for raising the matter.

The hon. Member for Eastbourne also quoted a Price Waterhouse survey at some length, and referred to shortfall between what we pay and the fees charged. If I heard him correctly, and I thought so, judging by the figures that he was quoting it must have been a more recent Price Waterhouse survey, not the original. The more recent survey was based on an example of 85 homes. We based ours on an example of more than 700. Therefore, statistically, one should take the results of the first survey, and we based our rates of income support on its median rates.

I shall now deal with the rest of the recommendations which have attracted debate in turn. The comments on recommendations which relate to the responsibilities of my hon. Friend the Minister for Health will be passed to her for examination.

Two major recommendations in the report have attracted most publicity. The first is top-up payments, which the hon. Member for Birkenhead recommends should be made by local offices; the second is the reintroduction of housing benefit. I shall deal with the second recommendation first, because it is based upon a complete misunderstanding.

Housing benefit was never payable in addition to income support, but was used in place of it by people who would not have qualified for income support, such as people living in a room run by a close relative, the long-term disabled and various other categories of people under pensionable age who were not eligible. They were protected when the change was made. However, we were not keen for housing benefit to be used in place of housing support for care, which is properly the provision of income support.

The hon. Member for Birkenhead also misunderstood what will happen after 1993. Yes, housing benefit will be an element of the total package, but will not be for the whole cost of care and will not be wholly additional to current rates of care. It will be the rental element of the home, but there will still be a package. Housing benefit will not come in on top of the rates.

Mr. Frank Field

That is what we advocated.

Miss Widdecombe

The hon. Gentleman says that that is what he is advocating, and says that we should reintroduce it now for those who face a shortfall in fees, but it would not make up the shortfall, because it would be part of the reasonable rate of fees.

Mr. Field

It would be additional.

Miss Widdecombe

It would not be additional. I am afraid that the hon. Gentleman has not understood the working of housing benefit.

The remarks about top-up by local offices was also based on a misunderstanding. In his opening speech, the hon. Member for Birkenhead said that we should "bring forward" the arrangements which will prevail after 1993, but it will not be down to the local adjudication officer to assess people to decide the appropriate care and to assess the reasonable rate. The hon. Gentleman is proposing something entirely different, which would certainly be without the law, which is not an advance on 1993 and which is probably impossible. Local adjudication offices could not assess individuals and it would be difficult to decide why Mrs. Y should get a top-up but Mrs. X should not. That is simply meeting the fees, no matter how high, in a more disguised and reasonable form. It would work in exactly the same way as a general rise in rates.

The hon. Member for Halifax asked whether national health service trusts would be subject to the same guidance rules and discharge procedures. She is a victim of her own propaganda. NHS trusts are NHS trusts, so they are subject to NHS guidance after 1993.

Mrs. Mahon

We know that when NHS circulars are sent to trusts they are sent "for information", but that they are sent "for action" to directly managed units. I was asking about that.

Miss Widdecombe

On discharge procedures and the trusts having to take care—in exactly the same way as health authorities now have to take care—of those for whom they believe that care is appropriate, the same rules should apply.

In the last minutes of the debate—the hon. Member for Birkenhead need not worry; I am leaving him time within the advice that I have been given—I must mention the generality of the issues raised. Time and again we have heard tonight—especially from the hon. Member for Withington—about shortfall and about the measures that we should take to meet it. Throughout the debate, shortfall has been defined as the gap between fees charged by some homes and the maximum level of income support which we will pay for different categories of persons in those homes.

The crucial thing is that we are talking about fees charged by the homes, not about reasonable costs. We are talking not about reasonable fees, which have been independently assessed, but about a fee levied by a home. That is vastly different from saying that we should consider the shortfall between the fees and the costs incurred by the homes. The answer is that we do not intend to meet all that shortfall. We have never committed ourselves to meeting it, no matter how high the rate.

In the light of all the sedentary interruptions from the Opposition, I would be interested to hear whether those hon. Gentlemen intend—in the unlikely event that they ever change places with us—to meet that shortfall, no matter how high the fees.

The hon. Member for Wakefield said that under an incoming Labour Government local authorities would receive much more support. We cannot wait for a Labour Government. We have to act in 1993, and we shall do so. Unless Opposition Members are prepared to stand up and pledge that they will meet the costs of every private home, no matter how high and heavy, our proposals for 1993 will overtake most of their objections. and I am grateful to have had the opportunity to respond to the debate.

7.16 pm

Mr. Frank Field

I am grateful to have the opportunity to respond to the debate.

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. The hon. Gentleman requires the leave of the House. Is that agreed?

Hon. Members

Yes.

Mr. Field

With the leave of the House, it remains for me only to thank the Select Committee on Energy for allowing us to hear the Government's reply. Even if the election is postponed until July, the Government will not be able to maintain the line that we have heard from the Dispatch Box.

The debate was concluded, and the Question necessary to dispose of the proceedings was deferred, pursuant to paragraph (4) of Standing Order No. 52 (Consideration of estimates)