HC Deb 27 June 1994 vol 245 cc657-64

Motion made, and Question proposed, That this House do now adjourn—[Mr. Arbuthnot.]

11.11 pm
Rev. Martin Smyth (Belfast, South)

I was interested in the Minister's comments in the earlier debate. He accused us of not talking up Northern Ireland. It is because we are concerned that the high quality of care manifested in Northern Ireland may be hindered by some policy changes that I am delighted to be able to have this Adjournment debate tonight.

At the outset, I should say that I share the tributes that have already been paid to Baroness Denton. She is one of the few Northern Ireland Ministers in my experience over the years who listens rather than using that lovely old English phrase, "I hear what you say," which means, "I am not listening at all and I am certainly not heeding what you say."

We are equally aware of the constrictions that are placed around a Minister. I had the unhappy experience of dealing with a civil servant who was advising a Minister about housing in my constituency. He said that there had never been houses in that area on that road. Thankfully, one of the delegation had the Ordnance Survey map of the year of my birth, which showed houses on that road.

I am happy to bring before the House some of our anxieties arising out of the closure of residential homes by the Eastern health and social services board. I welcome the opportunity to raise the matter, because it has immediate implications for the area that I represent. It also has widespread ramifications which will affect people not only in Northern Ireland but in Great Britain. Perhaps a cautionary word should go out to the planners: people may not be in the fortunate position of being able to pay for their own care in latter years. We are all getting older and the lifespan for many appears to be increasing. In 30 to 40 years, today's planners could be those requiring care. Therefore, we should all be guided by the principle: "Do unto others as you would they should do unto you".

As a convinced supporter of community care and care in the community, I have never seen them as cheap options. I certainly take issue with national health service planners who seem at times to be using the elderly as pawns, and I object most vehemently to money mattering more than people.

The background to the debate concerns the Department of Health, which has stated its intention to increase the number of elderly people aged over 75 having their long-term needs met at home, rather than in residential care, nursing homes or hospital settings.

Accordingly, the Eastern board has targeted a reduction from the existing provision of 1,823 independent homes and 394 statutory homes to 1,296 independent homes and 303 statutory homes. In south and east Belfast, growth in the private sector was encouraged by the Department and boards, but now many such homes are under threat. However, the real sufferers are elderly people who believed that their latter days would be spent in the settled home of their choice.

Significantly, south and east Belfast have twice the number of over-75s and over-85s as the other three community units of the Eastern health and social services board.

Ms Rachel Squire (Dunfermline, West)

I thank the hon. Gentleman for giving way. Does he agree that the rigidity of the decision-making by the Eastern heath and social services board about residential homes has been completely unacceptable to the residents, staff and communities concerned? Will he join me in urging the Minister and, indeed, Baroness Denton to tell the board that it must take into account the wishes of the communities concerned and start thinking about people, rather than only targets and beds?

Rev. Martin Smyth

I appreciate the hon. Lady's contribution. She was concerned about the situation in Northern Ireland, and travelled to Belfast at the weekend to discover first hand some of the issues affecting the staff, residents and carers. I share her views about the rigidity of the decision-making.

I shall turn to the criteria that were set to evaluate options. They were, first, the fabric of the building, including costs and suitability for its purpose—although so used for some time—secondly, the standards set by the Registration and Inspection Department; thirdly, the current demand and vacancies; fourthly, the running costs; and, fifthly, the locations within the area. The board added further criteria after discussion, including interest shown by the number of people attending meetings and the comments made. Presumably that took cognisance of the residents' views.

I give that only by way of background, as the issue is much wider. There is a difference in the national health service between the regions. In England, there is an obligation on local authorities to spend 85 per cent. in the private sector. In Scotland, there do not appear, as yet, to be clear guidelines. In Northern Ireland, however, it appears to be purely a numbers game, in which the target calls for 12 per cent. to be catered for in the independent sector, and only 2 per cent. of the elderly to be catered for in the public sector.

The rigidity of the formula does not allow for proper transitional arrangements. People, not beds, would be a better starting point, especially where it was admitted that it would be cheaper to keep open Ardview house in Ardglass.

Community care, as I understand it, should be offering choice, but instead, this chimera is offered. However, those in residential care are offered no choice. Surely there should be a transitional period. Those coming newly into care could have an informed choice and know what their options are, while those already in care should be left to finish their lives in peace.

In 1989, more than 88 per cent. of over-75s lived at home. By the end of 1992, that had fallen to an estimated 82 per cent. I suspect that that was because the Department and the boards were pushing for private homes to be developed. The 1992–1997 strategy document sought to increase that percentage again to 88 per cent. by 1997. However, it would appear that, whereas the Department set a period of five years for the adjustment to take place, the trusts have drastically reduced that to two years.

There does not seem to be any logical basis for the policies being adopted, other than a headlong rush to save money. The Banks home, which has been referred to this evening, has been described as "beautiful and convenient", Ardview as "beautiful but not convenient" and Cairns house as "old and adapted". Old See house is a comparatively modern, purpose-built building. All are scheduled for closure.

As I have watched not only in the Eastern board area, but also elsewhere in Northern Ireland, it would appear that monetary pressures have led to decisions being taken on the hoof without proper principles or discussions occurring. It is suggested that choice is offered, but no choice is given, because prior decisions have been taken. There can be no useful participation, since the beds are being drastically reduced. Support for residents is being eroded as they are being removed from their areas. The vaunted principle of consent is being denied.

The Minister will be aware that, in exasperation at the way in which they have been treated, legal challenges have been made. I ask the Minister tonight for a clear commitment that there will be no further closures until the issues have been resolved. I do this insofar as the board was challenged in court, and it would seem to me that the incoming community trusts should have been included with them as correspondents.

In fact, in a letter from the Central Services Agency legal eagles dated 13 June 1994, the planning department of the board—in reference to the Banks and Cairns judicial review—were advised: it is no longer of any consequence and should not hinder any decisions being taken in respect of these two homes. On the other hand, I draw the Minister's attention to the remarks of Mr. Justice Kerr in the High Court in May, when he suggested that it might be better to take no action on closure until the legal issues were resolved.

May I set out some of the disappointments which have already surfaced? While an advocacy service was promised, the residents had to push for it. The Friends of the Banks had to apply for it on 24 May. That was already on the late side, as—I am sure the Minister will agree—an advocate should be there at the beginning before battle lines are drawn and before the board or trusts decided on closure. The principle of advocacy is one which I, and I hope all reasonable people, support. The advocate should be there, not merely to listen, but to challenge the case for closure.

What has happened has been to some degree a travesty. The system does not appear to be independent, since the board appoints. Nor has it acted as a proper advocate. In the case of Banks, the advocate appeared to cobble together an arrangement. In Cairns and Old See, I admit that the co-operation was better. However, both sets of advocates ultimately relied on grants from the Department, and were not participating in the decision-making process. What plans does the Minister have for taking the process forward positively?

I contend that elderly citizens would appear to have few rights, and professionals can steamroller decisions which are made before any consultation process has been reached. I am not unmindful that options can be studied, but if they are not put forward for rational discussion, we are left only with a charade.

That was clearly illustrated in the decision by the Southern health and social services board to close Moylinn in Craigavon. The decision was announced to the residents on 7 July 1993 by the general manager of the unit, although the consultation period was to have commenced in September 1993. It would appear that the board had already decided to close Moylinn and transfer the residents to the new Fold home in Lurgan.

With a clever display of casuistry, it was argued that the board did not decide until later. It is not surprising, therefore, to read Mr. Justice Kerr's view: For a consultation period to be meaningful or worthwhile, the body conducting the consultation as a preliminary to making a recommendation must at least be prepared to change the view which it had formed before the consultation took place". That is what any reasonable person would expect.

Sir William Wade put it well in his sixth edition of "Administrative Law": Where there is a statutory duty to consult persons affected, this must genuinely be done, and reasonable opportunity for comment must be given". When other depositions highlighted that the Fold housing association had acquired the site of the Manor house in Lurgan for £4,000, when a similar property opposite was sold on the open market for £150,000, serious questions must be asked. Why shut so many homes, yet subsidise a new one? Was Moylinn really not suitable?

I should like to refer, finally, to a particular constituent, Miss K. G. Faris, now living in Ardview house. The Down-Lisburn unit of management has decided to close it on the issue of accessibility. Only two letters were written on that issue, however, on behalf of the same resident in St. John's house, Downpatrick. Is it not significant that one of those was written by a civil servant working for the Department at Dundonald house? I understand that the noble Lady Baroness Denton has had a letter on the subject, naming the writer.

Furthermore, it seems that Ardview will be shut, but then used as a facility for mental health and disability programmes. Although I recognise that there may need to be rationalisation as well as development of such services, is it just coincidence that the principal social worker who was responsible for the unit's residential homes for the elderly is now director of mental health services for the Down-Lisburn trust?

Although I could enlarge even more on the concerns expressed not only by residents and carers in the Eastern board, but by those even further afield, I will rest my case, so that the Minister is able to respond. If he cannot, I hope that Baroness Denton will exercise her manifest concern and restrain the headlong rush for closure in the statutory sector and show caution in the face of undoubted pressures that have appeared in the independent sector as a result of the strategic changes.

To change the metaphor, we should be wary, or else the chicks, or perhaps the old broilers, will come home to roost.

11.27 pm
The Minister of State, Northern Ireland Office (Mr. Michael Ancram)

I congratulate the hon. Member for Belfast, South (Rev. Martin Smyth) on obtaining this important debate. I am grateful to him for raising the question of the closure of residential homes by the Eastern health and social services board.

My noble Friend, Baroness Denton, who has responsibility for health and social services matters in Northern Ireland, has asked me to say that she is particularly conscious of the anxiety felt by those frail elderly people who are accommodated in the homes that have been marked down for closure. She has already visited one of those homes at least and has spoken to the residents and carers. She has undertaken to visit all homes that are referred to her for consideration. On her behalf, I welcome this opportunity to make clear the Government's view on the rationalisation of residential homes.

As the hon. Gentleman will be aware, the new community care arrangements were anticipated in the 1990 policy document, "People First". The new arrangements recognise individual needs and incorporates a proper needs assessment, which allows programmes of care to be individually tailored to suit the needs of the individuals and their carers. That is a most important concept to which the Government are fully committed. As a direct consequence of it, it became necessary to review the level of residential accommodation in the Eastern board area.

The Department of Health and Social Services' regional strategy for 1992 to 1997 requires boards to ensure that the service provision in the community is adequate to meet the assessed needs of the elderly population aged 75 and over who wish to stay in their own homes. The hon. Gentleman will be aware that the majority understandably do.

Trusts and directly managed units have responded to the new arrangements and are putting in place the essential range of home care, respite care and other non-residential services that will provide the necessary support for people who chose domiciliary care in preference to residential care. In most instances, people prefer to remain in their homes provided that adequate support is available. That fact is borne out by the figures. Of the 5,900 care packages agreed up to the end of last year, 50 per cent. were domiciliary based; 30 per cent. required nursing home care; and 20 per cent. were in residential care homes. It is clear, therefore, that as an increasing number of people choose to remain in their own homes, boards will have to develop and improve packages of care available in the community.

Some of these services will be provided by non-statutory agencies, which demonstrates the achievement of another essential element in the Government's community care policy—the need to develop a mixed economy of care by encouraging providers from the voluntary and private sectors to take on a greater responsibility for the provision of services.

We place great emphasis on the assessment process, which involves listening to people, and on the development of additional packages of care provided by a range of providers in the community. A framework for the monitoring and evaluation of the new arrangements has been put in place.

It is important that the hon. Gentleman should recognise that the provision of more services in the community has not been stimulated by a desire simply to cut costs, because care in the community is not a cheap option—[Interruption.] The hon. Member for Dunfermline, West (Ms Squire) may laugh, but it is certainly not cheap. In bringing forward those reforms, the Government are responding in a sensitive and flexible way to the needs and wishes of individual clients and their carers. The Government recognise the importance of properly financing those reforms and have transferred responsibility form the social security system to the health and social services boards.

Money has followed that move. In 1993–94, almost £30 million was transferred; that increased to more than £70 million in 1994–95. In 1995–96, £106 million will be available to boards for the development of community care services. Those sums, together with the resources which boards were already expending on community care, represent a substantial commitment to that important group of people.

Rev. Martin Smyth

Will the Minister give way?

Mr. Ancram

I shall give way if I have a little time before the end, but I want to deal with some of the points which the hon. Gentleman raised.

I hope that the hon. Gentleman will accept that my noble Friend and I understand the fears of elderly and other vulnerable people and their carers about the level of services available for them. However, what I have said already should go some way to allay those fears and I think that I have demonstrated that every care has been taken to safeguard that vulnerable group of people.

Far from being a threat to the welfare of the elderly and others, the new arrangements are designed to add security and quality to their lives and, wherever possible, to enable them to remain active and part of the community in which they have lived, in some cases for many years.

Attention has rightly been drawn to the sadness that can arise when an elderly person is required to move from a residential home that is to be closed, but the most traumatic move for people is when they have to move from their family home into residential care. There are few instances when such a move is welcomed and many people worry about the prospect of moving away from their familiar surroundings for months before the move takes place. The families of the elderly person also find this move traumatic and are often heard to say that they feel guilty because they cannot care for their elderly relative at home. The policies which we are now implementing aim to delay that move for as long as possible.

I hope that what I have said helps to put in context the background to the present review of statutory accommodation. As the hon. Gentleman will appreciate, with a diminishing demand it is no longer appropriate to maintain the present levels of residential accommodation. It is clear that fewer residential and nursing home places will be required in future. If we do not rationalise the overall number of places, two things will happen.

First, many high-quality, well-run independent homes will be faced with closure as the diminishing need for residential accommodation is met entirely by the statutory sector. We should not run statutory homes that are not being used to full capacity, and therefore trusts and boards will be forced to abandon the non-statutory provision in the first instance. We also know from experience that it is more expensive to maintain people in statutory homes than in the private and voluntary sectors, and by moving the balance of care towards statutory homes we would be failing to make the best use of available resources.

Secondly, the need to maintain excess accommodation will delay the implementation of improved community care services by reducing the resources that boards can move into their wider community care programme. In order to accommodate a few deserving people, we would be reducing the level of community services available to many more.

If I may discuss the specific points relating to the Eastern health and social services board, it has considered nine homes for closure, and a full round of consultation has now, I understand, been completed. It was the board's intention to ask my noble Friend to endorse their decision. However, the process has been complicated by the judicial reviews that have arisen from the consultation about some of the homes. In the time since the board began the consultation exercise, the homes have become the responsibility of the newly formed trusts. It will be necessary therefore for the trust boards to consider each closure and to decide if they wish to proceed before Baroness Denton is asked to endorse their decision. That means that the local provider will be, and must be, directly involved. The exceptions to that rule are Warren house, Drumlough house and Ardview house as the decision to close those homes was taken by the board before the judicial review was requested.

As the hon. Gentleman knows, Mr. Justice Kerr, in his ruling on 31 May 1994, rejected the application. The case for closure of those homes has been passed to my noble Friend and it is her intention to meet as many as possible of those people who have asked to speak to her about the closures. She will also visit all the homes and will weigh up the arguments before coming to a conclusion. I am sure that she will also wish to read what the hon. Gentleman has said here tonight. She has already visited Ardview house. She wishes to reach a decision as quickly as possible so that the uncertainty can be removed and, where it is decided to close a home, so that the people concerned can be carefully relocated and begin to build a life with new and old friends without the uncertainty.

I do not know whether the hon. Gentleman still wishes to intervene.

Rev. Martin Smyth

I look forward to specific answers to the points that I have raised, but I raise one more. The figures that the Minister gave about people going into homes would have left 20 per cent. to be accommodated in homes for the elderly, yet the target is 12 per cent. in the private independent sector and 2 per cent. in the public sector, so 6 per cent. are unaccounted for.

Mr. Ancram

I shall draw that point to the attention of my noble Friend and ask her to write to the hon. Gentleman. I hope that he will appreciate that the decisions that she has to take are not easy. I can assure the hon. Gentleman that she will make them with concern for the residents as the priority in her agenda.

I hope that the hon. Gentleman can also appreciate why it is necessary for the rationalisation programme to go ahead. It is not a thoughtless dictate, designed to reduce costs or deliberately to close down good-quality, well-utilised homes for elderly people. I understand how difficult it is for the people who are directly affected by a home closure and I give the hon. Gentleman a guarantee that no existing resident of a home that is to be closed will be forced out into the community.

We recognise that most people who have moved out of their own homes are happy with the type of care that they receive. We know that those homes are now their homes, and fellow residents in a sense their family. We shall deal gently with those people who are to be moved, and we shall give them a choice of alternative accommodation, taking into account groups of friends who would like to stay together.

Trusts will provide an independent advocacy service to ensure that the residents and their families are provided with the full information about the options available to them. The service will collaborate with trusts and units to ensure that the needs and wishes of residents are being considered. Existing residents will be accommodated in other homes just as good as where they live at present. My noble Friend Baroness Denton will keep a very close watch on this programme.

Hon. Members will be reassured to know that the figures obtained for the first nine months, from April to December 1993, show that the assessment and care management processes are coping very well. During that period, boards received 6,600 referrals for care management and carried out more than 5,900 assessments. The split of assessments completed between programmes of care was 73 per cent. elderly, 9 per cent. mental health, 8 per cent. mental handicap, 8 per cent. physical and sensory disabled and 2 per cent. other adult client groups. More than 90 per cent. of the assessments commenced within seven days from referral and at least 80 per cent. of assessments were reported to have been completed within a week. That major achievement has resulted from meticulous preparation by both Government and boards.

It is also important that we keep a close eye on the standards that we have set for access to, and the delivery of, care. If people wish to remain in the community it is important that we have in place high quality services to support their choice. In September it is our intention to undertake a detailed inspection of the assessment process. The focus of that inspection will be to seek to establish that local assessment arrangemments have embraced the priniciples that underpin the community care changes.

The Eastern board has made substantial progress in the development of domiciliary care schemes. The board offers a wide range of facilities for respite, including residential and nursing home care, day care and various forms of sitting services. I hope that the new arrangements for that care will be generally welcomed for their flexible response to an invdividual need. While understanding the deep concern of those affected, I also hope that I have managed to persuade the hon. Gentleman tonight that we have the interests of the residents in those homes at heart.

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at nineteen minutes to Twelve midnight.