HC Deb 06 February 1996 vol 271 cc239-46

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

10.15 pm
Sir Norman Fowler (Sutton Coldfield)

The previous Adjournment debate that I initiated was about the Good Hope hospital in my constituency. I criticised the position at the hospital and argued, among other things, that more beds needed to be opened there. I am glad to report that that has been done, and almost everyone in the community has welcomed that—the sole exception being the Labour party's health spokesman, the hon. Member for Peckham (Ms Harman).

I hope that the hon. Member for Peckham will take note of the issue that I draw attention to tonight—the future of a 40-bed residential home for elderly people, the Frances Withers home which, contrary to strong local feeling, the Labour-controlled Birmingham city council intends to close. It is a case, not of reducing beds, but of cancelling them and withdrawing care. Once that policy, which is in its last stages, has been implemented, no facilities will remain at the Frances Withers home for the elderly people who are there, or for any future residents from Sutton Coldfield and the rest of Birmingham.

I was Secretary of State for Social Services for six years, and this is one of the most extraordinary cases that I have come across. The media are rightly used to becoming passionate about the health service. I hope that the television companies which frequently visit Good Hope hospital will visit the Frances Withers home and confirm what I am about to say. The impression has been given that the Frances Withers home is decrepit and run down, requiring hundreds of thousands of pounds to bring it up to standard. In fact it is a modern, purpose-built home, providing single rooms for all 26 current residents and with other single rooms available to bring it up to capacity. The home is below capacity only because new entrants are being refused.

On entering for the first time, any visitor receives an impression of space. There are lounges on both floors and the atmosphere is self-evidently happy. The home, situated in a quiet part of Sutton Coldfield, is surrounded by gardens and has a good view of Sutton park. In other words, it is an ideal spot for a residential home for elderly people and, in the opinion of some people who have visited all the homes in Birmingham, it is one of the best homes in the city, if not the best. That makes the proposal to close that excellent home, with all the consequences that it will bring, all the more extraordinary. In my opinion, it is a policy of social vandalism.

What does the closure of Frances Withers mean? First and foremost, residents who have lived there for several years will be moved from what they rightly describe as their home. They are very elderly men and women, almost all of whom are in their 80s and 90s. There is Alice who is 96, Mary who is 91 and Gregory and Jessie who are both 90. No one should doubt the trauma involved in moving people of that age.

My mother died before Christmas, aged 93. She spent the last years of her life in residential and then in nursing care. As far as she was concerned, stability was essential. She would have been devastated had she been shuffled about at that stage of her life. Fortunately, she was not, but the 26 people now staying at Frances Withers face that traumatic prospect.

No one should doubt the strength of feeling of the relatives who are witnessing what is happening at Frances Withers. One wrote to me in the following terms: I believe this to be a mean and heartless measure on the Council's part. For many of the pensioners residing at Frances Withers this is the only home they have known for several years and to move them elsewhere would be a sad and traumatic experience. The policy means distress for residents and relatives as the council breaks up an established home. It will also mean splitting up the excellent team of staff who work at Frances Withers, some of whom have been employed there since it opened in the early 1970s. The closure of Frances Withers is opposed by me and my team of Conservative councillors—Alan Rudge and John Hood. David Roy, the Lord Mayor, obviously steers clear of controversy, but he has also kept himself informed about that issue. The closure is also opposed by Unison, the union which represents the staff, and by a number of Labour councillors. In other words, the policy has very few friends.

If the closure of the nursing home goes ahead, the supply of much-needed residential accommodation for elderly people in north Birmingham and the surrounding area will be permanently diminished. Apologists for the closure quietly suggest that demand for places in residential care is diminishing and that that is likely to continue, but that argument flies in the face both of present experience and of the estimates of future demand.

Last Friday at my advice bureau I met relatives of Frances Withers residents who are deeply anxious about the future. I pay tribute to the way in which they have put their case. My next appointment was with another resident of Sutton Coldfield who was concerned about her mother who is almost 80. At the end of October her mother fell and broke her hip and she was admitted to Good Hope hospital on the same day. It was decided that she could not return home—her daughter had cared for her for the past 18 years—as she now needed a greater degree of care. It took no fewer than 95 days to find her an alternative place—during which time she waited in the same bed, in the same ward, at Good Hope hospital. I acknowledge that that was an exceptional case, but we would be foolish to ignore the warning.

Mr. D. N. Campbell-Savours (Workington)

Will the right hon. Gentleman give way?

Sir Norman Fowler

Yes, I will, although the hon. Gentleman's knowledge of Sutton Coldfield and Birmingham is not exactly encyclopaedic.

Mr. Campbell-Savours

I do not claim that it is. Has not the local authority said that it has to make so many closures because it does not have the resources to keep the facilities going?

Sir Norman Fowler

I shall come to that point and I hope that the hon. Gentleman will be persuaded by what I have to say about it. I hope that he will not rely on that point, however, because it is a dud and invalid point.

I was making a serious point. If the Frances Withers home is closed, the same will happen as happened to my constituent: beds in the local hospital at Good Hope will be used for people who should be in residential care. That lady was kept in Good Hope hospital for no fewer than 95 days in a bed that could have been used for other patients. That is a disgrace. Doubtless, that is an exception and I do not claim that it is common, but the risk inherent in the council's policy is that such cases will become more and more common.

I will deal now with the argument that the hon. Member for Workington (Mr. Campbell-Savours) raised. What arguments have been used to defend a policy which, frankly, I believe is indefensible? Money, of course, is one of the arguments used. Birmingham has a budget of £1.2 billion a year. In 1996–97, some £188 million will be available to spend on social services. That is an increase of £11.5 million over 1995–96, and an increase of almost £83 million on 1990–91.I simply cannot believe that, in that vast budget of Birmingham council, the only decision that can be taken to save money is to close a purpose-built—I emphasise purpose-built—20-year-old old people's home. If that is the case, the council should pack up and go home.

Dr. Lynne Jones (Birmingham, Selly Oak)

Will the right hon. Gentleman give way?

Sir Norman Fowler

I will not give way. The hon. Lady was not here at the beginning of the debate. If she wants to have an Adjournment debate on the situation in her area, she has opportunities to do so.

When the press has asked about the policy, another argument has been advanced by the council spokesman. The press has been told about an estimated £530,000 that needs to be spent on refurbishments to meet the "1998 regulations". It has been suggested that they are European regulations—not so. It has been suggested that they are Government regulations—again, not so. Indeed, they are not regulations at all but a policy and a time scale that Birmingham council has itself decided to follow to make improvements to the home. It is, of course, sensible to improve physical standards in any home, and that should be done steadily year by year—councils should not allow spending to pile up so that they need to make a big investment all at once and have an enormous single bill— but there is no reason to set down an inflexible timetable.

The Government's policy was set out in the ministerial introduction to "Home Life": It will be for registration authorities individually to ensure that the code is applied positively and sensitively in a way that makes sense in local circumstances". Personally, I endorse those words entirely as I wrote them in conjunction with Lord Crickhowell, then Secretary of State for Wales. No one ever envisaged in a million years that a local authority would misuse guidance on best practice as an excuse for closing down a modern residential home.

I am not talking about an ancient, decrepit building. The home was purpose built. No requirement has been laid down by the Government or anybody else that certain standards should be met by 1998. That is a rod that the council has devised for its own back. If the net result is to close down a modern building, that is bureaucracy gone mad. Perhaps my hon. Friend the Under-Secretary of State for Health will confirm that there is nothing in Government regulations that would force the spending of £530,000 by 1998.

I do not think any more of the further argument that has been made—that residential provision for the elderly is above average in the Sutton Coldfield and Erdington areas. That is a fascinating statistic, but it is next to meaningless because the people there do not always come from Sutton Coldfield and Erdington—certainly, as I well know, their relatives come from all over Birmingham.

I believe that the policy is wrong because of the potentially disastrous impact that it will have on present residents. I believe that it is wrong because of the effect that it will have on future residents. I believe that it is wrong because it is bound to have the effect of increasing the pressure on local hospitals. And it is wrong because many of the reasons that have been given as justification for it are misleading.

We now know that alternative uses for Frances Withers are being actively considered. A letter from the head of acquisitions and valuation services to the social services department says: I should be grateful if you could kindly let me have some indication of when vacant possession of the premises is likely to be obtained and your thoughts on their future use, particularly with regard to the need to satisfy your committee's policy regarding the disposal of surplus homes. Another letter at the end of October from the social services department notes that the North Birmingham Mental Health trust, in partnership with MIND— the National Association for Mental Health—is among the organisations that have expressed interest in alternative uses for Frances Withers. In other words, we can take it that the policy of closure is being pursued vigorously.

The question is what can be done. I am highly critical of the policy and I do not withdraw one word of what I have said about it. I hope that there are now sufficient people of good will in all parties who do not want to see an excellent home closed down and residents moved against their will. One solution is obviously for the council to reverse its policy and to continue to run the home. If that is not to be the case, it needs to be said now that all other options should be explored to see how the home can go on running and how its residents can be cared for.

It may be that some new partnership arrangement can be reached with the council. It may be that a voluntary organisation will be able to help or even that a new voluntary organisation can be formed. However, I make it clear that it must be a voluntary organisation that wants to preserve the home for the elderly people who are there and does not want to dedicate it to some other use. Perhaps some form of private sector organisation may be interested.

If the council is not to run the home, the aim must be to continue to run Frances Withers as a residential home for elderly people. Clearly, options for the future cannot be explored sensibly with an axe poised over the home. What is now required is a minimum six months' stay of execution so that all the options can be explored. I very much hope that the council will agree to this, and I very much hope that the Minister will be able to confirm my understanding of the requirements that govern the home and to confirm that what I propose is an option that is open to the council. Above all, the aim must be to develop new policies that will give fresh hope to the elderly residents of Frances Withers home.

10.32 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)

I am grateful to my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) for raising the issue this evening and for bringing it to my attention, to that of the House and to that of the decision makers in the city of Birmingham. As a distinguished and long-serving former Secretary of State for Social Services, my right hon. Friend brings great personal experience and expertise to the subject, so much so that I am almost tempted to sit down and let him answer the debate. However, I will not do that tonight.

I know, too, that my right hon. Friend will acknowledge that we have built on his years of achievement, and have gone on advancing the provision of care for elderly people, especially since the introduction of the community care reforms in 1993.I also welcome his reference to the progress that has been made in the NHS in Birmingham, where, as he has acknowledged, work has started on two new operating theatres with emergency facilities at the Good Hope hospital, at a cost of £1.4 million. A further £1.4 million is to be spent on work at the City hospital NHS trust for refurbishment of the accident and emergency department.

At both national and local level, care for the elderly has, rightly, become one of the highest-profile and closely followed aspects of health and social services. In this place before Christmas, we had a debate on care of the elderly in Lancashire. A couple of weeks ago, my hon. Friend the Member for Hastings and Rye (Mrs. Lait) examined the regulation and inspection of homes. Last week, I was able to give evidence to the Select Committee on Health on the future of long-term care.

I very much welcome the attention that my right hon. and hon. Friends have given to this area of policy implementation, and the scrutiny that they have given to the decisions by local councils, so many of which are currently in the hands of the Labour and Liberal Democrat parties. Tonight is no exception.

The introduction of community care represented a major step forward in the delivery of services to the elderly. By the end of 1996–97, local authorities will have been given an additional £2.2 billion for their new responsibilities, representing a massive injection of resources at a time of tight restraint in public spending, and a total of well over £5 billion for community care. To take Birmingham as a example, the local authority's total personal social services resources will have risen by 46 per cent. in real terms since 1990–91. Its total social service resources in 1996–97 will represent an increase of 9 per cent. over the 1995–96 figures, as my right hon. Friend said.

Dr. Lynne Jones

Will the Minister acknowledge that Birmingham already spends well in excess of the standard spending assessment for social services? The council may be Labour-controlled, but the Government impose budget constraints. The Government grant has increased by about 0.5 per cent., and overall expenditure has risen by 2.5 per cent., so Birmingham faces cuts of about £41 million.

Mr. Bowis

The hon. Lady is quite right. Birmingham has to manage with the generous resources that it receives from the taxpayer. As my right hon. Friend pointed out, the increase in resources to social services from £105 million in 1990–91 to £187.8 million in 1996–97 is fair funding indeed, and Birmingham should be able to provide good and efficient services. Perhaps it needs to be more efficient.

Important as investment has been, we are committed to developing services that increase user and carer choice and control—choice in the services they receive and the way in which those services are delivered. Our reforms are about putting people first, and my right hon. Friend is absolutely right to say that, first and foremost, local councils should be looking at what is best for the residents of the Frances Withers home. He mentioned Alice, Mary, Gregory, Jessie and the other residents. As he says, they are at perhaps the most vulnerable stage of their lives, and they deserve utmost consideration from those entrusted with their care.

My right hon. Friend would be among the first to recognise that improving care for the elderly is not a task that central Government can approach by seeking to intervene and interfere in every local decision. Good-quality local care can be delivered only if the elected leaders of local authorities take responsibility for the planning, commissioning, inspection and, in some cases, management of services.

The Government have set out a clear policy framework within which local authorities can discharge their statutory duties. In addition to the National Health Service and Community Care Act 1990, we have in recent years issued guidance to local authorities on the procedures they should follow in making service changes, such as closing homes.

We have supported the development of guidelines for standards in residential care homes. My right hon. Friend will no doubt recall endorsing the "Home Life" report of 1984, to which he referred. He will be reassured to know that we have not endorsed the draft "Home Life II" report which has been circulating in recent weeks and caused such dismay as a result of its intrusive and politically correct content and tone. We have introduced a statutory direction on choice that gives anyone entering residential care, following an assessment by the local authority, the right to choose the home in which they wish to live, subject only to availability, appropriateness and reasonableness in terms of cost.

We have continued to develop the role of the social services inspectorate in overseeing standards and the local inspection of those standards. The Audit Commission is developing its work, and we have a Bill before Parliament to develop that further.

Within that framework, we want to allow local authorities as much scope as possible to carry out their functions, enabling them to diversify and, in partnership with providers, users of services and carers, to determine appropriate provision for the local population. The people of Birmingham elect their councillors to do exactly that job. They will be looking to them for solutions to problems such as those that my right hon. Friend raised this evening, and in due course they will hold them to account.

Local authorities around the country are increasingly providing residential care through contracts with independent sector providers rather than running directly managed homes many of which do not meet the registration standards required of independent sector homes. There is no requirement on local councils to provide directly managed homes, and that has been clarified by a recent judgment in the House of Lords. Their duty is to arrange for appropriate and good-quality care to be provided by residential and domiciliary care providers, no matter in which sector they are.

The key current responsibilities of local authorities towards their local populations are to assess needs and to make arrangements as necessary for residential and other forms of care. Their prime function is that of purchasers of care, but we make no requirements on them to reduce, or divest themselves of, their own homes. We certainly do not include the sort of requirements to which my right hon. Friend referred. Local needs and priorities must drive local decisions.

I stress that, even if a local authority decides that it is not best placed to run its own homes, there are alternatives to closure that should be considered. Many local authorities have transferred the ownership or management of their homes to the independent sector—private or voluntary—as my right hon. Friend suggested. Such transfers can take place without any disruption to the lives of the residents themselves, while giving better value for money for residents and ratepayers alike.

When a decision is being made to close a local authority-run home, we have made it clear in guidance—and it has been confirmed in judicial reviews—that local authorities have a duty to inform and consult existing residents. They should take fully into account the welfare and wishes of both residents and staff of the home involved.

Factors to take into consideration should include the availability of other homes in the area and any deficiencies in the existing buildings. Residents of a home should be informed of any proposal to close as quickly and sensitively as possible; they should be fully consulted about the range of alternative homes in which they can and might wish to be accommodated. When doing that, local authorities are expected to make every effort to enable residents to preserve friendships that they may have built up in the home, so that the move is carried out with the minimum of disruption.

There are two avenues that can be pursued where anyone is not satisfied that a closure has been carried out with due regard to such considerations: the first is judicial review, which I believe has recently happened in terms of another home closure in Birmingham; secondly, there is the local authority complaints procedure, with eventual recourse to the local authority ombudsman. I know that my right hon. Friend will understand when I tell him that Ministers cannot and have no power to intervene in individual cases. To do so would undermine one of the strengths of community care—that it puts local people in charge of local decisions.

With regard to the Frances Withers home in Sutton Coldfield, I can understand why feelings run so high on such a sensitive issue, which affects very elderly and vulnerable people. I understand that the director of social services has given an assurance that the council will not undertake any precipitous action. He has stated that the decision to close the home was taken after due consultation and consideration of the options available. I understand that his officers in the social services department have sought to engage residents in discussions about alternative accommodation, although there remains a group of people who have so far declined to engage in such discussions.

I know that, in arriving at its decision, the social services committee claims to have considered a number of factors, including the overall level of provision in the area—to which my right hon. Friend referred—and the extent to which the services are provided by the council. I believe that the council's provision is higher than the national average.

Other factors include the occupancy levels, which I am told have been less high in Frances Withers than in other nearby homes. That may be partly due to the uncertainty over the home's future. Some 23 of the home's 40 beds are currently occupied. The council claims to have concerns about the levels of staffing and the maintenance of good-quality care. It also claims to have taken into account the number of admissions, which suggested that the home was not being used as much as neighbouring homes, particularly for respite care.

There was also the question of the cost of refurbishment, to which my right hon. Friend referred. That is certainly not due to any Government requirement.

Sir Norman Fowler

My hon. Friend is making an important point. Will he confirm and underline the fact that there is no Government requirement that £530,000 should be spent on Frances Withers home, by any regulation propagated by Government, by the year 1998?

Mr. Bowis

I can give that assurance. There is no such requirement to do so, by 1998 or any other date.

I have listened carefully to the points made by my right hon. Friend. I was particularly concerned to hear about the wait endured by the lady who was finally admitted to a home. If he would like to let me have further details of that case, I shall certainly look into it. I shall be asking the social services inspectorate to keep a close watch on the position in Birmingham and to report back to me as appropriate.

The council in Birmingham, the social services and we in government need to ensure that there is a coherent strategy in place that is flexible enough to take account of the wishes of local people, particularly the residents of local care homes. I hope that Birmingham councillors will consider carefully the fact that, if they cannot continue to run the home—for whatever reason—they must adequately consider the option of inviting the independent sector to take it on and keep it going. I think that that is what my right hon. Friend is asking for on behalf of his constituents. It seems to be a perfectly reasonable option, which should be considered by the city council.

Question put and agreed to.

Adjourned accordingly at fifteen minutes to Eleven o'clock.