§ 11 am
§ Dr. Norman A. Godman (Greenock and Port Glasgow)
I raise a subject of serious concern to us all. Our elderly citizens deserve our abiding support. In their day, they helped to produce the wealth of our nation, and they and members of their families fought and defeated Nazism. They now deserve to be treated with respect, so that they may live out their years in dignity and comfort.
My concern is shared by many hon. Members. Some of us believe that pensions should be linked to earnings, but our leaders inform me that that might involve higher taxes, and we should never underestimate the self-interest and greed of the middle classes. We, for our part, must continue to campaign on behalf of elderly people. The Opposition have a good record in that respect, and many Conservative Members also fight similar campaigns.
Recently, the hon. Member for Perth and Kinross (Ms Cunningham) introduced a debate in which she spoke powerfully about the need for a more compassionate and effective cold weather payment scheme. In advocating a better scheme, she was joined by a number of my hon. Friends.
The commitment to a belief that our elderly citizens deserve a more comfortable and decent life is shared by numerous voluntary and professional associations in Scotland, including Age Concern Scotland, one of many organisations that brief us on what needs to be done, especially for frail and vulnerable elderly people.
I am sure that all hon. Members will echo my sentiments when I say that the Inverclyde elderly forum runs a formidable campaign, ably led by the remarkable Nell McFadyen and its secretary, Donald MacDonald. We can be sure that, if they have issues to bring to our attention, and criticisms of this place and its failure to concern itself with elderly people, they will not miss us and hit the wall.
The campaign must continue, because many of our elderly people live in poverty. Some of them live in private homes that are a disgrace. I wish to focus my speech, which will not be too lengthy, as many of my hon. Friends are anxious to speak, on the residential and nursing home care of elderly people. As I said a moment ago, in some respects it is a lamentable and disgraceful affair.
Again, our concerns are shared by numerous professional and voluntary associations. I have no doubt that many of them have submitted evidence to the Select Committee on Scottish Affairs, which, under the able chairmanship of my hon. Friend the Member for Kilmarnock and Loudoun (Mr. McKelvey), is conducting a study into community care. I look forward to debating the findings of his report, and, perhaps more importantly, its recommendations at a meeting, or perhaps a couple of meetings of the Scottish Grand Committee. I hope that those recommendations will lead to legislative change.
Yesterday, when we were considering the legislation on the Department of Social Security compensation recovery unit, I received a briefing from Jim Eadie of the Royal College of Nursing, saying, inter alia:Elderly people who have paid national insurance all their lives are now having to pay for long term nursing care which they thought the NHS would fund, causing distress and anxiety to elderly people and their families.278 The Royal College of Nursing argues for the provision ofnursing and social care under one roof regulated by a single system".There is much to be said for that.
The briefing continues:Instead of receiving care either in a residential care home or a nursing home, care homes to meet individual social and nursing care needs under one roof should be encouraged.It stresses the need tooverhaul the existing regulatory system so that new types of homes are registered and inspected by an independent nationally trained inspectorate made up of people with health and social care skills.A similar view was expressed in "The Dementia Manifesto for the 1997 General Election" produced by Alzheimer Scotland Action on Dementia. That excellent manifesto also argues for the unification of registration and inspection. Under the heading "Legislation to unify registration and inspection arrangements for residential homes and nursing homes", it states:The abolition of the distinction between residential and nursing homes would enable more flexible care to be delivered without subjecting the person with dementia to distressing moves.That is an important consideration. The Minister and his officials have a poor, if not disgraceful, record in the regulation, management and inspection of homes. In respect of the provision of residential and nursing homes, it is my view that the Scottish Office is being subjected to sustained lobbying by the private sector, which has sought to secure its position at the expense of local authority provision before the general election. I believe that the Minister and his officials are susceptible or receptive to lobbying and proposals for the complete privatisation of such provision.
I remind the House that the Public Accounts Commission is almost ready to commence a comprehensive study into the commissioning of such services; among other issues, it will examine the relative costs of provision. I understand that the report is due in the autumn. Any action that the Government take to swell the private sector and hence diminish local authority provision before the report is published would be politically motivated.
Some private sector nursing and residential homes are well managed. The residents are treated rightly and properly by trained staff who have good terms and conditions of employment. Other private homes, however, are entirely different, and the profit motive in all its nakedness reigns supreme. I was pleased that one such home in Port Glasgow was closed down. The Minister is aware of the case. It was an utter disgrace, and I was angry and ashamed to be part of a nation that subjected 18 of its elderly citizens to the behaviour of the owner of that home, who acted as general practitioner to the residents. I shall return to that point. The Minister knows that I have been pursuing it for a long time. I believe that he, his officials and his colleagues could be indicted on a political charge.
I remind the House of the appalling scandal at the Glasgow home, Glenglova. At a fatal accident inquiry into the death of an elderly resident, the sheriff was scathingly critical of regulations governing the ownership and management of such homes. As a direct result of that scandal and others throughout the land, the Minister set up a working group on residential care homes registration 279 procedures. He knows that I kept a very close watch on that working group's report. The report was published in the early summer of last year.
In a letter to me dated 24 July 1996, the Minister said:Following on your interest in the progress of the Working Group, I am pleased to be able to tell you that … the Report has been received.As you will see from the enclosed copy of the Report, a large number of recommendations have been made. The Government have a duty to ensure that people in residential care are properly looked after and that high standards of care prevail and we therefore propose that work be put in hand now to take forward a substantial number of these recommendations straight away.The House should note what the Minister said. I took that letter at face value, yet I am afraid that what the Government then proposed has just not happened.
A month before I received the letter, I asked the Secretary of Statewhat plans he has to modify the regulations governing the ownership and management of privately owned nursing and residential homes for elderly people.He replied:I can happily assure the hon. Gentleman that the report should be available to Ministers in three weeks' time, and I will come forward with our final recommendations for action with all possible speed.He went on to say, in a fairly lengthy answer:We will come forward with recommendations as soon as possible."—[Official Report, 5 June 1996; Vol. 278, c. 606.]Three weeks ago, I asked the Minister an identically worded question. As it is identically worded, I do not need to repeat it. Seven months on, the answer that the Minister gave was:The Scottish Office is currently consulting publicly on the standards and practice in nursing homes and is considering the recommendations made by the working group on registration procedures in residential care homes."—[Official Report, 5 February 1997; Vol. 289, c. 621.]The Minister should be arraigned on the charge of neglect of the interests and needs of many vulnerable and frail people. In the summer of last year, he promised speedy action, yet three weeks ago, he talked in terms of consultation. Meanwhile, some of our elderly people—not all—in private nursing and residential homes are being neglected.
I hate the thought of another Glenglova on the Minister's hands in the near future. There is to be no legislation between now and the election that would bar a professional from ownership and management of a home where he or she provides professional services to residents. No general practitioner should own, manage or be involved in the ownership or management of private homes. I would argue that the same holds for an accountant or a lawyer. Can the Minister confirm that, following that terrible scandal in Glasgow, the two services are separate, and professionals are not involved in the running of some homes of ours in Scotland?
It is full ahead on the expansion of the private sector and the reduction of local authority care. However, on the need rigorously to regulate the ownership and management of private nursing and residential homes, the Minister and his officials move at the proverbial snail's pace, which is a disgrace, and reflects very badly on the 280 Minister. I would argue that, in this regard, his conduct is unbecoming of his office. In the seven to eight months to which I have referred, and in the period from the fatal accident inquiry until today, action could have been taken to ensure, by way of rigorous inspection and tough regulation of ownership, management and staffing of homes, that elderly people enjoyed a decent, dignified existence.
I look forward to the day when we have a more caring and sensitive Administration, who will treat the elderly as they manifestly deserve. The Government have let them down badly. I sincerely hope that the Glenglova scandal is unique, but we all know of lesser scandals that are continuing each day of every week. Our elderly people deserve more, not only from the Government but from all representatives in this place.
§ Mr. Bill Walker (North Tayside)
I suppose the term "elderly" means people who are in receipt of the old-age pension. As I qualify for that, I must declare an interest.
I congratulate the hon. Member for Greenock and Port Glasgow (Dr. Godman) on securing the debate, and I agree that the elderly, particularly those who are for some reason not as fit as they would like, should be well looked after. They deserve, to use his words, to live in dignity and comfort.
I would not wish it to be imagined in this debate that people, certainly the vast majority of people of my age group and older in North Tayside, are not living in dignity and comfort. I mean the vast majority. There is no question whatever but that people of my generation and older are enjoying a quality of life of which our grandfathers and fathers could only dream. That does not mean that there are not some with problems and difficulties. There will always be some such people, and there are those with special health problems who require, quite properly, special health care. No one would dispute that.
I want to strike a sensible balance. It is nonsense, for instance, for people who claim to speak on behalf of pensioners to imagine that they are speaking on my behalf, when they never consult me about what they want to say. I believe that 90 per cent. and more of pensioners retiring retire with incomes from pensions linked to their former employment, just as we shall when we retire from this place. That is important, because it makes an enormous difference to the quality of life of the vast majority.
§ Ms Rachel Squire (Dunfermline, West)
Where does the hon. Gentleman get his evidence that 90 per cent. of pensioners have earnings-linked occupational pensions to support themselves in their life styles? That is certainly not my experience from contact with pensioners in Dunfermline, west Fife and elsewhere in Scotland.
§ Mr. Walker
I am sorry: I shall repeat what I said. I said that 90 per cent. and more of those retiring now are retiring with such pensions. I am talking about people of my age group and younger, rather than people whom I think the hon. Member for Greenock and Port Glasgow was probably addressing, who must be at least 75 years old or older to fit into the category to which he was referring.
281 We have a duty and a responsibility to address such people—there is no question about that—but it is nonsense to suggest that they are the vast majority; they are not.
§ Mr. Walker
I am not suggesting that the hon. Gentleman said that; I am responding to the intervention by the hon. Member for Dunfermline, West (Ms Squire), and choosing my words carefully.
We should recognise that voluntary bodies have an important part to play. Long may they continue to play it. I commend those who regularly look after the elderly through many and varied voluntary bodies in every constituency.
The hon. Member for Greenock and Port Glasgow concentrated his remarks largely on residential and nursing homes. I make no apology for the fact that I was partly responsible for initiating the inquiry into nursing care provision in Tayside. I wanted that done, because I knew that the nursing and residential homes provided by the local authorities were much more expensive than the private ones.
I visited every home in my constituency—I can speak with authority only about North Tayside—and in my judgment those in the private sector are superb. However, if the situation had arisen in my constituency that arose in that of the hon. Member for Greenock and Port Glasgow, I should have done exactly as he did, and drawn attention to it. It is unacceptable for anyone to run a home as he described, and no one would defend it.
The local authorities have a responsibility to monitor the situation, and to ensure that the private sector provides facilities of the right quality that meet the statutory requirements. If there has been a failure, it may be that the local authorities did not discharge their responsibilities as positively and accurately as they could.
We may want to tighten the regulations, and I would support any efforts to ensure that general practitioners did not own and run homes whose residents were their patients. The point about accountants was a good one. No one should operate on the inside, both making and monitoring the rules. The hon. Member for Greenock and Port Glasgow and I know that the GP plays an important part in monitoring and balancing what is being provided to his or her patients.
On value for money, we should remember that taxpayers' money is involved. It is not our job in the House to have preconceived views on the only way in which provision can be supplied. Local authorities can and should provide good quality of service where possible, but where that quality can be provided for £200 per person per week less by the private sector, as it is in Tayside, it is crazy to waste taxpayers' money. We can help many more people with the same amount of money.
Surely that is the point: are we concerned with caring for old people or with making narrow political points? I agree with the hon. Member for Greenock and Port Glasgow that it is our duty to ensure that taxpayers' money, where it is used, is used to the best value.
The military often have splendid arrangements for looking after old people. I again declare an interest, as I am involved with provision in connection with the 282 Royal Air Force, through the benevolent fund. The Army and the Navy have similar arrangements. I have been able to get help and assistance for the very category of individuals to which the hon. Gentleman drew attention: those who served in Her Majesty's forces—or His Majesty's forces, as they were in the second world war. No one with an ex-service background will ever be debarred from help.
There are always avenues to be explored. A great deal of money is available through military benevolent funds, and the tragic tales about ex-service people often come about simply because no one has gone to the trouble of making sure that the military knew the situation. Substantial help is available to anyone who has served in Her or His Majesty's forces.
No individual lives on the state pension alone. If any individuals in any constituency have only the state pension and no other source of income, they are missing out on all the other benefits to which they are quite properly entitled. I deliberately say "entitled", because I am astonished when people suggest that one should live on the state pension alone; we all know that rent can be paid through housing benefit, and that there are allowances for council tax, heating and other expenses.
We should recognise that it is part of our job as Members of Parliament to see to it that individuals in our constituencies get everything to which they are quite properly entitled, but not to suggest that the vast majority are suffering, when the opposite is the truth.
Anyone who comes to the Probus club—especially the Christmas dinner, as lunch is known there—at Forfar, or other pensioners' clubs in my constituency, will see that the quality of life in Tayside is high. Yes, there are some people with problems and some matters need to be addressed, but we should not get it out of proportion.
If we concentrate on dealing with the case that the hon. Member for Greenock and Port Glasgow mentioned, and any others that may exist—there are none that I know of in North Tayside, because if there were, I would be doing something about it—we can then focus our efforts on securing the best value for taxpayers' money, to the benefit of all our people.
§ Mr. Walker
I am about to sit down; I believe that I have been on my feet for 13 minutes.
The local authorities should become enablers and monitors rather than providers.
§ Mr. Michael J. Martin (Glasgow, Springburn)
The debate is not about service veterans, but I must say that many people in my constituency who served in the forces get no help from the organisations described by the hon. Member for North Tayside (Mr. Walker).
§ Mr. Martin
Some ex-service men are too proud to go to such organisations and say that they served in the war. Some people who left the services in 1945 are now suffering from dementia. I know someone in that situation. How can his wife apply to the British Royal 283 Legion, or other service organisations, when she does not get more than four hours' sleep at a time, because the man she married and has spent a lifetime with is now like a child and will not go to bed at night? The situation is not as clear cut as the hon. Member for North Tayside tries to suggest.
I declare an interest, because my father-in-law suffers from dementia. He lives in the constituency of my hon. Friend the Member for Glasgow, Maryhill (Mrs. Fyfe). On my wife's birth certificate, his profession is given as bombardier in the Royal Artillery. At one stage, we thought that he was entitled to claim for deafness, because he worked with the great guns in the desert during the war. The poor soul could not even remember his Army number to make a claim. When someone needs day-to-day provision, applying for charity is not the simple option.
I have a high regard for the military, and their work at Erskine hospital is excellent, but that is achieved through the voluntary work of men and women who have never served in the forces. As usual, the hon. Member for North Tayside is talking utter nonsense when he says that everything is fine.
The dedication of some men and women to the care of the elderly is amazing. We hear bad news from our communities easily, but we never hear the good news about the dedication that people display to the care of the elderly.
A dementia group in my constituency provides respite for those who care for the elderly. Every day, it provides lovely meals at a club in the multi-storey flats. On Saturday, in the workers' free time, it held a sale of work to raise money to take the people it cares for to Scarborough during the summer. It is good that such kindness is displayed in our communities, but we are failing as a society if friends and neighbours have to raise funds at sales of work for the men and women who fought against fascism for our right to free speech.
The way in which local authorities are attacked in the House is a disgrace. It is easy for us to say that they have gone over their budgets and are not spending their money properly, but the local authorities are in the front line of providing care for the elderly. The homes for the elderly in Glasgow are second to none, and could be filled three times over. The waiting list is enormous, because of the standard of care that is provided.
Our local authorities have built up a home help service that provides the elderly with meals and help with housework. The home helps also provide companionship for the lonely. The hon. Member for North Tayside said that most elderly people have second pensions, but it would not matter if they had three pensions if they are lonely. It is a disgrace that we allow such loneliness to continue. The only people who ever go into some pensioners' homes are the home helps. It is a disgrace that we attack local authority budgets for such vital services.
Every home help I speak to says the same about the terrible pressures on them. Sometimes they have time only to go to the post office for their patients, and to collect some messages. They have little time for conversation, but some home helps, in their own time, go back to their patients' homes at night to provide the companionship that should be provided at the taxpayers' expense. We do not need lectures from the hon. Member for North Tayside 284 about remembering that taxpayers' money is being spent. The elderly made provision for us when we were children by paying taxes. They paid into the community, and it is time they got something out.
Some 10 years ago, the railway workshops in my constituency were closed. We have high unemployment in the area, and the men in their 50s who lost their jobs did not work again. The railway industry is well known for providing a pension, but the pensions that those men receive at 65 will not be as good as the pension that I and other hon. Members will receive.
The Springburn elderly forum in my constituency meets to discuss the issues that it will raise with me and with councillors. The hon. Member for North Tayside said that he had not been consulted, but my local elderly forum does not consult every pensioner. I as Member of Parliament do not consult every pensioner before I speak, but every pensioner knows that they are entitled to consult me.
Pensioners ask me, "Michael, what is the point in getting a rent rebate when our houses are freezing?" The Barlornock and Barmulloch estates were built in 1945 and 1947 for the ex-service men the hon. Member for North Tayside mentioned. Those young men and women brought their families up in those houses, which contain four or five apartments. No two-apartment houses have been built to allow those people, who are now elderly, to stay in the communities they love. They are stuck in big houses that they cannot afford to heat, and there is no point in giving them rent rebates. Every elderly person should have a properly heated home.
We keep hearing attacks on local authorities. My local authority has introduced combined heat and rent programmes, in which elderly people in certain houses pay rent which includes payment for heating. They no longer have to worry about the gas or electricity bill, but the Government are cutting the funds to expand that programme. We are all guilty of saying that we want to do more for pensioners, but we cut funds for the very organisations that help pensioners.
I am glad that my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) has raised this issue. The care of the elderly should be a non-party political issue. Each and every one of us should unite to try to ensure that we provide our elderly with the dignity that my hon. Friend described.
§ Ms Roseanna Cunningham (Perth and Kinross)
I congratulate the hon. Member for Greenock and Port Glasgow (Dr. Godman) on obtaining this debate, because he does a service to the elderly in Scotland by insisting on the matter being debated in the Chamber. I, too, have had the briefing from the Royal College of Nursing, and I shall refer briefly to some of its points. No one could regard the RCN as a radical organisation; it is certainly not one given to hyperbole and exaggeration. It is concerned about three aspects of what is happening in the care of the elderly.
First, the RCN points to a serious shortfall of resources for community care in Scotland, which damages care for older people. Secondly, it is concerned about the funding system for long-term care, which undermines a central part of the welfare state. Thirdly, it is worried about the 285 need to provide nursing and social care under one roof and regulated by a single system. Those points should be kept in mind.
I see that the hon. Member for Kilmarnock and Loudoun (Mr. McKelvey) is here. I understand that the RCN gave evidence to the Select Committee on Scottish Affairs inquiry into community care, which drew attention to the many models of good practice in Scotland that can highlight how we can bridge the gap between health care and social care for the benefit of the patient. I understand that many of those initiatives are entered into a database of good practice that has been set up by the Nuffield Centre for Community Studies.
It would benefit us all to consider such examples. In my constituency, the Perth night care service helps people with dementia, and their carers. The project involves collaboration between social workers and community psychiatric nurses. It aims to offer help and respite to carers to prevent the breakdown of support networks—which are needed if a family member has dementia—and thereby contribute to establishing a package of care flexible enough to suit the people suffering from dementia and their carers.
I echo some of the points made by the hon. Member for Glasgow, Springburn (Mr. Martin). Like him, I speak with family experience. It is all very well to talk about the care of the elderly when it involves the able elderly, but if it involves elderly people with serious problems such as dementia, doors close. That is the experience of us all. I must tell the hon. Member for North Tayside (Mr. Walker) that, regrettably, that includes his wonderful military doors.
§ Ms Cunningham
I am sorry, but the hon. Gentleman spoke for a long time, and I want to finish my speech quickly.
The difficulty that results when an elderly relative is diagnosed as suffering from dementia is a concern for anyone who has seen it at close quarters in their family. There are problems in getting the care necessary at the different stages of dementia. The tragedy of dementia is that it is progressive. At the beginning of the disease, people may be able to cope at home, but gradually it becomes impossible.
The hon. Member for North Tayside was right to say that many people who retire now may have extra pensions. However, those people will not always be 65. In our day, people live considerably longer. The older they get, the more they are faced with such long-term problems. It is precisely those long-term problems that pose the biggest difficulty for care of the elderly. Quite apart from anything else—I do not mean this pejoratively, because my father was in this position—they are the most difficult people to deal with if one tries to keep them at home, which is what most people try to do for as long as possible.
Our society and politicians have not yet thought about the implications of the increasing number of people suffering from dementia, and other problems, and the enormous stress that that is starting to cause for families, especially daughters. It generally turns out to be daughters who end up caring in the long term, once the healthy spouse has died. We need to think carefully about the matter.
286 In our family, we found that the situation had become so severe that my father could be admitted to a national health service bed because he could not get into any of the residential homes which then provided places for dementia sufferers. They would provide places for dementia sufferers only in the early stages of the disease. It was not until he got an NHS place that he got any real care. There was an enormous gap in provision, and that gap continues.
Bed blocking is part of the same problem. There is a mismatch between the health service and social care. In my area, some 50 people are assessed as needing residential or nursing home care but are kept in hospital because there are no places for them. That means that the NHS is put under more strain. We are getting into a vicious circle, because we have not yet grasped the nettle of care of the elderly. The situation is unacceptable, but the difficulty is that only so much funding is available. It is only when places come up that someone can be moved, because there is not the flexibility to allow expansion of the places available.
Community care should be a priority. We all know that there is much anxiety about the impact of local government reorganisation and reduced funding for the new unitary councils on the future of the voluntary sector. Regardless of what Conservative Members say, that is having a real effect on services. When I listen to Conservative Members, I sometimes feel that I am listening to ambassadors from a parallel universe, because I do not recognise much of what they are talking about. I wonder whether we are discussing the different care of the elderly in Scotland and care of the elderly on the plant Zog. For all that they say relates to reality, we may as well be. I am concerned about that.
Much has been made of private sector involvement, and monitoring. I have often heard the hon. Member for North Tayside talking about the report into the community care on Tayside. It is true that it said that private homes could provide a cheaper service than local authorities, but it did not emphasise that that would be at the cost of the pay and conditions of the people who work in the service. That is the difficulty. Ultimately, that means trying to provide care—
§ Ms Cunningham
Indeed; I am indebted to the hon. Gentleman.
Local authority pay is one of the major factors in attracting and retaining staff with appropriate skills. They are paid approximately £5.20 per hour. In the private sector, it is unlikely to be more than £3 per hour, and in many places considerably less. In the private sector, staff often receive little training and have little prospect of advancement, but they are expected to carry out the most intimate and personal tasks for frail and vulnerable home residents. That represents savings perhaps, but only at the cost of employees' pay and conditions, and at the probable cost of the single-room standard, which is immensely important to elderly people. Their privacy is immensely important, and that cannot be guaranteed in the private sector.
There is great concern about monitoring standards. I understand that nursing agencies are subject to statutory regulation, but that does not necessarily extend to other 287 types of employment agency dealing with unqualified staff. That adds another element of risk in the places that have become homes for the elderly. The hon. Member for Greenock and Port Glasgow cited an especially worrying example of what can go wrong, and such cases will continue to arise unless regulation is addressed with great seriousness.
The private sector is expanding rapidly, but in many cases that comes at the price of lower quality. In many areas, our local authorities have provided excellent care; however, they are effectively being told that they can no longer provide that excellent care themselves, but must go out to the private sector, regardless of whether the care is as good. Local authorities are being penalised for trying to maintain high standards, and as a result our elderly people may also be penalised.
§ Ms Rachel Squire (Dunfermline, West)
I shall speak as briefly as possible, because I know that some of my hon. Friends are anxious to make a contribution to this debate.
I congratulate my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) on obtaining the debate. I pay tribute to his constant campaign on behalf of the elderly for high standards and quality in community care. I share his and other hon. Members' belief that the care of the elderly, and the way in which society in general and the Government in particular approach that care, is a yardstick by which we should all be judged. Given the way in which they have dealt with the elderly in our community, the Government should hang their heads in shame.
I am pleased to follow the hon. Member for Perth and Kinross (Ms Cunningham) and applaud her excellent points about the provision of residential care. She referred to the social work services inspectorate report entitled "Community Care Services For Older People in Angus, Dundee City and Perth & Kinross". I agree with her remarks about pay rates: a recent survey by the Association for Residential Care found that some of its members said that even a minimum wage of £2.50 an hour would result in a substantial rise in their costs. That gives an indication of pay levels in some private homes. If we value our elderly people, we should show our appreciation of those who care for them on our behalf.
I shall concentrate on two specific issues: choice and information. My first point is about housing: community care is built on choice, and many, if not all, of us would choose to live in our own homes for as long as possible. However, all too often the Government's actions have meant that choice is restricted to going into either a nursing home or a residential home. The Government's actions on housing have made it difficult for many people to continue to live in the community.
Let me give the example of one of my constituents. An elderly lady who had been living in the community was admitted to my local hospital for acute care. She wanted to be discharged to the community; her family supported that, as did the hospital, but it was agreed that she needed level accommodation. She was happy to give up her three-bedroomed council house to a family that desperately needed it and to move into sheltered accommodation.
288 The problem, of course, was that no sheltered accommodation was available, because of Government policy on the provision of public housing by local authorities, Scottish Homes and housing associations. I had intended to quote appalling statistics on the gross lack of sheltered and very sheltered housing in Scotland, but that would take up valuable time.
My second point relates to the crucial importance of information to enable people to remain in the community. The hon. Member for North Tayside (Mr. Walker) commented on how no one should be allowed to exist—and it would be mere existence—on a basic state pension, but the Government have done little to encourage elderly people to claim the benefits to which they are entitled.
It is reckoned that there is £14.10 a week in unclaimed income support for every pensioner in this country, and that between 12 and 15 per cent. of pensioners who are entitled to housing benefit fail to claim it. To make matters worse, housing benefit forms have increased in length, from four pages in 1988 to 16 pages today, and the single short claim form for attendance allowance has been replaced by two different forms of 12 and 24 pages respectively. Even the Clerks of the House might feel that that amount of paperwork was excessive.
Many Opposition Members were deeply disappointed by the Government's failure to extend the Community Care (Direct Payments) Act 1996 to people over 65 and so assist them in independent living. I pay tribute to Scotland's 700,000 carers, of whom 600,000 care for elderly people. Of those carers, 28 per cent. are themselves elderly—for example, in my constituency, I met a 70-year-old lady who cared for her 81-year-old disabled sister and her sister's blind husband.
Mention was made of the issues of dementia and general practitioners. The Government have ensured that GPs are increasingly overworked through having to provide GP care and cover to nursing homes that house hundreds of people who would previously have been in hospital. I applaud the remarks of the hon. Member for North Tayside about the importance of early diagnosis, especially of dementia and Alzheimer's disease.
§ Ms Squire
I apologise to the hon. Lady for that mistake.
Yesterday, I was pleased to learn of the announcement of United Kingdom licence approval for the drug Aricept, which is the first ever drug treatment for the symptoms of Alzheimer's disease. However, it is not a cure, and its effective use depends on early diagnosis by GPs. Given that GPs are already overworked, that will be extremely difficult.
I agree with the remarks about registration and inspection. I was shocked to discover that Tayside health board does not make nursing home inspection reports available even to local authorities, let alone to the families and individuals who are facing one of the most difficult decisions of their lives.
When does the Minister intend to ensure that inspection reports on residential homes and nursing homes are freely available and accessible to members of the community? Which of us would take a major decision—one that will affect our lives and our finances—without being able to 289 pick up detailed reports and information documents on the subject, take them home, look them over and discuss them with our families?
I shall end my speech there, so as to allow my hon. Friends to make their contributions; but I would add that I look forward to being part of a Government who are truly committed to community care, and to decent and dignified care for the elderly people of our country.
§ Mr. William McKelvey (Kilmarnock and Loudoun)
I shall be brief, because I know that my colleagues wish to speak. I join those who have congratulated my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) on securing this important debate. It has raised many issues, and we would have liked more time, but we are doing our best to make our point.
The Select Committee on Scottish Affairs is studying community care in Scotland, a great deal of which is devoted to the elderly. All our evidence is now in, and will be published. I hope that we have time to finish the report, but if not, I hope that the new Government will pick up the evidence and produce the report. It is important for our elderly and for the disabled.
I will cut my remarks because of a lack of time, but I want to put on record what has been said in "Kaleidoscope of Care", a publication from Her Majesty's Stationery Office. In just a few words, it gets to the heart of what is important about care for the elderly. It says:Officially, what most would consider admirable policies are in place. The aim is to support carers, encourage independence, foster co-ordination, and emphasise comprehensive but responsive assessment. But if these aims were really being achieved, would it be so difficult to achieve home help? Would the supply of occupational therapists be at its current low level? Would the systems for discharging the elderly patients from hospital be as haphazard as they now appear to be? Would so many old people continue to have what, by the standards of most in our population, are very low incomes and poor housing? Much good work is done in the community care of old people, but it is patchy. Unless resources for community care are considerably increased, the patchiness will remain and reforms will merely benefit one group of old people at the expense of another. We have seen that effective community care for elderly people is possible. Is there the political will to provide it?That publication is well worth reading and considering.
I do not have time to go into detail or to mention all the figures, but I want to give hon. Members an understanding of the extent of the problem. It is a general problem, but I will give the figures for the whole of Ayrshire.
In Ayrshire, 6,332 people are receiving home help. Drastic cuts in the provision of home help are likely to occur at the next budget of all the councils in that area. That will leave many people without that essential help. As my hon. Friend the Member for Glasgow, Springburn (Mr. Martin) said, some people see nobody from week to week, or even year to year, and their only contact with the outside world is their home help. It is an essential part of their life.
Ayrshire has a larger share of people in nursing homes than other areas, because many people wish to come to our nursing homes. Many large buildings have been turned into nursing homes. There are 2,174 people in nursing homes, and 1,017 in residential homes. The total of those receiving community care services in Ayrshire is 290 about 24,000. I cannot give an exact figure, because some people are listed twice if they are receiving different types of care. That is a large part of our population. When one considers the extent of that care and the many people it helps, one can see that any cuts in expenditure would be sad.
I understand that I walk a tightrope between what I can discuss here and what has been heard in evidence to the Select Committee. Much of the evidence received by the Select Committee is private and cannot be mentioned now. However, the report will be worth reading by those interested in this matter.
On the day on which the Minister of State, Scottish Office, the right hon. and learned Member for Edinburgh, West (Lord James Douglas-Hamilton), was giving evidence to the Select Committee I was handed a letter from Maggie McLeod of Edinburgh Voluntary Sector Community Care Alliance. The letter said:Edinburgh city social work department has stopped assessing people for care services"—all people, not just the elderly—and has a waiting list of 1,372 people.That list includes those who might need admission to residential homes. The letter said that, currently,admissions to residential homes have been frozen.I wonder whether the Minister took that up in his constituency, or whether he has any further information. The fact that 1,372 people in Edinburgh are on a waiting list for an assessment, which may take between 12 and 16 weeks before they receive the care they need, is something that any civilised society should find unacceptable. Edinburgh city council would say that that has happened because of cuts in its budget. Perhaps the Minister will comment on that.
I would have liked to say much more, but time does not allow me. It is only fair that I should sit down and allow others to catch your eye, Madam Deputy Speaker.
§ 12.5 pm
§ Mrs. Maria Fyfe (Glasgow, Maryhill)
I hope that my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) gets some answers from the Minister this morning. I shall be brief, so as to allow the Minister to respond.
On residential care, we have heard about the disgraceful incident at Glenglova. I believe that there should be national minimum standards for residential care to ensure healthy eating, suitable heating and opportunities for entertainment beyond a television parked in the corner of the lounge. I agree with the hon. Member for Perth and Kinross (Ms Cunningham) that decent pay for the employees is important in the standard of care.
I want to take an unusual step and congratulate the Prime Minister on helping to warm up a pensioner in Maryhill. She telephoned me to say that she woke up in her cold house and opened her morning mail, only to find a letter inviting her to contribute £20 to the Tory party election fund. She was so indignant that she warmed up immediately. She pointed out that £20 is equivalent to the Christmas bonus for two years. I agree with the pensioners charter that that whole issue should be looked at once again.
Transport for the elderly has not had an airing yet. Local authority provision for bus passes varies widely across the country. We should aim to achieve minimum 291 standards for the transport of the elderly at low prices. If people are to keep in touch with the community and enjoy life to the end of their days, transport is important.
There are clear signs that an overwhelming majority of the population feel that it is wrong that elderly people should be cold in the winter. They are prepared to pay to ensure that our elderly are not cold. They do not mind paying the taxes. The hon. Member for North Tayside (Mr. Walker) talked about taxpayers' money, but I have never met a taxpayer who objected to old people being warm in the winter, and who was not prepared to pay a fair share.
§ 12.8 pm
§ Mr. Malcolm Chisholm (Edinburgh, Leith)
I congratulate my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) on securing this rare debate on Scottish health and community care on the Floor of the House. It is the first such debate during the eight months that I have been on the Front Bench and for many months before that.
Our thoughts this morning as we discuss this subject are with the elderly people in Leith who are ill with E. coli. I am sure that all hon. Members want to send them and their relatives their best wishes this morning.
The latest shocking outbreak highlights the urgent need for an all-out war against E. coli in Scotland. First, research must be supported and prioritised. Secondly, the recommendations of Professor Pennington must be implemented in full, including the recommendations on butchers' shops. Perhaps the Minister could assure us this morning that the full report will be completed soon, and that there will be a debate on it on the Floor of the House in March.
One of the lessons from Lanarkshire was that information must be made available at the earliest possible moment. I have been asking questions about that last night and this morning, and shall continue to seek more detailed information about possible delays on Monday and Tuesday in Leith.
The conflict between commercial considerations and the interests of consumers was evident in Lanarkshire and elsewhere, and makes even stronger the incontrovertible case for an independent food standards agency, as advocated by the Labour party.
My hon. Friend the Member for Greenock and Port Glasgow raised many important issues. He referred to payment for nursing home and residential care. We believe that that issue is so important that it will be referred to a royal commission when Labour comes into government. Nothing less will do.
My hon. Friend the Member for Greenock and Port Glasgow and the hon. Member for Perth and Kinross (Ms Cunningham) raised the possibility of bringing nursing and social care under one roof, regulated by one system. That is supported in the dementia manifesto. The suggestion must be given serious consideration, as it seems a helpful way forward.
My hon. Friend the Member for Greenock and Port Glasgow and the hon. Member for North Tayside (Mr. Walker) homed in on the Tayside report into the provision of residential care in the council and private 292 sectors. The Government are trying to make the running on the matter, and suggest that local authorities could save money if they spent more in the private sector.
I welcome the fact that the Accounts Commission is studying the matter. Judgment should be reserved until that report is available. At present we can consider two factors—first, that quality is the key aspect, and secondly, that staff wages and conditions must be taken into account, as they appear to be the most significant factor in the cost variation. We should remember that the Tayside report makes it clear that there could not be a quick transfer to the private sector, even if it was desirable. We must also bear in mind the fact that, if all provision was in the private sector, the private sector could hold a council to ransom. The rates charged might be much higher in that situation.
There has been significant growth in the private nursing home sector, and it has been unplanned and unregulated. There are no common standards across Scotland, and there is no common registration and inspection framework. The problem was recognised by the Scottish Office as far back as January 1994, in response to a sheriff's verdict in the Highland region. The sheriff stated that there was no common standard that he could apply when giving a verdict on a particular nursing home.
In January 1994, the Scottish Office set up a working group to consider criticisms of the Nursing Homes Registration (Scotland) Act 1938, and to consider how the problems might be overcome by the issue of a national standards document, accompanied by client-specific guidelines. It is hard to believe that, after more than three years, we have no conclusions from that working party. We still do not have a regulatory framework that is applied consistently throughout Scotland and seeks to provide quality and protect the vulnerable. Perhaps even more shockingly, as my hon. Friend the Member for Dunfermline, West (Ms Squire) pointed out, the reports that are compiled regularly on nursing homes are not available to the public or to local authorities.
The Government like to run on the health versus local government issue, and keep telling us that they are prioritising health rather than local government. The debate reminds us that the distinction is unrealistic, because local government is crucially involved in the delivery of health via community care. My hon. Friend the Member for Dunfermline, West alluded to housing, which is also crucial to the delivery of health. The distinction between local government and health is phoney and worthless.
Social work is crucially involved in community care. This year £42 million was taken out of the grant-aided assessment figures for social work by the Scottish Office. Next year £55 million-worth of new burdens in community care must be met by councils across Scotland, at a time when their cash grant from the Government is being reduced. That has resulted in the current problems in community care. There is the dead person's shoes policy, whereby people cannot get places in nursing homes unless someone in the nursing home dies. There are further problems, such as the delays in community care assessment and the decline in home help.
Bed blocking has arisen because of the pressure on social work and community care budgets. That problem is exacerbated by the decline of almost 3,000 in the number of acute hospital beds in Scotland this decade, 293 the lack of step-down beds even partially to fill the vacuum, and the cut of almost 2,000 this decade in the number of long-stay beds available. Furthermore, there are no clear eligibility criteria for those beds. We shall address the problem as a matter of early priority.
We are not opposed to all bed closures. The theory of community care is that certain beds should be closed, with the transfer of resources into the community. That is welcome in respect of people with learning disabilities and of many psychiatric beds, although there are problems with the number of acute psychiatric beds. However, the transfer of resources should be made more transparent. There should be a standard method of recording resource transfers to make them transparent and traceable.
The scale of the bed closures, combined with the bed blocking problems, has led to the many health stories this winter about pressure on acute hospital beds. Ten days ago, we were told that all hospitals in Lanarkshire were having difficulties in coping with medical admissions. Throughout January, there was a red alert in Lothian, where only emergency cases were admitted to hospital, yet throughout that month it was openly stated in Lothian that 100 beds were blocked because it was impossible to find a place in nursing homes for those people. Bed blocking affects not only people who want to get into hospital and people who should be in another, more appropriate place; it also affects waiting lists, because surgical beds must be used to provide extra medical beds.
That is one reason why the most recent health statistics, which came out in December, show that waiting lists in Scotland were at record levels, at more than 82,000. The Government message on waiting lists is quite the contrary, but that is just one of the many phoney claims that they make about the health service. It is as empty as their claim to be cutting bureaucracy in the health service. I am glad that the Secretary of State and the Minister for Health have been a little more coy about making that claim since the health statistics were published in December.
The annual health statistics made it clear that bureaucracy in trusts soared last year by more than £13 million, or more than 5 per cent. Perhaps even the Government are now a little shy of claiming that they are cutting the costs of and the waste in NHS bureaucracy caused by their internal market.
We want a full debate on the health service to discuss bureaucracy and the Government's plans to increase privatisation and commercialisation in the health service in Scotland. We had a new angle on that at the Scottish Grand Committee last Monday, when the Health Minister admitted that the Government would not rule out plans to privatise clinical services under private finance initiative arrangements.
We press the Government for a debate on the Scottish health service before the general election. We do not seem to be able to secure such debates under the present system of government. This is the first debate on Scottish health on the Floor of the House that I can remember. If we had a Scottish Parliament, we would ensure that Scottish health received the attention that it deserves.
Let us have a health debate at least in the Scottish Grand Committee before the general election, so that we can return to the important issues that have been raised this morning, and discuss the waste of bureaucracy and the threat posed by further privatisation and commercialisation. I ask the Minister to confirm this 294 morning that the Government will grant that debate. If the Prime Minister wishes to appear before the Scottish Grand Committee, he may lead that debate. If the Government do not allow time for that debate before the general election, everyone will conclude, correctly, that they have nothing to boast about and everything to hide.
§ The Minister of State, Scottish Office (Lord James Douglas-Hamilton)
There have been several health debates, and we will welcome others whenever the opportunities arise.
This morning the hon. Member for Edinburgh, Leith (Mr. Chisholm) referred to the three cases of E. coli 0157 in Edinburgh. I extend my sympathies to the patients and families concerned, and I hope that the hon. Gentleman's three constituents make a speedy and full recovery. The hon. Gentleman has had the benefit of a briefing from the local consultant in public health medicine and the deputy chief medical officer at the Scottish Office, so he should be familiar with the up-to-date facts.
I assure the hon. Gentleman and the House that the latest cases have been taken seriously by Lothian Health and by the city of Edinburgh council environmental health department. Urgent investigations are in hand to identify the source. As a precautionary measure, a butcher in Leith, from whose premises all three patients bought cold meat, has agreed to close his shop. Anyone who had bought cold meat products from the shop since 10 February was advised through a press release last night to dispose of them. A helpline has been established to give advice to anyone who is worried about the situation.
The hon. Gentleman asked whether there had been delays in informing the public. The first case was confirmed on 20 February, the second on 24 February and the third yesterday, and action was taken to investigate each case as it occurred. It was possible to identify a likely common source only after all three cases were studied, which is what occurred. As soon as the possible source was identified, immediate steps were taken to inform the public in the way that I have outlined.
The hon. Gentleman asked about the implementation of the interim Pennington report. I assure him that the comprehensive action announced by my right hon. Friend the Secretry of State to the House on 15 January is well in hand. Although the debate is not about E. coli, I shall mention some of the on-going action.
First, a consultation paper on selective licensing of premises handling raw and cooked meat products was issued. Secondly, a committee under the chairmanship of Dr. Cairns Smith is reviewing the existing Scottish Office guidance on the investigation and control of outbreaks of food-borne disease in Scotland. Thirdly, the Advisory Committee on the Microbiological Safety of Food is reviewing its guidance on cross-contamination.
We are also taking urgent action to improve our arrangements for surveillance, data collection and analysis. I appreciate the other points that the hon. Gentleman made, and there will be a further statement to the House as soon as the Pennington inquiry reports its final recommendations.
§ Mr. Andrew Welsh (Angus, East)
As this is a particularly Scottish problem and Professor Pennington is one of the world's leading experts in this area, will the issue be researched properly, so that we may get to the root of the problem?
§ Lord James Douglas-Hamilton
I am grateful to the hon. Gentleman. Professor Pennington recommended further work in two areas: knowledge of the prevalence in livestock of the type of E. coli that caused the central Scotland outbreak, and more accurate laboratory methods of typing E. coli strains. We are pressing ahead urgently with turning those recommendations into research projects, in consultation with the relevant research bodies, including the Advisory Committee on the Microbiological Safety of Food. United Kingdom health departments have also initiated a programme of research, costing more than £2 million.
I must respond to the points raised in this significant debate. We have heard some good speeches. An additional £15 million was allocated to health boards on 9 December 1996 to alleviate the problem of bed blocking, and I believe that it helped considerably. The findings of the acute services planning assumptions review showed that beds were being blocked principally because of delays in care assessment processes and budgetary pressures on social care.
I have the figures for local authorities in Scotland. The hon. Member for Kilmarnock and Loudoun (Mr. McKelvey) referred to the position in Edinburgh. Edinburgh's community care provision has increased by 9 per cent. this year, which is above the national average of 8.5 per cent. Substantially more resources have been allocated to community care in 1997–98.
Research shows that most elderly people wish to remain in their own homes where practicable. The hon. Member for Glasgow, Maryhill (Mrs. Fyfe) asked about national standards. A working group is in the process of developing national standards for nursing homes, and guidance on standards in residential care is being prepared and will be issued for consultation very soon. I am glad that the Select Committee on Scottish Affairs is studying the matter, and we shall respond to its report as soon as we receive it.
I assure the hon. Member for Perth and Kinross (Ms Cunningham) that our aim is to provide a safe, seamless service to the user, involving care and support from a multi-disciplinary team, multi-agency working and the private and voluntary sectors, in order to meet the needs of constituents. We believe that the mental illness specific grant, which includes dementia and head injury cases, is important. Some £18 million has been allocated in that area in support of 370 projects.
We believe that it is important to develop respite care, and we have increased funding to £5.1 million. We are assisting organisations such as Alzheimer's Scotland and other voluntary organisations with a grant of almost £300,000.
The hon. Member for Dunfermline, West (Ms Squire) raised the issue of choice of accommodation. We encourage local authorities to improve choice by increasing the number of providers. Following consultation with local authorities, we shall issue directions on information that we hope will enable them to make the best decisions. The hon. Lady mentioned the 296 publication of inspection reports. That is currently a matter for health boards, but there is no bar to such publication. I shall reflect upon the hon. Lady's comments. I would prefer that the maximum amount of information be made readily available, but I shall consider that point further.
The hon. Lady said that the Community Care (Direct Payments) Act 1996 does not extend to those aged over 65. It was considered that authorities should not be overburdened in the development of direct payment schemes in the first instance. However, we have undertaken to review the matter during the first year of operation. People who are already receiving direct payments will continue to do so after their 65th birthdays.
The hon. Member for Greenock and Port Glasgow (Dr. Godman), who initiated the debate, raised some extremely important matters arising out of Glenglova. Ministers have responded positively by setting up a working group comprising representatives from local authorities and the voluntary and private sectors, as well as user representatives. It has made many recommendations, but I make it clear that many of them—notably, preventing a general practitioner from being a home owner as well as a resident's GP; a single registration system of residential and nursing homes; and improving the registration system—require legislation. They also raise some complex issues.
I give the hon. Gentleman an undertaking that we shall make a statement next month about our intentions regarding many of the working group's recommendations and related matters. We have in hand draft guidance to authorities covering the many topics noted in the group's report, which will go out to consultation next month.
The hon. Gentleman also referred to consultation on core standards. That matter is separate from consideration of the issues arising from Glenglova. The Government have issued model guidelines for the registration and inspection of nursing homes for the elderly, for people with dementia and for those with learning disabilities. All health boards are expected to comply with the national guidance.
The hon. Member for Glasgow, Springburn (Mr. Martin) raised the issue of carers and respite services, and I acknowledge the debt of gratitude that we owe them. The sums made available have increased to £5.1 million for this year.
The hon. Member for Leith mentioned charging. I can tell the House that we intend, in the near future, to issue for consultation the draft Community Care (Residential Charges) Bill, which will enable those who require residential care immediately, or who may require such care in the future, to protect more of their capital above the current disregard limit of £10,000.
We intend the Government to act in partnership with those who wish to protect their assets, and we are committed to the principle of cascading wealth within the family. The Scottish Office issued guidance to authorities on 16 January about discretionary charging—