HC Deb 06 June 1997 vol 295 cc768-74

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

2.30 pm
Mr. David Amess (Southend, West)

The issue of bed blocking is of importance not only to my constituents and to the county of Essex, but to the country as a whole, and I hope that I will be able to deploy a number of arguments and elicit solutions from the new Government. Before getting into my argument, it would be churlish of me not to welcome the new Parliamentary Under-Secretary of State to his position. He and I have nothing in common politically and will disagree completely on political matters, but that does not prevent me from wishing him well and hoping that he is a great success.

Like many other hon. Members, I received a letter from the new Secretary of State in which he described the responsibilities of the five new Ministers, and I thank the right hon. Gentleman for his courtesy. I am told that the Government are committed to doing all they can to promote public health. On that, there can be no disagreement—that is what the previous Government did for 18 years. We are told that the new Government will end the internal market in the NHS and will reduce waiting lists. My colleagues and I will watch carefully during this Parliament to see exactly what happens to waiting lists.

The first thing that surprises me is that, for the first time in my 14 years here, we have three Ministers of State. Why was that felt necessary, at extra cost to the public purse? Were not the previous Government criticised on many financial matters concerning the health service?

We also find that an overwhelming number of those Ministers come from London. I am a Londoner, and I am proud to be a Londoner, but anyone who knows anything about the health service will understand that many of the controversies in the service have concerned London issues, such as the city's hospitals. I hope that colleagues throughout the country will reflect on the appointment of so many Ministers in the Department of Health who represent London constituencies. Perhaps I am being harsh, but we will judge them by their actions. On both counts, I have put down initial markers.

The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)

Get on with it, David.

Mr. Amess

I will not accept orders from the new Minister and I will deploy my arguments in my own way.

There is a huge divide between the Conservative party and the Labour and Liberal Democrat parties on the management of the national health service, but I am very proud of the achievements of the previous Government during their 18 years in office. Anyone who wants to judge the success of the health service should look at the increased life expectancy of women and men. [Interruption.] The Minister gasps, but I think that that is very important. Women and men are living longer, and are not dying from diseases that people used to die from. Many new treatments are available. Babies can be saved at an earlier stage, as early as 22 and a half weeks—but unfortunately the majority of hon. Members do not recognise that fact when it comes to abortion.

By and large, the general public are much healthier than ever. As hon. Members go round schools, they can see that the children are much taller and healthier. Do the previous Government deserve the credit for that? I do not know, but I know that in the 14 years for which I have been a Member of Parliament we have heard constant criticism from Labour and the Liberal Democrats about the health service.

Civil servants supply briefs to Ministers—it was not so long ago that we had a debate on bed blocking and we do not have the time in this debate to refer to what was said then—but I hope that, when I have pointed the finger at one or two areas, the Minister, who may point the finger back at one or two other areas, will consider what my constituents and many others are concerned about.

My constituency ranks 31st out of 659 in the number of senior citizens. I got that statistic from Age Concern. We have an ever-increasing aging population. There are many private nursing homes in my constituency—almost into three figures—and in the past few months I have tried to visit as many of them as possible. They are homes in the real sense of the word. They are not institutions and do not have the general atmosphere of a hospital, which obviously deals with a large number of people. I salute the women and men who run those homes.

When Essex county council was controlled by the Conservative party, we delivered care in the community and looked after the elderly people to the best of our ability, but all that changed when control changed hands. After the elections on 1 May, the Conservative party became the biggest group; before that, the Liberal party was the largest, followed by the Labour party.

Mr. Bob Russell (Colchester)

The other way round.

Mr. Amess

Yes, the other way round: the Labour party was just ahead of the Liberal party and they shared power. As I understand it, that is still the situation, but, because Southend and Thurrock will leave Essex county council when they become unitary authorities next spring, the county council will become Conservative-controlled again, without an election. I hope that we will return to the Conservative policy on elderly people.

My constituents love their relatives. We could argue about whether everyone should or can look after their relatives in their own homes—those are profound arguments—but the fact is that many people are concerned about the circumstances of their aunts, uncles and other relatives.

A serious situation exists in Southend, West, in Essex and in the country, known as bed blocking, which is, quite simply, people who should be in residential or nursing homes occupying beds in hospitals. If it is all about money, let us have some answers from the Minister. In 1979, the national health service was on its knees. We need not go on about that this afternoon, but it was in a terrible state, as was our economy.

No one could possibly claim that the state of the national health service and the British economy in any way mirrors what it was in 1979. The economy is far healthier, although unfortunately today we have heard the damaging news that interest rates have been put up by a further 0.25 per cent. Many people will be distressed about that.

The leader of the Conservatives on Essex county council wrote to me about the latest figures on bed blocking. He enclosed a cutting about which I know the hon. Member for Colchester (Mr. Russell) will be concerned because it deals with the problem in Colchester. The Evening Gazette of 27 May says: Up to 100 patients are being denied hospital beds because social services is dragging its heels, a health chief has claimed. Social services needs to help discharge certain patients. But they have been accused of being too slow and as a result, hospital beds are effectively being blocked. The Conservative group's opinion is that, because of the policy of the Liberal and Labour parties over the past four years, there is a 50 per cent. over-provision of care home beds in the county. They have continued to fill publicly owned homes rather than biting the bullet and dealing with the situation.

I have to confess that I no longer understand the Labour party. I do not understand what the British people decided to do on 1 May. The things that the leader of the Labour party said when he and I were first elected, and what he has said today seem to be completely different messages. If private capital and private nursing homes are no longer a problem for the Labour party, why are they still a problem for Essex county council? A huge capacity is not being used and we have the terrible situation of bed blocking.

County-owned homes are £200 a week more expensive than homes that can be provided in the independent sector. In even the best case, the cost is more than £50 a week extra in public homes. That is a huge difference. Over the past four years, Essex county council has bled the capital programme dry. It has spent £6 million on refurbishments.

A home in the constituency of my hon. Friend the Member for Rayleigh (Dr. Clark) received a £330,000 quotation to upgrade its property by means of lease transfer. The developer would then have had the income from the beds that the county would have purchased, usually over a period of 21 years. Instead of taking that route, the council carried out a refurbishment that cost in the region of £1.5 million. That is an absolute disgrace. I could go on and on and on about the money that is being wasted by the Labour and Liberal parties on Essex county council.

I do not want the Minister to deploy any arguments about capping and the way in which funds have been used in respect of Essex county council. Frankly, the council has the money to fund the elderly people. According to the latest information that I have from the hospital, 62 beds are blocked in Southend hospital with another three pending; 90 per cent. of those cases are awaiting funding from social services for long-term care or community-care packages. Half the surgical ward is blocked with medically fit people awaiting discharge, and new intake has been completely stopped. By September, it is expected that three wards will be blocked.

The Minister has the opportunity to put right all the things that he and his colleagues perceived that we Conservatives had been doing wrong. Of course, as the Labour and Liberal parties are in bed together locally, no doubt they will be able to persuade each other to release these much-needed funds.

People are waiting for care even though more than 600 bed vacancies are listed in the south of the county. Approximately 380 of those beds are in Southend. I warmly pay tribute to the sterling work of the South Essex Care Homes Association. I have met many of its members, and its homes are of a very high quality. I have spoken to many of the relatives who are delighted with the care and attention that patients receive.

There is unfair competition between in-house and independent homes. The cost to the private payer is £370 a week, whereas the contract price for the private and voluntary sector in Southend is £233 a week. The county council is the provider, the purchaser, the paymaster—under the reorganisation of the health team—the contract organiser, the inspector and the regulator. The South Essex Care Homes Association thinks that that is unsatisfactory.

I pay tribute to the former Secretary of State's White Paper, which tackled those problems. I hope that the Minister, when he reads himself into his new brief, will reflect on whether he and his colleagues agree with any of the points made in that document.

I could raise many important issues, but I am a fair individual and I believe in splitting the time between the Government and the Opposition to allow the Minister to respond to all the points raised. I said at the outset that the Minister and I would not agree on anything politically, but I ask him to consider certain matters.

Last week, I visited many of the 26 people in Runwell hospital who are in psychiatric wards. I pay tribute to Mrs. Sheila Taylor, the chairman of the trust, who has done an excellent job. I have met many members of staff and many of the patients. Beds are being blocked in two areas. In contrast to that are the vacancies in the beautiful homes in my constituency. Many of those people could go into those homes: staff are available and the quality of care is first class. I am not saying anything against Runwell hospital or Southend hospital, where the staff do a magnificent job. The homes run a different operation from the hospitals.

I want to know from the Minister what I should say to relatives who write to me. Do I say that the new Government think that the problem is due to a lack of funds and is the fault of the previous Conservative Government? I am sure that the Minister does not intend to say that; I simply suggest that I cannot tell them that. Can I tell them that the new Government recognise that there is a problem, that Rome was not built in a day and that, as we have entered the promised land, anything and everything is possible? There may be changes to the arrangements that Essex county council has entered into for the homes in their ownership and private homes.

Those people's life spans may be limited. Their relatives believe that for them every day is precious. They have no time for Conservative, Labour and Liberal Democrat politicians to argue with one another. I ask for some straight speaking, which I know I will get from the Minister. Can the problem be solved fairly quickly, or is it intractable because of the changing pattern of the United Kingdom population? All I ask is that the Minister does his best to give some hope to the loved ones of the people in those hospitals—hope that they will be transferred elsewhere as soon as possible.

2.49 pm
The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)

I am grateful to the hon. Member for Southend, West (Mr. Amess) for raising this topic and for allowing the House to consider the subject of bed blocking in its wider context as well as in relation to his constituency. He asked for plain speaking and he will get it.

The hon. Gentleman asked what he should say to the relatives of those who find themselves in this unenviable position. He should begin by saying sorry. He should say, "We are sorry that for 18 years we got it wrong and neglected the issues. We are sorry that you have had to wait so long for a Labour Government to begin to address the problem."

I am sorry that I had to begin my speech in that way because, when I was first made aware that we were to have a debate about bed blocking in Essex, I had hoped that it would be possible to approach the matter in a non-party political way. I am not in the slightest bit interested in scoring party political points over the issue of bed blocking. We need to move forward and look to the future, not the past—that is the theme of this new Labour Government.

I was therefore sorry that the hon. Gentleman, in his inimitable fashion, having cast a few kind personal words towards me, immediately began to castigate the new Government on their size. The Government are smaller than the Conservative Government who preceded them. There are fewer Ministers in this Government than there were in the Conservative Government, yet the hon. Gentleman had the nerve to call us the party of big government. The reverse is true: we are a small and more efficient bunch than they ever were.

The hon. Gentleman began in that rancorous tone and then started on his knockabout stuff in relation to the Liberal Democrat-Labour leadership of his county council. We did not have to have that; we all understand that bed blocking is a problem. We all know where its origins as a national phenomenon lie. We all know what the NHS and local authorities have had to endure these many years. We all know that we have begun the process of addressing those problems. The hon. Gentleman did not have to seek to point the finger at his own county council in the partisan, party political way that he did. It was simply not necessary.

Mr. Bob Russell

We have heard a one-sided view from the hon. Member for Southend, West (Mr. Amess). This is a national issue as well as an Essex one. People are living longer and we have to return to the fact that the NHS has not been adequately funded. In the current financial year, Essex county council's revenue support grant was less than the amount required to fund the service.

Mr. Boateng

There we have it—part of the authentic voice of Essex. [Interruption.] The hon. Member for Southend, West expresses surprise and incomprehension at what the British people decided at the last general election. It is because of his incomprehension of the needs of the British people that he and his colleagues find themselves in such greatly reduced numbers in the House. That is part and parcel of the reality—the hon. Gentleman finds it hard to comprehend the nature and spirit of the British people.

Mr. Amess

What is the Minister going to do about the problem?

Mr. Boateng

If the hon. Gentleman will be so kind as to contain himself, he will find out how we intend to proceed on this matter. He will also find out how we are markedly different from the Administration of which he was one of the most slavish and sycophantic supporters before taking the chicken run from Basildon to his present constituency. Let us be aware of the context in which the hon. Gentleman is raising this question.

I have had the opportunity to speak both to the chairman of the local social services department and to Mrs. Taylor, the chairman of the local NHS trust. We met in totally different circumstances, but I raised the issue of bed blocking with both of them. I have also made sure that officials in my Department have had an opportunity to consider the issue, specifically in relation to Essex.

What we find is this: that the Southend Healthcare NHS trust, the chief executive of South Essex district health authority and the director of Essex social services are working together on the issue. They are working in a collaborative way, trying to get past the culture of blame that, unfortunately, bedevilled the previous Administration. A report has gone to the executive board of South Essex health authority setting out a range of options that could be pursued to relieve the pressure caused by the current level of delayed discharges, including—the hon. Gentleman will be glad to hear this—the purchase of nursing home placement, the extension of domiciliary care services and new arrangements with the voluntary sector.

Let us pause at that point. What we are talking about is private provision and voluntary sector involvement, as well as and alongside public sector involvement—a big difference. I suggest that the big difference between the new Labour Government and the Conservative Government—to whose last Secretary of State for Health the hon. Gentleman made obeisance in characteristically sycophantic form in the closing part of his speech—is that we genuinely believe in public-private partnership. The hon. Gentleman and his party do not believe in it.

The Conservatives sought to distort the market. They never created a level playing field between the public and the private sector and, even more shamefully, they failed to put in place the proper regulatory mechanism to enable us to address that matter. We shall not make the same mistake. It is the Conservative party that is the party of dogma, which is why the number of their Members of Parliament has been so reduced. We are the party that is about dealing with the problems that we have inherited, and doing so in a practical and efficient way.

We have begun the process of bringing together the parties involved in this problem—parties concerned, first and foremost, with the experience of patients and concerned to make sure that patients get an opportunity to return, not only to the community, but to their own homes with the properly established rehabilitative and recuperative services that are necessary to ensure that we relieve the problem of bed blocking, but do not then have to re-admit them. That is very important and I am glad that, in the collaborative and co-operative manner that is now the order of the day in terms of the interface between the NHS and local authorities, the issue is being taken forward.

Good practice is what we need. The Government will seek to ensure that we get it—that we balance the needs and wishes of patients and their carers with the requirement for the most effective use of available resources, both public and private. The test will be quality and value for money. I want to encourage that patient-centred approach. Our manifesto made a commitment to introduce a charter for long-term care, which will set out what people can expect from health, housing and social services when they face difficult and sometimes painful decisions when making plans for their future care. I have set in motion within the Department the necessary work to bring that about.

Many patients need to be given the time and opportunity to recover properly from any treatment that they have received and any illness or conditions that they have been afflicted with. We shall give them that. We are anxious that at all times their dignity and independence are respected and nurtured.

I welcome the fact that the hon. Member for Southend, West has brought this issue to the Floor of the House. I very much hope that we can continue to work in a non-party political, non-partisan way, across the boundaries and fault lines that exist in the political process and, above all, across the boundaries and fault lines that have existed from time to time between the NHS and local authorities. I hope that, in that spirit, he will find my response to this important debate helpful and constructive.

This is only the beginning. Things can only get better and we are here to work with the NHS and local government to ensure that that happens, to ensure that all our citizens—

The motion having been made at half-past Two 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 accordingly at Three o'clock.