§ Mr. Andrew Lansley (South Cambridgeshire)I am most grateful for this timely opportunity to raise an issue of considerable importance to my constituents. That importance was emphasised only a fortnight ago, when I received a letter from the Cambridgeshire and Huntingdon local medical committee, which wished to raise with me precisely the same issues that I shall raise in this debate. I should like first to take this opportunity-my first opportunity-to welcome the Minister to the Dispatch Box. He has onerous and important responsibilities—especially so given the forthcoming social services White Paper. I wish him well in meeting those responsibilities.
I shall do three things in this debate: first, highlight the impact of underprovision of residential care homes in South Cambridgeshire; secondly, demonstrate that, despite the benefit of measures being pursued by the health authority and Cambridgeshire county council social services, an increase in core funding for social services is necessary to prevent deterioration in the position; and, thirdly, draw specific attention to the circumstances arising from the proposed closure of the Red Cross-owned Meadowcroft residential care home in my constituency.
Let me first explain the nature of the problem. In August, and at intermediate times during the summer, Addenbrooke's hospital in my constituency and other local hospitals have been closed to non-emergency admissions. Such summer closures have been unprecedented in recent times. The nature of the problem underlying the closures is demonstrated by the fact that 160 patients –160 beds is almost equivalent to five hospital wards—in the local national health service system have been assessed as no longer requiring hospital care but remain in hospital beds.
About 83 of those hospital patients are awaiting placement in nursing or residential care homes. Additionally, Cambridgeshire county council has told me that 117 people are receiving care packages in the community who should be placed in residential or nursing home places. The council is unable to place those people. I know from personal conversations with some of those involved that some of those waiting in hospital are waiting not only for residential care places but for home adaptations that would allow them to return home.
Why has the problem continued? Additional money has been provided to deal with winter pressures, and I am sure that the Minister will give us further details on proposals for dealing with the coming winter. In the past three years, my health authority has provided Cambridgeshire social services department with £2.3 million to deal with explicit winter pressures. For the winter ahead, the health authority has provided £1.2 million to the social services department, and, because of announcements and allocations made in recent days, even more may be allocated.
The character of the funding provided in winter pressures money does not meet all the problems and, in some respects, may even exacerbate them. Places were purchased after winter pressures money was provided by the health authority to social services last winter, for example, creating a recurrent revenue implication that has to be borne by Cambridgeshire county council social services. This year, the cost is estimated at £400,000, 327 which will have to come out of the money available to social services, thereby reducing its ability to do other things.
At the same time as winter pressures money was being provided through the health authority, Cambridgeshire county council's social services standard spending assessment was cut by £1 million, not in real terms but in cash. The Government are therefore effectively giving with one hand while taking away with the other.
Meanwhile, pressures are increasing. The number of placements to homes is rising and the population of those over 85 is increasing in Cambridgeshire faster than in neighbouring counties. Although it is a happy fact that residents in homes are living longer, that is creating additional funding pressures. Additionally, more residents are exhausting their savings to below the £16,000 limit, to the point at which they effectively become a first charge on social services departments. That has happened in 32 cases so far this year.
Cambridgeshire social services is doing what it can. It is supporting the elderly at home; trying to prevent admissions; being flexible in its review of care packages; and attempting to turn some of the available respite care beds into intermediate and convalescent beds, thereby allowing hospital discharge. The county council is consulting on a proposal to privatise remaining local authority provision of residential home places, as that would enable it to purchase about four residential home places for each three places that it currently provides in its own homes.
There is, however, an underlying problem of underprovision to the social services department. Provision to neighbouring counties may demonstrate the point. In 1996–97—the last year for which I have comparable figures for counties in the eastern region—in total on residential care, home support and nursing care, Cambridgeshire was spending £467 for each 75-year-old or older resident in the population. The figure was £840 for Hertfordshire, £908 for Norfolk, £925 for Suffolk and £1,075 for Bedfordshire.
The Minister and those of us who know Cambridgeshire well will know that Cambridgeshire social services has a particular requirement to focus its activities on children's services and to support its child protection activity. The county council is taking that responsibility extremely seriously, and that is partly influencing its distribution of funds within social services. However, that is only part of the story.
The principal determinant of the county council's ability to spend on services to the elderly remains provision of finance as dictated by the standard spending assessment. The Minister will realise that Cambridgeshire county council is capped at an extraordinarily low spend level, and that it therefore lacks the discretion to go further in increasing its overall resources.
I ask the Minister to do three things. The first is to enhance Cambridgeshire's standard spending assessment in the forthcoming round, to the point at which the county council's social services department is able to meet the responsibilities that it incurs. The second—on the process of winter pressures money being provided to assist in ending delay in discharging patients from acute hospital beds—is to end ad hoc funding and to make funding reflect the continuing revenue costs of such placements. The third is to end the process whereby the Government 328 are effectively paying for social services activity with health money—whereby health care funds are being diverted into social care. Such a diversion of funds has adverse effects on a health authority's ability to use the resources with which it is provided for health rather than social services.
I hope that I have demonstrated that there is an underlying problem of a lack of residential home care places in South Cambridgeshire. I shall refer in particular to Meadowcroft home in Trumpington, which is not a local authority home, but is owned by the Red Cross. It formerly had some 20 places, but, in March 1997, the Red Cross decided that it should close—at a time when South Cambridgeshire can scarcely afford to lose residential care places.
The Red Cross has presented three arguments as to why it is necessary to close Meadowcroft. The first was that it was non-viable. It is clear that it was once perfectly viable, but the decisions to run the home down, not to take additional placements to reduce the number of residents and to discontinue a contract with the Lifespan community trust for two respite care beds have made it no longer viable. Secondly, it was argued that the home needed considerable investment to bring it up to registration standards. As a royal charter body, the Red Cross is not required to bring its homes up to registration standards. It would be desirable to do so if it were planned for the home to provide long-term care for new residents, but the existing residents see absolutely no reason for their living standards to be changed. Thirdly, it was argued that the remaining residents could and should be moved as it would be in their interests. However, it is perfectly apparent that they do not need full-time nursing care. Meadowcroft is a residential care home, not a nursing home, and is perfectly capable of supporting its residents.
After a period of rundown, Meadowcroft has only four remaining residents, all over 90-years-old. Two of them were among the first lady medical practitioners in Cambridge, who were part of a three-handed practice before the war. Dr. Margaret Reed is 98 years old and Dr. Joan Cooper is 106 years old. Last week, Dr. Cooper told me that she qualified as a medical practitioner in 1920. They are distinguished constituents of mine and they have provided a considerable service to the local community and to the Red Cross in the past.
I understand—not least because I have spoken to those who took the decision—that the decision to close the home was made with good intentions and that the Red Cross seeks to focus its activities on short-term emergency care. However, I continue to contend that bureaucracies and committees are capable of making decisions that individuals would not make. If one asked the individuals involved whether they thought it right that, after 15 years residence at Meadowcroft, Dr. Cooper, who is 106 years old—although she is by no means frail for her age—should be moved as a consequence of a desire to close the home, no doubt they would reply no, but I fear that bureaucracies will continue to say yes. The time has come for that to stop.
I feel quite strongly about Meadowcroft: very frail or elderly people have been moved from places where they were happy and which they regarded as their home and, as the Minister knows, that can have adverse effects. Even if, viewed objectively—and not least by bureaucracies—a move is to better or more appropriate circumstances, it can be in the interests of the individuals concerned to 329 remain in familiar surroundings where they are happy and content. Anyone visiting the Meadowcroft home in Trumpington will know that the residents are perfectly happy there and that they are well settled and looked after and capable of being sustained there if the Red Cross cares to sustain them.
I call on the Red Cross to fulfil the expectations of the residents; the intention of the original trust deed established by Lady Ida Darwin in 1946, under which a substantial bequest was made; and subsequent benefactions. I do not believe for a moment that any charitable donor to the Red Cross would begrudge its meeting its obligations in that way, especially as the home has made considerable contributions to Red Cross finances in the past.
I thank the House and the Minister for listening to these related issues. I hope that the Minister will recognise and respond to the problems experienced by south Cambridgeshire and my constituents relating to the provision of social services and the placements into residential home care beds. I hope that the Red Cross will listen to the debate and change its mind about its proposal to close the Meadowcroft home early next year and to require my constituents to move to alternative accommodation.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)First, I congratulate the hon. Member for South Cambridgeshire (Mr. Lansley) on securing a debate on this important subject, and thank him for his generous words of welcome at the beginning of his speech.
The hon. Gentleman has raised a number of issues around residential care. In doing so, he has emphasised the links with the national health service. He is right to do so. In Cambridge, as elsewhere, the NHS is an integral part of community care. He also raised the issue of the closure of the Meadowcroft home in Trumpington, to which I shall refer later.
It may help if I begin by talking about the aim of community care, which is to provide the support that frail or vulnerable people need to live in their own homes or homely settings, retaining the independence, dignity and quality of life that come from being a part of the community. Social services, to which the hon. Gentleman referred, have a central role here, but as one of several partners, along with housing authorities and the NHS. Each partner needs to understand the others and to draw effectively on their contribution to overall care provision.
Social services have the lead in community care planning. In Cambridgeshire, as elsewhere, that is about planning and commissioning a balanced range of services—including residential care—to enable authorities locally to meet the assessed care needs of individual service users.
People's needs do not recognise organisational boundaries. That was one of the themes of the hon. Gentleman's speech. In the case of older people particularly, they are often complex. They also change both in the short term and over a longer period. Following a period in hospital, people may need additional support, perhaps from the community health 330 service, if they are to return to their homes; or they may need a residential care place if discharge is not to be delayed or unnecessary readmission caused. We need to consider residential care provision within the broad context of community care services, mapping out the key links with the NHS, housing and other agencies.
In planning residential care, in Cambridgeshire as elsewhere, what is important is joined-up thinking in the wider community care and health context. Residential and nursing home care provision is closely linked with hospital discharge arrangements, rehabilitation services, domiciliary support and current work on prevention.
The interdependence of health and social care make it essential that the provider agencies collaborate effectively in service planning and commissioning, assessment and delivery, and not least, funding. Section 28A of the National Health Service Act 1977 has long been a key funding mechanism enabling health authorities to support social services. I am sure that the hon. Gentleman would not want to give the impression that the new Government are approaching the issue any differently from their predecessor. That mechanism includes supporting residential and nursing home placements through "dowries" and similar payments in respect of people transferring out of long-stay hospitals, and supporting innovative cross-agency service.
We are providing a positive agenda of change. Joined-up thinking and partnership between health and local government run through our agenda. We have an ambitious programme of review and reform including the royal commission on long-term care, the forthcoming social services White Paper and our charter on long-term care. Other examples include the better services for vulnerable people initiative and "Partnership in Action: New Opportunities for Joint Working Between Health and Social Services", the recent discussion document trailed in last year's "The New NHS" White Paper. It might be helpful to say a little about that context before returning specifically to residential care, to social services funding and to arrangements in South Cambridgeshire.
Collaboration between local authorities and the NHS is considered in detail in the recent discussion paper "Partnership in Action", which sets out plans for a new statutory duty of partnership. Much of the paper is about collaborative funding mechanisms, such as proposals for the new NHS Bill to provide for health and social services to pool budgets, delegate functions and resources to each other in lead commissioning arrangements or develop integrated provision of services. It also envisages a significant widening of health authority powers under section 28A of the 1977 Act, with funding going to local authorities in support of objectives set out in health improvement programmes.
Last December, following our manifesto commitment, we established a royal commission on the funding of long-term care for elderly people. The commission is looking at demographics and future levels of need, different models of provision and how it should be funded. The commission is due to report around the end of the year.
Last year, in an executive letter, "Better Services for Vulnerable People", we set out the medium-term agenda for people with continuing health and social care needs. The circular asked local and health authorities to take forward work in three areas: first, drawing up joint 331 investment plans; secondly, establishing a national framework for multi-disciplinary assessments of older people in acute and community health settings, carried out jointly with social services; and thirdly, developing a range of recuperation and rehabilitation services for older people.
Further guidance on the better services initiative was issued in August by the NHS executive and the Department's social care regions. Joint investment plans are a distillation of the health improvement plan and community care planning information. They bring together in a single document the joint information needed for health and social services to deliver on their respective responsibilities. The recent guidance requires health and local authorities to have JIPs in place by April 1999, as a minimum, for older people, including those with mental health problems.
Multi-disciplinary assessments by health and social services have always been a joint responsibility in community care. More effective multi-disciplinary assessment means better co-ordination of care services. In the community, it may avoid unnecessary hospital admission and allow older people to remain in their own homes for longer; within the hospital setting, good multi-disciplinary assessments may avoid an unnecessary admission subsequently to institutional care. Similarly, developing recuperation and rehabilitation services will enable people to return to the community sooner and to remain in their own homes. I am sure that the hon. Gentleman agrees that that is common sense.
Those are also key themes in the forthcoming social services White Paper, giving the context within which services such as residential care must be seen and developed. We should be aiming to maximise independence rather than supporting dependency. We need a new emphasis on rehabilitation, recuperation and prevention services. Crucially, the White Paper programme is underpinned by the personal social services settlement—an additional £2.8 billion over three years secured in the comprehensive spending review.
Last winter, an additional £269 million was allocated for tackling winter pressures. While that money was non-recurrent, it was not just elastoplast for the winter. It provided an opportunity for longer-term improvements in services, relationships and systems. Among the priorities applied in allocating the funds were plans that would reduce delays in discharging patients and reduce the need for people to be admitted to hospital in the first place, for example by strengthening primary, community and social services.
Winter pressures were well managed by social services departments, health authorities, trusts and other agencies working in partnership. Cambridge and Huntingdon health authority received £1.4 million of the £15.174 million available to the Anglia and Oxford region. Nearly £1 million of that went to social services to enable the discharge of delayed patients at Addenbrooke's, Hinchingbrooke and Lifespan into nursing and residential homes.
Let us look ahead to the coming winter. Last week, the Chancellor of the Exchequer announced that we would find a further £250 million to help the national health service and social services to cope with 1998–99 winter pressures. The English share of that total is £209 million. On Monday, my right hon. Friend the Secretary of State 332 for Health announced how the first £159 million would be allocated. That will build on the success of our measures last winter by again tackling discharge and unnecessary admissions and by strengthening community-based services. I am sure that the hon. Gentleman will join me and his fellow Cambridgeshire Members in welcoming the additional £14.67 million that the Cambridge and Huntingdon health authority will have at its disposal in the next year. That is a 4.1 per cent. real-terms increase. I am sure that the money will be used to address some of the concerns that he has raised.
Once again, health authorities will be encouraged to use section 28A to transfer resources for joint schemes to social service departments when appropriate. In some pressure spots, that will mean purchasing extra long-term placements in residential and nursing homes. We would also expect social services to be supported to invest in community-based rehabilitative and recuperative care.
§ Mr. LansleyI am sorry to interrupt the Minister. Will he clarify that the £14.7 million to which he refers is an increase in the overall allocation to Cambridge and Huntingdon health authority? Is he yet able to say what winter pressures money is available for the year ahead and whether there will be continuing support to follow up that money?
§ Mr. HuttonThe £14.7 million includes the additional allocation for winter pressures in the forthcoming period. The money has been treated together.
Decisions on the level of local authority expenditure are taken each year, following detailed discussions with the local authority associations. In setting the level of expenditure for each of the main services, the Government take account of anticipated pressures on those services. Resources are distributed on the basis of standard spending assessments.
Spending priorities vary from area to area and no one is better placed to assess those priorities than the authorities locally. Some 90 per cent. of resources for social services are allocated to the local authority on an unhypothecated basis. Authorities are free to choose how best to allocate the money internally.
Cambridgeshire's standard spending assessment per head is below the national average, but the hon. Gentleman should bear in mind that the SSA reflects the relative need for social services in an area, which research has shown to be linked to the extent of social deprivation. Cambridgeshire is a less deprived area overall, so we might expect it to have less social need than the average authority. For example, in 1996, around 15 per cent. of people over 60 in Cambridgeshire were on income support, compared with more than 40 per cent. in Tower Hamlets and Hackney. The hon. Gentleman also referred to the change made last year in distributing the elderly residential SSA for Cambridgeshire, mentioning a figure of £1.4 million. That allocation was made after extensive independent work by the University of Kent on the characteristics of people requiring local authority assistance. There is no question of Cambridgeshire being unfairly treated in the allocation or victimised by the change in the method of distributing resources.
We intend to ensure that social service budgets are given the right priority among the many services receiving Government support. We recently announced that funding for social services would rise by more than 3 per cent. above inflation for each of the next three years. 333 The hon. Gentleman referred to the closure of the Meadowcroft home in Trumpington. I am sure that he appreciates that decisions about the commercial viability of individual homes are not matters for Ministers in the Department of Health. When residents have to move because of the closure of a home, I expect local authorities and health authorities to work together to ensure that the arrangements are appropriate and are handled sensitively. I understand how traumatic it can be for frail, elderly and vulnerable people, such as the hon. Gentleman's constituents, who have to move from residential care or a nursing home that has become their true home. We are not in a position to prevent the closure of an independent home if the home owner or the organisation running it considers it to be no longer viable. I repeat the message that we have sent to many organisations in this field—we expect local authorities and health authorities to work sensitively to manage the movement of those very frail and vulnerable people.
In conclusion, I am grateful to the hon. Member for South Cambridgeshire for giving the House an opportunity to discuss some very important issues. In the longer term, we are aware of the need to develop a fair and sustainable method of funding long-term residential care, and I look forward to future opportunities to debate those issues more fully in the House.