HC Deb 22 July 1999 vol 335 cc1459-68

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

8.22 pm
Mr. Nigel Waterson (Eastbourne)

The Government appear to be obsessed with youth. They are keen on cool Britannia, and the so-called rebranding of Britain. Yet, as a country, we are getting older—some of us faster than others. I am constantly amazed by the number of 100th-birthday parties to which I am invited in Eastbourne. I see from a newsletter issued recently by the Debate of the Age that Posh Spice can expect her new baby, improbably named Brooklyn Adams-Beckham, to live to the ripe old age of 130. It sometimes seems, however, that the Government are oblivious of those simple facts, and even that their policies, taken together, are designed to disadvantage older people. I think that I can claim to know what I am talking about: roughly 40 per cent. of my voters are over retirement age, and I am co-chairman of the all-party group for older people.

Almost the Government's first act was to abolish tax relief for retired people who had private medical insurance. I received many letters on the subject. For many such people, who had been in corporate schemes when they were working, tax relief was what made maintaining their health cover in retirement just possible. As a result of the Government's action, many had to give it up, or reduce the extent of their cover. I even initiated a debate on the matter, but the Government were deaf to all entreaties.

Then the Government reneged on their clear pre-election pledge to legislate against age discrimination. We all know from our experience as constituency Members how often able older people aged 50 or even younger are tossed on the scrap heap. We have a voluntary code of conduct; no doubt good employers are already following it, but bad ones will not.

Nor has the Chancellor been kind to older people. In his first Budget, he ripped off pension funds to the tune of £5 billion. Then we had the abolition of dividend tax credits, which directly prejudices 600,000 mainly elderly non-taxpayers. The married couples allowance was removed for couples who will be under 65 in April 2000. Widows have lost their bereavement allowance, which has a particular effect on older widows. Moreover, 250,000 women will be losers under the new rules for widows benefit.

Many older people in Eastbourne and elsewhere are very dependent on their cars, but this Chancellor is trying to tax them off the road. Now, we hear that the Government are intending to abolish concessionary television licences. What next, I wonder—especially when the BBC is seeking to raise the fee to well above £100?

The Government are moving towards a two-tier, means-tested state pension system that will penalise those of my constituents who have been thrifty during all their working lives. The so-called minimum pension guarantee is a fraud on pensioners, as more than 1 million pensioners will simply not be eligible for it.

Then there is the state earnings-related pension scheme scandal. As from April 2000, widows and widowers will be able to inherit only half of their late spouse's SERPS entitlement. Despite the fact that the change was made as long ago as 1986, until relatively recently, the Benefits Agency was misleading my constituents, and those of many other hon. Members, who have been affected by the change. In common with other hon. Members, I referred cases to the ombudsman. I am pleased that Ministers now accept that the problem must be examined, with a view to compensation being paid. I do not know whether the Minister will be able today to shed any light on the matter.

When in opposition, Labour said that things could only get better—but surely it could not have been speaking about our national health service. After a recent debate that I initiated, the Minister ordered an urgent inquiry into nursing at Eastbourne district general hospital. Our local NHS has also had cuts—in chiropody services, for example—that cause great distress to many of my elderly constituents. In all, about 300 people were thrown off podiatry waiting lists.

The royal commission on long-term care deliberated for 18 months, but its conclusions have now effectively been shunted into a siding by the Government. While the commission deliberated, an estimated 75,000 people had to sell their homes to pay for care. When will Ministers tackle the very real problems of funding long-term care for the elderly? As the Minister knows, many older people are cared for, or are carers themselves. I have had letters from constituents in their 70s and 80s who have taken on the role of carer, often for a spouse suffering from Alzheimer's or another condition. Hard-pressed health services and social services departments are struggling to help when they are able, and I know that the Minister has taken a close personal interest in carers' issues. Although some of the Government's proposals on the matter deserve a cautious welcome, the extra funding announced recently works out at an additional 15p a week—which is hardly enough to recognise the billions of pounds saved to taxpayers each year by the estimated 5.7 million voluntary carers in the United Kingdom.

Taking all those factors together, one could be forgiven for asking: what do the Government have against the elderly?

Mr. Charles Wardle (Bexhill and Battle)

My hon. Friend is analysing accurately the damage that the Government are doing to elderly people. Is it not also true that people who have fought for the United Kingdom, and lived long lives here, resent the Government for putting the euro ahead of the pound sterling and for selling our gold reserves at knock-down prices?

Mr. Waterson

My hon. Friend makes a very cogent point on a view that is held by many of my elderly constituents.

The most important and pressing issue that I should like to raise today affecting the elderly in East Sussex is the plight of independent residential care homes, which face two major problems: a Labour Government, and a Lib-Lab pact running the county council.

I recently addressed a meeting, in Eastbourne town hall, of more than 100 worried care home operators. Some of them had already gone out of business, whereas others were under pressure from their banks. They told me that they were facing a triple whammy. East Sussex pays the lowest fees to the private sector of any county in the United Kingdom. The current rate is £209, which is made worse by the fact that the county council pays its own homes the equivalent of £402 per person per week—an incredible difference of almost £200. The situation is rightly perceived as unfair by the private sector.

Furthermore, by insisting on keeping its own homes open, the county is wasting millions of pounds that could be better spent in the private sector. That is partly a matter of political dogma. I pay tribute to the dedication of staff in the county council-run homes. However, there is no less commitment in private homes, where the facilities are often more modern and more comfortable. It is therefore all the more distasteful when local Liberal Democrat politicians try to make political capital by claiming that residents of those homes would not receive treatment at least as good in the private sector.

Indeed, it is interesting that, in principle, the ruling group seems to have accepted the wisdom of disposing of the county's homes, despite what is said in its focus leaflets from time to time. As Councillor Peter Jones pointed out in a letter to me the other day, in 1998–99, the group tried to sell three homes as going concerns—those that were most non-compliant with current minimum standards.

The Conservatives on the council warned that the poor state of the homes meant that the group would almost certainly fail. Indeed, after some months, the group had failed to find a single credible buyer. There is a real problem here, with the county homes—despite the best efforts of staff—falling below the standards required in this modern age.

This is nothing new. I drew attention to the problem in a debate before the last election. On 19 February 1997, in an Adjournment debate, I said that even if the Government could be persuaded to give a few million extra pounds to East Sussex, there would be no guarantee that the money would find its way through the system to independent care home owners. I regret to say that nothing has changed. The same bunch of Liberal Democrats are, in effect, still running the county.

I pointed out in the 1997 debate that the disparity between what the council spent on its own homes and that spent in the private sector was £150. The gap has widened in the intervening period. The then Minister, my hon. Friend the Member for West Chelmsford (Mr. Burns), said that East Sussex was spending £5 million more than it needed. He went on to say: When a local authority is complaining that it does not have enough money, I cannot understand how it can justify spending about £152 a person a week extra just by placing them in its own homes."—[Official Report,19 February 1997; Vol. 290, c. 890–898.] Does the Minister agree with his Conservative predecessor? Has he an up-to-date calculation of the money being wasted in this way by the county council? Does he agree that the council is in danger of abusing its dominant purchasing power in this instance? Will he initiate an urgent inquiry into the policy of the county council?

The council claims, with some justification, that it does not get enough funding from the Government. We know that the Government have cut grants for areas such as East Sussex. They have also rigged the calculation of grants, so they no longer fully reflect the effect of large numbers in our elderly population locally. Will he try to justify the level of funding for East Sussex?

We are dealing with Liberal Democrats, so they must look for someone else to blame. It is a bit difficult when they are, effectively, in a coalition with Labour, both locally and nationally. They are talking to Ministers about an all-party approach, but the harsh reality is that they are part of the problem, not part of the solution.

The owners of homes are threatened with over-regulation, and they have the working time directive and the minimum wage to contend with. It is a matter not just of the rules themselves, but of the extra record-keeping that is involved.

As if that were not enough, we have the Government-sponsored report from the Centre for Policy on Ageing, which calls for some nationally required standards, including those relating to room sizes. This is all very well in an ideal world, and we should all aspire to ever-higher standards. However, the plain fact is that many existing homes would have to close if those proposals were implemented. The physical standards proposed are a major problem, but so are the proposals about staffing, sharing rooms and so on. This could be the final straw for many homes. We recently debated that worrying development—at my instigation—in the all-party ageing and older people group.

I am pleased that Ministers confirmed to me recently that the proposals would be subject to proper consultation later this year. Will the Minister outline his plans for the consultation and confirm that he has a genuinely open mind? I am particularly indebted to Terry Fribbens of the East Sussex Independent Care Group and Carole Alford of the Registered Nursing Home Association for bringing this dreadful state of affairs to my attention.

I have heard also from many individuals—too many to name here. Here are some examples of the authentic voice of the independent care sector in my area. A letter from a lady who runs a residential home in my constituency said: The private sector providing Residential Care Homes have been persecuted for too long…What we want to know is why we the private sector are paid almost half the fees that the Councils pay themselves. This is grossly unfair. A lady from another home who attended a meeting that I addressed recently complained about the 1 per cent. or thereabouts increase given by the county to the private sector when it increased the fees for its own homes by 6 per cent. She talked about people in the sector being caused real difficulties by the squeeze from the county council.

I can tell the Minister without fear of contradiction that there is a major threat hanging over the independent care sector in East Sussex. At least 24 homes have closed in East Sussex, Brighton and Hove in the past year. That is extremely worrying, because they provide more than 90 per cent. of the care home rooms in East Sussex. If they are driven out of business, where are the people in need to be looked after? Certainly not in the public sector.

In our area, the residential care sector is a major part of the local economy, employing about 10,000 people. They are victims of the attitude of the Lib-Lab pact at county hall: a mixture of dogma and incompetence. The Government have promised that this is the year of delivering on their election promises across the board. What will they do to help?

8.36 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)

I congratulate the hon. Member for Eastbourne (Mr. Waterson) on raising these important matters. He spoke about the Government's policy towards older people and how we are going to tackle hardship and poverty among them. I rebut his allegation that we are indifferent or have not developed effective policies for tackling those issues, because I strongly believe that we have.

If we are to succeed in tackling poverty and the social exclusion that is its direct consequence, we have to take effective action right across Government. That is exactly what we are doing. Past attempts to deal with these issues—including those by the Government of whom the hon. Gentleman was a supporter—have principally focused on short-term alleviation and very little has been done to prevent problems occurring in the future.

Our approach is radically different and dynamic. It is based on tackling the causes of poverty and social exclusion, not merely alleviating the symptoms. We are determined to create a fairer society in which all our citizens have opportunities to maximise their potential. Fundamentally, our strategy is about investment in individuals and communities to equip them to take control of their own lives and to get out of dependency and deprivation.

The hon. Gentleman has understandable concerns about hardship and poverty for older people in and around his constituency. Our policies will directly benefit those people. For many people, retirement is a time of opportunity, fulfilment, and contribution to the family and society, but for too many it can still be a time of financial insecurity, isolation and poor access to services.

Our policy priorities are to ensure that more of tomorrow's pensioners can retire on a decent income, and to tackle the problems of low income and social exclusion among today's pensioners, while improving opportunities for older people to live secure, fulfilling and active lives.

We are reforming pensions to give people real opportunities to save for their retirement. Our Green Paper "Partnerships in Pensions" set out our proposals for a new contract for pensioners, including dramatic improvements in state second pensions for low earners, carers and disabled people, and a better deal for middle and higher earners through new low-cost stakeholder schemes.

The hon. Gentleman failed to mention the fact that we have announced a £4 billion package, over the lifetime of this Parliament, to support our poorest pensioners. We have introduced a more generous minimum income guarantee for pensioners provided through income support and we announced in the Budget the introduction of a minimum tax guarantee to take 100,000 pensioners out of tax altogether.

Mr. Michael Jabez Foster (Hastings and Rye)

That policy has been well received, certainly in less well-heeled constituencies than that of the hon. Member for Eastbourne (Mr. Waterson), such as mine. More than 10,000 of my constituents have had the benefit of the minimum pension guarantee and more than 20,000 have benefited from the winter fuel payment. That has made an enormous difference, particularly in view of the Government's agreement that that minimum pension will be increased in line with wages, not just inflation.

Mr. Hutton

I am grateful to my hon. Friend for helping to correct the misleading impression that the hon. Gentleman has tried to give. The Government are clear that we intend to be fair to all our pensioners. That is precisely what our policies will do. My hon. Friend referred to winter fuel payments. We are giving every pensioner £100 to help with winter fuel heating costs. We have put in place a more generous home energy efficiency scheme and have ended VAT on domestic fuel which, I understand, the hon. Gentleman and his hon. Friends voted for during the last Parliament—not a popular policy with pensioners.

The hon. Gentleman referred to the Government's general approach to older people. In addition to the hardships endured by older people because of their circumstances, many are not helped by the fragmentation of, or lack of access to, local services. The hon. Gentleman himself referred to some of those problems.

The Government are fully committed to providing better services that can better meet the needs of older people. We shall do so by listening to and consulting older people themselves. This summer, as part of the international year of older persons, Ministers have been setting up and participating in a string of listening events up and down the country. They are organised by local organisations and attended by older people, who have the chance to put their views directly to Ministers. I am attending two of these events. I and other Ministers will listen very hard to what is said. At local level, the Government are supporting the better government for older people programme. This involves local agencies working together on behalf of older people, consulting with them, and ensuring that services are appropriate and convenient.

I now want to focus on this Government's record on health and social care services for older people, to which the hon. Gentleman referred. We have achieved much in the short time that we have been in office. Much of what we have set in train will benefit older people throughout the country, including those who are fortunate enough to live in East Sussex.

The Government's polices centre on a number of key themes. Foremost is promoting the independence of individuals and listening to what they say they want from local services. We want to give older people more say in and control over the services that they receive, and we want to ensure that they have access to services when and where they need them. I shall briefly mention just some of our initiatives. The hon. Gentleman referred to the royal commission which we set up in 1997 to look into options for the funding of long-term care. That fulfilled a manifesto commitment. The report of the commission was published only in March 1999, and the Government are carefully considering their response to the proposals of both the majority and minority of commissioners, and the many comments that have been made on the report by a variety of organisations. I remind the hon. Gentleman that the report contained 24 main recommendations and a host of other minor recommendations, too. It is right, therefore, that we spend an appropriate time on developing our response.

The hon. Gentleman expressed his concern about the existing rules which, he felt, were harsh and unfair. I hope that he will not mind my reminding him that the rules he was describing were the rules that he voted for and sustained in Government over many years.

We also introduced free eye tests for people aged 60 and over from April this year. We have spent significant amounts of new resources developing new health action zones. I know that the hon. Gentleman takes a close interest in the situation of carers. He will remember that in February this year we published, for the first time in this country, a new national strategy for carers, backed up with a new special grant of £140 million over three years to help local authorities provide a better and wider range of services to support carers. During the course of his remarks, the hon. Gentleman again failed to mention that the Government whom he supported had plenty of opportunities to introduce a similar mechanism of support for carers. Sadly, his Government never quite managed to get round to doing that.

Earlier this summer, we published a new charter, "You and Your Services", which local authorities are certainly consulting on now. We hope to see those new local charters introduced from April 2000.

Through a range of initiatives, we are getting health and social services authorities to work more closely and effectively together. For example, we have published new national priorities guidance with clear targets. In "Partnerships in Action", we set out a new range of operational flexibilities which will allow the NHS and social services to work more effectively together. Those proposals are now enshrined in new legislation and we expect to implement them as soon as possible.

We are also developing this year, for implementation next year, the new national service framework for older people, which will be issued to health and local authorities in April 2000. This framework will focus on those parts of the health service that are particularly important to older people; and, again for the first time, we will set new standards to increase the quality of local and health authority services and equity of access to them.

In summary, we are improving health and social care services by getting agencies to work more closely together and by ensuring that people receive services when and where they need them. The Government will achieve a great deal for older people, and lessen the hardships that many experience as they try to access local services.

The hon. Member for Eastbourne referred to some of the problems in his constituency and county, so I shall now address my remarks to his concerns. He said much about local authority finance. I should remind him that within the total amount for local government in the current financial year, the Government have provided a 6.3 per cent. increase for social services departments across the country. For the first time, we have guaranteed that national resources for social services will increase in real terms for each of the following two years, enabling social services departments to plan ahead, knowing that there will be increasing funding. In fact, social services will receive almost £3 billion more in total over the next three years.

This year, for example, East Sussex county council plans to spend £39 million of its £89 million social services budget on services for older people. East Sussex, Brighton and Hove health authority has £505 million at its disposal—3.76 per cent. more than in 1998–99. Its budget for services for older people currently exceeds £130 million.

The hon. Gentleman referred to our manifesto promises. We have honoured our election manifesto pledge to make the distribution system for local authority funding fairer by introducing some changes to the standard spending assessment formula. It is clearly for local authorities, not the Government, to decide on the local allocation of funding to services in accordance with local circumstances and priorities. That is a particularly pertinent point in this debate, as East Sussex has latitude to use its resources as it sees fit, in line with local needs, priorities and policies. Two of the SSA changes that we made this year clearly did not benefit East Sussex. There is no point pretending otherwise, but I am absolutely certain that we were right to make those changes.

In addition to resources delivered through SSAs, the Government have made additional resources available to local authorities. In addition to the carers' special grant, new special partnership and prevention grants are helping local authorities to work with health authorities to develop preventive and rehabilitative services for older people and other adults. These three new grants, totalling £890 million over three years, will help social services to promote independence and develop community-based services. Older people living in East Sussex will certainly benefit from the new grants, which amounted this year in East Sussex to £3.2 million, in addition to the total social services SSA.

The hon. Member for Eastbourne referred to his concerns about the commissioning of residential care in East Sussex. We certainly want local authorities to commission social care services that deliver best value. Best value is the key element in the Government's agenda to improve the quality of local authority services and the efficiency and economy with which they are delivered. Best value will help to ensure that local authorities commission fairly and openly on the basis of a full consideration of costs, quality and outcomes. A new performance management framework will support the delivery of best value services.

Intrinsic to our approach to the provision of services must be even-handedness. We are pragmatic, not dogmatic, over who should provide services. We have no ideological bias in favour of either independent sector or public sector providers. We want local authorities to have an even-handed approach to internal and external provision. Under best value we want decisions on services to be based on proper and transparent reviews of services and accountable decision-making, which reflects local objectives and is based on the aspirations and views of local people and their communities.

I understand that the relationships between the local authority and independent providers in East Sussex have caused some concern in recent years. As he reminded us, the hon. Gentleman brought those matters to the attention of the House in an Adjournment debate more than two years ago. I fully understand his concerns. However, I understand that the new director of social services is keen to improve relationships and I hope that that will lead to greater co-operation in the future. Relationships between local authorities and independent providers have certainly been improving elsewhere in the country.

One problem in East Sussex to which the hon. Gentleman referred seems to be the large number of residential and nursing homes in that area. Although extensive use is made of the independent sector—89 per cent. of local authority residential care placements are in independent homes—the large number of homes means that fee rates for residential and nursing homes are depressed.

When it comes to the mechanics of contracting, we believe that the details of contracting arrangements between local authorities and suppliers are primarily matters for local decision. The Government do not set the rates at which local authorities should contract. We do, however, acknowledge that local authorities' commissioning activities need to improve, and we intend to assist that process of improvement. Strategic planning needs to pursue agreed strategic objectives, which are transparent to users and providers. Market management and contract setting should involve a variety of contract types, with contract prices that reflect providers' costs and planned outcomes for users. Local authorities need to ensure that services meet people's specific needs, and that groups with particular needs, such as ethnic minorities, are better served. We set out that agenda in more detail in our recent White Paper.

We are taking a number of steps to help local authorities and providers to develop those relationships, and to think through their social services agenda. For example, we have just completed a well-attended series of highly productive regional conferences, designed to improve the arrangements for commissioning and paying for those residential services. One of the conferences was held in Brighton, and was attended by officers from East Sussex social services department and representatives from some of the independent homes in the East Sussex area.

Finally, I reassure the hon. Gentleman that I, like my predecessor, meet representatives from the independent sector quarterly to share information, views and concerns. The hon. Gentleman asked me to take a close interest in—

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

Adjourned at eight minutes to Nine o'clock.