HC Deb 23 November 2001 vol 375 cc642-50

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

2.30 pm
John Cryer (Hornchurch)

May I begin by thanking you, Mr. Deputy Speaker, for selecting this subject for debate? I also thank the Under-Secretary of State for Health, my hon. Friend the hon. Member for Salford (Ms Blears), who will respond to the debate. Ministers must feel that they have drawn the short straw when they have to reply to the Friday afternoon Adjournment debate, so I thank my hon. Friend for being here.

My main aim in this debate is to consider the loss of local authority beds, delayed discharge, and high bed occupancy—especially in the acute health economy—in the boroughs of Barking and Dagenham and of Havering, and their relationship to the operation of the national health service throughout our area. I am glad that my hon. Friend the Member for Dagenham (Jon Cruddas) is in the Chamber. This is an enormous issue for the areas that we represent.

I shall quote from the Treasury Minute on the first report of the Public Accounts Committee 2000–01 "Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals". It states: There is a clear relationship between high bed occupancy and the risk of cancelling elective admissions. This risk becomes very pronounced at occupancy levels above 83 per cent. Bed occupancy rates in hospitals ranged from around 50 per cent to 99 per cent in 1997–98. The average across all hospitals was 81 per cent.

On 17 October, my right hon. Friend the Secretary of State for Health gave evidence on the same subject to the Select Committee on Health. He said: What you cannot do is provide the optimum levels of emergency care or shorter waiting times in hospital unless outside the hospital you have a social care system that is operating more effectively and in cooperation with the local health service. On 24 October, he said: We have commissioned research from York University which the Committee can see, which indicates that if you get occupancy rates in excess of 82 per cent you start getting a higher level of cancelled operations taking place at the last minute … What we have been looking at very closely is what we can then do to get occupancy levels down from around 89 or 90 per cent at the moment across the NHS … The problem is that it"— the hospital sector— becomes less efficient the more you get above 82 per cent bed occupancy rate.

That is clear. Occupancy rates of more than 82 per cent. diminish the efficiency of the sector and create other problems across the health economy.

Oldchurch hospital is a big accident and emergency hospital that serves my area, as well as that of my hon. Friend the Member for Dagenham and several other hon. Members. A press release issued recently by Barking, Havering and Redbridge Hospitals NHS trust stated that the bed occupancy rate is currently running at 97 per cent.

Jon Cruddas (Dagenham)

Does my hon. Friend agree that the problem affects not only his constituents in Hornchurch and Havering but those in Barking and Dagenham? Recent figures that I have received from the trust show that 54 of the 154 delayed discharges, or blocked beds, affected Barking and Dagenham constituents. Does he agree that the consequential effects of the problem are so great—the cancelled operations and the implications for the functioning of the accident and emergency centre—that urgent action is needed from the Department of Health, local authorities and the trust itself?

John Cryer

Yes, I agree with my hon. Friend that that is a problem right across the health economy.

Delayed discharges are a problem in our area, partly because its population is, on average, one of the oldest in any Greater London borough. In fact, Havering might have the oldest population of any borough. Barking and Dagenham also has an elderly and ageing population. Barking, Havering and Redbridge Hospitals NHS trust issued a press release on 12 November. It uses the term "bed blocking"—a phrase that I detest. I prefer to use the phrase "delayed discharges", which is far more accurate and sympathetic. Nevertheless, it uses that phrase and says: We currently have 160 beds 'blocked' which means we have 160 people who are medically fit for discharge but cannot return to their own homes. This may be that they are unable to look after themselves or require support to undertake tasks essential for daily living, such as cooking. So there is clearly a high level of delayed discharges.

I should mention the fact that the Government made £500,000 available to the London borough of Havering so that it could deal with delayed discharges and try to get people back to their homes, or at least into accommodation elsewhere. I pay tribute to the Department of Health for making that money available to the local authority. I have lobbied it for that money in the past, as have other people and bodies. However, that money will not solve the kind of long-term problems that we have in Barking, Havering and Dagenham.

Undoubtedly, we do not have the necessary residential care capacity, either in the public or private sectors. Havering council is presently engaged in a programme of closing care homes in my constituency and throughout the borough. For example, The Grange—a residential care home for elderly people in the Romford constituency—has just closed with the loss of 37 beds. Maybank Lodge is a very fine home in my constituency. The people who live there are very happy, as are those who go to the day centre there, but it is facing closure with the loss of 43 beds. Only two people—Vic and Edie—still live there, and they are determined to stay there as long as they possibly can. They have been to court to try to save the place that they have regarded as their home for some years.

More closures are scheduled. I have always disagreed with the policy of closing local authority care homes. I have campaigned against it and made my views absolutely clear in my constituency, in Havering and on the Floor of the House. One of the key factors in the home closure programme is the appalling level of the standard spending assessment handed out to Havering, year after year. That is not the current Government's fault; it is a historical fact that goes back at least to the fall of the poll tax and actually to the 1950s and 1960s.

In fact, under this Government, the settlements given to the local authority have been much more generous than those given to it when the Conservatives were in power.

Nevertheless, when starting from a low base, even if a borough's settlement is increased by a high percentage, it still does not help a lot because it is continually playing catch-up with neighbouring boroughs. Boroughs with a similar socio-economic mix as Havering tend to get a much better SSA. That plays a key part in the destruction of care homes in the London borough of Havering.

There is no evidence—certiinly not in our borough—that the private sector has anything like the capacity or ability to provide the necessary care for elderly people. In fact, some private care homes have closed.

I was very pleased that in the trust's recent plans for a new Oldchurch hospital, which will be built on a site opposite the existing hospital, the number of beds was increased by 60, although the original proposal contained a cut in bed numbers. That decision was reversed following a long-standing campaign for a new hospital carried out by myself and others.

The trust is consulting on the provision of 83 intermediate care beds, and I would appreciate it if my hon. Friend could comment on the status and role of those beds. Their provision is comparatively recent—they have come in in the past few years—so how does she see them interplaying with acute beds and other sectors of the local health economy?

However, the increase in the number of acute beds and the introduction of intermediate beds over the next few years will not compensate for the loss of beds in the care sector. In the next few years, Havering could face a crisis in long-term care for the elderly. Will my hon. Friend say something about that?

When we came into office in 1997, we faced an invidious position in respect of long-term care for the elderly. I would argue that probably the first big privatisation post-1979 was that involving long-term care for the elderly. In 1970, long-term care beds in the NHS outnumbered those in the private sector by two to one. By 1990, the position had been reversed: beds in the private sector outnumbered those in the NHS by two to one. By the time that we came to power in 1997, long-term care beds in the NHS had virtually been obliterated. During 18 years of Tory Government, the number of beds overall in the NHS was cut by a third and many of them were in the long-term care sector. We have had to live with that inheritance and we shall have to live with it for some time to come.

Given an ageing population and all the problems in the health sector, many of which we inherited, delayed discharge is clearly a national problem. However, from what I glean, it appears that Barking, Dagenham, Havering and Redbridge—the health authority also covers the London borough of Redbridge—is the worst area in Greater London for delayed discharges.

The key factor is to provide even more resources. Although the Government have provided additional resources for coping with problems in the health economy, we need more resources to go into long-term care for the elderly and into acute and intermediate beds. I hope that my hon. Friend will say something about that.

I also hope that my hon. Friend will say something about the royal commission on long-term care for the elderly. It made some constructive suggestions on how we could resolve the problems, so perhaps she will comment on them.

2.42 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I reassure my hon. Friends the Members for Hornchurch (John Cryer) and for Dagenham (Jon Cruddas) that there is almost nothing that I would rather be doing on a Friday afternoon than replying to this debate. The issues that they have raised are extremely important for hundreds of thousands of people throughout the country, and not just those in their constituencies. It is right that we should debate them.

My hon. Friends have highlighted the need to try to ensure that we have a seamless system so that we can effectively treat people—particularly elderly people—in the right place, at the right time and with the right kind of care. Therefore, making the connection between acute care, residential care, intermediate care and care at home is one of the biggest challenges facing us and everyone in the health service, social services, local government and the sector as a whole.

My hon. Friend the Member for Hornchurch pointed out that the issues relate to the whole system of health care. The problem of elderly people being kept in hospital for far too long is not only bad for them—instead of being in acute hospitals, they should be in residential care or supported at home—but it affects our ability to carry out elective care to ensure that people's operations are not cancelled and that they take place on time.

Furthermore, at the front end of the hospital system, the problem means that people who need care in accident and emergency or casualty departments are unable to be assessed and cannot find a bed because people at the other end of the hospital are kept in for far too long. Therefore, we should not view the issue in isolation. We need to put all the solutions in the right place.

Mr. Andrew Rosindell (Romford)

Will the Minister give way?

Ms Blears

No, I want to finish my response.

We need to ensure that a proper system is in place.

My hon. Friend the Member for Hornchurch is also worried about the capacity of residential beds, especially in his community. The overall number of care homes in England is falling. There is concern about capacity across the country which is having an impact on hospital discharges. Providers of residential care places are worried about the level of fees that are paid to them. Some care homes have had to close, which is another problem that we face. I hope that I can reassure my hon. Friends and deal with the local matters that they raised.

The Government reached an agreement on 9 October with local social services departments. Building capacity and partnership in care is a concordat between the national health service and the social care system to discover whether we can put in place longer-term measures to increase the capacity of residential care in our communities. It is not good enough to have an on-the-spot purchasing policy. The system needs to be sustainable so that authorities can plan provision over years instead of facing the vagaries of the market.

The agreement sets out a range of principles and practices on how to build capacity and to make the fees that are paid to care home owners adequate so that they can continue to provide care. It will also consider how we can involve nurses, residential care workers, home care workers and people who work in sheltered housing in the system so that we provide the right care for people in the right place at the right time.

An important aspect of the agreement is its ability to be dynamic and flexible so that as circumstances change the contracting arrangements between local authorities and the residential care sector can change as well. My hon. Friend the Member for Hornchurch concentrated on the number of beds. That is a crucial issue, but we need to be innovative and creative in providing extra capacity. It is not simply a case of providing beds in residential care homes or hospitals. We need to put in place many more domiciliary care packages to provide hospital treatment at home. The vast majority of elderly people want to live independently in their homes if they can manage to do so. We have not been quick enough or creative enough in recent years to put in place extensive support packages that enable people to stay at home. Obviously there comes a time in people's lives when that is no longer possible and we have to ensure that good residential care is available, but we can find greater capacity by being more creative with our schemes.

Many authorities are thinking of setting up "fall" clinics that offer advice to elderly people on simple aids and adaptations to their homes, such as rails to ensure that they do not fall down the stairs. If an elderly person has a fall, they are far more likely to suffer a fracture and to be admitted to hospital where the institutional surroundings make them more dependent, which puts them on a vicious spiral that robs them of their ability to care for themselves. If we stop the fall occurring, we not only prevent the system from incurring huge costs, but improve dramatically that elderly person's quality of life. We need to do far more in terms of outreach teams and helping people to survive in their own homes.

We have provided £300 million over the next two years to tackle delayed discharges. It is a cash-for-change programme. The money comes with a commitment to change the way in which we have acted. Both my hon. Friends recognised that we have been in this situation for a number of years and the stop-gap mentality cannot continue. The systems that we put in place have to take us forward. The £300 million for delayed discharge is in addition to £900 million that has been earmarked for the rapid development of intermediate care, such as step-up, step-down facilities, so that people who do not need intense acute care have access in the community to more appropriate treatment. Sometimes people need nursing care rather than acute intervention. As my hon. Friend the Member for Hornchurch said, that sector is new, but it is growing at a tremendous rate.

Of the £100 million allocated this year, we have focused £47 million on the 55 councils that need most help. We recognise that some local authorities have a big problem, but we want to help every authority, so the remaining £43.5 million is being distributed to the other 100 councils on the basis of the standard spending assessment. A balance is being struck: we have allocated disproportionate amounts to the places with the greatest problems to try to bring them up to speed, but we are providing support for everybody because we know that there is a problem nationwide.

I agree entirely with my hon. Friend about the phrase "bed blocking". It is not one that I want to use, as the problem involves people being delayed in hospital. We must never forget that they are real people; they are not simply the occupants of beds. My hon. Friend is right that many hospitals are running at 97 or 98 per cent. capacity and the fact is that, once such a rate is reached, the knock-on effect on trolley waits and cancelled operations becomes all too apparent.

For the past 30 years or so, the received wisdom has been that we need fewer NHS beds. About 40,000 were lost in the last years of the previous Administration, but we are reversing the trend completely and this is the first year in which the number of general and acute beds has risen. The NHS plan sets a target to increase the number of general and acute beds by 2,100 by 2004. The latest figures, published this September, show that we are a third of the way there—an increase of more than 700 general and acute care beds in the past year.

We are beginning to turn things around, recognising that we need to increase capacity, and my hon. Friend generously acknowledged the increase of 60 beds at the new hospital that will be built at Oldchurch. I understand that there will also be an extra 19 beds at the King George hospital, which is exploring a new clinical model for organising its services and will be able to achieve extra capacity.

As both my hon. Friends are aware, a share of the extra £300 million to tackle delayed discharges has been received by Barking and Dagenham and by Havering. Barking and Dagenham got £480,000 and Havering received an additional £555,000, so almost £1 million is going into that community. It will have a significant impact on the ability of social services to purchase additional care and reorganise the way in which they support people through outreach teams, help at home, working with sheltered housing and working with all the other partners. I acknowledge that my hon. Friend the Member for Hornchurch thinks that even more resources are necessary, but we have an extra £200 million to spend next year from the £300 million in total and I hope that it makes a significant impact on the problems there.

Recognising that this is a whole-system problem, not simply one of delayed discharges, the Government are trying to tackle the difficulties at every stage in the hospital system. We have allocated extra funds to the NHS locally, so Barking, Havering and Redbridge Hospitals NHS trust received £254,000 in October to tackle longer waiting lists and ensure that, by next March, nobody has to wait more than 15 months for an operation.

That money is being used to fund extra theatre lists in the trust, and orthopaedic and ophthalmic patients have been transferred to the independent sector to create and free up capacity so that more people can come in for elective operations and there is no problem of cancelled operations, which devastate the patients concerned. Often they have been prepared for surgery, but suddenly the operation is cancelled. We are absolutely determined to try to ensure that that does not happen.

We also allocated £50 million at the beginning of November to reduce occupancy and trolley waits. Barking, Havering and Redbridge Hospitals NHS trust received £490,000. It has used £400,000 for patients requiring joint replacement and surgical work, so again capacity is increased and people get through the system more quickly. It has also commissioned 25 additional step-down intermediate care beds on the Harold Wood site. Patients waiting for discharge from the Oldchurch hospital site can be nursed in those beds, freeing up an extra 25 beds in the acute hospital to ensure that elective admissions get through as well.

I am sorry that I am citing rather a long list, but the Government have been extremely active recently in all the areas that I have mentioned. The most recent allocation of money from the centre was to reform emergency care. We issued a reform of emergency care strategy. That was a £50 million package to get additional nurses into A and E, and to provide a better assessment system to enable people to get through the system more quickly. The local trust will receive £154,000 this year to provide additional nurses for the two A and E departments. A further £632,000 will be provided next year, to try to ensure that patients in A and E receive the right care at the right time in the right place.

If we can get streaming systems into A and E departments that ensure that patients are dealt with by the appropriate level of staff—people with simple needs can be dealt with by nurses, and people with complex matters can be dealt with by consultants—we will be able to reduce waiting times. That will enable us to ensure that we increase capacity for elective operations, get people out of hospital more quickly once their need for acute care has been dealt with and then get them into residential care. We shall then see a flow of people through the system, with no one waiting any longer than is necessary at any stage of care.

Mr. Rosindell

Will the Minister give way?

Ms Blears

No. I have a few more comments to make and I am not in a position to give way to the hon. Gentleman.

My hon. Friend the Member for Hornchurch mentioned that Havering council is undertaking a review of its care homes. I know he is concerned about doing that. It is clear that it wants to ensure that in future it is able to meet care standards and to provide the highest quality care for local people, with privacy and dignity. I understand that it will establish four new resource centres that will be capable of meeting people's care needs—there will be not merely accommodation but activities. The centres will try to ensure, however, that people are looked after properly in the community.

I understand that the council is developing innovative packages of care for local people. It is being creative and imaginative in trying to ensure that people are given a reasonable quality of life in residential care. Many of us have visited care homes, and I am sure that some of us have expressed concern on occasion that sometimes there is little activity for people in such settings. We should ensure that people are engaged in proper activities. It is crucial that they should be able to get out and about and live a full life.

In some areas, bed occupancy in care homes is extremely high. I am aware that in London and the south-east there is a shortage of care home accommodation. I understand that nationally there are still some vacancies in the care home sector. The picture is not uniform. However, I am aware of the stresses and strains on residential care in some areas. That is why discussions have been taking place with providers to try to ensure that we can pay them the appropriate sums and give them the certainty that they can plan their provision so they can look forward to a future in which they can provide high quality care for local people.

I am encouraged that last year about 5 per cent. more households received intensive home care packages, compared with the previous year. That tells me that we are beginning to see a shift from simply residential care to supporting people at home. In many instances, it is intensive care. For example, it is possible for a home-care worker to be arranged to visit someone perhaps three times a day, six days a week for four weeks, to try to ensure that someone who has had a fracture is given intensive support when they first go home. That will enable that person to re-establish their routines, including cooking and shopping. Such individuals will be able to begin to look after themselves again.

It is crucial that the workers who help the elderly in such circumstances try to ensure that they get those elderly people to regain their self-confidence. Often, after an elderly person has had a fall, there is a loss of self-confidence and he or she no longer wants to venture out. Eventually, it is necessary for the individual to go into residential care because of what has happened to them. That is not necessarily the result of illness or physical things that go wrong.

It is vital that we try to ensure that elderly people, as far as possible, are encouraged to retain their independence. We must try to give them as much choice as possible in determining how and where they receive care. We are able to pursue a range of initiatives because we have put extra funding into the system to try to ensure that we do not have one size that fits all. We want elderly people and their families to be involved in considering options and in making decisions that are right for themselves.

We will probably see a reduction in reliance on traditional care homes. There will probably be a move towards domiciliary care packages and independence. We have a hugely challenging agenda. I have tried to set out the considerable amount of extra resources that the Government are providing in all stages of the care system and all stages of NHS care.

The motion having been made after 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 at Three o 'clock.