HC Deb 02 July 2002 vol 388 cc199-206

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

10.30 pm
Richard Younger-Ross (Teignbridge)

First, I declare an interest: my wife is an employee of Devon county social services department.

There is all-party support for the debate. I requested it because on 10 January a delegation of all four party leaders in Devon came to meet all the Devon Members. They explained that there was a funding crisis in social services, and in detailed and fairly graphic terms they described the effect that it was having on elderly people in the county.

Before going into the details, I shall sketch the broader picture. At the end of last year, directors of social services from across the country met and produced a document that stated their estimate that £1 billion of funding was required for social services departments. Since then, the Government have given two tranches of money totalling some £700 million, which still leaves social services departments across the country short of at least £300 million. However, months have passed since that estimate was made; costs have increased, and the Chancellor has levied national insurance charges on employers that add to those costs.

Recent research published last month by the Joseph Rowntree Foundation states that there is a shortfall in social services funding, and estimates that £1 billion is now needed to counter the shortfall in fees for care homes.

Mr. Adrian Sanders (Torbay)

That report suggested that the £1 billion funding should be provided and linked to care homes and nursing homes meeting the new required standards, so that the new required standards and new money going into the system would be achieved at the same time. Should not the Government now consider that proposal?

Richard Younger-Ross

My hon. Friend makes an excellent point—I could not have put it better myself.

Last year. 75 per cent. of social services departments overspent, but for the elderly of Devon, the picture is bleaker still. The pot for social services departments is too small, but Devon does not even get a fair share from that pot. The standard spending assessment per head of population for the south-west is the lowest in the UK: it is about £114 per head short of the UK average, and more than £200 less than the SSA for some other parts of the country. Devon now has the fourth lowest SSA of the 15 local authorities comprising the south-west.

The House should not be lulled into thinking that "glorious Devon" does not get as much money as other parts of the country because it is so nice there. That picture postcard image of the county is inaccurate. There is real poverty and deprivation in Devon. Between those comber and vales, from the moors to the sea, are people who live in poverty and find it hard to make ends meet. The two counties of Cornwall and Devon have the highest levels of poverty of any county area in the country.

Why is there so much overspend among social services departments? Among those departments that have overspent, 65 per cent. of the overspend is on child services. That is certainly so in the south-west, and it is diverting resources that are required for elderly people. In a report published by the 15 directors of social services last year, they said that they were all having to divert money from elderly services to meet their legal requirements on child services.

I raised that point with the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), in the social care debate in January, and she stated that that was not right and that there would be an investigation. I hope that the Minister responding to this debate can say how far that investigation has gone and what his Department is doing to look at that problem. County councils spend between 50 and 100 per cent. over their SSAs. In the south-west, £79 million is spent over the SSA—some £10 million above the budget, because costs have continued to rise.

All that represents a triple whammy for elderly people: social services departments across the country receive inadequate funds; there is a low standard spending assessment for Devon and the south-west; and there is a diversion of funds to child services to meet legal requirements such as child protection. The result is misery for elderly people in the county of Devon: it is 572 bed losses and the closure of 32 care homes in the past year.

Is it any wonder that, when I visited my local hospital in Teignmouth recently, I found elderly people who were fit and able to go to a care or nursing home for whom a place could not be found? The term used for that is bed blocking, but this is bed locking. Effectively, lack of funding is chaining those people to a hospital bed, in which they do not wish to be and which is desperately needed by others in the national health service.

Today we can see the sad result of such home closures. It has been reported in the national press that one lady who was over 100 years old decided to go on a hunger strike because she had been forced to move from the care home where she lived, and as a result she died.

The outcome is not always as dramatic, but when a home closes and elderly people are forced to move, they can be put under considerable stress. When a local authority decides that it needs to close homes, and it manages the closures, scales down the facilities and speaks to people, it causes some, minimal, stress. However, what does it do to elderly people and their stress levels when a home is going bankrupt, when they can see that around them and when the certainty about how long they can stay disappears? There is no question but that that can lead to illness and premature death.

What do we do? I ask the Minister to consider how we can find adequate funding for social services departments across the country. Bluntly, there is not enough money being put into social care and social services at the moment. The situation is even worse when one considers the Government's refusal to fund all the social care provision required, such as the personal care that people need when in homes. Scotland has led the way, as it said yesterday that personal care would be funded, although I am sure that the Minister will say that money is being diverted from something else. A lot of money is available to the Government and I urge them to look at giving some of it to the elderly. They should comply with the full details of the report, which says that personal care ought to be funded.

We need a fair deal for Devon and the south-west. I appreciate that the Government are looking at reviewing SSAs, but please can they make sure that the south-west does not lose out again? There is poverty, as I have described, and there are problems that cannot be ignored.

Mrs. Angela Browning (Tiverton and Honiton)

Does the hon. Gentleman agree that it is iniquitous that we get less per capita for our elderly population than to other parts of the country? I cannot understand why their needs are deemed to be less than those of people elsewhere.

Richard Younger-Ross

I agree. It does not make sense that it costs more to look after an elderly person in one part of the country than in another. In fact, the reverse is the case. In rural Devon, where there are large spaces and communities are far apart, it is more expensive to look after elderly people and provide services.

The Government need to look not only at a long-term solution to the problem and but at what they can do now. There is a crisis and elderly people are suffering. I will not go so far as to beg or plead with the Minister, but I ask him to look at what can be done this year to provide emergency funding for social services departments in Devon and the south-west. Will he ask the Secretary of State to meet representatives of social services departments across the south-west who have got together and worked co-operatively? That is not party political point-scoring because those people serve on Labour, Liberal Democrat and Conservative councils, as well as those with no overall control. There is a consensus in the south-west that there is a crisis and a problem that needs to be put right. I urge the Minister to arrange that meeting and see what can be done to stop the elderly people of Devon and the south-west suffering any further.

10.43 pm
Mr. Anthony Steen (Totnes)

I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on securing one of the most important debates in the House for some time. I thank him for his generosity in allowing me to say a few words.

All parties must back our concern about the elderly in Devon. Our concern is genuine because more elderly people probably live in Devon than anywhere else in the country, yet social services do not get the resources that they need. I am not sure how the Government are going to deal with the problem. They will have to give more money to social services to care for elderly people in their own homes, which I favour, as provided for by the Community Care Act 1990, and provide more hot meals. At the moment, there are virtually no hot meals for the elderly in Devon. They get block deep-frozen meals, which last them a month. They have a special deep-freeze where they put that frozen food, and are supposed to live on it for a month. Nobody comes to see them, as people from the old meals on wheels did.

The home help service is no longer strong, and neither is the chiropody service or the shopping service. There are no services any longer, and elderly people understandably cannot look after themselves in their own homes, so they are forced into residential homes. However, 50,000 residential places have closed all over Britain. If we do not look after old people in their own homes by providing the support services, we must provide residential and nursing homes to look after them instead. That has not happened.

I am not necessarily asking the Minister for more money, although a little more would be useful—we all need more money. The main point is to make sure that the social services have the resources to provide the services that keep old people in their own homes. If we fail to do that, we force them into hospital because there are not the residential homes to look after them.

That is a serious indictment of the Government. The comments of the hon. Member for Teignbridge reflect the unanimous view of all the councils in the area that we face a crisis. The only reason that the crisis has not spilled into the street is that the hospitals are shoring up the gaps, but they can do that for only so long. The hon. Gentleman rightly asks that something be done about the matter.

Not only are there fewer residential homes, but the elderly have to sell their own homes and pay all the money over to the residential or nursing home, so they die impoverished, rather than passing their money on to their family. The matter transcends all parties and worries us deeply. I pay tribute again to the hon. Gentleman for raising an issue that is of great concern to everyone in Devon.

10.46 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)

I begin by congratulating the hon. Member for Teignbridge (Richard Younger-Ross) on securing the debate. I can see the strength of support in the south-west on the issue, as he is joined by so many colleagues from that area. I am pleased to say that I am going to Devon on Thursday, so I am sure that I shall be able to see part of the situation first-hand. I shall ensure that my office writes to hon. Members to alert them to where I am going.

In the time available, I want to make clear the investment that is going in and our provisions for elderly people in the community and in hospital. My officials have reported positively on the ways in which the authority plans to develop services for elderly people in Devon, and the work of its senior staff, where I understand that the hon. Gentleman has some personal interest, which he drew to our attention. Care of the elderly is a most important subject, and it is timely that we should discuss it now.

The Government are committed to improving access to health and social care services for older people and to ensuring that standards of both health and social services are as high as possible, and that variations in levels and quality of services throughout the country are minimised. To take this commitment forward, the national service framework for older people was published on 27 March 2001. The national service framework will help to tackle age discrimination, and will raise standards and reduce inconsistency in the health and social care of older people in England. That will be backed by huge investment.

The Government have made unprecedented investments in social services. Between 1996–97 and 2002–03, personal social services resources increased by more than 20 per cent. in real terms. That is an average real-terms increase of more than 3 per cent. a year. It compares with average annual real-terms growth of only 0.1 per cent. per annum between 1992–93 and 1996–97 under the previous Government. That is important and it should be borne in mind.

We acknowledge the need for continuing investment in social services. PSS resources will increase by an average of 6 per cent. a year in real terms over the next three years. Those new resources will enable further significant improvements to be made to social care, including services for older people who need support so that they can continue to live in their own homes in the community. The hon. Member for Totnes (Mr. Steen) drew attention to provision in the home, which is a core part of the Government's policy. The task for the Government and local government in places such as Devon is to make the best possible use of those funds so that we can deliver the services that the public deserve.

I believe that Devon and other councils in the south-west have received a share of those substantial increases in resources. In 2002, Devon's PSS standard spending assessment—its Government allocation of general revenue funding—is £114.6 million. I think that the hon. Member for Teignbridge referred to a lower figure, so I want to be clear on the numbers. On a like-with-like comparison, the county's standard spending assessment has increased this year by 5.2 per cent., in comparison with the national average of 4.9 per cent. That follows increases of 4.1 per cent. for 2001–02 and 5 per cent. for the previous year. Furthermore, those year-on-year increases in general revenue funding are well above the rate of inflation.

Nick Harvey (North Devon)

Is the Minister aware that in the last year in which places in residential homes for the elderly were paid for by the Department of Social Security, Devon had more than 16 per cent. of England's national spend? Currently, we have less than 4 per cent. of the national spend on elderly residential places, yet we still have the same number of elderly people in residential homes as we had under the old system. Does he understand the specific difficulties that Devon has had in coping with that enormous disparity?

Mr. Lammy

I understand that there are particular problems in Devon because of its size, its population make-up and its share of the SSA in comparison with other areas. None the less, there have been significant increases and the £114 million to which I referred is a lot of money, and I want to go on to speak about the review and the other particular issues if I can be allowed the time to do so. It is important when talking about provision for the elderly to recognise that other issues also affect capacity and that the Government are dealing with them. That relates to provision in some of the hospitals and modernisation. We have embarked on a very strong modernisation agenda and it has to bed down in Devon, as elsewhere, to ensure that some of the capacity issues are dealt with.

In addition to the general revenue funding, Devon has received large increases in the specific ring-fenced grants made available by the Department. In particular, its carers grant has increased this year by 22 per cent. to £1.1 million and its children's services grant has increased by 15 per cent. to £4 million. Those increases follow significant increases for last year—for example, they include a 40 per cent. increase in the carers grant and a 13 per cent. increase in the mental health grant.

The hon. Gentleman was right to draw attention to the review that is under way. Of course, my colleagues in another Department are considering that review, and Devon, like all other local authorities, will make its submissions and views known. Indeed, Ministers in the south-west will continue to lobby on this very important issue. The difficulty with all formulae is that those at the margins can lose out. I recognise the serious concerns of Devon Members, which is why I am very pleased to be visiting the area, but it is wrong to say that money is not going in.

Richard Younger-Ross

I hope that we can welcome the Minister to Devon, wherever he is going. I am sure that he will tell us.

The Minister has referred to small percentage increases in what the Government have provided. According to the figure that I quoted, county councils are spending between 50 and 100 per cent. above SSA. That is not 3 per cent., 4 per cent. or 6 per cent.; it is a massive sum, and it needs to be addressed.

Mr. Lammy

One must be careful in comparing SSAs per capita. Allocations are based on the weighted proportion of the population, which is different in different areas. It is up to councils to make their own assessments and choose where to allocate their funds according to the nature of the formula and how it affects their areas. That is the same throughout the country. But I note what the hon. Gentleman has said, and of course Hansard is available to those in other Departments.

Mrs. Browning

Devon's difficulty is that it has had to put more money into children's services because it must fulfil its statutory obligations first.

Mr. Lammy

I note what the hon. Lady says, but I need to make some progress. As I have said, we have had a formula for some time based on particular groups in the area. It is up to individual councils to decide where to allocate their money, but a review is in progress and we must await its outcome.

The Government's policy is to promote independence for older people wherever we can, and to enable them to remain in their own homes whenever possible. That is what the people concerned and their families tell us they want. The number of people receiving intensive care and support in their own homes has increased by 6 per cent. in the last year, which is an excellent achievement.

Clearly we continue to need residential accommodation, but we must not make the mistake of judging the success of Government policy simply by looking at the number of people in residential care and nursing homes. Our policies are designed to ensure that people can live in their own homes with the appropriate support. The Government aim to provide that support whenever possible, balancing it with good, effective, high-quality residential accommodation where necessary. It is a matter of getting the balance right for local communities.

The care-home sector is very important. There is a real need for the authorities to do some long-term, sustainable planning. It is important for local-authority commissioners—with their partners, including providers— to have a joint and transparent strategy that is clear about how it is intended to provide care and support for local people in future.

Last October, the Government announced that they would give local councils an extra £300 million over two years to tackle delayed discharges from hospital—or, as the hon. Member for Teignbridge described it, bed-blocking.

Richard Younger-Ross

Bed-locking.

Mr. Lammy

I am sorry—bed-locking.

The extra money was targeted at the councils that needed it most. The first £100 million has been given to local councils, and we have been monitoring how they have been choosing to spend it. More than half the money has been spent on care home places, but it is noticeable that that is not the only way in which those on the front line have chosen to spend it.

Some councils are increasing intermediate care to enable more people to leave hospital and regain their independence in their own homes. Many have increased the provision of intensive home care support, so that more people can be supported in their own homes and do not need to enter residential care. Each of the schemes not only allows councils to exceed their targets for reductions in delays and enables people to leave hospital when they are ready to do so, but highlights the scope that exists within social care for supporting those who cannot live independently.

As Members will know, there has been a small loss of care home beds since 1997. Although 50,000 were deregistered, during the same period over 33,000 beds entered the care home market, making a loss of just 17,000. That is, of course, still a loss, but what is more important is that there is still spare capacity. The carehome market peaked in 1996, when there were too many beds to be sustainable in the long term. Indeed, the recent report by the Joseph Rowntree Foundation goes as far as to suggest that the decline in care home capacity should be welcomed.

The debate has given the House a welcome opportunity to discuss an important issue—

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

Adjourned at Eleven o'clock.