§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pearson.]
7.14 pm§ Miss Ann Widdecombe (Maidstone and The Weald)I am very grateful to have this opportunity to raise an issue of supreme importance for my constituents in Kent, where 236 care beds and 17 care homes have closed in the last year alone.
I am not seeking to make specific party political points in this debate. The Minister may or may not be aware that in 1990 I led a rebellion—very unlike me, of course—against the then Government on a similar issue in respect of a constituent, Florence Smith, who I believed under regulations that then existed, but which were changed, was not getting a fair deal in her care home. Today it is a widespread phenomenon for people who are in care homes to face eviction through closure.
In that debate in March 1990, when I raised the case of Florence Smith, I was supported by the now Leader of House. He said:
I am bound to ask how we, as a legislature, can have permitted circumstances in which elderly men and women—too confused and too disoriented to know what is happening to them—are evicted from residential care homes.—[Official Report, 13 March 1990; Vol. 169, c. 198.]Tonight, I ask exactly the same question. The Government, through the care standards regulations, are assessing not the degree of care, attention and love that should be given to the elderly and the vulnerable but the extent of the physical facilities. That is causing untold hardship.
The new minimum care standards will impose a considerable cost burden on the new care homes and on their owners. It is not good enough for the Prime Minister to say, as he did when answering questions yesterday, that some of these regulations will not take effect until 2007. Some of them take immediate effect, and I shall refer to one of them specifically, but even if others do not have to be introduced for a few years, we must remember that things cannot be introduced overnight: preparations must be made now, money must be found now, plans must be made now, and an immediate financial burden results from all of that. We end up with a complete nonsense whereby married couples are unable to share a bed.
§ Miss WiddecombeI will give the exact case. Further examples include sisters separated by fixed screens, and en suite facilities that are never used because residents are incapable and need to be escorted to specially adapted bathrooms. All that regulation has not been backed up with the funding to meet it. Care home owners are therefore being driven out of business because they cannot afford the provision of the facilities now laid down as required.
For example, I have received a letter from an elderly constituent who until a few weeks ago was resident in a home that has now closed. She said:
I am nearly 70, and have been in Residential Care for the past 18 years. I suffer from short-term amnesia. We have just been told that the …Nursing Home has to close down, in a matter of weeks, 506 as it cannot come up to new guidelines: i.e. en-suite bathrooms and other absurd requirements. I have been wonderfully cared for here, and have no other place to go, especially as I am on Income Support. I have written to Mr. Blair asking him what option he would take, in my positionRegulations have led not only to homes closing but sometimes to their tottering on the brink of closure, thus creating uncertainty and tensions for some of the most vulnerable people for whom they are caring.Under the Care Standards Act 2000, it has become an offence to run a home that is not financially viable, yet homes now have to meet huge extra costs to meet the regulations. If that means that they cannot break even, they risk prosecution if they continue to function. Precisely because of that, two homes in my constituency have closed. I submit that that is not just an unsatisfactory but a profoundly cruel state of affairs.
Let us consider the case of Hawkhurst Castle in Kent. It has become another casualty of the ongoing crisis in the care home sector. Because it does not come up to specifications, it has failed to win placements from social services, and that has led to a decline in the number of residents. Kent is not exactly generously treated under the revenue support grant settlement. Kent gets for a granny in Kent only a third of what a granny in Islington would get, and it finds it difficult to meet the current standards. It is certainly not able to fund the new standards that are required. Sadly, as a result of that, Hawkhurst Castle will close on 14 August.
One resident who has been in the home for 20 years says that she would like to spend the rest of her life in what has naturally become her home. Not only does she say she is happy, but her friends who visit her say objectively that even when they arrive unannounced they find that she is well cared for, happy and content. In that same home is a man with Down's syndrome. His sister has said that the home is wonderful and the staff devoted and that the family has no idea how it will find another home.
I now turn to the case of the Greenbank residential care home and will develop the comment that caused the Minister to heckle "rubbish" at me. The proprietor of Greenbank is concerned about standard 23.11, which is due to come into force on 1 April 2007. The standard stipulates that existing homes must provide 80 per cent. of places in single rooms. Greenbank currently has 15 rooms, 13 of which are single and two double—so 86 per cent. of its rooms are single, but only 76 per cent. of the places are in single rooms. The home thus falls below the standard.
The problem is not even ridiculous. The owner says that, if a double room is converted to a single room, the cost will be about £16,000 per annum. That is the hard money involved. And what about choice? A husband and wife who had been together for 50 years would have to be split up. Even if a room that could take two people were available, it could not be used because it would take the home below the standard 80 per cent. of places. The choice should be left with the residents whom the decisions will affect. Indeed, the proprietor of Greenbank says that we are talking about counsels of perfection. It is simply not possible to meet all the requirements.
The Salvation Army care homes in the London and south-east division also raise major concerns. The sheer costs of refurbishment and staffing to bring them up to 507 the new standards will only exacerbate what is already a bad situation caused by gaps in local authority funding. In the three care homes that the Salvation Army runs, it faces an estimated deficit of £340,000 for this financial year, and that is even before all the new regulations take effect. Of course, it will now be an offence to run a home that is not viable.
Refitting the Salvation Army's homes will make hundreds of thousands of pounds of new work necessary. The Salvation Army—like other care home owners to whom I have spoken, residents and the Conservative party—accepts that a Care Standards Act is, in principle, a good thing and that there is no possible objection to minimum standards. However, practicalities must be taken into account and sensible commonsense standards applied.
Probably worst hit of all are the religious orders, which now cannot even nurse their own members, because the standards cannot be met. Iden Manor in my constituency, which closed recently, was run by Roman Catholic nuns. They used to care for drug and alcohol-dependent women, a rare service to which it is not easy to find alternatives. As they told me when I visited them last weekend, they had to close because it was illegal to run a home that was not viable. With the new regulations and requirements, there was no earthly way their home would be viable.
Where will those women dependent on drugs and alcohol go now? It is not only the elderly who are affected by the present situation. It is a sad state of affairs when a devoted nursing order, which has run Iden Manor for years and years, to the huge benefit of individuals, has to close its doors simply because the physical requirements do not match up. That is God's work being destroyed by the wisdom of bureaucrats.
What is the answer to the problem, not least given that NHS beds, which are urgently needed, are occupied by people ready for discharge but who have nowhere to go? The Government should suspend the implementation of the minimum standards and follow our suggestions in the new clause 4 that we tabled when the 2000 Act was discussed. The Government rejected that new clause. At the time, we argued that while we accepted the need for minimum standards, we also needed to ensure that they did not become counter-productive. Therefore, we needed an extensive consultation period and then to subject all the standards to proper parliamentary scrutiny.
New clause 4 also suggested other safeguards to try to ensure that the minimum standards that would be imposed on those essential services would be reasonable and achievable, and that did the job of ensuring proper quality of care without making it impossible to provide that very care. The feeling in Kent, in Greenbank, Iden Manor, Hawkhurst Castle and other homes that are tottering on the brink but are not quite over it, is that the minimum standards as currently laid down—I have given the House only a selection tonight, because I could not go into full details if I wanted to hear the ministerial reply—spring from an Alice in Wonderland world in which the Mad Hatter rules. Sadly, the elderly, the sick and the vulnerable are the victims.
I ask the Minister today for the application of some common sense, before more care homes close, more residents have nowhere to go and more people are stuck 508 in hospital through no fault of their own, occupying desperately needed beds. We need sensible standards and proper funding for local authorities and, at the same time, a recognition that it is the care, love and attention received, and not the presence of a fixed screen and an en-suite lavatory, that decide whether someone is happy in old age,
§ The Minister of State, Department of Health (Jacqui Smith)I congratulate the right hon. Member for Maidstone and The Weald (Miss Widdecombe) on securing this debate on an issue that is. I agree, important and significant. She has rightly had much to say about the state of the care home sector in her area. I recognise that the care home market in Kent is not ideally balanced, and some care home owners remain under pressure to sustain viable businesses.
It is worth reminding ourselves of how we got to this position. It is important to remember that Kent, along with other parts of the country, experienced a significant, but unplanned and unmanaged, expansion in the independent care home sector as a result of the use of an uncapped Department of Social Security budget throughout the 1980s. That led to the unnecessary and completely avoidable admissions of many older people, and others, into institutional care. We are still dealing with that legacy of the 1980s.
Let me make it clear that I agree that some people will always need residential care, and we need to ensure that they get it, but the Opposition have been all too quick to scaremonger about a crisis in the care home sector. Care homes have always closed. What the Opposition choose to ignore is that new homes are opening and existing homes are expanding.
According to the independent care consultants, Laing and Buisson, there has been a drop of about 19,000 places since 1997. That is a far cry from the figure of 50,000 often bandied around by the Opposition, although I accept that the right hon. Lady did not quote it this evening. Once again, even within Kent, there is evidence of expansion in care homes. I understand that 25 care homes either received planning permission in the past year or are awaiting it so that they can extend their premises. The story is not all one way as the right hon. Lady would have us believe.
What matters, however, are not political number games but whether older people are getting the right care in the right place at the right time. The legacy that we inherited means that there are genuine concerns in the sector. We are addressing those by providing extra money, for which the right hon. Lady called, and by developing innovative new approaches to care.
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—an average real terms increase of more than 3 per cent. a year. That compares with an average annual real terms growth of only 0.1 per cent. per annum between 1992–93 and 1996–97 under the previous Government. The right hon. Lady outlined the issues on fees, but the build up of underfunding in our social services departments as a result of the level of funding provided when she was a Minister bears some responsibility for that.
509 The right hon. Lady can see the results of the Government's investment in her area. Kent county council's personal social services standard spending assessment increased by 4.9 per cent. this year following an increase of 5.7 per cent. in the previous year. We acknowledge the need for continuing investment in social services. That is why personal social services resources will increase, as my right hon. Friend the Chancellor announced, by an average of 6 per cent. a year in real terms over the next three years. That increase is a result of the Budget and the Finance Bill that Conservative Members have just voted against.
We listened to the concerns of local authorities and announced the £300 million building care capacity grant last year to address how we maintain capacity in long-term care, especially for older people. Kent received £2.1 million last year and £4.4 million this year from that grant. It has enabled Kent to improve on its target of a 25 per cent. reduction in delayed transfers from hospitals by using the funds in a variety of ways.
About half the grant has been used to uplift contract prices in the types of homes that the right hon. Lady mentioned, especially in localities where supply had been under the most acute pressure. I agree that it is important for the extra resources to be reflected in fee levels. However, I disagree about who has been prepared to will those extra resources into local authorities, and we should bear in mind who has voted against them. Local councils are also choosing to spend some of their additional money on fee increases for care homes, which in Kent amounts to an increase of £2.5 million for 2002–03. It has also committed £1.54 million to domiciliary care price increases. Those have largely been funded by the grant.
Although money is important, alone it is not enough. Local commissioning arrangements also need improving. That is precisely why my predecessor formed the strategic commission group, and why I continue to chair it. We have established a new and more positive partnership between the statutory and independent social care and housing sectors at a national level. This needs to be replicated at a local level. That is why we published the agreement "Building Capacity and Partnership in Care" last October. This guidance sets down how councils and their partners should work together.
Kent council has also heeded the advice of the joint review undertaken by the Audit Commission and the social services inspectorate between November 2000 and February 2001. The report, which was published in October 2001, encouraged Kent to develop more locally sensitive commissioning through consultation with precisely the providers that the right hon. Lady is concerned about. There is a need, especially in a council with 1.3 million residents, to balance carefully the allocation of resources to the different types of need.
In addition, the Department's change agents team is to provide further assistance to the local whole systems planning groups in Kent in getting the balance and composition of local services right. That is largely due to concerns expressed not least by my hon. Friends the Member for Chatham and Aylesford (Jonathan Shaw) and for South Thanet (Dr. Ladyman). They have expressed their concerns, along with their colleagues, about the position in Kent. They have taken up especially what the Government can do to support the commissioning that is necessary for older people.
510 The change agents team will also work at a regional level to analyse the structure of the market, and the trends that are evident. This will enable councils and their partners, working collaboratively, to make the appropriate decisions to ensure that the national standards for older people are achieved, and that independent living is a reality for those who wish it.
I move on to the issue of national care standards. It has always been the case—at least since 1984—that, rightly, care homes have been regulated. However, before the Care Standards Act 2000, they were regulated by 150 different authorities in a different way, often with different standards. There was confusion among users and their families, and there was confusion also among providers. That is why those providers were among some of the most vocal of those arguing for national minimum standards and for the National Care Standards Commission to enforce them.
I acknowledge that there is considerable concern and anxiety about the new care standards and how they will be enforced. Some care home providers are worried that the new standards will impose unreasonable and unsustainable costs on them and force them out of business. I shall shortly set out the action that the Government have already taken to ensure that that is not the case. However, such concern is not alleviated by hon. Members—the right hon. Lady is not alone in this—who choose to misrepresent the truth of what the standards mean. Misinformation is good neither for the older people and others who depend on care homes, nor for providers.
It is not the case that our standards prevent those who choose to share from sharing. Married couples would not be forced to separate. Existing homes do not have to have en suite bathrooms. The constant repetition of these claims by people who should know better and could read the facts which are set out in the national minimum standards does nothing to safeguard our care homes and does nothing to reassure our older people.
§ Miss WiddecombeThe Minister has said categorically that it is not necessary for people who want to share to be split up. How does Greenbank address the issue that the standards refer not to 80 per cent. of rooms but 80 per cent. of places? Unless it splits up the occupants of double rooms, it will not be able to meet that standard. Is the Minister saying that it need not bother?
§ Jacqui SmithThe answer is found precisely by recognising the right hon. Lady's concerns for a commonsense approach. Earlier this year—I wrote to hon. Members about this as well—I instructed the National Care Standards Commission to consider precisely those circumstances where the needs of older people in a home should take precedence over the type of environmental standards issues that the right hon. Lady raises. I have made it completely clear that the needs of older people should be considered when enforcing those standards. As the National Care Standards Commission itself made clear, those standards are not about closing good homes—that clarification was welcomed by care home representatives as a common-sense approach.
The right hon. Lady slipped in concerns about staffing. I must take issue with her, as it is not unacceptable for us to expect that the care homes that some of our most vulnerable older people live in should be staffed by people 511 trained to care for them. The right hon. Lady seemed to imply that it was unreasonable to expect that of staff caring for vulnerable people. It is a reasonable requirement which, once again, we are matching with extra resources to ensure that care home providers can access the necessary training.
Most responsible care home providers, as I have suggested, welcome the introduction of new national standards, which aim to protect the vulnerable in our society. We are determined to take a commonsense approach to those standards, and have already done so. Long-term care, however, is not just about care homes. Increasingly, older people want the choice of staying at home. Sometimes the emphasis on the concerns of care home providers has stopped us focusing on the choices of older people. We are giving them independence through alternative, more flexible forms of provision, such as extra care housing, and more intensive home care packages to keep people in their own homes longer.
We must aim to provide more of those modern alternatives, balancing them with good, effective, high-quality residential accommodation where necessary. It is a matter of getting the balance right for local communities. Investment from the Government has given Kent a massive increase in intensive home care packages—there was a 37 per cent. increase in households receiving them between September 2000 and September 2001. There is therefore a choice of support for older people.
Another alternative for older people is intermediate care, a new service providing an essential bridge between home and hospital, which is why we have made a 512 substantial investment in it. Good progress is being made on meeting the NHS plan targets. By the end of this year, compared with the baseline of 1999 to 2000, we shall have an additional 2,400 intermediate care beds; 6,200 non-residential intermediate care places; and 126,000 more people will be in receipt of intermediate care services. The 2003–04 target of an extra 1,700 non-residential places has already been exceeded. The hon. Lady called for more funding, on which there has been progress, with additional capital investment to fund intermediate care. On 6 March, we announced the allocation of the first phase of £46 million-worth of funding for 80 projects, with an increase of more than 1,300 beds. Further bids have since been approved and additional funds are still to be allocated. In Kent, the number of people receiving intermediate care services increased from 4,975 in 1999–2000 to 10,758 in 2001–02, which represents an increase in excess of 5,000 people having the services that they need to keep them out of hospital in the first place and gain fuller independence on discharge.
I therefore agree with the right hon. Lady that we need to take a commonsense approach to care homes and that we need to invest. The Government are doing so in the face of opposition from Conservative Members. We must ensure that we provide the resources needed to pay fees for residential care, but we must also provide the alternatives that older people themselves say that they want. We are accomplishing those goals and are steering away from the scaremongering that we have heard too often from Opposition Members.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes to Eight o'clock.