HC Deb 23 July 2002 vol 389 cc869-84 4.46 pm
The Secretary of State for Health (Mr. Alan Milburn)

With permission, Mr. Deputy Speaker, I wish to make a statement on services for older people.

As the House will recall, the Budget made available substantial increases in funding, not only for the national health service, but for social services. In due course, I will outline how some of the major increases in resources for the health service will specifically assist older people. Today, I can outline to the House how older people will benefit from the extra resources for our country's social services.

Older people are the generation who created our great health and social services. They, above all others, deserve to get the best from them. The mark of any civilised society must surely be how it treats its most senior citizens. Labour Members take pride in the Government's commitment to help to secure dignity and security in old age. Increases in pensions make the average pensioner household £840 a year better off today than in 1997, and there is also special help to lift pensioners out of poverty.

It is for others in the House to explain their opposition to reductions in VAT on heating, extra winter fuel payments and free television licences, given that more than 11 million pensioners have been helped by those measures, which were introduced by the Labour Government. Eye tests are now free, whereas older people used to have to pay for them. Nursing care is now free for older people; they used to have to pay for that, as well. Breast screening is being extended to women aged over 65. Last year, the number of knee operations on older people rose by 7 per cent., cataract operations by 11 per cent., and heart operations by 13 per cent.

None the less, there is much more to do to provide services that genuinely offer security, promote independence and widen choice for older people. Ours is an ageing society. We should not fear that—in my view, it is something that we should celebrate—but it means that our public services must now rise to the challenge of delivering better, faster care with higher standards for older people. Indeed, securing improvements in older people's care is one of the key priorities of our 10-year NHS plan. Today, I can announce how we intend to take that commitment forward.

Social services have for too long been the poor relation to health services. Between 1992 and 1997, real-terms funding for social services rose by only 0.1 per cent. a year. Today. it is rising by 3 per cent. a year, and from next April that rate of growth will double to an average of 6 per cent. a year above inflation. I can confirm today that older people will be the principal beneficiaries not only of those extra resources, but of the reforms that we are introducing to secure improvements in social care, working with our colleagues in local government, the private sector and the voluntary sector.

By 2006, compared with the resources available today we will provide an extra £1 billion a year in real terms for social services for older people. Reform will be required to get the best from these extra resources. The extra £1 billion—combined with the reforms that we will make—must guarantee for older people not more of the same but faster access to a wider range of services, offering older people greater choice.

First, we will guarantee older people faster assessment of their needs. Reforms are already in train to bring local health and social services together and to ensure that they provide a single seamless assessment process. Older people, above all others, need a one-care system, not competing care systems. Older people also need faster assessment. Some councils currently delay assessments for older people for up to nine months. That is completely unacceptable. I can tell the House today that by the end of 2004, all assessments will begin within 48 hours and will be complete within one month. Following assessment, the services to older people in need will be in place within one month. All equipment needed to help people live independently in their own homes will be provided within just one week.

These shorter waiting times will be accompanied by major reforms to ensure that older people are able to leave hospital when they are ready to do so. To accompany these extra financial resources, which will increase capacity in all aspects of older people's care, local authorities will gain the financial responsibility for older people once they are ready to leave hospital. I can tell the House that we intend, subject to legislation, to introduce this reform by April next year.

Secondly, there will be more support to help more people who need care in residential and nursing homes. For many frail or disabled older people, care homes—thanks to the efforts of care home staff—offer the best security and support. The size of the care home market peaked in the mid-1990s. Since then, it is true that the boom in the property market—especially in the south of England—combined with low increases in fee levels paid by local authorities, has led to a fall in the number of care homes beds. Laing and Buisson, perhaps the foremost analyst of the care home market, says that ideally occupancy levels in care homes should be at about 90 per cent. It estimates that occupancy levels are now running at about 91 per cent., suggesting that a modest increase in bed numbers from current levels is what is needed. We will now plan to increase the number of care home places supported by local councils.

Since last November, when we made available an extra £300 million to social services, fee levels have risen—by up to 10 per cent. in some parts of the country. The resources that we are providing from April next year will allow local councils to pay higher fees still if that is what is needed to stabilise their local care home market.

Greater stability must be accompanied by higher standards. That is what care home providers called for and, indeed, it is what the Care Standards Act 2000 enshrines. For the first time, clear national standards are in place, but we always said that we would keep the new standards under review.

The size of rooms and doors, the availability of single rooms and the number of lifts and baths are important, but they should not mean good local care homes having to close. We will therefore shortly issue for consultation an amended set of environmental standards to remove them as a requirement on existing homes, instead making it clear that they are good practice to which all care homes should aspire. We will require care homes to spell out whether they do or do not meet those standards and let those who are choosing homes make an informed choice for themselves.

Other standards—for example, those covering qualified staff—make a greater contribution to the quality of care provided for older people. I can therefore tell the House that we will make £70 million available by 2006—ring-fenced—to support training for social care staff, most of whom currently do not have a qualification, and many of whom are employed in the care home sector.

Thirdly, we will guarantee greater choice for older people in the services that they receive. Care homes are a good option for some older people, but not for all. They are not, and must not become, the be all and end all of elderly care services in our country. Our objective is to broaden the spectrum of services available for older people to widen choice and promote independence.

To enable local councils to provide more rehabilitation services, we will earmark resources to ensure an extra 70,000 older people a year get those services to avoid them going into hospital unnecessarily or to help them leave hospital speedily when it is safe for them to do so. I can tell the House today that I intend to legislate to ensure that those and intermediate care services will be free whether they are provided by the health service or, indeed, by social services.

We will also invest in new models of supported care for older people. We will therefore resource a 50 per cent. increase over the 1997 total in the number of extra-care housing places—very sheltered accommodation—available for older people, and we will work with local authorities, housing associations and others to bring that about.

Fourthly, more older people will get the support that they need to continue to live in their own homes if they choose to do so. The choice that too many older people have faced in the past is between going into care homes or struggling on in their own homes. Just like everyone else, older people want to remain as independent as possible for as long as possible. As a result of the investment that I am announcing today, by 2005 there will be twice as many older people receiving the intensive help that they need to live at home than there were in 1995.

Charges are currently made for community equipment, such as hand rails or hoists, which can make the difference between older people becoming dependent or remaining independent in their own homes. So I can tell the House today that—again, subject to legislation—from April next year, I plan to remove those charges altogether. Through ring-fenced funding, up to 500,000 extra pieces of community equipment will be provided free of charge to an estimated 250,000 more older people.

Fifthly, older people will be given a direct choice over their own care. Direct payments have already given younger disabled people the chance to spend for themselves the resources that they are assessed as needing. Now, in line with our manifesto commitment, I can tell the House that we will make it an obligation on every local authority, for the first time, to offer older people access to direct payments. Every older person assessed as being in need of care—whether for rehabilitation after a hip operation, or for a bit of help with household chores—will be given the choice of receiving a service or, instead, receiving a cash payment to purchase care for themselves that better suits their individual needs.

We will work with older people's organisations to make that choice a reality for tens of thousands of older people. I believe that that reform will empower older people, their families and their carers in a way that has never been possible before. Direct payments will give older people direct choices over the services that they receive.

Finally, many older people rely on more informal care from their family, their friends or their neighbours. Without the millions of carers in our country the services provided by the NHS or local councils simply could not do their job. In my view, the whole country owes our community of carers an enormous debt of gratitude. They are living proof that there is such a thing as society.

In recent years, we have provided more help to carers. Now we plan to build on that. So I can tell the House that I intend to more than double the carers grant to £185 million by 2006. As a result 130,000 additional carers will get help not just with short breaks through respite care, but with the extended care that they need so that they can continue caring. Carers put so much into the community, so it is right that they should get something back.

That is a major package of investment and reform to the services older people receive. The proposed new independent commission for social care inspection will be responsible for ensuring that councils in every part of the country deliver for older people. I can inform the House that the new commission will start operating in shadow form by the end of this year, so that it can inspect and audit how those extra resources are being used. The councils that do best will get more freedoms and greater rewards. There will be intervention for those that fail.

Those reforms and those resources will increase capacity to make choice a reality for hundreds of thousands of older people. There will be more places in care homes and sheltered housing. There will be more intermediate care services. Crucially, there will be more support for older people to live at home and for their carers. More older people will be able to gain access to more services and exercise more choice.

Increasing choice for older people is possible only because of the choice that this Government have made to put sustained levels of investment into our health and social services. As Labour Members, we know that resources plus reforms deliver results.

Our commitment is to deliver for this generation of older people and future ones. It is for those who oppose both the investment and the reforms to explain now how they would go about delivering dignity and security in old age. For our part, the emphasis must now be on helping more older people to live more independently for more of the time. When these reforms are fully implemented, there will be a greater proportion of older people being cared for at home than there is now.

After all, that is the choice most older people say they would prefer. That is what older people have every right to expect. It is what we intend to deliver. I commend the proposals to the House.

Dr. Liam Fox (Woodspring)

I am grateful to the Secretary of State for his statement, and for making a copy available in advance. As ever, the statement is strong on rhetoric and well-delivered, but lacking in substance. It is largely a set of re-announcements and U-turns and seems to be timed more to avoid embarrassing headlines generated by tomorrow's report from the Select Committee on Health than anything else. It is more about managing news than managing patients.

The statement is a wish list that rings hollow when compared with the Government's record. It is littered with some real gems. We heard that "Nursing care is now free for older people"; try telling that to our constituents up and down the country. The Government might be making a contribution, but care is anything but free. We were told that "We need to stabilise the care home market"; what an incredible statement from the Secretary of State. We have been telling him that for the past three years. It is his failure to listen not only to the official Opposition and other parties, but to those involved in the care home industry that has led to the loss of more than 60,000 care home places. It is a failure entirely of the Government's own making. As patients are discharged too quickly from our hospitals to relieve the bed-blocking crisis, the number of re-admissions within 28 days is rocketing. It is a revolving-door policy for our elderly people—some dignity or security that provides.

As the number of blocked beds rises, the number of cancelled operations is going up, many of which were intended for elderly patients—some dignity or security. Perhaps the Secretary of State can tell us how many of the 100,000 extra admissions to accident and emergency departments in the past two quarters have been elderly patients denied dignity and security as a result of the Government's failure.

When the Secretary of State has the gall to stand up and say that the size of rooms and doors is important but should not mean good local care homes having to close, I have to ask where he has been for the past three years. It is too late for many homes, which have already closed as a result of the very legislation and regulations that the Government brought in. They are now telling us that they will have another look at the matter and that they will have a more flexible approach. That is too late for many homes. The damage has been done, just as the damage has been done to the security and dignity of many older people in those homes.

It is wonderful what the Secretary of State believes now, but it was not what he believed when the Care Standards Act 2000 was being rammed through both Houses of Parliament. The only word missing today was sorry. Today, he has talked about the quality of care given by care homes, but only recently he was talking about people being "banged up" in care homes. The rhetoric is different today.

We heard the right hon. Gentleman's interesting pledges on equipment, but we have heard them before. When the Audit Commission produced its report on equipment provision in March 2000, the Secretary of State said: It paints a very stark picture of frankly a second-rate service in some parts of the country. What we have to do now is ensure that the Audit Commission's recommendations are actioned in every part of the health service. Of course, it became "a priority" for the Government to improve the service. We have just had the Audit Commission's follow-up to that report. After the Government making it a priority and such an important part of their programme, the Audit Commission found that users continue to report long delays for equipment of dubious quality … many who could benefit from equipment services are excluded by stringent eligibility criteria … waiting times for some equipment is up to six years … a mood of despondency is common among managers running equipment services … no progress has been made in integrating mobility services, leaving the wheelchair and orthotics services marginalised. [Interruption.] The Government Chief Whip says that there was no money. Why was there no money if it was a Government priority to improve those services? They have been in office for five years and it has been a priority in their programme for two years. They promise so much and deliver so little.

What the Government have said about domiciliary care is unbelievable. Of course, Conservative Members welcome the introduction of what will effectively be care vouchers, which the Secretary of State mentioned today. He has, however, a stark reality to confront. When the Government came to office, 479,000 people were receiving domiciliary care. That figure has now plummeted to fewer than 400,000 in the last year. The number of people receiving care has therefore gone down dramatically under the Government's domiciliary care programme, and the shortage of capacity will limit any plans that the Government may have.

Where are all these extra care workers to come from? How will they be employed? Has the Secretary of State actually tried to find a carer for an elderly relative recently? Has he tried to find respite care? Where are these people to come from? Are they to be plucked from the carers' tree, or bought from the carers' supermarket? How are we going to attract people into these jobs? Who will carry out the assessments that the right hon. Gentleman mentioned? How many extra staff will be required for that? Who will initiate the assessments? How will urgency be accommodated within a guaranteed time?

This is certainly not good enough. The Government are making promises yet again, even though they have not kept them in the past. The good points in the proposals are those that abandon Government policy and make U-turns. This is the initiative du jour, and the elderly will see through it for the sham that it is.

Mr. Milburn

I was pleased that the hon. Gentleman was grateful for getting a copy of the statement in advance. I was even more grateful for getting a copy of his press release in advance. In fact, I got a copy of his press release even before he got a copy of my statement. Perhaps it is not surprising that he has remained on the Tory Front Bench, with such extraordinary powers of extra-sensory perception.

The hon. Gentleman said that this was a wish list for older people. It is actually a delivery list for older people. He said that the number of people being delayed from discharge from hospital was rising. That is not true; it is falling. He said that the number of cancelled operations was rising. It is not; it is falling. He said that the number of people being helped to live at home by social services was falling; it is, in fact, rising.

On the issue of community equipment, the hon. Gentleman continually bleats about the lack of provision of services yet he is never prepared to commit the necessary extra resources and earmark them for the purpose for which they are needed. That is precisely what we are doing with community equipment. One of his hon. Friends asked earlier from a sedentary position whether much of this money was earmarked. Yes, it is. Two thirds of this £1 billion package for older people is ring-fenced and earmarked specifically for the purposes that I have outlined today. The hon. Gentleman is opposed not only to investment but to the earmarking of investment. He wants to see extra resources going in somehow, but I am afraid that the invisible hand of the market will not deliver extra handrails. extra support, extra care home places, more intermediate care, or more domiciliary care. Those are provided only because of the investment that we are making. The hon. Gentleman's problem relates not just to what the Conservatives did when they were in government but to what he is saying while they are in opposition, and to their abject failure to match either our investment or our programme of reform.

Does anyone seriously believe that the Conservatives who landed pensioners with more poverty, VAT on fuel, and charges for eye tests that used to be free, have somehow been regenerated and reborn as today's caring, compassionate Conservatives—the sort of Conservatives you could take home to meet your mother without fear of her being mis-sold a pension? Nobody believes that, not even the hon. Gentleman. We know that public services, social services and elderly care services need both resources and reform, and that is what we are committed to delivering. The problem for the hon. Gentleman is that he cannot commit to either.

Mr. David Hinchliffe (Wakefield)

By a strange coincidence, the Health Committee is delivering at midnight a report that has direct relevance to the statement made by my right hon. Friend this afternoon. Obviously, I am precluded from referring to the conclusions of the report, but I can refer to evidence that is in the public arena. I was struck by the evidence from a particular witness, who suggested that the entire debate on the care of older people has been hijacked by the interests of the private care home sector.

I have listened carefully to my right hon, Friend's statement, and he is clearly setting out an agenda to move away from dependence on residential and institutional care. I welcome that, but I would also welcome a commitment that he will work with the private care sector to encourage it to move away from the outdated institutional models of care that countries such as Denmark abandoned many years ago.

Mr. Milburn

As always, I pay heed to what my hon. Friend says—as Chairman of the Select Committee on Health, and as a friend of mine. His comments make perfect sense. It is obvious that, at some point in their lives, some older people may well need residential or nursing care in a care home. Some may require supported or sheltered housing, and others may require intermediate care. However, survey after survey has shown one simple thing about older people's needs and desires: they want to live as independently as possible for as long as possible. Surely, we have got to get the pendulum swinging in the right direction. That means moving away from institutional forms of care, wherever they are provided, towards a new emphasis on more individualised forms of care that support people for as long as possible in their own homes.

A moment or two ago, the hon. Member for Woodspring (Dr. Fox) described these measures as a series of re-announcements, but real money backed by real reforms means that, for the first time—certainly since my Department has collected such figures—the number of elderly people supported by social services will rise to more than 1 million. The proportion of older people cared for in their own homes will also rise. That is getting the pendulum swinging in precisely the right direction. The hon. Gentleman is right to say that, to deliver these changes and resources, we need to work in concert not just with our friends and colleagues in local government and the voluntary sector, but with the private sector too. That is precisely what we will do, but let there be no doubt: the direction is now firmly towards more individualised care, and less institutionalised care.

Mr. Paul Burstow (Sutton and Cheam)

I thank the Secretary of State for giving us an advance copy of today's statement. The Liberal Democrats certainly welcome the extension of direct payments, putting cash into people's hands so that they can buy for themselves the care that they think that they need most. However, will he ensure that those who organise the purchasing of their care in the independent sector do not then find that a VAT bill has been slapped on top, and that the money given therefore goes back to the Treasury? Will he also consider ensuring that direct payments are made to those currently in nursing homes or care homes? They expected a reduction in their fees to reflect the fact that they were receiving free nursing care, but that has not happened. Will he therefore create a direct payment scheme to ensure that they get the money themselves, rather than passing it on through care home owners?

In his statement, the Secretary of State described giving councils a financial responsibility for delayed discharge as if it were some form of new privilege. Is there not a danger that, rather than delivering better care, the culture of mutual blame and buck passing between the NHS and social services will be reinforced, with patients being yet further victimised as they become parcels bundled between the two? Does the Secretary of State share the concern that the Government's over-concentration on delayed discharge is leading to a rise in the numbers discharged prematurely, only to be re-admitted as emergencies? Can he confirm that the targets set for emergency re-admissions in the implementation programme for the NHS plan have been comprehensively missed, and that a growing number of elderly people are turning up in accident and emergency departments just days after their discharge?

Carers are the backbone of our care system. Given that the oldest carers tend to have cared for the longest time—and often at the greatest cost to their own health—will the Secretary of State offer carers a direct payment to enable them to purchase respite care for themselves, rather than running the risk of those payments being held up by social services departments that are ill able to pay for such care? Does he accept the findings of the Rowntree report, "Calculating A Fair Price for Care", which points out that there is a £1 billion black hole in the finances of the care home sector? Given that the latest figures from Laing and Buisson show that a further 13,100 beds have been lost in the last year alone, just when will the free fall in the care market end? When will the Government take the actions that are necessary to stop it?

The Secretary of State made much of the extra places that would be available in care homes. His own Department's figures show that 109,900 fewer people are receiving home care today than five years ago. Is that because cash-strapped social service departments have been shifting the goal posts, disqualifying the frail elderly and casting them out because they can no longer afford to provide the care that those people need?

The Secretary of State has told us that there will be real-terms growth in the future, but in the first three years of the Labour Administration there was a real-terms reduction in funds for social care. There is a huge legacy of underfunding to be made good. Will the Secretary of State say a little more about the baseline for his spending plans? Is he assuming that the extra services he has announced today will receive funds on top of the £1 billion that local authorities already spend in excess of what the Government consider necessary for social services?

The Conservative party has rightly identified over-regulation in the care homes sector as an issue, but the key issue was underfunding of the sector, and today's statement did not address that. What the Government have done is say that they are prepared to trade off the vulnerable young—not to give them the resources necessary for their protection—in return for looking after the elderly better, and giving them dignity. Such a trade-off should not be accepted.

Mr. Milburn

I suppose that that counts as a warm welcome for the package of measures for older people.

It is nonsense to suggest that just because we provide extra support for older people, we cannot provide extra support for working-age adults or indeed children. As I said at the outset, we will announce further measures in due course, and further resources for precisely those groups who need help from social services. The hon. Gentleman will find that for them, too, extra investment is being made and reforms are being introduced. I know that he opposes those reforms, but he will note that the overall volume of care is increasing dramatically.

When the hon. Gentleman spoke of the number of older people being helped to live at home, he was counting a partial figure. He was counting people who receive some form of home help and some form of personal care. He was not counting those who receive, for instance, meals on wheels or community equipment assistance. The hon. Member for East Worthing and Shoreham (Tim Loughton) smiles, but for literally tens of thousands of older people, that means the difference between independence and dependence. The number of people receiving support of that kind from local authorities is not falling but rising, and it is set to go on rising as a consequence of the extra resources being provided.

The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether direct payments would be made to carers. Yes, they will. We will consult in August on changes to regulations on such payments, and we intend the new regulations to be in place by the end of the year. He is welcome to respond to the consultation, and of course we shall listen to what he has to say.

The hon. Gentleman commented on the reform contained in the package. I know what he wants: he wants to snaffle the resources, but he does not want any reform. For older people, that will mean more of the same. Not a single older person whom I have met—and probably not a single older person whom the hon. Gentleman has met—wants more of the same. Older people want change in the services delivered to them. They want more power, more say, more direct control and a wider spectrum of choice. Of course they want a working partnership between the health service and social services, but partnership is a fudge unless it is clear who takes responsibility for each aspect of an older person's care, and that is precisely what we will make clear.

As always, the Liberals bleat nationally about shortages of resources, but the story is rather different when it comes to the position locally. When, before the last local election, I visited Liverpool—whose council was controlled by the Liberal Democrats—what was planned then was not increases in services or resources for vulnerable older people, but cuts in those services and resources.

As always, the Liberal Democrats tell one group of people one thing, and another audience another. In fact, the hon. Member for Oxford, West and Abingdon (Dr. Harris) says different things to the same audience. That is the Liberal Democrats—no more believable than their friends on the Conservative Front Bench.

Mrs. Anne Campbell (Cambridge)

I warmly welcome today's statement by my right hon. Friend, and especially those measures that will enable elderly people to stay in their homes longer. However, will he look carefully at areas such as mine, where housing costs are high and unemployment is low? The supermarkets can always afford to pay more than social services departments, which is causing real recruitment problems. That will not change if people try to recruit help through direct payments. Will my right hon. Friend see whether extra help can be made available for areas such as mine?

Mr. Milburn

It is very important to get the resources to the right parts of the country. As my hon. Friend knows, proposals already exist for redistributing resources within local government, and there will soon be proposals for redistributing resources in the NHS. However, pay rates are not a matter for me but for negotiation between local authorities and the trade unions.

Mr. Anthony Steen (Totnes)

I have difficulty in understanding how any hon. Member can disagree with the spirit and sentiments of what the Secretary of State has announced. Problems of detail remain, and it is right for my Front-Bench colleagues to mention matters of concern, but the general spirit of the statement must be right.

I draw the Secretary of State's attention to the problem in Devon. There, elderly and frail people who are homebound have a supply of deep-frozen food delivered every month, which they cook in a microwave supplied by the authority. They are like homebound Boy Scouts, or participants in an outward bound scheme. Every 28 days, another crate of deep-frozen food arrives. The idea of hot meals on wheels is disappearing, as are chiropody or home help services. The elderly people involved are going into residential care prematurely.

The Secretary of State says that he will ring-fence the package that he is offering, but is he aware that the Government have ring-fenced rumble strips, road widening and traffic humps, but not social services? As a result, money is going to pay for humps and road widening, but not for hot meals.

Mr. Milburn

I am grateful to the hon. Gentleman for his welcome to the announcement. The £1 billion that will go into social services for older people is a real-terms figure, not just a cash figure. I think that I am right in saying that, of that, some £650 million will be ring-fenced for specific purposes, with a strong emphasis on ensuring that there are appropriate home-care services for older people. I cannot comment on the position in Devon, but in general it must be right that older people being cared for at home get an appropriate range of services. I hope that the package of measures that I have announced will help people to receive precisely that.

Mr. Peter Pike (Burnley)

My right hon. Gentleman has announced a very welcome package this afternoon, but severe problems can arise when elderly disabled people living in two-tier counties—where there are both shire and district councils—need adaptations made to their homes. Can we iron out such problems? In Lancashire, there has been a major consultation exercise about care homes, and a decision is imminent. Should not that decision, which is for the county council to finalise, be deferred, so that close consideration can be given to the many important announcements that my right hon. Friend has made today?

Mr. Milburn

My hon. Friend is tempting me astray, and I want to avoid that at all costs. As he said, the decision is the county council's responsibility, but the Minister of State for Health, my hon. Friend the Member for Redditch (Jacqui Smith), is keeping a close eye on the situation in Lancashire.

My hon. Friend the Member for Burnley (Mr. Pike) makes an important point about the relationship between district councils and county councils. I understand the problem, as my area of Darlington suffered from precisely those difficulties before it became a unitary authority. It is incumbent on all parties involved, especially when they are of the same political persuasion—and I do not know whether that is the case in Lancashire—to sit around a table with their partners in the private and voluntary sectors and work the problems through. In that way they can ensure that no institutional barriers, of any size or shape, stand in the way of older people getting precisely those seamless services that they need.

Mrs. Angela Browning (Tiverton and Honiton)

The Secretary of State has announced a range of measures today relating to, for example, equipment, support for carers, support for people at home and for those going into residential care. What plans has he to make any changes to the means-testing that affects all those measures?

Mr. Milburn

As I said in my statement, overall there will not be changes to the means test. I think that the hon. Lady is aware that we issued guidance in November last year about domiciliary care services, suggesting new guidance to local authorities. However, one aspect of the means test is about to disappear altogether—again, subject to legislation—and that is charging for community equipment. The hon. Lady will be aware from her constituency, as I am from mine, that as well as having a long wait for assessment and for getting equipment, older people often face a charge for it. The equipment can be simple, like a pressure mattress, a hoist, a minor ramp or even help with toileting. If imposing those charges deters more older people from being cared for at home, we must address that.

Let me give the hon. Lady a gentle warning. It is all very well and good for Conservative Back-Bench Members to give long wish lists of improvements they want to see. They cannot have the wish lists unless they are prepared to commit the necessary investment.

Glenda Jackson (Hampstead and Highgate)

I congratulate my right hon. Friend and warmly welcome his statement. On direct payments, will individuals be precluded from selecting from whom they wish to buy services? Many of my constituents from the ethnic minorities live in extended families where no one person cares for elderly parents and no one is registered as a carer as such. Will it be possible for them to obtain the direct payment, which would be of enormous benefit?

Mr. Milburn

Yes, in those circumstances, they can. We know that where the direct payment system has been implemented, it has worked. It has not meant that local authorities incur more costs than they do in providing a mainstream service. Disabled people who have a direct payment have chosen to appoint a personal helper from a variety of places and have been able to tailor the care that they need to their own circumstances. That seems to be the right principle.

We are moving towards a care system, I hope in both health and social services, in which the needs of the individual come first. The system is designed around the needs and comforts of the individual rather than the individual always having to fit around the needs of the service.

Dr. Vincent Cable (Twickenham)

Since it is essential to maintain public confidence in private care homes, can the Secretary of State explain why his Department is blocking the release of an independent inquiry into Lynde house in my constituency, which is owned by the leading private provider, Westminster Health Care? Given that I wrote to him about that six weeks ago as a matter of urgency, why have I still not had a reply?

Mr. Milburn

I do not know about the individual details but I am informed by my hon. Friend the Minister of State that she intends to write to the hon. Gentleman shortly.

Mrs. Ann Cryer (Keighley)

I agree with everything that my right hon. Friend has said. The majority of elderly people do not want to go into care if they can manage to stay at home, because home is where their memories and friends are. From what I have seen of my own relatives, sometimes when an elderly person is released from hospital, a care package is set up. Unfortunately, however, social services departments often do not have the time to check that the arrangements are carried out satisfactorily. The service provided could be the delivery of meals or it could be someone getting an elderly person up in the morning and putting her to bed in the evening, doing the cleaning, ironing or laundry. No check is carried out on such arrangements until someone such as myself telephones and moans about something.

Mr. Milburn

My hon. Friend makes an important point. It often happens, day in, day out, that there are good intentions on the part of those concerned, but unfortunately those intentions are not always carried through. That means that we need a better system for assessing need and then implementing the services that arise from that assessment.

None of this stuff is glamorous, but it is hugely important to literally hundreds of thousands of older people. We do not want to have an endless procession of professionals—the health visitor, the GP, the district nurse, followed by the social worker and others—trailing to the older person's door. We need one single assessment process, so that the older person's needs are assessed holistically at the point at which they enter the care system, a clear decision is taken as fast as possible, and then the services are put in place. That is what we intend to do.

As my hon. Friend well knows, none of that comes for free. It is useless to pretend that we can reform the system without investing in it, and that is the problem for Conservative Members. What they want, if they would—

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. I have let the right hon. Gentleman go on to subjects that Mr. Speaker has taken a restrictive view on in the past. The right hon. Gentleman is also lengthening his answers when other hon. Members are trying to speak.

Mr. Andrew Mitchell (Sutton Coldfield)

Does the Secretary of State accept that his statement this afternoon will have been listened to with particular interest in Birmingham, and that there is huge cross-party concern that Birmingham's social services are in chaos? Will he give the House an undertaking that he and his Ministers will follow very closely what Birmingham social services do to pursue the laudable objectives that he has set out tonight? If he finds that they do not pursue them in the way that all of us would expect them to, will he and his Ministers intervene directly, either by using the powers that they already have from this House or by taking the additional powers that they need to ensure that Birmingham social services deliver a decent service to elderly and vulnerable people, which they are not doing at the moment?

Mr. Milburn

Yes, of course we will keep under active review our monitoring of social services in Birmingham. That is what we are doing and we shall continue to do it. I think that the hon. Gentleman is aware that, as a consequence of that active monitoring, extra resources have been found for the social services in Birmingham, which I am sure that he will welcome. I do not want to incur your wrath any further, Mr. Deputy Speaker, but the problem for the hon. Gentleman is that he cannot commit to the resources.

James Purnell (Stalybridge and Hyde)

May I draw my right hon. Friend's attention to the efforts that have been made in Tameside, where the hospital, the social services and the mental health trust agreed a long time ago to pool staff and resources so as to create a one-stop shop for older people? Will he consider the fact that that has increased and improved services available to older people? Is not that the type of bottom-up reform that we should be trying to encourage, and will he reassure me that this money, which is very welcome, will be aimed at the reformers and not just at bailing out the under-performers?

Mr. Milburn

My hon. Friend is absolutely right. Throughout the country, the examples are now legion of much-improved co-operation between the health service and social services. That has come about because we have provided the legal vehicles to enable the local authorities that want to co-operate and the health services that want to co-operate to do so, whether they are pooling budgets or establishing care trusts.

My hon. Friend is right that we must ensure that we get the best use of the money by ensuring that there is greater, not less, co-operation between health and social care. Why? For the very simple reason that the older person who by and large needs the health service will very often also need the support of social services or indeed housing services, and we need to see all these public services working together.

Rev. Martin Smyth (Belfast, South)

The Minister will be aware that South and East Belfast HSS trust has developed a very fine partnership, which allows both domiciliary care and respite care for the elderly. I welcome the further advance in his statement today, because I remember the days when a young woman whom I can think of, who worked in the city hospital laboratory, had to pay superannuation while she went out to look after her mother. Caring for carers is important.

The right hon. Gentleman mentioned assessment. Can he assure the House that there are enough occupational therapists in the country to do the assessments in adequate time, thus encouraging the providers of the equipment and those who make adjustments to houses to get on with the work much earlier than they have been doing?

Mr. Milburn

I agree with the hon. Gentleman on both counts. On the model of care, Northern Ireland has had the distinct advantage for many years of combined health and social services. As he is aware, we are moving towards that in England and we need much more of it. He rightly made a point about the number of people needed to staff social care services for older people. There too, there is good news. For example, the number of physiotherapists entering training has increased by 62 per cent. since 1997 and the number of occupational therapists has increased by 63 per cent. and there are increases in the number of staff employed. As he is aware, that is partly about ensuring attractive careers for those people, but also about ensuring that there are adequate resources for the services that they provide.

Ms Meg Munn (Sheffield, Heeley)

I welcome my right hon. Friend's statement, which set out a range of services that will ensure that most elderly people can stay at home, where they want to be, rather than go into residential or nursing care. I welcome in particular the statement on the speed of assessments for equipment and the provision of equipment. Can my right hon. Friend tell me whether that includes minor adaptations to people's homes, which can often be crucial to ensuring that they get home quickly?

Mr. Milburn

My hon. Friend speaks with real knowledge of these issues from her previous occupation outside the House. As she is aware, there are basically two strands of resources: community equipment grants, which we are going to enhance as I described and, for larger adaptations such as ramps or walk-in showers, the disabled facilities grant, which is operated by the Office of the Deputy Prime Minister. There too, there is good news, because the resources committed to the disabled facilities grant are, or will be, 50 per cent. higher, I think, in the next financial year than they were in 1998–99. She is right to issue a note of caution that we need a greater alignment between the resources available for small pieces of equipment and more major adaptations to housing. I can assure her that my hon. Friend the Minister and I will discuss those issues with colleagues.

Mr. Elfyn Llwyd (Meirionnydd Nant Conwy)

The Secretary of State said that one care system was required, not competing systems, and I welcome what he said about intermediate care services being free, whether they are provided by the health service or social services. That principle being established, will some thought be given to those people who require long-term care?

Mr. Milburn

I know the hon. Gentleman's position and that of the Welsh National party on this matter. We studied the issues around personal care at the time of the Sutherland commission and my right hon. Friend the Chancellor and I did so again in the lead-up to the Budget. In the end, we decided that that was not the right way forward for a simple reason: if we went down the personal care route, it would involve spending substantial extra public resources on the minority of better-off pensioners. Perhaps that is what the hon. Gentleman and his hon. Friend the Member for Banff and Buchan (Mr. Salmond) want to achieve; I want to commit those resources to more services for more older people, in particular for poorer older people.

Mr. Hilton Dawson (Lancaster and Wyre)

I commend my right hon. Friend for the good sense and compassion of his statement—allied to investment and modernisation, that is four ways in which the Labour party differs from the Opposition. In welcoming his response to the question about Lancashire, will he agree that this statement offers the opportunity for the private sector to develop services creatively in partnership with local authorities? It certainly gives organisations such as the Lancashire Care Association the opportunity to refrain from the very destructive industrial action that they have in effect been taking over their care home fees and to come together to create a much better service for elderly people.

Mr. Milburn

I think that I had better keep out of that particular local dispute. In general, my hon. Friend is right. As he is aware, it is a condition of the building capacity grant that we issued in November 2001 not only that this money should be spent wisely—the £300 million—but that in addition it should foster much closer co-operation between local authorities and between those authorities and the independent sector, including the private and the voluntary sectors. That is precisely what we would expect to see, not only in his part of the country, but in every part of it.

Mr. James Paice (South-East Cambridgeshire)

The Secretary of State has bandied about a number of figures: thousands of people will gain; 70,000 would receive some free services and tens of thousands more would receive direct payments. Can he be more specific? Precisely who will receive that assistance, particularly direct payments? If he is not going to alter means-testing levels, can he be more precise? Who will not be entitled to direct payments?

Mr. Milburn

I thought that the hon. Gentleman was here when I made my statement but that might have been in body rather than in spirit. I said that henceforth every single elderly person who is assessed as part of the reformed, faster assessment process that I described will be offered the choice of a direct payment. In terms of the number of people offered that choice, that is liable to run into many hundreds of thousands.

I personally think that that is a good thing, not a bad thing. I want to empower older people. People should not be just passive recipients of services. They should have the choice and ability to shape services for themselves. I cannot think of a better way in social care services than direct payments. There will be direct payments on offer for all. Of course it is for the elderly person, their carers and families to decide whether to take advantage of that.

The hon. Gentleman asked how many other people would benefit from the package of measures that I have outlined. In terms of the number of households receiving intensive home care support, an extra 30,000 will benefit. In terms of extra rehabilitation services, an extra 70,000 will benefit. In terms of the number of people who are supported in residential and nursing care homes, it will run into several thousands.

Overall, this package of measures will benefit approximately 440,000 people. On top of that, it will benefit the 230,000 old people who are currently supported in the care homes sector. That is because we have committed the investment. The issue for the hon. Gentleman is whether he or his Front-Bench team are prepared to match it.

Several hon. Members

rose—

Mr. Deputy Speaker

Order. We must now move on.