HL Deb 07 July 1999 vol 603 cc874-5

2.53 p.m.

Lord Laming asked Her Majesty's Government:

What are the responsibilities of local authorities for the continuing care of the elderly people they place in independently run residential homes.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)

My Lords, local authorities have an ongoing responsibility for people they support in residential care. We are aware, however, that local authorities do not always keep placements of older people under regular review. In our White Paper Modernising Social Services we have made it clear that when people are admitted to a care home case reviews should be carried out by the local authority within three months, and thereafter at least once a year.

Lord Laming

My Lords, I am grateful to the Minister for that helpful reply. Does she accept that local authorities have moved from being the dominant providers of residential care to being principally purchasers of care? That being so, does the Minister agree that it is important to remind local authorities that they have a continuing responsibility both to ensure that a placement is appropriate for the needs of the individual and of good quality, and also regularly to review an individual's needs, as these change over a period of time?

Baroness Hayman

My Lords, the noble Lord obviously speaks with a great deal of experience in this area. In 1990 policy guidance was issued to remind local authorities that they should review the needs of people in receipt of services, whether those services were provided by local authorities or commissioned by them. The noble Lord is right to point out that we should recognise that regular reviews offer benefits both for the individual and for the service as a whole. Under the fair access to care services initiative, we are taking steps to ensure that local authorities will be required to undertake regular reviews. We are consulting on the details at the moment and we intend to issue draft guidance to them in April 2000.

Baroness Gardner of Parkes

My Lords, what can be done to help those people who undertake to pay for their own care in a home—they may choose to do so because they want to be independent or they may do so for some other reason—but find after a time that they run out of money? As I am sure the Minister knows, these people find themselves in a difficult position because local authorities can be unwilling to accept responsibility for these people who have tried to be independent. Can the Minister say how we can make life simpler and more seamless for these people?

Baroness Hayman

My Lords, the responsibility to review care will apply to the care needs of all people, whether they are in local authority homes or in independent residential homes, when they are funded by a local authority. However, as the noble Baroness rightly points out, not everyone is funded by a local authority. The House has considered some of the problems that can arise in that situation, most recently when we considered the Statement that accompanied the report of the Royal Commission on long-term care. Some of the fundamental, underlying problems of the funding of long-term care have to be analysed in the context of that report.

Lord Clement-Jones

My Lords, what has been the fate of the report of the committee which looked into standards of residential care in homes for the elderly, which I believe was submitted to the department in January? Further, what progress has been made by the national beds inquiry into the whole issue of delayed discharge from acute beds into residential homes which has been caused by the lack of clear eligibility criteria?

Baroness Hayman

My Lords, the noble Lord, Lord Clement-Jones, pinpoints a number of areas. He is right to suggest that we have to make sure that we have in place proper hospital discharge policies that take into account both the need for adequate hospital care but also the need for adequate provision of non-hospital care when that is most appropriate to the needs of the individual. That entails co-operation and partnership between local authorities and health authorities. It also entails—I come back to the issue of reviews—ensuring that placements continue to be appropriate. I believe that the reviewing of a placement after three months is particularly important. We are interested in fostering independence. We have to consider whether placements—which are often allocated as the result of an emergency situation—are still appropriate or whether they might be more appropriate for others. We do not want placements to become permanent by default.

Earl Howe

My Lords, is the Minister aware that many independently run residential homes are being squeezed by government in two ways? On the one hand, they are constantly being told to raise their standards of care but, on the other, they are told by local authorities to accept below inflation levels of fee increases, notwithstanding nationally imposed pay increases for nursing staff that are well above inflation? Does the Minister acknowledge that this squeeze is placing many residential homes in a very difficult financial position indeed?

Baroness Hayman

My Lords, there are pressures on those providing services, whether in the public or the private sector. However, I do not think anyone would think it acceptable for us to abrogate responsibility for ensuring that standards in private placements are of an adequate quality, especially when—as the noble Lord, Lord Laming, reminded us—many of those placements are commissioned and paid for by local authorities.