§ Motion made, and Question proposed, That the sitting be now adjourned.—[Jacqui Smith.]
9.30 am§ Mr. Gordon Prentice (Pendle)I welcome the fact that I have been given this opportunity to raise a matter of huge interest to my constituents in Pendle and to the wider public in Lancashire. It is the proposed closure of a large number of residential homes run by Lancashire county council. I shall not speak for long because I want to leave time for hon. Members of all parties who represent the other Lancashire constituencies to contribute to the debate. However, my hon. Friend the Member for West Lancashire (Mr. Pickthall) will have to leave before the end of the debate for an urgent meeting at the Home Office, and he will not be able to contribute as he would have wished.
These are days of tremendous anxiety for the many elderly people in my constituency. They and their relatives are fearful about what is to happen. I have seen nothing quite like it. Action groups have sprung up around the county. The county council's proposals have convulsed the local communities. In public houses, petitions saying, "Sign the petition to keep the old folks' homes open" have been raised spontaneously. On Friday, my constituency Labour party carried a resolution to fight the proposals.
We read in the local press of people's despair about the proposed closures, yet the area has a Labour MP, a Labour Government, a Labour district council and a Labour county council, so no one else's fingerprints are on it. There are no Liberal Democrat or Conservative fingerprints on it. The issue has to be resolved by the Labour party—by the Government and the local authorities.
The sheer scale of the proposal meant that it struck as a shell burst. Residential care homes have been closed before, but the county council proposes reducing the number of homes in the county from 48 to 13, and although the residual 13 homes will still be owned by the county council, they may not be managed by it. The justification for that cataclysm is that the county council, with an annual budget of close to £1 billion, cannot afford to bring the residential care homes up to the standard that has been set by the Government.
The county council talks of its vision for the future and the provision it wants to make for elderly people, but that vision has been obliterated by the headline fact of the closures. That fact dominates, and everything else cascades down from it. We cannot hold a discussion an intelligent conversation about future provisions because of the headline fact that many of the homes will close.
§ Mr. Hilton Dawson (Lancaster and Wyre)I agree with my hon. Friend that funding is a headline fact, but 178WH the substantial issue is not funding but the provision of quality community care in a county that is under special measures—partly as a result of its over-concentration on institutional forms of care.
§ Mr. PrenticeMy hon. Friend will be able to develop that point in his own speech.
People are angry about a consultation exercise that they perceive to be bogus. The county council has presented one option, not a series of alternatives. When people ask what the alternative is to the closure of residential homes, the county council promises consultation with other providers, but there is nothing substantial for people to get a grip on.
Last week I visited the five residential care homes in my constituency—I have visited them many times over the years—because I wanted to see how far they fell below the standards that we hear so much about. I visited Favordale in Colne, the home that has been identified for retention; Pendle Brook in Barrowford, a very popular home; and Wheatley Court in Fence, where the oldest resident is 102, going on 103. We are talking about very elderly, frail people.
I asked the manager of Wheatley Court, a small home with 15 bedrooms, how many bedrooms do not meet the standards. I was told that 14 meet the standards and only one does not. At Cravenside, a larger home in Barnoldswick, where I live, people are bemused. When I asked them the same question, I was told that 44 of 45 bedrooms meet the standards. Cravenside was built 16 years ago, so it is a relatively new home. People there are mystified when they read in the consultation document that homes must close because they cannot be brought up to standard.
§ Mrs. Joan Humble (Blackpool, North and Fleetwood)Does my hon. Friend agree that much of the debate on standards has centred on the fabric of the buildings and the size of the rooms, whereas to many of the residents and their relatives the standards and quality of care are most important? In fact, they value the quality and the high standard of care in Lancashire county council homes so much that they want to stay in them and want the homes to be retained.
§ Mr. PrenticeThat is true. Many people who have the option want to stay in a county council residential home rather than enter a private home. What really rubbed salt into the wounds in Barnoldswick, which is a town of 12,000 people, was that just after the bombshell was dropped that Cravenside—built 16 years ago and up to standard—was destined for closure, through the letterboxes fluttered a leaflet that said:
Our home is your home. High quality residential care for the elderly…Thornton Hill"—That private sector home just outside my constituency is cashing in. People tell me that they have nothing against Thornton Hill or other private homes for the elderly, but they want them elderly relatives to remain in a county home. They do not understand why they should be driven out of the county sector.My hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) and others may feel that I think that the county council is acting with malign intent, but that is not so. I believe that the chair of social services, the 179WH leader of the council and my colleagues in Preston are acting with the best intentions. I do not believe that they have it in for the elderly. They have considered the Government's proposals for the future care of elderly people and are trying to tailor their services accordingly, but it has all gone badly wrong. By alleging that it has insufficient money to bring all the homes up to standard, and then compounding it by saying that it is being forced by the Government to close homes, the county council has lost a lot of sympathy.
We are all signed up to the Care Standards Act 2000. We do not want the elderly living in tiny bedrooms in which you cannot swing a cat. I visited the Walverdene home in my constituency and asked the manager to show me some of the rooms that did not meet the standard, and I was quite shocked: Walverdene was built in 1974–75—none of the buildings that we are discussing are Victorian workhouses—but, incredibly, it was not possible to get even an armchair into those rooms; there was room only for the bed and a washbasin in the corner. So cramped were the surroundings that no one should be expected to live in them.
All parties signed up to the Care Standards Act, and we all want to drive up standards. The county council said that meeting the necessary standards would cost more than £14 million, but that is a bogus figure: the true one is a third of that. The county council told us that essential associated remedial renovation work would take the cost to £14 million, but that is not true.
Another claim is also not true—although I say that respectfully, because it was made by a Labour party colleague. On 15 February, the chairman of the social services committee, Councillor Chris Cheetham, told my local paper, the Lancashire Evening Telegraph:
If we just do nothing"—about getting homes up to standard—then all the homes will close in 2007—simple as that.Well, it is not as simple as that. I have read the circulars and the Minister's letters to the National Care Standards Commission, which was presumably copied to all the social services authorities. The word that appears over and over again in those documents is flexibility—no one will be driven out of a home for the elderly that marginally failed to meet one standard.We are all signed up to the vision that the county council paints for us. I am not wedded to a specific sort of institutional care for the elderly, nor do I believe that we must preserve in aspic the form of residential care that we have in Lancashire. Last week, the Chairman of the Select Committee on Health, which deals with social services, reminded me that there is no institutional care for elderly people in Denmark: they are looked after in small sheltered housing units, and that works well. The answer to the question why we cannot have such provision in the UK is that we can, but it will cost money, just as care in the community does.
The county council has discussed bringing in providers from the private and voluntary sectors, but there has been no detailed discussion with them. The consultation document mentions workers' cooperatives, but I cannot get a handle on them; I have asked staff, but no one knows about them. They have 180WH simply been dropped in to the document, and, like so much else, have not been thought through. The county council has not discussed the options with providers or with the national health service in the north-west. If lots of frail elderly people leave residential care, they may end up bed blocking in our hospitals, and who wants that?
As far as I can gather, there has been no discussion with the district councils or with the housing associations that are flagged up in the consultation document and would be expected to provide sheltered housing for the elderly. I believe—this is a divide between me and the Prime Minister and a few others—that councils that want to be should be in the business of providing residential care services directly to the public. We should not contract out all such services so that we get bargain basement prices for everything.
We should do what works, but not if what works is putting people into the private sector where they are paid the minimum wage and have lousy terms and conditions. I do not want that. If my mother were in residential care, I would not want someone looking after her who was scraping by on the minimum wage with poor terms and conditions. Many people want their relatives to be in a residential care home that is run by the county council, because the staff in such homes are treated well. The council document states that staff in the county homes would have to be paid less to make the homes competitive with the private sector. What state of affairs have we reached when we read that in a Labour council document?
The county council must withdraw the proposals. The sword of Damocles hangs over the homes, their residents and the wider community. The county council should start talking to the other providers in the private and voluntary sectors, and propose a plan for care for the elderly in Lancashire.
I always want something from the Government, and sometimes I am disappointed. I want them to reconsider funding for social care. Many of us received the document from the social policy on ageing information network, which lists the main actors in social policy that have signed up to it, including Age Concern, the Alzheimer's Society, Anchor Trust, Arthritis Care, Carers UK—the list goes on and on. The document states:
Social services departments routinely budget more than 10% (almost £1 billion) above government guidelines for social services, and even so, they overspend.On 1 February, my right hon. Friend the Member for Norwich, South (Mr. Clarke) gave an interview to The Independent that appeared under the headline "Minister admits more should be spent on care for the elderly". That is common ground between us. It is what I believe.I grieve that we have got ourselves into a situation in which so many elderly people are wracked with anxiety. We can correct that if the county council can sweep the proposals off the table and have an intelligent conversation with the other providers and the Minister.
Mr. Deputy SpeakerOrder. A great many hon. Members—at least eight—applied in writing to speak in the debate. There are 45 minutes available to them. If 181WH the arrangement is to be consensual, those 45 minutes indicate the length of speech required if everyone is to catch my eye.
§ Mr. Michael Jack (Fylde)I congratulate the hon. Member for Pendle (Mr. Prentice) on securing the debate. I agree that the council's proposal should be withdrawn. During the constituency break, like other hon. Members, I visited homes that the proposal affects, and I found that people were very emotional. An 86-year-old lady broke down in tears when I talked to her about the proposal, and all the residents at one home said that it was their home and that the care was fantastic. I wonder how Councillor Cheetham would feel if someone walked up to his front door, told him that his home did not meet the required standards, and invited him to move out. I suspect that he would give them short shrift and send them away. That is how many people feel.
Just before Christmas, I wrote to the county council about my concern that because of the many recent closures, there were not enough nursing home or care places in Fylde to enable people to be discharged properly from hospital over Christmas. The council replied that the work was being done. In December, the council did not know the relationship between the capacity of the care sector and the requirements of the hospital sector. Just as I was recovering from that, suddenly, like that Volkswagen commercial where the car arrives out of the blue into the midst of a group of surprised people, so dropped the consultation document.
It is ironic that I received a letter this morning from a Mr. Slater of the county council telling me that the county council is holding a consultation exercise on the closure of old people's homes; he asked me whether I would like a copy of the document and to take part in the consultation. For weeks now, the argument about our old peoples' homes has been raging in Lancashire's newspapers. As the hon. Member for Pendle says, the proposal looks like a fait accompli.
Nobody who knows anything about care for the elderly can be ignorant of the changes that have taken place. The Care Standards Act has been passed and more people are being looked after in their own home, but where is the analysis? How do we know what is happening in our constituencies?
I asked Councillor Joyce Stewart, the Conservative spokesman on social service matters in the county, whether she had seen the consultants' document that had been produced by the county council justifying its policy. She replied that she had not. It had not been shown to county councillors. Why has that document not been made available to us all? We need to know how the decisions are made. Mr. Slater, who describes himself as an "assistant director special projects", wrote to other and me colleagues on 8 February enclosing a document marked "Private and Confidential". I will not reveal all the information in the document, but it purports to tell us how the various sites were selected. There is nothing about occupancy rates or running costs.
I am a veteran fighter for one of two homes in my constituency that have been fingered to have their day care facilities removed. Our campaign to save Milbank 182WH in Kirkham from closure was based on the fact there was a real need for that type of facility in rural Fylde and the private sector had not fully catered for the demand. We won the argument. I do not know what the reasons now are for taking the day care centre out of Milbank, but I know that an unspecified sum of money is to be spent on making it one of the survivors. That is all well and good—but hang on a minute. What about all the people who are not in rural Fylde who would not find it easy to go to that home? What will happen to the people who use the day care facility at Milbank in Kirkham? I do not know.
Crossacres, which is threatened with total closure, does not look run down inside, although it needs some en-suite facilities. About £250,000 needs to be spent on it. However, one can almost see from the external fabric that the decisions about its future have already been taken: it has been allowed to run down. The county council thought about all of that a long time ago.
The problem is that we do not know or understand what the options are. Take the day care out of Crossacres and where do those people go? There is only one day care centre left in the Fylde constituency—the Church road Methodist day care centre—and it is already chock-a-block. It is basic details like that that are completely lacking from this inhumane method of consulting elderly people.
I saw a copy of a letter dated 31 January from Councillor Cheetham to our elderly people. I asked the staff and the elderly residents whether they understood what was happening. Had anyone sat down with them and gone through it? Yes, there were meetings, but many of the elderly people are frail and confused. They are in their 80s, 90s or bordering on a century and, with no disrespect to them, it is difficult for them to understand and properly contribute to a sophisticated consultation exercise. When I asked them where their loved ones were, the replies were varied, but they included Canada, New Zealand, and the south of England. Those people had no back-up and no one to help them. Some people's relatives were present because they knew I was coming, and they spoke to me, but it is difficult to have a proper consultation in such circumstances.
Where is the imagination in the proposal? All it talks about is closure and sale-of-site values. There was no thought about whether Crossacres could be developed into a more advanced care village. Much about the consultation exercise rings of fait accompli. The facts have not been put before us. I agree with the hon. Member for Pendle that the proposal should be withdrawn straight away. A proper study should be done which takes into account all the needs of the elderly in every part of Lancashire.
§ Mr. Peter Pike (Burnley)I, too, congratulate my hon. Friend the Member for Pendle (Mr. Prentice) on securing the debate on a subject that is important to elderly people living in homes throughout Lancashire, and to their families. The equation proposed by the county council does not consider what will happen to the private sector, which, if it is to meet the Government's requirements, faces major challenges. I have grave fears that there is not enough capital in the 183WH private sector to bring in the new standards for homes, and many will lose bedrooms, which will make them uneconomical and so likely to close. If that happens, the number of private sector homes in Lancashire will decrease at the same time as the closure of a large number of county care homes is being proposed. It is extremely important to consider that possibility before any closures are agreed.
Sheltered housing has been mentioned. Everyone, including the county council, accepts that normal sheltered housing would not be adequate, and "super-sheltered" housing has been mentioned, but that would need more staff, supervision and care than there are at present. That is another factor in the equation that we must consider more closely before any hasty decision is taken after the consultation.
I was first approached on the matter of the new standards on 4 May 1999, when a Mr. Porter of Jalna, a private home in my constituency, raised the issues with me. I looked into the matter and I have been in correspondence about the size of the rooms with the county council and Ministers for the past two or three years. I accept that the type and size of the rooms described by my hon. Friend the Member for Pendle are nonsensical, but one must accept that the old rooms containing four or five beds were also nonsensical, and that Lancashire got rid of them. We must look carefully at room sizes.
I have received letters on the subject of en-suite provision asking how many old people will actually be able to use such provision given the care and assistance that they need. Is it really necessary to incur such capital costs, whether they are met by Lancashire care homes or by the private sector?
In January, I visited all six Lancashire care homes in my constituency, five of which are proposed for closure, which is more than in any other constituency or borough in Lancashire. I have visited the homes every year in January since I became a Member of Parliament. The standard of the care that they provide is excellent. I have also visited some private homes and was present when the unions signed an agreement with the Lancashire Care Association on standards and training for staff. Some of the old arguments used many years ago against the private homes no longer apply, because there is a much greater acceptance that a good standard of care needs good staff.
As I went round the homes, not knowing that the proposal would advance so speedily, it struck me forcefully that most of the people there were in their 80s and 90s, or even more than 100 years old—the number of people there in their 100s is incredible—and that 90 per cent. of them would not be able to go back into the community or back to their own home. They had gone to the residential home because that was the only way in which they could get the care and the lifestyle that they needed and to which they were entitled. I visited one of the homes for which closure is proposed, Ebor House. As Labour party organiser in Burnley, I attended its opening in the mid 1960s. The age profile in the home at that time was different: most residents were in their late 60s and 70s.
184WH The £4 million that has been mentioned to improve homes to meet the new Government standards, and the £10 million in county council budgets for the period until 2007, are chicken feed. We must ensure that the consultation is genuine. Society as a whole, the Government, county councils, local authorities and all of us in public life are judged by the care and attention that we give our vulnerable people and the elderly.
I have received a mass of letters from my constituents on the subject, as I am sure has every hon. Member. I shall quote a letter from Hazel Harding, the leader of the county council, to my constituent Mr. Beint. She says:
I would like to assure you that this is a true consultation stretching over many months in which all views will be listened to.If the county does not withdraw the proposals, I hope that that assurance proves genuine. I also hope that the other parts of the equation to which insufficient consideration have been given—the private sector and the new super-sheltered accommodation—will be taken into account. Whatever changes take place, we will be judged by the care that our elderly people in Lancashire receive.
§ 10.1 am
§ Mr. Nigel Evans (Ribble Valley)I congratulate the hon. Member for Pendle (Mr. Prentice) on securing the debate. I am sure that we have all been inundated with letters and that we have all been visiting care homes, especially over the past few weeks. I am proud of both my private care homes and my local authority homes, which seem to be of the highest standard.
The so-called consultation has not been properly thought out—indeed, the way in which it has been carried out is tantamount to abuse of the elderly. As my right hon. Friend the Member for Fylde (Mr. Jack) said, we are talking about very vulnerable, confused people, who are now fearful for their futures. Does Councillor Cheetham understand what he has done by initiating the consultation in such a fashion? On page 6 of his consultation document he says:
Clearly the closure of Local Authority homes is distressing for residents and their relatives and staff.That is an understatement. In the letter that accompanies it he says:I realise that putting the plans into practice will disrupt the lives of many residents.Of course it will—so why has he embarked on the exercise in such a way? I spoke to Councillor Pat Case, who was unaware of the proposals.I have visited Castleford in Clitheroe and Fell View in Longridge—two excellent homes. The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) will know Castleford because there a few years ago she opened the day centre, which receives up to 120 people a week. They get meals there and are properly looked after and monitored, which would not happen if they were living at home. Some of those people live in the most isolated and rural parts of the Ribble Valley and they look forward to coming to the day centre, where they can mix with people of their own age who have the same interests. They are picked up from their home, taken to the day centre, and taken home at the end of the day. They can have two meals and breakfast, which they might not get if they are isolated at home.
185WH For some of those people, their home can be a prison. If the council thinks that condemning such people to confinement in their home will create no cost, it should think again. It would have huge implications for social care if people had to stay in their homes 24 hours a day, seven days a week.
Homes also provide entertainment for the elderly. They can be taken out on day visits to other parts of the country. Rehabilitation is another important part of the day centres' work. Those who have gone into nursing homes from hospitals are taught again how to use kitchen and bathroom facilities. Who will carry out such important work in future? Elderly people who come into day care centres regularly can be properly monitored, weighed and checked to see whether they are eating properly. If they have any ailments or are taking medication, they can be supervised.
Should the proposal go through, the residential part of Castleford would be expanded slightly, but the day centre would go. That would be a cruel policy to people living in that area. I congratulate Eireen McGee and all the staff there on the work that they do. They are dedicated and skilled professionals.
Fell View, which opened in 1967, is in exactly the same position. I was shown around by Margaret Buckingham, who has worked there for 21 years. What price can be put on her skills? I have a letter from the Royal British Legion saying how important the home is to local people. Some of the residents are regularly visited by their spouses who still live in their own home. What would happen to the bathing facilities, rehabilitation and medical supervision if that home closes? We know that if elderly people are confined to their homes they become ill more quickly, are confined to hospitals more regularly and block beds.
When the announcement of proposals to save money was made, the county council published an advertisement that was an insult. "'Dynamic duo' to spin closures tale" was the headline in the local press. The county council seek to spend £50,000 on a couple of spin doctors to try to dress up their policy as humane. They must be joking. The hon. Member for Pendle mentioned that the misinformation is about the cost of bringing care homes up to standard. The council has been giving one set of figures, but the real cost is a fraction of that. It is time that we had some honesty about what the council intend to do and why.
A member of staff at one of the homes told me that she was thinking of putting a poster in the window that says, "They fought for us. It is now time that we fought for them." That is absolutely right. I say to councillor Chris Cheetham, "Think again and ditch these proposals." Let us ensure that we give proper care to the elderly in Lancashire.
§ 10.7 am
§ Mr. Greg Pope (Hyndburn)It is unusual that I agree with everything that my hon. Friend the Member for Pendle (Mr. Prentice) says, and rare that I agree with everything said by the right hon. Member for Fylde (Mr. Jack), but it is completely unheard of for me to agree with both of them. It is a measure of the seriousness of the issue that there is such consensus among Lancashire Members of Parliament.
186WH I am a friend of the county council and a personal friend of its leader and deputy leader. Sometimes, it is a friend's duty to let people know when they have got it wrong, when they have made a mistake. Today I say in public what I have already said in private to the leadership of the county council: they have got this matter completely wrong and mishandled it from the beginning. They must take the proposal away and think again.
Like every other Lancashire MP, I have been inundated with letters from constituents and concerned relatives. One said that residents want to be treated
with respect, not like animals…herded like cattle, placed here and there in an area that they do notcall their home. Another said thatthey give you tablets to keep you going and thenwhenthey do this to you, I…wish they would give me a tablet to end it all".One old lady was in tears: she had no family and was not sleeping; she did not know where or when she was going. The letter ends by asking mehow would you feel if she was your mum"?I feel pretty unhappy even though she is not my mum. The proposals are completely wrong-headed and must be withdrawn.We need a mature debate about the future of the sector. That debate should include carers, residents, the private sector and local health trusts. It is shocking that Lancashire has not engaged properly with the local health service, or with the private and voluntary sectors. It would have been sensible to have held the consultation and debate before any concrete proposal was made. However, such a debate is not possible when, as my hon. Friend the Member for Pendle said, certain homes have the sword of Damocles hanging over them. Lancashire must withdraw the hit list—there is no other appropriate term—of 35 homes.
I think that we would all agree that some homes might have to close. The current number of 48 homes may not be right for Lancashire. Demographic trends are changing, and an increasing number of old people do not want to go into a home—they want to remain in their own home and be looked after there. Perhaps 48 is not the right number, but it is impossible to have a proper debate while there is a hit list of homes. I repeat, Lancashire county council should withdraw that list.
Local Labour MPs met the county council a fortnight ago. We had a robust exchange of views. My understanding is that the council refuses to rethink its position. I am sure that we can all think of examples of politicians refusing to withdraw unpopular policies because they think that to do so would be a sign of weakness. It is a sign not of weakness, but of strength to hold up one's hands and say, "I've made a mistake." It is a sign of confidence in one's own politics, and I urge my good friends and colleagues on the county council to take that brave step and admit that they may not have handled the matter terribly well. They should acknowledge that it would be sensible to withdraw the hit list and invite everybody to have a proper debate.
§ Mrs. Joan Humble (Blackpool, North and Fleetwood)It is a great pleasure to follow my hon. Friend the Member for Hyndburn (Mr. Pope), because I want to reinforce some of the points that he made and set our debate in the context of the Community Care (Residential Accommodation) Act 1992, which was passed under the Conservative Government and which received all-party support, as does the current debate on care standards.
The 1992 Act was debated and passed with everybody agreeing that we needed to look after elderly people in a variety of different settings, that residential care was not the right answer for everybody, and that more and more people needed and wanted to be supported in their own home. That legislation placed a burden on local authorities to manage a process of change from residential to domiciliary care. However, in many parts of the country there has been a substantial reduction in the amount of residential care available, which has resulted in problems of bed blocking and elderly people not receiving the support that they should receive.
We in Lancashire are in a fortunate position: we still have both county council care homes and a private care sector. We ought to take advantage of that fact and have a debate about how many care facilities and what sort of increased domiciliary care or day care provision we need. We should ask how we can best use our existing residential provision. We should not lose the opportunity to do that and end up in the same position as many other local authorities, which do not have that sort of provision. Let us have the informed debate for which we have all been asking. Let us examine the needs of our elderly people.
The care homes run by the county council do not provide only residential care and day care. Excellent facilities such as the one referred to by the hon. Member for Ribble Valley (Mr. Evans)—I remember opening that day centre—also provide respite care. Many people neither need nor want full-time residential care, but need respite care on occasions.
Like other hon. Members, I have taken the opportunity to visit the two homes in my constituency that are involved in this debate. Worsley House is earmarked for closure. The local authority must face up to the fact that an area as large as the district of Wyre contains many towns. Fleetwood has its own identity, and those of its people who use Worsley House do not want to go to the far end of the constituency of my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson)—I hope that he will forgive me—even though it is in the same district. They want to have the choice of a Lancashire county council home or a private home in Fleetwood, and they feel strongly about that.
It is suggested that Thornton House be retained, but its residents would still have to be moved out because an enormous amount of work needs to be done to remodel the home as the county council suggests. There will, therefore, be disruption even in homes that are proposed for retention.
I thank my hon. Friend the Minister for seeing a delegation from the Lancashire private sector last week. As my hon. Friend the Member for Burnley (Mr. Pike) emphasised, the, proposals would affect the private sector. The number of residential placements has 188WH decreased. We must take all care providers into consideration. We must value the work that they have done to improve the care that they offer and the buildings in which they offer it.
Let us think about the needs of the people of Lancashire and ensure that they have respite care, nursing care, rehabilitative care and day care when they need them. Domiciliary care, too, is important. Many constituents tell me that they want that to be improved so that they can remain in their own homes for as long as possible, until they really do need residential care.
§ Mr. Hilton Dawson (Lancaster and Wyre)I am grateful to my hon. Friend the Member for Pendle (Mr. Prentice) for securing this important debate. We have reached the same conclusions, although by very different routes.
I support change, because there is too much residential care provision in Lancashire. I want facilities to be transformed to provide better day care services, better support in the community, and better support for sheltered housing. The action that Lancashire county council has taken shows that it is trying to work within the framework of the good policies that the Government have laid down. It is trying to work in the serious, stringent context of special measures.
Changes are always difficult, even those that will improve the lives of the current generation of vulnerable people who live in residential care. Those people must have the first call on everyone's support, compassion and assistance. I do not always support the council, but it is only fair to acknowledge its record of helping elderly people through difficult and traumatic changes in compassionate, caring, sensitive and highly professional ways.
I believe that the consultation is genuine, but fatally flawed, and hon. Members have drawn attention to the lack of partnership with health services. The national standards framework for older people requires the council to enter into such a partnership. A couple of weeks ago, I and my colleagues were told that the health service was unable to meet that requirement because it was in a process of transition, but that excuse is unacceptable.
The council needs to enter into a powerful partnership with the private sector. On Friday afternoon, I held a meeting with a couple of representatives from the Lancashire Care Association and with County Councillor Chris Cheetham. It was a good meeting because there was real communication—people said that it was the first time that they had been able to communicate. It is unacceptable that the proposals did not emanate from a robust partnership between social services, health, the private and voluntary sectors and the district councils. That is why the consultation is flawed and must be reconsidered.
There are important issues to tackle in Lancashire, and we desperately need to improve services. The argument is not about money, nor can it be until proper structures, proper communication systems and proper ways of working in partnership are in place. We must get those partnerships going. The county council operates good services and is trying to implement changes in difficult circumstances, but the structures work against 189WH it. I was told on Friday that there is a structure for consultation with the private sector, but the fact is that there is no substance or content to the process. There is a crying need for a health and social services trust. We need to use the greater flexibility that the current Government have introduced because we need major changes to the way in which services operate.
§ Mr. David Borrow (South Ribble)Like many hon. Members, I visited the care homes in my constituency last week—Peterfield House in Penwortham, New Manor in Longton and Broadfield House in Leyland. I had constructive meetings with residents and their families at all three homes, but I was unable to reassure residents about their future as they get older.
Figures in the consultation document demonstrate that in December 2001 there were sufficient care home places in the private sector in Lancashire. Under the proposals, 746 places in the county council sector would be closed. At the end of December, there were 1,215 vacancies in the private sector. That would mean that 65 people in South Ribble would have to be moved out of Lancashire care homes. There are currently 82 vacancies in the private sector.
The problem with the document is that the county council has not consulted the health service or the private sector, nor has it analysed probable future need for residential, care. Hon. Members have heard tales of the potential closure of private care homes in the next few years, and it is self-evident that some will decide not to spend their money to bring their care home up to the new standards. The demand that will be placed on the residential care sector is unclear, but in three years' time, I do not want to have to tell a constituent with an elderly relative who visits my surgery that there are no vacancies in South Ribble, and that they must go to Manchester, Yorkshire or Merseyside to find a vacancy.
I want to ensure that there will be vacancies for respite care if people who are caring for elderly relatives need to make use of it. I want to ensure that residential care will be available for people who have been in hospital but are not fit to go straight home, and that that care will be available to them until they are sufficiently recovered. I want to ensure that the right sort of residential care in the right place, which is in people's communities, is retained. That provision might not be in a Lancashire county council care home, but I am not convinced that the county council has a clue about whether there are enough places now and whether there will be enough places in 2007 or 2012. Until it is sure, the document should be withdrawn. The necessary information should be obtained so that we can have a grown-up, constructive discussion about all the issues.
§ Mr. Lindsay Hoyle (Chorley)I congratulate my hon. Friend the Member for Pendle (Mr. Prentice) on enabling us to -lake part in an important debate about the future for old people in Lancashire.
I am one of the first to say that the decision is crass and should never have been taken in such a way. Of the three homes in Chorley, two are to be closed and one is to remain open—what a lottery. Care homes in Lancashire are 98 per cent. full. It is unacceptable that 190WH a Labour-controlled Lancashire county council should scuttle around Lancashire announcing closures, upsetting some of the most vulnerable people in society, and leaving them with no hope and no future.
People turned to Lancashire county council when they applied to its care homes, which offered provision of which we could all be proud. Two days before Christmas, a private home closed in Chorley. Where was the safety net when emergency beds had to be found? It was with Lancashire county council. That safety net will disappear if we allow the proposals to be implemented.
Lancashire county council must withdraw its proposal immediately and ensure that people have a choice. People should be able to choose to live in private or county homes—or to remain in their own home, with appropriate support. I accept all that, but if our county provision is taken away, there will be nothing left for those who need it. Will we have to tell a 95-year-old, "I am sorry, but this home is down for closure. You will have to find somewhere else"?
People living in the homes have already been told to start looking for private accommodation. Sadly, they are being told that they must look around quickly, because there will not be enough accommodation left if they all look at the same time. The danger is that those vulnerable people will opt for a private home that might close in four or five years' time. That is not acceptable.
There is nothing wrong with the homes in Chorley. I invite the Minister to come to my constituency to see the quality of those homes and to see the damage that is being done by our county council. It should withdraw its proposals now, so that people can feel once again that we have a listening county council.
§ Geraldine Smith (Morecambe and Lunesdale)I congratulate my hon. Friend the Member for Pendle (Mr. Prentice) on obtaining today's debate. I am saddened and angered by Lancashire county council's proposed closure of 35 care homes. I am saddened because over the years the county council has, by and large, provided good service to the people of Lancashire. I am extremely angry about the acute distress and bewilderment that has already been inflicted upon the elderly residents of those homes as a result of the cavalier and uncaring way in which the proposals were announced.
Three of the care homes threatened with closure are in my constituency—Beaumont View, the Craggs and Slyne House. All have an excellent reputation for providing high quality care. Before travelling to Westminster yesterday, I took the opportunity to visit Slyne House and the Craggs. It was heartbreaking to hear people in their 90s saying that they were being well cared for and looked after, and how much they dreaded being uprooted and moved elsewhere.
One elderly resident had his wartime medals in his bedroom. That an elderly gentleman who had fought in the war should now 'be rewarded in such a way is heartbreaking. Another resident, a wonderful lady, is celebrating her 100th birthday today, but it has been overshadowed by the proposals: she is frightened that she will lose her home. It is not only the elderly residents who will be affected, but also their relatives. I spoke to the sons and daughters and the husbands and wives of 191WH residents who were distressed and worried about their elderly relatives. That is cruel. Many of the residents were at a loss to understand why their home was going to close. They were desperate to know what was to become of them. I felt ashamed that proposals that have caused such heartache and pain were put forward by a Labour-controlled council.
Of equal concern is the fact that staff and residents of the care homes have been told by Lancashire county council that the closures were being forced upon it by the Government because the homes do not meet best value criteria. They have been told that the homes have to close, and that if the county council will not do it, the Government will step in and do it. I ask the Minister to confirm whether that is true.
I am sure that all hon. Members know that the provision of good quality care such as that provided by Lancashire county council is not cheap, but that care is what the elderly in our communities need and deserve. We should ensure that care in the private sector is raised to the standard of that provided by the county council, not try to round it down to the lowest common denominator. It must be clearly understood that the proposal entails the mass relocation of frail, elderly people. It is our duty to ensure that their interests come first and that they are considered before any decisions are made.
When considering future provision of residential care homes in Lancashire, I am aware that we need to improve and expand other areas of care and support as well as residential care. Yes, people prefer to stay in their own homes if possible, but it is not always an option if they are too frail or require a great deal of care. Regardless of the success of other measures, there will be an ever-increasing need for residential care. People are living much longer and, even though they stay longer in their homes, they still need to go into residential care later in life.
My hon. Friend the Minister will know that Lancashire county council is also cutting back on the number of private sector placements. If we accept its policy and fail to ensure that sufficient residential care places, both public and private, are available to those who want and need them, we will not only fail the elderly in Lancashire, but put an intolerable strain on the health service by causing massive bed blocking.
§ Mr. Paul Burstow (Sutton and Cheam)I congratulate the hon. Member for Pendle (Mr. Prentice) on securing the debate, and all those who have taken part. They succinctly stated the serious concerns that hon. Members on both sides of the House have about the proposals for the reduction in public sector care home capacity in Lancashire. I shall address some of the concerns that have been raised in the debate and ask the Minister some questions.
As I listened to the debate, three phrases came to mind: "piecemeal", "ill conceived" and "lacking in vision". That is what strikes me about the proposals about care homes controlled by Lancashire county council that are out for consultation. The fact that the consultation continues until 14 June is no comfort to the 192WH residents of the care homes that have been nominated for closure, or to their relatives and friends, or to the staff who are affected. I am aware of the trauma and difficulties that accompany the closure of care homes, whether they are in the private, independent or public sectors. It is a sad fact that poorly managed closures can increase the possibility of death among residents who are transferred. That fact must fuel the anxiety of relatives and staff.
Members made several important points that go to the heart of the wider debate about the provision of residential and nursing care in institutional settings. I shall comment on them, but I was very struck by the right hon. Member for Fylde (Mr. Jack) pointing out the feeling of ownership that residents in care homes have. When a well run home is established and doing a good job, it ceases to be an institution and becomes a home. When a resident describes it as "My home," we should listen and take it as a serious sign of that person's feelings about the place.
The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) referred to the overall context of the community care legislation that set local authorities' responsibilities for managing care home places. That is a fair point, but it is worth bearing in mind that the same legislation placed on local authorities a fairly onerous and difficult gatekeeping role. There is a tension in being both the gatekeeper and the person that commissions care provision for residents on their behalf. That does not sit well in many cases, and I suspect that in Lancashire it has resulted in the introduction of a poor set of options.
I am strongly of the view that although a spectrum of different types of care in different settings—ranging from low intensity domiciliary care packages that enable people to stay independent in their own homes, through to the most intensive home care and residential sector—should be available in this country, and Lancashire in particular, it must not become a matter of dogma that people must stay at home. Any vision must always be built around the needs of the individual and proper analysis of them.
The debate has highlighted an apparent lack of analysis or serious engagement with the other partners and players in the provision of care in the community and residential care. I am shocked to learn from today's debate that Lancashire county council has failed to engage seriously with the NHS about the impact of the proposed reduction in capacity, and that it has also failed to have that dialogue with the independent sector. To remove up to a third of bed capacity simply by removing places from the public sector fails to acknowledge what is happening in the private sector.
All hon. Members know from their mailbags and conversations with care home owners about the pressure in the private and independent sectors in terms of the costs and new standards and how they are making many contemplate leaving the sector altogether. In some parts of the country, many people have already left the sector: they have decided that they could no longer do a decent form of business because they were not getting any return.
As the hon. Member for Pendle said, when the Care Standards Act was passed, Members on both sides of the House were committed to national minimum 193WH standards to drive up quality in all sectors. It is important to recognise that although there is no straightforward relationship, there is undoubtedly a cost attached to that compliance. I emphasised that several times during the passage of that Act. Today's debate has proved that some statements made in the regulatory impact assessment failed to provide an accurate estimate of the cost of complying with the new standards. That is why local authorities—not only Lancashire—are saying that they plan to close homes: they cannot find the capital to fund the changes. The hon. Gentleman was right to set his remarks in the context of the budgetary pressures that fall on local authorities, particularly social services authorities, when trying to manage such issues.
Physical standards—lifts, doorways and room sizes—present problems: they often carry the greatest capital costs, but they are not the best proxies for quality. That point has been made by hon. Members and was acknowledged by the Government in a letter sent by the Minister to Anne Parker, the chair of the National Care Standards Commission. In it, the Government recognised that the standards in respect of room sizes that are due to come into effect from 2007 must be interpreted flexibly. It would appear that Lancashire county council has ignored that in its calculations and proposals.
I hope that hon. Members will continue to challenge the council about that, and that the Minister can confirm what, she wrote to the chair of the NCSC. The letter makes the specific point that
For example if it were harmful for a resident to be moved, it would be open to the Commission to decide that a room which falls below the standard nevertheless suits the persons' needs.That is as clear as possible, and Lancashire county council should take the point into account.The hon. Member for Pendle mentioned the social policy on ageing information network report. Research into the funding available for social services was conducted by charities and private sector interests. He referred also to the £1 billion above standard spending assessment that social services authorities throughout England spend on providing services for the elderly and children. Interestingly, just two weeks ago, a new survey was published by the Local Government Association and the Association of Directors of Social Services. It examined current, not historical, budget pressures and, unsurprisingly, confirmed that there has been no change. In the coming year, councils throughout the country expect to overspend their budgets by more than £218 million. They are already spending dramatically more than the Government think that they need to spend, as reflected in SSAs. Nine of out 10 will overspend their budgets in the coming year, and many forecast further pressures looming in later years.
Everything boils down to capacity and whether it is being planned. In Lancashire, it is not. The Minister should ask the county council, through the social services inspectorate and others, what it is doing to improve its understanding of the knock-on consequences of its proposals on care for the elderly throughout the county. There is no doubt that the proposals will reduce choice and increase pressures elsewhere in the care system.
Hon. Members said that a lack of capacity in the care home sector had a knock-on effect on the NHS in the form of delayed discharges and more people waiting 194WH longer to leave hospital, with all the attendant consequences for their health. That effect works its way through the system, and ends in people waiting longer on trolleys because there are no beds to which they can be admitted. All that is happening and will continue to happen if there is not a proper dialogue between all the players in Lancashire to address the problem.
The hon. Member for Burnley (Mr. Pike) mentioned the loss of private sector capacity, and other important points were made, to which I hope the Minister will respond today.
§ Mr. Oliver Heald (North-East Hertfordshire)This has been a passionate debate, and rightly so. The hon. Member for Sutton and Cheam (Mr. Burstow) described the proposals as piecemeal, misconceived and showing a lack of vision. Many hon. Members might have gone further and said that the proposals are heartless and cynical in the way that they strip assets from the public sector and shunt costs, and that the county council has been arrogant in not listening to the views of elected Members of Parliament. As the hon. Member for Hyndburn (Mr. Pope) said, he and his colleagues approached the county council but it simply did not listen.
I congratulate the hon. Member for Pendle (Mr. Prentice) on instigating this important debate, because it is clear that the proposals are not acceptable. As my hon. Friend the Member for Ribble Valley (Mr. Evans) said, the idea that the problem can be solved by spending £50,000 on a couple of spin doctors shows the values of Lancashire county council. There is no doubt that this is a tragedy in the making.
The hon. Member for Morecambe and Lunesdale (Geraldine Smith) touched on what is happening in the private sector as well as the public sector. The Lancashire Care Association was told before Christmas by Lancashire county council that it planned to reduce residential care home placements in the private sector for the frail elderly by two thirds between now and 2007—a decrease of 1,200 places, from 1,880 to 600 a year. At the same time, the council plans to close 35 of the 48 county homes—a loss of 700 places. Two thousand places for frail elderly people in Lancashire are to be stripped out within a very short period.
That is a tragedy for the individuals concerned. My right hon. Friend the Member for Fylde (Mr. Jack) spoke to a resident who said, "This is my home." The hon. Member for Burnley (Mr. Pike) said that people involved are in their 80s and 90s, and the hon. Member for Pendle spoke about people being fearful. The hon. Member for Morecambe and Lunesdale spoke about wartime medals on their walls, and the hon. Member for Chorley (Mr. Hoyle) said that this treatment was being meted out to some of the most vulnerable people in Lancashire.
My hon. Friend the Member for Ribble Valley said that some of the most frail residents were living in fear of the proposals, and pointed out that day centres were important to people if they were not to be imprisoned in their own home. The hon. Member for Hyndburn said that people were being treated like animals, and the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) pointed out the loss of respite care places. There is no doubt that the effect on individuals who live in homes is dramatic and that the policy is heartless.
195WH The hon. Member for Burnley also talked about the staff. We should not forget that there are 600 jobs in care homes in the public sector in Lancashire. In an intervention, the hon. Member for Blackpool, North and Fleetwood referred to the standard of care that is so appreciated by residents. That is not an accident: the staff are committed to providing excellent care. Given what all the expert evidence and research shows, it is odd to put their jobs and those of all the caring people in the private sector at risk.
The leading institute that considers demography and projections for the future is the personal social services research unit. Its latest research, published in Health Statistics Quarterly, shows that there will be a huge rise in the number of over-65s in the next 30 years. The Government Actuary's projections show that that number will rise by 60 per cent and that the number of over-85s will increase by almost 90 per cent. It is projected that the number of residential places throughout the country needs to rise by 65 per cent. to meet that demand—in addition to what is needed in domiciliary care, where it is estimated that a 48 per cent. increase will be needed in home care hours provision.
Against that background and the fact that all the evidence is that we need more places and more capacity—the Government say that, too—why on earth is Lancashire county council stripping out places? That goes back to the point made by the hon. Member for South Ribble (Mr. Borrow): the council simply has not done the analysis. This is a national issue because getting rid of places in care homes makes the NHS inefficient. The Government are spending much more money on the NHS but are not getting much more activity out of it, because although elderly people in NHS beds throughout the country want to move into a nursing or residential home, places are not available. Making the situation worse, which is what Lancashire county council suggests, is wrong.
We have to wonder about the reason behind the proposals, and I think it is that the council has problems—indeed, special measures have been mentioned. If it does not provide care home places in the public or private sector, it does not have to pay for them, and other authorities have to pick up the tab. Housing is the district council's responsibility, so it will have to provide more sheltered housing, and the NHS will have to do more work on intermediate care to provide places. The financial burden is thereby shifted from the county council to the district council and the NHS. That may be a good accounting trick, but it takes no account of the costs to the individuals involved—people who will lose their home and be treated like animals. Nor does it pay attention to the loyal staff who have worked for the county council for years.
What is so stupid is that the council has not even troubled itself to consult the NHS or the independent sector before going down this route. I join in the pleas made by hon. Members on both sides of the House for the consultation to end and for the proposals to be taken away and reconsidered. The Minister is reported in the local press in Lancashire as saying that she is "ordering a probe". What does that mean and what action will she take? The situation is intolerable.
§ The Minister of State, Department of Health (Jacqui Smith)I join in the congratulations to my hon. Friend the Member for Pendle (Mr. Prentice) on securing a debate on a matter of considerable importance to Lancashire. I commend all hon. Members who have spoken: they have made good use of their role as constituency Members of Parliament to raise a significant local issue. Even before today's debate, I was well aware of those concerns. The decision is clearly one for Lancashire county council, but as we have heard it has wider implications. I shall state the reality of the Government's policy and its relationship to the activities of Lancashire county council.
As my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) pointed out, Lancashire county council has had a relatively high number of admissions into residential and nursing care. In 1999–2000, it made 182 admissions to residential and nursing care per 1,000 people aged over 65. By 2000–01, that had dropped to 146 per 1,000, but even so, it was still 45 per cent. higher than the average for shire counties.
It is right that Lancashire considers its commissioning strategy. It should assess whether it offers the right balance of care for older people in the county. However, as my hon. Friend the Member for Hyndburn (Mr. Pope) made clear, it is crucial for this type of consideration and planning to take place in the context of consultation with older people themselves, with partners in care provision in both the statutory and independent sector, with other local authorities, with the NHS and with other local representatives, including those who have spoken so ably today.
It is important to understand, as noted by my hon. Friend the Member for Morecambe and Lunesdale (Geraldine Smith) and the hon. Member for Ribble Valley (Mr. Evans), that the proposals could lead to 700 older people having to move from their care homes. Our debate is not merely a theoretical discussion about the design of a system. Many could have lived in their existing homes for many years and the move could entail significant disruption. Any changes should be contemplated only after thorough consultation, up-to-date care assessments and detailed discussions with residents and their families.
A central aim of Government policy is to reduce reliance on long-term institutional solutions to the needs of older people and to encourage the development of services to promote their independence. As right hon. and hon. Members have made clear, provision of services for older people is complex, so we need a range of alternatives to provide an opportunity for older people to exercise choice.
Complex objectives can be achieved only if they are well planned and if change is well managed and accompanied by investment. That has been the Government's national approach to achieving the reconfiguration of services that we all want in the longer term. It is a testament to those measures that we now support more people living at home than in the past: in 1998–99, of every 1,000 older people 82 were supported to live at home; by 2000–01, that number had risen to 84. All sorts of support—home care, community equipment, home adaptations and repairs—are included.
197WH Also central to the Government's plans to reform the care system is the development of intermediate care services, so that we can prevent avoidable admissions into hospital and allow patients—especially older people—the time and care necessary for rehabilitation. Such services will enable older people to live independently for longer. The NHS plans investment of an extra £900 million to be made available by 2003–04 for new intermediate care and related services. It is already bringing benefits and will be part of the overall reconfiguration of older people's services.
The Government have already provided significant extra support to local authorities engaged in the reconfiguration to ensure that we avoid the problems associated with delayed discharge, to which some hon. Members have referred. From the £300 million made available by the Government last autumn, Lancashire county council received £1.6 million in 2001–02 and will receive a further £3.4 million in 2002–03. That funding will be available for the purchase of nursing home placements, intensive home care packages and disability equipment, and for the expansion of existing intermediate care and rehabilitation schemes.
We need to offer our older people a range of services. Generally, people want to live in their homes as long as they can, but in some cases residential care is the best option and we must provide the necessary capacity to cater for it—either in the statutory or independent sector. My hon. Friends the Members for Burnley (Mr. Pike) and for Blackpool, North and Fleetwood (Mrs. Humble) mentioned their concerns about private sector capacity in Lancashire. On that account, last week I met representatives of Lancashire Care Association in a delegation led by my hon. Friend the Member for Blackpool, North and Fleetwood. They expressed the association's desire to work with Lancashire county council to ensure that residential and other provision is made available to Lancashire people in a planned and strategically managed way.
The Government are committed to working in partnership with the independent sector to use its capacity and resources to achieve the best possible outcome. That is why we established a strategic commissioning group—initially chaired by my fellow Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and now by me—which published an agreement setting out the responsibilities and expectations for central Government, local government, the NHS and independent providers.
The agreement focuses on councils and the independent sector entering into long-term agreements about placing people into care homes or providing other forms of support. It also highlights the need for fees to reflect the costs incurred. I expect all local authorities to follow the agreement; otherwise we shall be unable to achieve the necessary changes in capacity and the sort of planning which, as my hon. Friend the Member for South Ribble (Mr. Borrow) and others pointed out, is missing in Lancashire.
Several hon. Members mentioned national care standards. We are all agreed on the need for uniform standards to cover not just environmental issues, but quality of care, training and the rights of residents. Those standards are being introduced sensibly. The Government have issued statutory guidance to the 198WH National Care Standards Commission to ensure that the application of new standards does not lead to the closure of good quality homes. The guidance states that the commission should assess whether care homes can fulfil the needs of service users without making environmental changes to meet the standards. It especially covers issues surrounding room sizes, lifts, and baths and shared rooms. To respond to a point made by my hon. Friend the Member for Burnley, existing homes are not required to provide en-suite bathrooms in future.
Care home representatives have welcomed the guidance. Some people, including hon. Members here today, have raised questions about the public statements made by Lancashire county council about the cost of bringing its in-house provision up to the level of the new care standards. I understand that the publicly stated figure of £14 million is inaccurate and that the real one is nearer to £4 million. Any higher sum would include expenditure on routine maintenance.
I understand the significant concerns expressed in today's debate. The social services inspectorate is already closely monitoring the council in several respects, because it was placed under special measures in February 2000. I also understand the concern about the intention to decrease dramatically the number of nursing and residential placements. That is why the social services inspectorate is following closely the work undertaken by Lancashire county council to assess its current care provision. Consultation on future strategies is taking place with the NHS, local people and other interested parties.
Concerns have been expressed that the local authority is not communicating properly. The social services inspectorate is actively seeking to open lines of constructive communication between the two parties. Today the SSI is holding a regional workshop attended by representatives of the local council and the Lancashire Care Association, and further meetings will follow. I have instructed the SSI to monitor closely the outcome of those discussions. I have also asked to be kept up to date with crucial research on capacity in Lancashire. I shall regularly examine SSI reports to ensure that progress is being made in the areas about which hon. Members have voiced concern today.
The Government's reforms are intended to lead to an evolutionary change in the care sector—
§ Mr. Deputy Speaker (Mr. Frank Cook)Order. It is time for the next debate.