§ Mr. Alan Hurst (Braintree)I am most grateful for the opportunity to raise an important issue that is affecting people in my locality, although its ramifications extend well beyond Braintree and its sister town of Bocking.
The issue has been highlighted by the imminent closure of St. Francis's nursing home in Bocking. appreciate that the Under-Secretary of State for Health, my hon. Friend the Member for Tottenham (Mr. Lammy), and his Department are not responsible for the closure. The home is a charitable institution run by the Missionary Franciscan Sisters of the Immaculate Conception. Although its closure is entirely a matter for them, the same is not true of its effect on the patients, their relatives and friends, and others who live in Braintree and Bocking.
As I said, the home is run by the Franciscan order. It is adjacent to St. Francis's convent, which was founded towards the end of the 19th century. The property was, in part, acquired from the Courtauld family, who played a large part in the development of Braintree. The home does not adjoin the convent, but is on the other side of the appropriately named Convent lane. It has had a number of uses over the years—as an orphanage and then a school—before becoming a nursing home. It currently has permission to provide 40 residential nursing places.
It is not only the Franciscan order that has contributed to running the home; a substantial and successful appeals committee has operated for many years. Only last week, I spoke to Susan Harper, a former Braintree councillor who has served on the committee for many years. She told me that it had raised about £1 million, predominantly from the small communities of Braintree and Bocking. That substantial sum has not been spent on matters ancillary to nursing care; it has been expended in large part on the building's fabric and on providing the material wherewithal to run the home. The effects of that spending will disappear if the home is closed.
For several weeks in the summer, there was rumoured to be a notice of closure. Closure was announced in mid-summer and it is now scheduled for 10 January 2003. Like the local people, I understand that there may be reasons why the Franciscan sisters do not want or cannot continue to run the nursing home. They might be unable to find a sufficient number of sisters who are young enough or able enough to carry out that function. I make no criticism whatever of the local Franciscan sisters, who are held in high regard in Braintree and who for many years have done a wonderful job for those in their care. I am fairly certainly, however, that the decision was not taken in Braintree. I suspect that it was taken on the advice of the accountants, solicitors and land valuers who advise the head of the order, who is, I believe, in Rome.
The purpose of the local campaign is to secure the future of St. Francis' as a nursing home, and there is a great desire to find another proprietor. Although the names of potential buyers have been put forward, people remain concerned. I have no connection with BUPA, but I made a cold call to ask whether it would be interested in running the home. It expressed an interest, 132WH and, quite naturally, I passed the information on to the Franciscan order. The local care trust, which was set up only last month—I cut the welcome cake at its inauguration—has also expressed great interest in being involved in the operation of the nursing home, and I understand that other prospective purchasers have shown an interest
I have spoken to Dr. Paul Zollinger-Reid, the new chief executive of the care trust, who is most anxious to ensure that the facility is maintained and extended in the Braintree district. I have written to the Bishop of Brentwood, as have others, and only yesterday we attended upon the office of the Archbishop of Westminster, Cardinal Murphy-O'Connor, to present a petition of more than 2,000 names urging him to use his good offices to seek to persuade those who take such decisions to keep the home open, albeit with another proprietor. So far, unfortunately, there is no news. In many spheres of life, it is said that no news is good news, but as the days slip by I fear that, in case of St. Francis', no news is bad news.
I do not know whether it was the delivery of the petition or the imminence of this debate, but I am told that yesterday, several months after the first approach was made, a representative from BUPA was being shown around the home. It is often said that one swallow does not make a summer, and there is no more than one swallow, but it is certainly the first spark of hope.
One of the banes of nursing home provision and many other types of social provision is the high price of land. Braintree is a housing boom town. Houses are going up in every vacant space, both in the town and in the surrounding areas. That impedes progress, because the higher the price of land, the more difficult it is to use it for anything other than the building of houses. In the past, when land was cheap, mid and north Essex had the advantage of public institutions with large gardens and surrounding green areas. Those green areas remain, but they provide a terrible temptation for housebuilders and developers to acquire public or charitable institutions and develop them for other purposes than were originally intended St Francis's home is no exception. We need to consider the importance of the value of land in our social policies. I wonder whether it is time to reread Henry George's "Poverty and Progress" in order to realise the link between the price of land and the speed with which we can make progress.
If St. Francis's nursing home closes, 40 places will be lost. I accept that it currently has only 16 residents, but that is because the order has decided to reduce the number of places to none by January—which is understandable if the home is to close. The constituency of Braintree has a total of 89 places for more than 100,000 people—not a good ratio, which will worsen if the closure of St. Francis's goes through—and not all those places are available to the public: more than half are available only to private patients. The reason for that is probably divinable: the prices paid by private patients can be higher than those paid for by state organisations.
Essex county council, which is currently controlled by our political opponents, is conducting a review of care home facilities in the county, but I do not hold out much 133WH hope, as it has proceeded with due diligence to close one home after another. It will not be long, therefore, before we have to rely entirely on private provision.
The difficulty lies in striking a balance between public and private provision. I fully accept that not all nursing or care homes can be run by public authorities. Many will be well run by private operators, and many others will be well run by charitable trusts. It is a question of balance. I give due credit to my hon. Friend the Minister and his colleagues in the Department for the additional moneys that have come to the county. I think that £7.4 million has been directed towards nursing home care. That money alone has allowed the health trusts to offer higher fees to nursing homes, and therefore a greater proportion of the nursing home places in the county can be secured.
Nevertheless, there is still a difference in fees between nursing care and residential care. Assessments of all residents are now taking place to ascertain what categories they should properly be put into. Unseemly disputes have arisen in the past about such questions as whether Mrs. Jones should go into the home as a nursing patient; a squabble might then ensue about how quickly to take her out of that category, because then the fees would fall and the payer of the fees would change from the health trust to the local authority. We need to avoid such unseemly conduct, and I believe that progress is being made. The extra financial provision for fees is welcome and will assist.
The effect of home closures is severe on patients and their relatives and friends. Every one of us is attached to the place in which we live. It is said that moving house is near the top of the list of traumatic events in life—even for people who are hale, hearty and in good fettle. What must it be like for a frail, infirm person, who has had to become acclimatised after leaving their own home for a nursing home, to find that they must leave that nursing home and all the bonds that they have formed with staff and other people, and go to a strange situation? I do not want to speculate on the possible consequences, but I am sure that hon. Members have all seen examples in their constituencies.
Another problem is the location of nursing and care homes. Essex, people are surprised to learn, has the longest seaboard in England. That is because it has so many creeks and inlets around its coast. A large proportion of the care homes in the county are situated along the sea coast, even though much of the population does not live along the coast, that is because it is relatively easy to take over hotels and convert them. The result is that there is an imbalance of provision in relation to need, and inland areas of the large county of Essex are disadvantaged.
Many of the relatives of elderly patients are bound to be elderly too. It is terrible when a man's wife goes into a nursing home at the other end of the county. How is he to get to see her as often as he would like if she is not within easy travelling distance? Halsted is only 10 miles from the man to whom I was speaking about that issue, and that is a long way for him, so to have to travel 30 or 40 miles must seem like the end of the world.
My general point is that we can go too far in deciding that private providers can provide everything. Many years ago I served in opposition on a borough council in Essex. The then leader of the county council, Norman 134WH Clarke, was a Conservative. As always in the 1980s there was a big debate going on about privatisation of council services, including privatisation of the direct labour force. In the end, he said to me that he had decided against privatisation that if he could avoid it, because he would then have no control over council operations if the private provider failed.
If we have no fallback position, we need to be careful that our private providers do not fail us. I can go further than Councillor Norman Clarke by recalling the words of Frederick the Great, King of Prussia, who once said:
Allies are fine, but one's own troops are better.It sounds like an argument for the mixed economy and it can be taken that way. We need a balance between our allies in the private and charitable sectors and our own troops in public provision.The relatives, friends and people of Braintree and Bocking are literally praying that St. Francis' can be saved. They are looking for help and support from whatever quarter aid might come.
§ The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)I congratulate my hon. Friend the Member for Braintree (Mr. Hurst) on securing the debate, making a powerful case for the care home sector in his area, and—as usual—illustrating his argument with a literary allusion. His constituency is at the forefront of establishment social care thinking. It established this country's first care trust to specialise in caring for older people, which was launched by my hon. Friend very recently.
I appreciate that there is local concern that St. Francis's nursing home has been forced to announce its closure. I put on record my deep respect for the work that the sisters have carried out there over the years. I understand that the sisters are now ageing, with many of them reaching their 70s, and that there have been no new recruits to the order in the past 15 years. Those factors, coupled with a facility that is currently not financially viable and is unlikely to meet the national care standards that we have set, mean that, sadly, the order has to close the home. My hon. Friend is right to emphasise that there has been no enforcement activity by the National Care Standards Commission that has precipitated the closure; none the less, the closure has come as no surprise.
We must never forget the human face of such issues, and it is right that my hon. Friend brings the matter to the House today. Such closures mean the moving of individuals from places that they consider to be their homes and probably thought would be their last homes. However, the decision has been taken outside the control of central Government and for what seem to be understandable reasons. It is important that we ensure that the best is done for those residents.
Good notice has been given of the closure, and there has been time to prepare properly and to consult and involve the individual residents. I understand that every effort is being made to encourage the Franciscan Sisters of the Immaculate Conception to sell the home as a going concern. I hope that those efforts are fruitful. I am assured that the care trust will continue to offer support and look for any possible solution that will maintain the facility. However, if the home closes, it is important that the trust identifies alternative arrangements.
135WH I shall outline briefly some of the steps that have been taken to manage any closure. In July, social services and the primary care group met with two trustees and their financial adviser to offer support to explore the options for keeping the nursing home operational. Benefits checks were run on identified residents to ensure that they were in receipt of their maximum allowances. Essex county council and the care trust offered to act as a broker between the order and any parties interested in purchasing St. Francis's as a going concern. There has been ongoing support and discussions with the manager to find employment elsewhere in the sector for the experienced staff who would be displaced in the event of closure.
A closure date of 10 January next year has been formally given to Essex county council, so it has a duty to ensure that a process is in place for funding new placements for the remaining 16 residents. All residents and relatives were invited to a meeting in September, and two social workers have been allocated to work closely with each resident to secure an alternative placement. In short, there is a lot of work going on to help the 16 residents who will be left to find suitable alternative accommodation should the home close.
My hon. Friend is understandably concerned about capacity in the area. We are all encouraged that he has taken such an active part in trying to keep the home open as a going concern. I hope that the flame that he talks about will be a bright one in the future.
As my hon. Friend will know, there is more to the care of older people than simply care home provision. The Government's objectives, as set out in the national service framework for older people, are to provide the right care in the right setting and to promote the social inclusion of older people. Much is said in the House about social exclusion. We should never forget that the elderly are the most vulnerable and often the most socially excluded people of all. It is right that we enhance their independence. That means allowing people with care needs to remain in their own homes as long as possible, which is what older people and their families tell the Government they want, and the figures suggest that we are helping more and more people to achieve that. In September 1998, 60,700 households were receiving intensive home care packages; by the end of 2001 that number had risen to 76,400 households. That is quite an achievement for the Government.
On 23 July, my right hon. Friend the Secretary of State made an important announcement in which he said that there would be an overall £1 billion package of investment for social care services for older people by 2006. The purpose of the new investment is to improve access to social care services and expand their capacity, increase the choice of services available to older people, stabilise the care home market, and ensure that delayed discharge is reduced to a minimum. I hope that my hon. Friend is encouraged by our right hon. Friend's announcement. The investment will help to alleviate the difficulties and increase care home capacity in his area. Within the overall £1 billion package, resources have been allocated to allow councils to pay higher fees if that is what is needed to stabilise the local care home market. I hope that my hon. Friend will be encouraged by that and that providers in his area benefit.
136WH There will, of course, be a need for care home provision for the foreseeable future. I accept that there has been a reduction in the number of care homes in recent years, but there is spare capacity within the sector nationally. That spare capacity varies from region to region, which is why we are providing further resources to councils to assist them to further stabilise care home provision in their areas. There will be demographic changes and features particular to a certain area, for example, some parts of the country have larger elderly populations than others.
The allocation of the building capacity grant for Essex in 2002–03 is £5.5 million. That grant has been used to fund increases in assessment capacity, additional community equipment, a 24-hour care scheme attached to an accident and emergency service, increased payment rates for residential, nursing and domiciliary care, and incentive schemes in the most difficult of localities to increase that capacity.
Thanks to the additional resources that Essex social services department received from central Government, it has been able to increase the fees it pays to nursing homes from £386 a week to £453 a week, and to increase the fees it pays to residential homes from £310 to £364. Of course, there is more to improving services than providing resources: relations between councils in their role as commissioners and independent sector providers have often been fraught—indeed, adversarial in several cases—which has damaged both the prospects of good strategic planning that would add stability to the care system, and the interests of service users and their carers, leaving them anxious about the future.
By establishing the strategic commissioning group—chaired by my colleague, the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith)—we have established a new, more positive partnership between the statutory and independent social, health care, and housing sectors at national level. That must be replicated at local level—for example, by setting up care trusts, such as the one in Braintree.
The "Building Capacity and Partnership in Care" agreement was published last October. It sets out clear good practice guidelines about the nature of the relationships that need to be developed to secure stability in the system and to deliver benefits to the people using services and their carers. The document encourages a whole-system approach: we cannot view the care home sector in isolation from the entire health, housing and care economy or from the reforms that are happening elsewhere.
My hon. Friend the Member for Braintree drew careful attention to the context in which his local care homes operate and the relationship between the private and the public; that was very instructive. We should never forget how we got into this position: throughout the 1980s, there was a huge expansion in the number of care homes, when uncapped Department of Health and Social Security budgets were available for publicly-funded people entering residential care, and money flowed from the public purse into the private purse. Profits were high, but I think that all of us accept that standards were far too low—the result of many of the policies of the 1980s. We have tried to control that and to bring provision closer to what older people say they would prefer.
137WH Essex council is taking steps to try to keep the home open. However, if it is unsuccessful, it must ensure that any displaced residents are placed in suitable alternative accommodation, and that should, of course, be done in discussion with residents and their relatives.
Witham, Braintree and Halstead care trust was the fifth in the country to be set up and the first to specialise in older people. It will enable health and social care 138WH partners to integrate their services in a single organisation and I wait with interest to see how the trust will be able to improve local services for older people and, in particular, to show how these arrangements can help to deliver the type of services that older people and their carers want now and in future.
§ It being Two o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.