HC Deb 27 March 2003 vol 402 cc152-5WH
7. Miss Anne McIntosh (Vale of York)

How many care home places were available on 1 January (a) 2002 and (b) 2003; and if the Government will make a statement.[104453]

The Minister of State, Department of Health(Jacqui Smith)

The latest data available for 2001 show that there were some 528,000 places in care homes for residential or nursing care in England. In addition to the £300 million building capacity grant in 2001–02 and 2002–03, we are providing record levels of funding for social services. Funding will increase by an average of 6 per cent. in real terms each year for the next three years. Councils can use those resources to stabilise the care home sector and to expand the range of services for older people, including home care and extra care housing.

Miss McIntosh

That is the answer to a question, but not to the question I asked. Since 1997, 60,000 care home places have been lost and there has been a decrease of almost 100,000 in the number of households receiving domiciliary care packages. Does the Minister accept that her Government is to blame, at least in so far as the Care Standards Act 2000 introduced prescriptive standards that led to that large fall in the number of care home places?

Jacqui Smith

As the Select Committee on Health said, 60,000 is a somewhat spurious figure. The latest figures in the Department suggest that between March 2000 and March 2001 there was a decrease of 11,200, and that between 1997 and 2001 43,000 households received intensive home care packages—the equivalent of a care home place. During the past year, there has been an increase in the number of older people receiving support to live in their own home. That is a result of additional investment, but we need to do more to ensure that older people have a choice of care home places, support in their own homes, equipment necessary to enable them to live independently, and extra care housing. My right hon. Friend the Secretary of State announced £1 billion investment over the next three years precisely to develop such services.

Mr. David Drew (Stroud)

My hon. Friend is right to concentrate on choice. Does she accept that we should prioritise that in April, with the onset of supporting people, which is a very good initiative that allows people's homes to be adapted? People often have to return to hospital because their accommodation is totally unsuitable.

Another aspect of the problem is that we are disaggregating funding, which makes the position of those who are not in receipt of benefit and are living in sheltered accommodation more stark. Does my hon. Friend accept that it is necessary to look at that, because we must encourage people to live in the accommodation most suitable for them, which for older people is often sheltered accommodation?

Jacqui Smith

I strongly agree that there is greater opportunity for older people. They are able to live in new-style extra care housing or remain in their own home with the contribution of better community equipment services and better adaptations for disabled people. For the first time, the Department of Health is contributing to home improvement agencies to ensure that the necessary changes to older people's homes to enable them to leave hospital and return to their own homes are properly funded. I also agree with my hon. Friend that this is a time of transition as we move to supporting people. We must be careful to ensure that the whole range of support services and benefits are in place to allow older people to have what they want: more independence and more choice.

Chris Grayling (Epsom and Ewell)

Will the Minister please address the concerns of both care home owners and care home residents and their families in my constituency? They say that the current system of contributions to nursing care by the NHS is shambolic. Payments are received months after the period that they cover and have to be administered by care home owners, who end up paying money back to families. The result is chaos for everybody involved. Will she re-examine the system?

Jacqui Smith

Certainly, it is unsatisfactory if care home owners are paid late by primary care trusts. If the hon. Gentleman wants to tell me in what specific areas that is happening I shall pursue the matter. We are currently evaluating the free nursing care scheme, and in many areas we are finding that the NHS is being brought, often for the first time, into a much closer relationship with nursing homes. That helps to develop better joint working, better training and a better approach to services, for example, continence services. Although I am willing to tackle problems, in addition to the financial benefits to many older people, there are other significant benefits from bringing the NHS into a closer relationship with nursing homes.

Mr. Simon Burns (West Chelmsford)

Will the Minister please come out of her fantasy world and answer specific questions? Has she read the Health Committee's report? I am a member of that Committee. Does she accept that she is being disingenuous in her choice of figures? If she has read the report, she will know from the special work commissioned that just under 65,000 places were lost between 1997 and last year. That figure includes the loss of local authority places, which she steadfastly refuses to include in her answer.

Jacqui Smith

First, I have read the report. Secondly, the figure that I used in my last answer included local authority places. The hon. Gentleman has a basic difficulty: I have never argued that there has not been a reduction in capacity in care home places. There has been a small reduction since 1997. According to Laing and Buisson independent consultants, the national occupancy rate for care homes is only about 90 per cent. There are capacity problems in some parts of the country, and we have to ask ourselves how we can address them. Care home owners tell me that they want local authorities to be able to pay fees at levels that reflect the quality of care homes. The hon. Gentleman can nod, but until he is willing to support our extra investment in local authorities to enable them, where it is necessary, to raise fees to safeguard capacity, ranting is cheap. He needs to enter the real world and to recognise that the investment, which he is unwilling to support, is necessary to make a difference for older people.

Mr. Burns

If the Minister had read the Health Committee's report properly, she would know that the specific work commissioned on numbers makes it clear that if one includes local authority losses with the private sector, the result is almost in line with the Laing and Buisson figure of just under 65,000 beds lost. The sooner she accepts that, the sooner she will have a greater understanding of the problem in the long-term care sector. In certain parts of the country, people cannot find beds for their parents in their immediate vicinity.

Jacqui Smith

The difference between the hon. Gentleman and me is that I recognise that there is a problem and, unlike him, I am willing to put the Government's money into solving the problem by ensuring that local government has the necessary resources to safeguard capacity in the care home sector. Opposition Members often fail to recognise that although care homes are important, they are not the be all and end all for older people. We need to ensure that the 43,000 increase in the number of older people who can live in their own home, which is a result of the increase in intensive home care packages, continues to grow in the coming years. We must continue to develop opportunities for extra care housing and must ensure that additional community equipment is in place to allow older people a genuine choice. That is what we are committed to. Both reform and investment are required. I will not take the hon. Gentleman's crocodile tears seriously until he is willing to vote the investment to make a difference for older people.

Mr. Paul Burstow (Sutton and Cheam)

Does the Minister not accept that the issue is not only safeguarding capacity, but adding capacity? The 90 per cent. figure that she quoted is, as she rightly says, a national figure, but care homes are not a national service. We do not put older people on buses going from one part of the country to another to find spare places for them. Will she tell us what the Government are doing not only to safeguard capacity, but to add to it and specifically to deal with the chronic shortage of care for people with dementia, for whom the loss of places has become critical?

Jacqui Smith

The hon. Gentleman makes a point that I dealt with in my previous response. Care home capacity is not spread equally across the country. That is why, along with the additional investment, we must allow local authorities to make the right decisions about the balance of placements in their areas. He is also right that we have a particular challenge in providing for mentally ill elderly people. The additional investment going to local authorities has enabled a third of them to increase fees by more than 10 per cent., often for such specialised provision. That is an important way in which we ensure that we safeguard such provision. My right hon. Friend the Minister for Pensions made it clear last summer that the number of supported residents in residential care homes has increased over the past year. Our planning assumption is that local authorities will have the resources to increase the number of care home places that they commission from the independent sector over the next three years.