The Minister of State, Department of Health (Norman Lamb)
I thank the hon. Member for Luton South (Gavin Shuker) for securing this debate and for speaking in a reasonable tone about issues of enormous concern to some of his constituents. I very much noted the fact that they have told him that they have experienced good care. They regard the care home as their home. In a way, that demonstrates the conflict that sometimes arises, in that there is a general trend towards more people wanting to live in their own communities with support, as the hon. Gentleman rightly said. He described his sense that he would want to remain in his own home were he to be disabled, but at the same time there are those who regard a care home as their home and they have no desire to change that. It is right to recognise that that conflict exists, and it creates a dilemma.
The hon. Gentleman suggested that, in a way, Scope was closing the home because of Government policy. Government policy, as enshrined in the Care Act 2014, is to put people in charge—to focus on well-being, which is the central theme of the Care Act. As far as possible, it should be the individual who determines where they want to be. I have spoken to Richard Hawkes, the chief executive of Scope. Scope is very clear that this is its decision: it wants to do it and is doing so for what it regards as a good purpose. However, the Government’s focus is simply on the individual—on ensuring that, as far as possible, we enable people to make the decision that is right for them, recognising, however, the conflict that can arise.
Care homes often look after some very frail people, but also individuals with quite complex needs. It is understandable and reasonable that, should there be a possibility of a care home closing, residents and their families will be extremely concerned about the future, particularly with the upheaval of having to move. It will inevitably be an unsettling and potentially stressful time. The decision to close a care home voluntarily is taken by the owner or operator—either the local council, where that remains the case, or, if it is an independent home, the proprietor, whether the home is in the private or the voluntary sector. Of the approximately 17,000 care and nursing homes in England these days, over 90% are in the independent sector—that has been the case for many years—and are owned and operated by private companies or charitable and voluntary sector organisations such as Scope.
Homes may close for a variety of reasons, including lack of financial viability and/or insufficient demand for places, retirement of the owners, the sale of premises for alternative use and even the de-registration of unsuitable or unsafe services as a result of the Care Quality Commission’s intervention. In the case of Scope, the organisation is looking to redesign the services it provides to support people. It is important that people who need care and support are accommodated in appropriate settings that are based, critically, on their choice as far as possible. It is clearly not desirable if someone has to move from a care home where they are settled and happy and where their needs are being met.
Local authorities have a responsibility, through good commissioning strategies, to ensure a healthy local care home sector. Through the Care Act 2014, which will come into force next April, we are giving local authorities a core duty to promote their local care market, with a particular focus on ensuring diversity, quality and sustainability. Importantly, they should ensure that sufficient high-quality services are available to meet the needs of individuals in their local area. However, although local authorities should make all reasonable efforts to ensure that good care homes remain viable and stay open, there will be situations where homes have to close or where the proprietors choose to close them. We have to face this. What is most important is that any decision to close a home should be handled sensitively and appropriately. It is essential that person-centred care planning identifies the best possible alternative for each individual. Adequate time should be allowed for the process, so that residents and their relatives can be properly involved and be given plenty of time to make decisions and arrangements in a way that minimises stress.
I must emphasise that, should a home have to close, local authorities have a statutory duty to arrange suitable alternative accommodation for those residents who are assessed as being in need of residential care, so it should never be the case that someone who needs residential care will not be provided with it. I fully appreciate, however, that that does not reassure someone who regards a particular building and set of care workers as their home and their home environment.
I am aware that some providers of residential care for disabled people—including the charity for disabled people, Scope—are reviewing their residential services and are consulting users of services and their families. I appreciate, as I have said, that this can be an extraordinarily worrying time and a stressful situation both for the people in those homes and for their families. Parents of adult disabled people are often themselves quite elderly, which can cause additional stress. The hon. Gentleman touched on that when he talked about his constituent. I would encourage the residents and their families fully to engage with the consultation process and ensure that their views are taken into account.
Scope has given an assurance to the Department of Health that it is committed to ensuring that all users of its services who may be affected are properly consulted and supported. It has promised to provide any individual who needs it with advocacy so that every resident of its homes can understand what the proposals mean for them and can make it clear what they want for the future. Richard Hawkes told me that Scope has even provided care workers to come down to Parliament to support people who were lobbying their MPs against the closures. It says that it has tried to be as reasonable as possible. This process will not, Scope says, be rushed or hurried. It has informed the Department that the consultation will take place over a period of three years.
Scope runs many other care homes that will remain open. There is a particular focus on the larger care homes, but there are also many smaller care homes that it intends to keep open—eight of them, as I think the hon. Gentleman mentioned. Scope appreciates that many residents are happy in its homes, but has to face the fact that there is a lessening demand for large, traditional residential care services.
Richard Hawkes, as chief executive, made the point to me that more people are taking on personal budgets—a concept substantially and rightly developed under the previous Government and one that is continued by this Government and now legislated for in the Care Act 2014. The concept was designed to put the individual in charge, so that they can determine how the money available for their care is spent to meet their particular priorities. As people take on personal budgets, according to Richard Hawkes, they are increasingly voting with their feet and choosing not to go into larger care homes, which often have long corridors, shared bathrooms and so forth. They are increasingly choosing to remain in supported living if possible with a package of care built around their individual needs. Scope is reviewing its services now, so that decisions can be made and, if need be, homes closed in a controlled, planned manner before vacancy levels make them unviable.
Richard Hawkes also told me about an experience that Scope has been through in Southampton. It proposed to close a care home, leading to the same totally legitimate anxieties and concerns. It went through the process and all the individuals in the home have been relocated in circumstances that suit those individuals, with their having a central say in where they are going to go. He tells me—I base my comments just on what he says—that all now appear to be happier with their new circumstances and are finding a new sense of freedom that they did not experience in the past. Although these changes to circumstances can be traumatic and difficult, the end-result, as demonstrated in the experience of Southampton, can sometimes be a good one for the individuals involved. I realise, though, that elderly parents in particular will sometimes find that quite hard to recognise.
It is worth taking a moment to look at the history of this issue. Many traditional, large residential care homes are quite old now. A number of Scope’s homes date back to the 1970s. They were developed in—and designed to suit the needs and demands of—a different era. By modern standards, they lack privacy, and they do not allow residents the degree of freedom, choice and control that we rightly expect and demand nowadays. As a result, many Scope homes are under-occupied. The increasing availability of new models and types of care, support and accommodation means that traditional large care homes are no longer the default or only option when it comes to providing care and support for people with disabilities.
Innovations and developments in supported living, and the various types of housing with care that are available these days, offer disabled people far more choice than they ever had in the past, and control over their lives. I am sure that, ultimately, we should all welcome that. Scope has informed us that, owing to the newer options that have become available, local authorities do not automatically make routine new placements in residential care, and it expects the number of empty places in its older homes to continue to rise. In the long term, it can only be a good thing that people have so many more choices when it comes to the care that is available to them, but, as I have said, I entirely appreciate that, as with any change, the process is not without its short-term challenges.
The Government want to give people more control over their health and social care services, and, therefore, over their lives. That is the central ambition of the Care Act. Personalisation means building support around individuals and providing more choice, control and flexibility in the way in which they receive care and support, regardless of the setting in which they receive it. There is no central policy, incidentally, that says care homes are bad: absolutely not. It is a question of what is right for the individual involved.
The Care Act provides a new legislative focus on personalisation, increasing opportunities for greater choice, control and independence, so that people can choose the services that are best suited to meet their care and support needs. The Act provides that adults who are eligible for care and support must receive services that meet their individual needs. It also requires that they must be involved in care planning. Some, of course, will need and benefit from residential care. There will always be an important job for care homes to do. However, for others a different model of care may now be more appropriate to their needs, and, most importantly, to their aspirations and desire to lead the sort of independent life that all the rest of us take for granted.
We are committed to ensuring that people who wish and are able to live in their communities are given the support that they need in order to do so. Everyone, especially younger adults—including those with a learning disability—should have the opportunity to make informed choices about where and with whom they live, and to have greater choice and control over their lives and support to help them to lead a fulfilling life of their own.
Question put and agreed to.