Care Services: Elderly People

Baroness Greengross Excerpts

Wednesday 6th March 2013 Grand Committee

[Baroness Greengross]

My Lords, I thank the noble Lord, Lord Turnberg, for so vividly portraying the crisis that is preventing us celebrating, as we should be able to do, the aging of our population. We can all expect to live to a great age. The noble Lord, Lord Roberts, has described very movingly that life is not always so good. Certainly it is not so good with the number of people who need appropriate care. We have an opportunity to get things right now, and we must do.

I was the lead commissioner for the EHRC inquiry into the needs for care and support of people living in their own homes. We found that half the people in this country were satisfied, but that means a huge number were not getting an adequate service, most of them elderly women. We are just about to celebrate International Women’s Day. It is appalling that they are not getting the sort of care and support that they need. We should be able to do something about their isolation, loneliness and the bad situation that they face, particularly with the impending—if it is not already with us—crisis of dementia.

As chair of the All-Party Parliamentary Group on Dementia, I am aware of this issue every day as this group has the highest attendance of MPs and Peers of any all-party group. People are recognising that this is a huge issue and we have to get it right. I would like us to look at how we can prevent things going as wrong as they have done up to now and get this right, with the help of the draft Care and Support Bill that will come to us shortly. We need to look more broadly at alternative ways of meeting the needs of a huge number of people in our population. I hope that the Government will do this. One way of meeting these needs is to look at the Scandinavian model of hospital hotels, which brings in another sector to help provide appropriate care. This happens almost automatically in Scandinavia. I hope that the Minister will agree to look further at that model. I have a group studying ways of implementing it.

We must also prevent people going into unsuitable hospital care, as the noble Baroness, Lady Jolly, clearly pointed out. We should not do anything to stop people with acute needs going into acute hospitals but it would be far better to transform some of them into local hospitals which deal more effectively with people suffering from one form or another of dementia and other chronic conditions. No MP would ever agree to a hospital closure but they might agree to the transformation of a hospital into one more suited to meet the needs of many patients today. Those patients are badly cared for in hospitals that are unsuited to their needs. It is also very unsuitable for patients with other conditions to be on the same ward as patients suffering from some form of dementia, which is usually the case. The latter ought to be able to stay in the community, but to make this work we need more collaborative working and integration between health and social care. The draft Care and Support Bill will facilitate this to some extent but other measures are also necessary.

We have to hope that local authorities will use the flexibility they have—they do have some—to allocate their money in a different way. However, health, social care and housing need to be integrated under the law, where possible, to enable more co-operation to take place. One way of doing this is to provide more preventive care. Local authorities must realise that they can save the NHS a lot of money if they keep people who have multiple needs, but not acute ones, out of acute hospitals. There has to be co-operation in this regard and local authorities must use any flexibility they have. There is not enough money but there is some money which they could use in this respect. Integration is terribly important.

Another important aspect of the draft Bill is that for the first time self-funders will be included as users of services. A fact that is not publicised is that very often when those self-funders have to go into a care home they pay over the odds. The local authority has negotiated a very low rate per patient but the self-funders are charged more than their care costs. We may approve of that “Peter and Paul” situation but it is not publicised and we should not have that sort of secret “tax” in this country. That has to be looked at by the Government who should make clear what is and is not appropriate as regards cross-subsidies. I hope that the Minister will look at that.

In summary, will the Minister look at the savings that can be made to acute NHS budgets through the provision of adequate care? Will he also look at the Scandinavian model and make sure that staff at all levels are trained in human rights, which the EHRC inquiry insisted on, and will he look at cross-subsidies?