Care for the Elderly (Kent)

Paul Burstow Excerpts

Tuesday 8th February 2011 Westminster Hall

[The Minister of State, Department of Health (Paul Burstow)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Dover (Charlie Elphicke) on securing the debate. He, like the hon. Member for Dartford (Gareth Johnson), has used it to ensure that those responsible for making the decisions are properly held to account and the issues are fully aired and in the public domain. The summing up given by the hon. Member for Dartford underlines the important contribution that a debate in Parliament can make to illuminating an issue and ensuring that local decision makers account to their public for their decisions.

The hon. Member for Dover raised an issue that is causing a great deal of concern to his constituents, the hon. Member for Dartford and many other Kent residents. He talked specifically about Sampson Court and identified the commitment that he and his constituents feel towards that facility. It is a much loved, long-standing part of the community. Both hon. Gentlemen talked about the passion displayed by those campaigning on these issues.

The county council has already taken decisions on this and other home closures of the sort about which the hon. Member for Dartford spoke. Parliament has given the responsibility for taking final decisions on care home closures to councils not to Ministers. I know from my constituency work just how upsetting care home closures can be. Clearly, in the event of any care home closure—I will not prejudge where a subsequent challenge to the decisions in Kent would get to—our first thoughts have to be about the welfare of those who live in the homes and use the services, as has been clearly described by the hon. Member for Dover who talked about his father and about the representations received from constituents. I realise that for residents and families associated with the care homes, this is an unsettling time. Moving home when a person is elderly or frail can be hugely distressing and potentially damaging to their health. If badly handled, it can actually foreshorten life—I make no bones about that.

I have asked Kent county council for reassurance about its plans to reduce the disruption and harm to residents who will be transferred as a result of the decisions that it has made. As I understand, the council is currently assessing the needs and preferences of all residents and services, and it is doing everything in its power to accommodate people’s wishes. For example, it is ensuring that people are not moved to a place that is different from the place their friends from the home are moved to. If people want to stay together, they will have the opportunity to do so.

The council also told me that the families or advocates of those affected are being kept informed during the process. That is crucial, although some of what I have heard during the debate suggests that there are different opinions about that statement, and from some of the body language, I see that others share that feeling. The council hopes to support residents to move at a pace with which they are comfortable, and evidence from past closures demonstrates that that is crucial for minimising the effects of such a move. The sense that there is an arbitrary timetable can have a significant impact on the health and well-being of an individual.

I am told that all residents and service users will be found places in centres and homes of an equivalent or higher standard. I do note, however, the representation made by the hon. Member for Dover about the experiences of his constituents and the lack of assurance that they have received so far in their efforts to discover an appropriate home for their loved ones. The council has said that, within reason, service users will not lose out financially, and that an independent arbiter will deal with any disputes over costs associated with the move.

The hon. Gentleman was right to say that we must put this into a national context, and across the country all councils are having to grasp the nettle and take painful decisions to reshape social care around the changing needs of their population. We need a broad strategic shift towards preventing and postponing dependency, and promoting greater independence. That includes ensuring that the services available are the right services for a particular point in a person’s journey with a degenerative neurological condition, such as dementia, for example, which he mentioned. Earlier diagnosis is key to sensible planning and it is important to ensure that we deliver the right care at each stage of the journey taken by an individual and their family carers. That means that over time, councils need to spend less on care services where there is overcapacity, and free-up resources to invest in more personalised support.

This Government have no ideological opposition to residential care, although there is a sense that that was the case in the past under previous Administrations. There will always be a need for good-quality residential and nursing care in our communities, and anyone who has had a long-term engagement with the sector—as I have, and I am sure other hon. Members have—will know how much it has changed over the past 20 years. The level of need and dependency of residents has risen significantly, and the length of stay has shortened.

Currently there are approximately 50,000 vacancies in care and nursing homes across the country. According to the recent “Care of Elderly People UK Market Survey” by the independent health care analysts, Laing and Buisson, the level of spare capacity in the care home sector is currently 10% nationally. That carries a significant opportunity cost and locks a public resource that could be released and spent more effectively on early intervention and more personalised forms of care.

We should be clear that these closures are not—or should not be—a question of budget pressures forcing the council’s hands. The money for social care is there. The Government made a clear choice on decisions about funding critical services, and despite inheriting the largest peacetime deficit in our history and the largest structural deficit in Europe, and despite paying £120 million a day in interest repayments on the national debt, we have chosen to protect the care and dignity of older people. In the spending review, we made it clear that an extra £2 billion a year for adult social care would be available by the end of the spending review period. Furthermore, £1 billion of that would be added to the local government formula grant, which comes on top of the existing £1.3 billion social care grant. That means that total grant funding from the Department for social care will reach £2.4 billion by 2014-15. For those keeping up with the numbers, the other £1 billion will be transferred from the NHS and spent on social care measures that also support health.

That settlement is frontloaded, so that extra resources are put into the system at the beginning of the spending period. It means that considerable amounts of extra investment are available now. Kent county council has already received £1.4 million in November to improve re-ablement services, and £4.1 million in January as part of a national investment of £162 million to cope with winter pressures facing social care services. From April, it will get an additional injection of £16.2 million, which is its share of the £648 million that we are allocating via primary care trusts to support social care. That is on top of the extra funding for social care that we are putting into the local government finance settlement—a share of the £530 million extra available nationally next year, rising to the £1 billion I have just mentioned.

My understanding from briefings I have received is that Kent county council’s approach is not a sudden, hasty, knee-jerk response to tighter financial circumstances. The proposals are part of a long-term plan in Kent to improve care and meet the changing needs of the local population. The council published its “Later Life” plan in 2009, and it has been working over the last two years to restructure and transform services to put more emphasis on prevention and practical support.

Services need to be tailored to people’s circumstances and population need, and I emphasise that residential care is part of that mix and must be carefully thought through when services are designed. We need services that deliver value for money in a climate where we expect higher demand as the population ages, and we want good quality services—whether provided in the public or independent sector—that are well equipped to give people the choice, comfort, compassion and independence they deserve.

The council argues that the facilities at Sampson Court no longer meet the standards we should expect. The hon. Gentleman has rehearsed that argument and stated his concerns. The council also argues that the building would require extensive refurbishment to bring it up to scratch, and that the money could be better used in other ways. The council’s view—painful though it clearly is—is that closure is the right way forward. I understand that many people will disagree with that, and believe that alternatives have not been adequately considered—the hon. Gentleman referred to the petition collected by Councillor Julie Rook. The Government are keen to give communities the opportunity to run community facilities. That is what the Localism Bill currently making its way through the House attempts to put in place. That Bill also seeks to reduce the barriers that enable a variety of organisations, including community groups, to provide services.

The council’s view is that it has been through an extensive consultation process and considered the alternative options. The 11 care home changes have been debated in the council’s chambers, and the proposals have been the subject of the council’s overview and scrutiny committee. I know that there are great concerns among those who have led the campaign against the closures, and I am told that lawyers have been instructed to look at pursuing the matter through a judicial review. In that way, the process that the council has gone through can be tested, and if it is flawed, the decisions will be reopened and further options considered. However, that is not a matter for me as a Minister; it is about deciding whether the process has been properly followed, and a matter for judicial review. Parliament has not given Ministers that power, and the Government have made it clear that in the past, far too much rested on the desks of Ministers in Whitehall and other officials.

During conversations with Kent council over the past few days, the director of adult social services said that the council would be pleased to continue discussions with the hon. Gentleman and his colleagues, to see whether further points of concern can be addressed. In conclusion, I hope that we have covered some of the issues raised, but in the end, this matter must be resolved locally.