Care Home Top-up Fees

Debate between Paul Burstow and Barry Sheerman

Tuesday 22nd July 2014 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

It is a pleasure to have the opportunity under your chairmanship, Mr Sanders, to debate an issue that is of growing importance and will increasingly find its way into the mailbags of hon. Members on both sides of the House. The issue is how much people pay for care in the 10,000 or more care homes up and down England and, in particular, whether the top-up payments that some residents and their relatives make to secure care home accommodation are fair and transparent. With the Department currently consulting on draft guidance for the Care Act 2014, this is a good time to turn the spotlight on these issues.

The legal framework setting out what local authorities need to do when a resident who qualifies for means-tested support enters a care home has been fairly clear for a long time. The “Charging for Residential Accommodation Guide” and the 2004 choice of accommodation directions are straightforward, at least in so far as they clarify that, if local authority-supported residents would like to move into more expensive accommodation—for example, they might want to secure a place in a home nearer their family—they can, provided that a third party, normally a relative, can pay a top-up payment, make that choice. The rules are also clear that if, for whatever reason, no care home places can be provided at the rate that the local authority would normally pay, it is the responsibility of the council, not the resident or their relatives, to pay more to secure reasonable care home accommodation.

The rules are clear. The trouble is that evidence is mounting that they are being broken. Local authorities are confused about how to apply the rules consistently, so that families can be informed about the rules on choice and choose more expensive accommodation, knowing that that will involve additional costs, while at the same time being protected from paying a top-up payment for essential care that it is the council’s responsibility to pay for and meet.

An estimated 54,000 local authority-funded adults are part-paying their care home fees. That is 28% paying top-up fees. Just over one in 10 of all care home placements involve someone paying a top-up fee.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I congratulate the right hon. Gentleman on securing the debate, because up and down the country and certainly in my constituency of Huddersfield, there is real concern about this issue. Does he agree with the finding of a recent survey that many councils do not know what is going on? It is not that it is malign; they just do not know what is going on.

[Paul Burstow]

That is really the thrust of this debate. Whether it is malign or not, it is ignorance, and when it comes to a local authority, that ignorance is not acceptable.

The problem is that the people I am talking about are often out of sight and out of mind. We do not know how many of the 54,000 people who pay a top-up know that a top-up is intended to allow relatives to pay a little extra for a care home place that is above and beyond the “standard” level available from the council. We do not know how many of the 54,000 people know that their council or care home should not be requesting a top-up for any care; it should request it only for a higher standard of accommodation.

Based on the evidence that I have seen, I believe that we need to examine whether the rules governing choice and charging for residential accommodation are working as intended and that we need to look again at what we can do to clarify local authorities’ responsibilities now that the legal framework is being strengthened by the Care Act. We need to get this right because top-ups look set to grow in number, not least with 35,000 more care home residents qualifying for some level of means-tested support when the upper capital threshold is increased to £118,000 from 2016. It is in councils’ interests to get it right because, again thanks to the Care Act, there will be a new appeals process for each local authority. Unless the often grey area of top-ups is sorted out, it is likely that a growing number of residents will be challenging the decisions that councils have made about care home fees. Councils can take steps to minimise the risk of legal challenges, but they need the Government to provide clear and practical guidance on what they are required to do and, crucially, what they cannot do.

[Mr Sheerman]

Will the right hon. Gentleman give way, just on that point?

[Paul Burstow]

I cannot because—

[Mr Sheerman]

May I intervene very quickly just on that point, because it is very important?

[Mr Adrian Sanders (in the Chair)]

Order. It is for the Member who secured the debate to give way.

[Paul Burstow]

I will give way, but I need to stress to the hon. Gentleman that this is a half-hour debate and I need to make quite a few points myself.

[Mr Sheerman]

I was trying to intervene on this point only because it means so much to some of my constituents. Some of them have said that the trade association for care homes, which is a very powerful one, should have a charter of rights. As someone goes into a home, it should be there and should show the clear responsibilities and clear duties of care.

[Paul Burstow]

That is a very good point and one that I am sure Care England and other organisations representing care homes would want to take on board.

It is important to understand the scale of the problem. Research carried out last year by the charity Independent Age highlighted the fact that 72% of local authorities—there was a very high response rate to this freedom of information request—were unable to demonstrate that they met their legal obligations with an overview of top-up payments in their area. In other words, they were not routinely monitoring and reviewing whether third parties remained “able and willing” to make top-up payments. That is a core requirement of the existing guidance. The onus is on councils to check that families are not unwittingly making top-up payments for care that should be paid for and met by the council as part of its duties to meet assessed, eligible needs. Those payments can range anywhere from £31 a week to perhaps £131 a week. In some cases, it is probably even higher than that.

The research also found that just under 30% of councils said that they did not hold or collect information about top-up fees in their area. This was a typical quote from a council:

“As a Council we’ve never had any involvement in top-up care home fees...The Council does not know how many top-ups are in place, in any financial year”.

Perhaps most disturbing was that so few councils knew what was taking place in terms of top-up fees arranged between care homes and families in their area. Almost 80% of councils did not routinely check up on the health of top-up payments as part of their annual reviews, and 75% of councils did not signpost families of care home residents to independent advice before entering into third party top-up agreements.

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 12th June 2012 Commons Chamber

[Paul Burstow]

My hon. Friend, who chairs that all-party group, met me recently to make those points, and as a consequence of that meeting and his excellent note of it I undertook to write to him in greater detail. He will understand that some of those issues go to the heart of data collection and to the quality of the data currently available throughout all cancer sites, and that is the reason why we may not be able to do quite what he wants at the pace that he wants.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Why do the tests for bowel cancer and breast cancer have an age cut-off? Just when people are more likely to have either condition, they are not regularly tested. Why is that the case in many parts of our country?

[Paul Burstow]

On the day that the Government have confirmed that from October there will be a complete ban on age discrimination within the national health service, except when it can be objectively justified, the answer to the hon. Gentleman’s question is that the evidence used to determine who is eligible for a screening programme is the basis on which recommendations are made to the Government, and they will be extended in future.

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

I am grateful to the right hon. Gentleman for his question, because he outlines the need to reduce health inequalities—something that the party of which he is a member failed to do in government. I can assure him that the Bill, which has now gone through all its parliamentary stages, will place a duty on clinical commissioning groups to seek to reduce health inequalities —something that his Government never did.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Minister aware that when walk-in centres fail—or when any aspect of the national health service fails—it is because of poor management? Does he realise that good managers up and down the country are leaving the national health service? Doctors are not trained as managers. The Institute of Management has said that 43% of our managers are not up to the job, and we are not training our managers in the national health service because they are GPs.

[Paul Burstow]

This Government respect the contribution that NHS managers make, and we respect the contribution that the NHS Confederation makes as well. However, we also want to ensure that clinicians are at the heart of commissioning services. They are the people who understand patients most, and they are the people we are giving that responsibility to, because we think that is the way to drive improvement in the NHS.

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 22nd November 2011 Commons Chamber

[Paul Burstow]

There is no doubt that more integration between health and social care is a way of improving the quality of services delivered to the public, and of releasing resources that can then be reinvested in improving services. We know, for example, that the use of reablement services can reduce costs and improve the quality of life outcomes for the people who receive them.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

18. What steps he is taking to improve the training of nurses and doctors.

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 26th April 2011 Commons Chamber

[Paul Burstow]

Absolutely. By bringing public health home to local government we will have the opportunity to ensure that many of the underlying causes of ill health can be tackled more effectively, and that is why we are making the reform in this way. By having a health and wellbeing board that brings together all the interested parties we can also ensure a far more integrated approach.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Will the hon. Gentleman persuade the Secretary of State to come to Yorkshire and perhaps speak to a small group of people—no more than 60—in a quiet room about what these boards are supposed to do? Who will be on them, how accountable and transparent will they be, and will they have any teeth?

[Paul Burstow]

My right hon. Friend of course is more than happy to go to all sorts of places to talk to people about the health reforms. However, local government fully supports this particular proposal and sees it as a vital innovation for the involvement of local government in the health service. It will be transparent because it will be part of the local authority and will meet in open.

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 25th January 2011 Commons Chamber

[Paul Burstow]

My hon. Friend is right to draw attention to the need to integrate not only the way in which we deliver and plan services, but the way in which we manage complaints. That is why the Government have included in the Bill our proposals for the establishment of local healthwatch and healthwatch England. Local healthwatch will have the ability to deal with complaints and also have the capacity to refer concerns about services to the Care Quality Commission so that it can take the necessary steps to investigate. In that way, we will deliver a more integrated system for dealing with such complaints.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Minister aware that most of us are in favour of much better co-ordination of these services, but we worry about the backdrop of the reforms? In Yorkshire, some doctors are saying, “Come on, guys, this is a bonanza and we will all be California-style millionaires under these reforms.” What sort of a backdrop is that for health care reforms and better co-ordination of services?

[Paul Burstow]

The backdrop that the hon. Gentleman has just painted is a rather thin one. In fact, it does not exist at all. The Government set out in the Bill we published last week that there will be clear responsibilities on GP commissioning consortia, working in partnership with their colleagues in local government, to commission services in ways that will improve quality of life for people in his constituency, my constituency and the constituencies of all hon. Members.

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 2nd November 2010 Commons Chamber

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

I am grateful to the hon. Gentleman for drawing attention to the Government’s commitment to develop reablement services, especially the win, win, win that they can deliver for the individual who gets back on his feet, gets his confidence back and leads his life independently; for the social services departments, which do not have to provide ongoing support; and for the NHS, which does not have to deal with readmissions. Occupational therapists have a vital role to play in providing good quality support following discharge and are therefore critical players in the development of reablement services around the country.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

T9. Is it appropriate for my constituents in Huddersfield to be lectured about healthy living standards by a Minister who is out of condition, overweight and a chain smoker?

Oral Answers to Questions

Debate between Paul Burstow and Barry Sheerman

Tuesday 7th September 2010 Commons Chamber

[Mr Burstow]

The best way of responding to the hon. Gentleman’s very appropriate question is to say that we are taking a four-pronged approach to diabetes. First, we need to tackle the causes of the condition through a renewed impetus on public health. We shall announce more of our plans in our White Paper later this autumn. Secondly, we need earlier identification and diagnosis so that we can help people to manage their condition at an earlier stage so that it does not progress. Thirdly, we need effective management and self-directed care. Finally, we need world-class research so that we can better understand the condition and deliver better treatments.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

10. What steps he is taking to ensure the adequacy of resources allocated to hospital accident and emergency departments.