§ Mr. Tim Loughton (East Worthing and Shoreham)
In West Sussex we know something about the elderly, and we certainly value them. In 1996, 171,000 people out of a total county population of 727,000 were over pensionable age. That is 23.6 per cent.—almost a quarter—against 18.2 per cent. for the country as a whole. It is forecast that by 2016—twenty years on—that gap will have widened and more than 27 per cent. of the population of West Sussex will be of pensionable age against the national average of 21 per cent.
The constituencies on the coastal strip, which are represented by my hon. Friends who are in the Chamber today, all feature in the top 27 constituencies with the highest number of pensionable age residents. Top is Worthing, West with 42.6 per cent.; ninth is Bognor Regis and Littlehampton with 36.8 per cent.; Chichester is 17th with 33.2 per cent.; and my constituency of Worthing, East and Shoreham is 27th with 32 per cent.—almost a third—of residents of pensionable age.
Worthing borough has the highest number of pensioners in the entire country, but it is forecast that we will be overtaken by Clacton-on-Sea in 2000. Although the average age of people in Worthing is decreasing, we have twice the number of over-65s, and three times the number of over-85s, compared with the national average. Nationally, the number of over-85s is forecast to double to 2.2 million by 2040. That will impact on us most of all.
There is net immigration into West Sussex, which we welcome; it is a nice place to live, and also to die. Part of the character of Sussex is represented by its elderly population. None of us in the Chamber would want it any other way, but, contrary to popular myth, not everyone in Sussex—and on the coastal strip, in particular—lives in a castle. There are many areas of deprivation.
Under the index of local deprivation drawn up for judging single regeneration budget challenge fund criteria, Central ward in Worthing, for example, was ranked among the 10 per cent. of wards in England that are most deprived. Areas of Adur, in my constituency, suffer high unemployment, which leads to poorer pensioners living in rented accommodation. The same is true in parts of Littlehampton, in the constituency of my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb).
The high preponderance of elderly people in our county means that very great demands are placed on the health budget and on social services spending, which is what I want to discuss today. The national health service survey produced by The Times last November revealed that West Sussex has the longest delays for hospital treatment in the whole of England: one patient in seven on the waiting list—14.9 per cent. of that list—waits for more than a year for hospital treatment. Lambeth is next, with 12.7 per cent.
At the opposite end of the scale, northern authorities such as Sunderland and Northumberland have less than 0.5 per cent. of patients on waiting lists waiting for over a year. There are 30 times more patients waiting over a year on West Sussex waiting lists than on those of the best performing hospitals in England.
Only West Sussex last year recorded a bigger rise in the number of patients waiting for over a year. The figure increased from 902 to 3,634, which is a very large 896 increase. Typically some of the longest lists are for age-related operations, such as hip replacements and cataract operations. Problems are widespread, extending particularly to mental health. There is a dire shortage of acute mental health beds.
It is no surprise that the largest branch of the Alzheimer's Disease Society is in Worthing. The priority care trust responsible for those services has overspent by £550,000, with two months of the financial year to go, despite having made savings of £450,000 already. For the first time ever, it will not be able to balance its books. Worthing also has the largest branch of the Parkinson's Disease Society, and I pay tribute to the work that it has done.
West Sussex health authority overall is £5.5 million over budget, despite the best efforts of all its staff. We are desperately trying to reduce the waiting lists, but Worthing and Southlands Hospitals NHS trust, for example, has 90 nurse vacancies and a severe problem with nurse recruitment. A high level of emergency admissions compounds that problem.
We need special help for special age-related problems, but, despite the extra money last year, our funding remains under capitation. The health authority is the worst funded in the whole of the South Thames region, after the accumulation of years of being funded well below capitation. Now we are threatened with unbearable pressure to reduce waiting lists by the end of March. For example, if Worthing and Southlands Hospitals NHS trust does not reduce its waiting list from 7,500 to a target of 5,000, it will be penalised to the tune of £450 for each patient over that target figure at the end of March. The largest reduction target for any hospital in the country has been given to Worthing and Southlands. It is trying its best, but it will be hard pressed to meet the target.
In social services, the county council has radically overhauled its policy towards care for the elderly. Shortage of funds has regrettably forced the closure of four residential homes in the county, two of which were in my constituency, but at least the funds raised are being recycled into the social services budget, with significant reinvestment in preventive home care. That will enable more people to be looked after in their own homes, but other schemes cannot be funded because of the shortfall. I pay tribute to the sensitive way in which West Sussex county council social services department has handled those closures, which have been forced upon it.
An increasing number of elderly people are looking for residential or nursing care in our county. There are 5,000 nursing home beds in West Sussex, which is 0.64 per cent. per head of the population compared with a national average of only 0.3 per cent. Again, the figure is double. The problem is worsening. A man aged 65 has a 9 per cent. probability of requiring residential care for the rest of his life, or a 5 per cent. probability of requiring nursing home care. The figures for a woman aged 65 are 13 and 37 per cent.
Given that Worthing has almost twice as many women as men over the age of 60, the problem is compounded in our part of the world. It is a particular problem with the increasing number of people who enter care paying for themselves, but who become a demand on local authorities when their capital falls below £16,000. In the past eight months 140 people, no less, have moved from being self-funded to being supported by public funds. 897 The cost to the county, so far, has been £700,000, which is a sizeable sum. On present trends, that will increase to £1.6 million in the next year.
We therefore have problems with bed blocking. Currently, 32 elderly people are waiting for placements in residential and nursing home care, 28 of whom are in hospital at a time when there are virtually no available beds in our hospitals. Social services wants to help to reduce bed blocking, but it is caught in a Catch-22 situation. We need special help for special age-related problems.
§ Mr. Howard Flight (Arundel and South Downs)
Does my hon. Friend agree that, faced with those problems—and although the social services department has an excellent record—it is monstrous that the gerrymandering of the standard spending assessment funding has resulted in a 10.4 per cent. cut in the social security budget this year, notwithstanding a 7.4 per cent. increase in council tax? Does he deplore what has happened? We were given the lowest award in the whole country and the special transitional grant was not phased into the SSA rollover.
§ Mr. Loughton
My hon. Friend anticipates the point that I was coming to. We have said that we need special help for special age-related problems, but West Sussex received the lowest Government grant of any shire county in England recently. There was, on the face of it, an increase of 3.8 per cent., against an average of 5.2 per cent., but, as my hon. Friend said, after adjustments for community care funding, nursery voucher abolition and discretionary arrangements, the increase was only 2.2 per cent.
The social services figure is even worse; it suffered a reduction of £4.7 million after adjusting for last year's special transitional grant, which is not to be rolled forward. That is the 10th-lowest increase of all 150 councils in the country and, again, the lowest of all shire counties.
The additional £1.7 million for West Sussex announced only two days ago—it is amazing what an imminent Adjournment debate can achieve—is a small improvement, but it comes at the same time as the teachers' pay award and other new responsibilities for local authorities. It is a drop in the ocean in terms of the deficit on social services alone. Incredibly, the number of people in residential care has been excluded from the calculation of funding needs for people in residential care. Therefore, funding does not take account of people moving into residential care in West Sussex from other areas of the country.
Under Labour's first local government settlement, West Sussex social services had to make savings of £2.5 million, which is almost as much as the total savings for the previous four years put together. It is often assumed that wealthy West Sussex is a soft touch for large increases in charges. However, as the joint review by the Social Services Inspectorate and the Audit Commission observed:Charges already represent a substantial proportion of gross expenditure and the scope for greatly increasing income seems limited.So the nearly poor are paying for the really poor. It is little wonder that the recent settlement was condemned in West Sussex, by all parties, as grotesque and devastating.
898 Other Government changes have compounded the problem. The abolition of tax relief on private medical insurance in Labour's first Budget has particularly affected Worthing, which has the highest number of pensioners with such policies. That has undoubtedly led to an increase in waiting lists.
§ Mr. Nick Gibb (Bognor Regis and Littlehampton)
My hon. Friend explains very well the difficulties faced by the elderly in West Sussex. Is he aware that retired people will suffer severely from the array of stealth taxes introduced by the Government? They will pay £95 a year extra because of the reduction in the value of the married couples' allowance, £50 a year more because of extra duties on petrol, and an additional £75 a year because of the abolition of the repayment of dividend tax credits.
§ Mr. Andrew Tyrie (Chichester)
Further to the intervention by my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb), I have received many letters making exactly that point. It is clear that many people in my constituency who are on modest incomes have been hit by the decision to abolish ACT dividend tax credit. The 1997 Budget was disastrous for them. Does my hon. Friend the Member for East Worthing and Shoreham (Mr. Loughton) have the same experience in his constituency?
§ Mr. Loughton
I completely agree with the points made by my two hon. Friends. The abolition of dividend tax credits will affect more than 300,000 people nationally. Many of my constituents are the typical victims of that measure. Those people may have just a few shares. They may, on the face of it, be asset rich in that they own their own home and a few shares from privatisations or building society demutualisations, but they are income poor, and to take away a large chunk of that income exacerbates their poverty. Despite the Paymaster General's assurances that there are alternatives, there are none for those people.
Honest attempts by poorer pensioners in West Sussex to save in retirement and for their retirement to enable them to stand on their own two feet have, through recent stealth tax changes, been dealt a blow by an intransigent Government.
Many people in West Sussex may be forgiven for thinking that the Government are Sussexist. I should like to pay tribute to hospital and social services staff across the county for the excellent job they are doing in difficult circumstances. I also pay tribute to our county council staff for their sensitivity in handling these appalling settlements. When West Sussex suffers, our poorer pensioners, in abundance, bear the brunt. I ask the Government to give proper recognition to the very real and growing funding problems that go with having such a high population of pensioners in our county.
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. I am sorry, I cannot call the hon. Member for Worthing, West (Mr. Bottomley). He has not intimated that he wishes to speak.
§ Mr. Bottomley
If I have done wrong, I apologise. My impression was that, if one stood up during the debate, 899 one had the opportunity to be called, if the Minister and the hon. Member who had secured the debate would allow.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)
Yes, Mr. Deputy Speaker.
§ Mr. Peter Bottomley (Worthing, West)
I congratulate my hon. Friend the Member for East Worthing and Shoreham (Mr. Loughton) on his initiative. I hope that the Minister and his colleagues will agree to meet a deputation from the organisations that are concerned with the illnesses and circumstances of the elderly. We know that we cannot change the rate support grant settlement for this year, although the extra £1 million is welcome. If, in the years to come, we face the prospect of more and more money being taken away from social services and less and less money being available as increases for the health services, people with Alzheimer's and Parkinson's disease and others will be hurt.
In praise of Government Departments and people in West Sussex, I should like to refer to a letter that I received today from a mentally ill constituent, who says that the voluntary and statutory services have combined to give him a fuller life than he had elsewhere. We should like to receive such tributes more often, but to provide such services requires resources.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)
I congratulate the hon. Member for East Worthing and Shoreham (Mr. Loughton) on securing this important debate. I welcome the tribute that he paid to NHS and local authority staff in West Sussex. I am aware that a high proportion of older people live in West Sussex, especially in the hon. Gentleman's constituency and the surrounding area. That has an impact on social care and local health services, and I welcome the opportunity to discuss the way in which our policies and our positive agenda will improve vital services in the hon. Gentleman's constituency.
Older people make an enormous contribution to our national life, and the Government are determined to ensure that their wishes and needs are taken seriously. We also intend to ensure that older people are valued properly and can play their full part in society as a whole.
The hon. Gentleman has raised some specific issues, and I shall try to address as many as possible in the time available. He referred to mental health pressures in his constituency, but he conveniently forgot to mention the Government's "Modernising Mental Health Services" strategy document, which we published in December. On top of the initial spending that we have allocated to mental health services in Britain, we are making a further £700 million available to support modern mental health services in England. Within that strategy, we have recognised the need for extra beds in the acute sector, throughout the service into the community and in the high-security forensic services. If the hon. Gentleman has time, he should look at our strategy document, and he may draw some satisfaction from it.
900 The hon. Gentleman also referred to nursing shortages. I am sure that he welcomes the excellent news—which the Secretary of State gave at Health questions yesterday—that nurses not currently working in the NHS have shown significant interest in returning to employment within the NHS. That is a positive response to our advertising campaign. Given that response and the nurses' pay award, we are confident that we shall begin to address the problem of nursing shortages in the short and medium term.
In a thoughtful part of his speech, the hon. Gentleman rightly referred to the charging regime for long-term residential care. That is a fundamentally important issue, and in our White Paper, "Modernising Social Services"— I do not know whether the hon. Gentleman has had an opportunity to read it—we said that we were determined to introduce greater consistency in the charging regimes across local authorities. Given that the royal commission on long-term care is currently examining this issue, it would be appropriate to wait until it makes its recommendations, so that we can have a proper debate about charging policies for domiciliary care and charging regimes for residential care.
I should point out, however, that we inherited the regime that the hon. Gentleman is now criticising and complaining about from the Government he strongly supported. Some of the problems he highlighted did not start on 1 May 1997. We inherited a range of problems with which we are seriously trying to get to grips.
§ Mr. Hutton
No, we are not making them worse. We are trying to get to grips with the problems in the NHS and in social services. By providing record levels of spending, we are ensuring that those two services receive more resources than they ever received during the 18 years when the hon. Gentleman's party had responsibility.
The hon. Gentleman referred to winter pressures. I am grateful to him for praising NHS staff on their efforts to tackle the acute pressures that the service came under over the winter holiday period. A huge effort was made in West Sussex to ensure that everyone received the necessary treatment and care. I am sure that the hon. Gentleman will join me in congratulating the staff again. A huge amount of collaborative work has been done across health and social care to ensure effective service planning, commissioning assessment and delivery of services to the people in West Sussex.
That effort has paid particular dividends this winter, despite a sharp increase in the levels of illness, especially for older people, which resulted in a huge increase in the number of patients using the NHS. It was better prepared than ever before to cope with those illnesses, and in most places, including across West Sussex—despite what the hon. Member for East Worthing and Shoreham said—most hospitals have coped well with the pressures.
§ Mr. Loughton
I am interested in the general points that the Minister is making, but he has not addressed the fact that West Sussex has effectively had a £4.7 million cut in its social services budget and West Sussex health authority has by far the longest waiting lists of any health authority in the country, with one in seven of our people 901 waiting for more than a year. That does not sound like a good modernising deal for my constituents in West Sussex.
§ Mr. Hutton
I will address the hon. Gentleman's points in the course of my remarks, but I have only just started to try to do so. As he will know, 2,200 schemes are under way nationally. Of those, we have supported 28 schemes in West Sussex, with the help of an additional £1 million from the resources which the Government made available before Christmas. Those schemes include £70,000 for a project in the hon. Gentleman's constituency of Worthing to reduce medical and acute admissions for the elderly; £31,000 for rehabilitation to be provided in residential establishments; and more than £100,000 to fund a medical assessment area, thus preventing admissions to main wards.
The additional money has helped, but we have not stopped there. From the £50 million contingency fund announced by my right hon. Friend the Secretary of State for Health last month, we have provided another £500,000 to support 15 new schemes in West Sussex, including £75,000 for a joint collaboration with social services for a nursing home discharge scheme in Mid Sussex; £20,000, again in Worthing, for the provision of three non-NHS beds at a local rest home to facilitate early discharge; and £10,000 to provide additional elderly care consultant sessions at the Queen Victoria hospital.
We have encouraged health authorities to support joint schemes such as those that I have outlined. Indeed, the local health authority has provided support to West Sussex social services by transferring funds through section 28A of the National Health Service Act 1977, which, as the hon. Member for East Worthing and Shoreham will be aware, has long been a key funding mechanism, also used by the previous Administration, to enable health authorities to support the work of social services. Significant resources have been transferred to assist that process.
This winter we also extended flu vaccinations to all those over 75, rather than confining vaccinations to particularly vulnerable groups. As a result, nationally a third of a million extra doses have been given this year compared with last, and the vaccine remains available. I am sure that many older people in West Sussex have taken advantage of that initiative, and they will have had the opportunity to benefit from the many other initiatives recently announced, including the national lottery new opportunities fund; the renewal of a quarter of accident and emergency departments across the country; and NHS Direct.
§ Mr. Hutton
The hon. Gentleman who seeks to intervene from a sedentary position got into trouble recently because he made inappropriate remarks to other hon. Members.
§ Mr. Hutton
I shall not apologise to the hon. Gentleman. Someone on the Opposition Benches is 902 muttering very rudely and inappropriately. It may be worth reminding Conservative Members that Adjournment debates are usually an opportunity for a proper and friendly exchange of views. I am trying to do that and it is a great shame that Conservative Members seem to have lost their manners.
The hon. Member for East Worthing and Shoreham mentioned the rise in waiting lists and times in his and other constituencies in West Sussex. We are aware of the problems, especially in the orthopaedic service, but those problems did not start on 1 May 1997. I am assured that the hospital to which the hon. Gentleman referred, the Worthing and Southlands NHS trust, is aiming to meet its target for waiting list reductions by the end of March.
The rise in waiting lists and times in West Sussex were as much a consequence of historical financial pressures as of the increasing need for treatment by patients. We are putting that right by investing more in West Sussex. In 1998–99, we invested an additional £6.3 million, which was the largest real terms increase in the then South Thames region. That is not the picture that the hon. Gentleman presented. From the first stage of our £21 billion extra investment, in 1999–2000 the health authority will receive nearly 4 per cent. real growth in funding of some £16 million.
§ Mr. Hutton
No, I will not. We are therefore delivering our promises to the people of West Sussex, both with this additional money and also our firm commitment to reduce waiting lists overall. We have provided extra money and we will deliver on our commitment. Nationally, the waiting lists reduced by 136,000, or nearly 10.5 per cent., between April and November 1998.
In West Sussex we have set very demanding targets—some of the most demanding in the whole of England. To their credit, the health authority and the local trusts are getting on with it and have been able to reduce the waiting lists by nearly 4,000 since March 1998. I understand that the health authority is aiming to reduce the waiting lists by just under 28 per cent., or nearly 7,000 patients, before the end of the year. That substantial programme of work includes treating a great many more patients, including treatments targeted mainly at older people, such as those for cataracts.
The hon. Member for East Worthing and Shoreham mentioned problems with cataract surgery. He might be interested to learn that if the figures for the first six months of last year are compared with those for this year, they show that more than 450 more cataract operations have been performed for West Sussex residents. That is a positive and encouraging step.
I know that the West Sussex health authority is keen to reduce waiting lists even further in the next financial year, especially in targeting in-patients, and is currently discussing that with the south-east regional office of the NHS Executive.
The hon. Member for East Worthing and Shoreham mentioned the situation of the local authority in West Sussex. The hon. Member for Worthing, West (Mr. Bottomley) asked whether I would be prepared to meet a delegation. I am always happy to talk to hon. Members about issues to do with social services or the NHS that are my responsibility. If the hon. Member for 903 East Worthing and Shoreham and his hon. Friends wish to arrange such a meeting, I would be more than happy to try to accommodate them.
I shall comment briefly on the pressures on social services in West Sussex. Resources nationally for social services are increasing by 6.1 per cent. next year, significantly above the rate of inflation. We are targeting a large proportion of that increase at improving the services for older people through better planning and delivery of services across the interface between the health service and social services, and in particular through improved rehabilitation services. I accept that the increase in resources for personal social services in West Sussex will be less than many other local authorities will receive. That is a result of changes to the formula used to allocate national resources for both children's and elderly services between local authorities. Those changes were made as a result of detailed independent academic research and have been fully discussed with all our partners in local government. We now have in place a much fairer and more equitable distribution system.
The hon. Member for East Worthing and Shoreham referred specifically to the problems with institutional care and excluding people in residential care from the standard spending assessment formula. If the SSA calculation reflected the total number of people in institutional care in an area, it would risk giving SSA credit to the wrong authority. Some of the people publicly supported in care in West Sussex are probably not that authority's financial responsibility, because they have been placed in those homes by other boroughs, perhaps from outside Sussex. It is therefore fairer to take no account of the numbers in care, because that does not properly reflect the needs of the population.
§ Mr. Tyrie
Before the Minister concludes, can he give some comfort for the future and confirm that the proportionate cuts in West Sussex county council's budget will be reversed, so that we can tell our constituents this weekend that there is some hope that the Government will reconsider the issue?
§ Mr. Hutton
As the hon. Gentleman knows, the ink is not yet dry on the local government financial settlement. Further announcements are due on the subject and he may draw some satisfaction from them.
Unfortunately, we are running out of time for this debate. The hon. Member for East Worthing and Shoreham raised other points that I would have liked to address, and I shall correspond with him about them. We want first-class services for the people who use the NHS and we want the best possible social services that we can provide for people in Britain. That is the whole purpose of our modernisation agenda for the NHS and social services and that applies just as much to the hon. Gentleman's constituents in West Sussex as it does to anyone else in the country.
§ Mr. Peter Bottomley
On a point of order, Mr. Deputy Speaker. I did not raise the point during the Minister's speech because he was being conciliatory and we wanted to hear what he had to say, but the voices he heard did not come from here. If the problem recurs, you have the ability to refer the matter to the Royal College of Psychiatrists.