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§ Mr. James Clappison (Hertsmere)
I am very pleased to have this opportunity to raise the subject of Borehamwood Care Village, the future of which has been a source of great concern for my constituents. The Minister is already aware to some extent of that concern through correspondence with me, and I am grateful to have the opportunity to meet her with a group of representatives from the home, including residents and family members. By coincidence, that meeting will take place later this afternoon, so what I say now is something of a preview.
Borehamwood Care Village is an important care setting for almost 100 elderly people in my constituency. It offers 40 residential places and 39 nursing bed places, as well as places for 16 close care tenants. It is a modern facility that was opened only 10 years ago, as I know, having opened part of it when I became the Member of Parliament for Hertsmere. It was opened as a modern facility offering continuity of care for people who, as they got older, were looking for stability more than anything else.
I should make it clear that the residents and the family members have no complaints about the fabric of the care village, nor about the quality of the care that they receive from staff. Indeed, I pay tribute, on their behalf, to the care and dedication of the staff, who have been as concerned as anyone about its prospects.
Just before Christmas last year, the residents and staff received the startling news that the home's proprietor, Assured Care Centres, was planning to close it. The company intended to sell the site to developers Bryant Homes for residential property development. That caused the gravest concern to the residents, their families and the wider community in Borehamwood and Hertfordshire, who all joined in a campaign to save the home.
In many ways, the name of the campaign tells us what we need to bear in mind. It is called STOP: Save the Old People—the action group working to save Borehamwood Care Village. The campaign has been vigorous, imaginative and well justified. It began with a packed public meeting in the Hertsmere civic offices, which was attended by a wide variety of people, including family members, councillors from both the borough and the county councils, representatives of the local churches and civic dignitaries, including the mayor of Borehamwood. The meeting was very well supported, reflecting the amount of interest in the matter in Borehamwood.
The campaign later held a march through Borehamwood, which was also very well supported and drew tremendous support from the people of the town. It was moving to see shoppers and shop workers coming out to give their support to the march. The people threw their full weight behind the campaign to save the facility.
There followed a widely publicised visit to Downing street by a delegation of residents and family members, who took with them a petition containing thousands of names of Hertfordshire residents. That delegation included Miss Rose Cottle, who is 102 and a remarkable old lady, and who is present for the debate, along with 157WH other representatives from the STOP campaign. Following the impact of that visit, both ACC, the proprietors of the home, and Bryant Homes, the would-be purchasers, showed a desire to draw back from their proposals and made public statements to that effect.
Before turning to those statements, I pay tribute to all those who have played a part in the STOP campaign, including Mr. Bryan Mayson, its chairman, who is also present today, Councillor Martin Heyward, the mayor of Borehamwood, Rose Cottle and the other elderly residents of the Borehamwood Care Village, all of whom contributed remarkably to the campaign.
I should like to report that this story has a happy ending in that the home's future has become assured, but we are not quite at that point. Several issues need to be resolved, which I shall highlight through the debate. On 26 March, Bryant Homes wrote to Mr. Bryan Mayson, the chairman of STOP, stating:We have asked Assured Care Centres to release Bryant from the contractual agreement relating to the site of Borehamwood Care Village, and are currently in negotiation with them.Bryant says that it cannot withdraw the planning application because of contractual arrangements that require the firm to consult the planning department of Hertsmere borough council.
Assured Care Centres, the proprietor, says that it accepts Bryant's offer to withdraw, but must observe legal requirements. The company says that it is discussing the sale of the care village with other parties who would retain it for its present use, which is what we all want to happen. We want Borehamwood Care Village to continue in its present state and to provide much-needed residential and nursing care.
I have no wish to pry into the legal arrangements of Bryant Homes and ACC, although I note that they are both expressing the same intention—one saying that it wants to be released from having to sell the property and the other saying that it wants to withdraw from buying it. It would be helpful if they could both make it clear that they have no plans at all for the sale of the site or any part of it for residential development and want to withdraw altogether from their original proposals. It would be helpful, too, if the issue of the planning application could be resolved as soon as possible, because, notwithstanding what they have said, the application remains extant and is still with Hertsmere borough council. It is clearly in the interests of the residents of the home, when they are being reassured about their future, that that planning application should be withdrawn and that ACC should go on to discuss the future of the home with other would-be purchasers who want to continue its present use, providing residential and nursing care.
What is happening in Borehamwood is part of a wider picture of what is happening in Hertfordshire and the rest of the country, in relation to nursing and residential care. The Minister may be familiar with the survey by Laing and Buisson, which reported that there had been a substantial loss of long-term care places since 1996. The loss of some 50,000 residential care places stands in contrast to the needs of an increasingly ageing population. Nursing home bed losses have been particularly serious, with 22,000 nursing care beds lost since 1998.
158WH Hertfordshire represents no exception to that worrying picture. Nursing home beds have been lost, and the losses are continuing. The most recent market analysis by Hertfordshire county council states that 103 nursing home beds were lost in Hertfordshire between April and November 2001 alone—November being when the most recent survey was concluded. Hertfordshire could ill afford the further, substantial, loss of 39 beds in Borehamwood.
The corollary of nursing home bed losses is the problem of delayed discharges from hospitals and the difficulties that flow from that. The Minister may be familiar with the surveys and statistics relating to delayed discharges. Her own Department suggested towards the end of last year that, at any one time, 6,000 beds in NHS hospitals are occupied by people whose discharge has been delayed. Whatever the figures, it is clearly a serious problem, and leads to other problems, such as cancelled operations and longer waiting lists.
Those problems have been evident locally, as I witnessed on NHS day in February, when I visited Potters Bar community hospital, a facility valued for its care. I was told that 12 out of the 45 beds were occupied by patients who would not have needed a hospital bed if one in an appropriate care setting had been available. That is confirmed by Hertfordshire county council, which said:The high occupancy rates within Hertfordshire homes mean that it is increasingly difficult to find affordable care home vacancies for elderly people whether those people are awaiting discharge from hospital or the community.
Earlier this year, the Government announced £200 million of additional spending to deal with the problem of bed blocking, about £3 million of which will come to Hertfordshire. However, spending money will not solve the problem if nursing home beds continue to be lost. On the steps of Downing street, Rose Cottle drew attention to the connection between the loss of nursing home places and the wider problems in the health service. As she put it:What's the point of clogging up hospitals with people like me?On this, as on so many other things, Rose and the residents of Borehamwood Care Village are the voice of common sense. We can ill afford the loss of such nursing and residential care places. Such a loss would be a tragedy for the very elderly people there—people who have entered that care facility on the basis that it will give them stability and reassurance in the later stages of their lives—and for their families. It would also have a serious effect on the wider community and on the health service, bringing problems of which we are only too well aware today.
We owe it to Rose Cottle and the wonderful elderly people like her to keep open homes such as Borehamwood Care Village. That is my plea to the Minister. We need to keep such nursing home and residential care places available. We need to safeguard the future of the Borehamwood Care Village, and to have the proposals and planning application for residential development there withdrawn. It must be transferred into hands that will keep it open as a much-needed residential and nursing care facility, offering high-quality care to people who deserve no less.
§ The Minister of State, Department of Health (Jacqui Smith)
I congratulate the hon. Member for Hertsmere (Mr. Clappison) on having secured a debate on a subject that is important and significant to his constituents. I, like many others, have been impressed by the vigorous campaign run by STOP, and moved by the eloquence and dignity displayed by Miss Cottle throughout a period of undoubted distress for both her and her fellow residents of Borehamwood Care Village, and I am looking forward to our meeting this afternoon, when we shall be able to consider the background to the issue in more detail.
Nothwithstanding the hon. Gentleman's concerns, I am pleased that the residents' position now seems to be much more secure and there seems to be more certainty that they will be able to remain in their present care home. It seems that, in this case, good sense has prevailed. I understand that several organisations are willing to purchase the home as a going concern, which will provide some important certainty and continuity for those living there. He made some important points about issues that must be resolved elsewhere, regarding the position of ACC and Bryant, as well as the planning applications. I am sure that those points will have been heard and hope that they will be acted on.
We appreciate that the independent care home sector is facing a number of challenges at present. The Government are very aware that the closure of any care home causes considerable anxiety and disruption to its residents. I want to touch on the wider context and the particular actions being taken to ensure that, in Hertfordshire, it is possible to provide the range of provision and capacity necessary for older people to have security, stability and independence.
Many care homes are private businesses, and as such, each must take its own decision about how to conduct itself, including whether to close. However, when it comes to the standard of care provided in a care home, the Government have an important role. The new regulatory system introduced by the Care Standards Act 2000 provides stronger powers to monitor the financial viability of homes and contains requirements for residents to have contracts that specify their rights. I am concerned that any decision to close a home should be handled as sensitively and appropriately as possible. Councils and care home owners must work together to ensure that closures take place in a planned way, with maximum notice being given. Although it seems unlikely to happen in this case, in the event of a home being forced to close, the council should reassess the needs of those residents for which it has responsibility and arrange an alternative placement or service promptly and with as little distress to the residents and their families as possible. Even where people are funding themselves, councils should be able to offer advice on arranging alternative accommodation.
§ Mr. Clappison
Does the Minister agree that, however good the regulatory provisions are, and whatever other arrangements are made, it is desirable to keep very elderly people in the same home whenever possible, and to avoid moving them at that stage of their lives?
§ Jacqui Smith
The hon. Gentleman is absolutely right, which is why I hope that, in this case, there will be the 160WH continuity that he outlined. I was just trying to point out that when homes have to close, it is crucial that the process is handled sensitively and appropriately.
Both today and on other occasions, attention has been drawn to the issue of funding and the ability of local authorities to meet the fees that are necessary to maintain capacity. There have been substantial increases in the level of funding provided for local authority social services departments in recent years. Since 1996–97, the overall level of funding for social services increased by just over 20.4 per cent. in real terms. That equates to an average real-terms increase of 3.1 per cent. per annum. However, we recognise that more is needed, and we are considering the future funding needs of social services as part of the current spending review, the results of which will be announced later this year. Hertfordshire county council has received above-average increases in its personal social services standard spending assessment allocation in each of the past two years. In 2002–03, its allocation increased by 5.7 per cent., compared with a national average increase of 4.9 per cent. That was on top of an increase of 7.6 per cent for 2001–02, compared with a national average increase of 4.7 per cent.
Last autumn, the Government further recognised the need to maintain and develop capacity in the care sector and to ensure that delayed discharges from hospital were reduced—a problem that the hon. Gentleman highlighted—by allocating not, as he suggested, £200 million, but an additional £300 million to local authorities. Hertfordshire county council is one of the authorities targeted for extra money from that £300 million. It received £1.7 million for the last financial year and will receive an additional £3.6 million this year.
My right hon. Friends the Prime Minister and the Secretary of State for Health recognise that it is crucial that local authorities, in their commissioning of services, maintain the fee levels necessary to ensure continuity in the capacity necessary to provide our older people with the care that they need. We accept that local authorities need the resources. I welcome the fact that Hertfordshire has been able to use some of the additional £5.3 million to increase residential and nursing home fees above the inflation rate for 2002–03, and has undertaken to review the pricing structure in 2003–04.
I am sure that the hon. Gentleman will be pleased to know that that extra investment has produced an important result: Hertfordshire has met its target for reducing delayed discharges—a planned reduction of 25 per cent.—since last September. I recognise his concern that the whole system—the health service and the care system—should work together. The fact is that the extra investment and the reforms and new capacity have brought important results.
I take issue with the hon. Gentleman's repetition of the Laing and Buisson figure of 50,000 care beds being lost. That survey showed a net loss of about 19,000 care beds since 1996–97: the 50,000 figure takes no account of those that have opened or been extended. The most recent figures suggest that there are now more residential and nursing care places in Hertfordshire than there were in 1997. I realise, however, that it is an important matter. The demand for placements in the county has been rising over the same period, so I am 161WH pleased that the county council is actively working with its partners in care commissioning and provision—the district councils, primary care trusts and the independent sector—and using the extra resources made available by the Government to maintain and stimulate the market across the whole spectrum of care.
A number of projects are under way to develop additional community services such as intermediate care and extra care. I shall give two examples. I understand that a 40-place extra care housing scheme is being developed in Borehamwood in partnership with a housing association and the district council. I was recently able to announce an additional £46 million investment into intermediate care over the next two years, including support for a 60-place intermediate care facility to be developed in partnership with South East Hertfordshire primary care trust and the independent sector.
Intermediate care, although clearly not fulfilling the same function as residential care, can provide a crucial bridge between hospital and home. It can ensure that older people are able to regain independence. Since the base line of 1999–2000, there has been provision for an additional 1,188 people to receive intermediate care services in the Hertfordshire health authority area. Hertfordshire also has in place plans to increase the number of intensive home care packages that can be offered to support people in their own homes.
It is the Government's policy to promote independence for older people wherever we can and to enable them to remain in their own homes whenever possible. The number of people receiving intensive domiciliary care is increasing—about 76,400 households benefited in England in 2001, an increase of 6 per cent. on the previous year—and we want to encourage that trend where it meets people's needs.
Clearly, some people are too frail or vulnerable even to be supported by an intensive domiciliary care package, and they will need residential accommodation. However, we must not get bogged down in judging the success of policy simply by the number of people in residential care and nursing homes. The policy of community care, which I know that the Conservative party supports and implemented when it was in government, is designed to ensure that people can live in their own homes with intensive support. We must also provide effective, high-quality residential accommodation where necessary—it is a matter of getting the balance right for each local community.
§ Mr. Clappison
Since the Minister is quoting a mass of statistics, may I draw to her attention Hertfordshire county council's claim that since 2000 the number of nursing home beds has gone down from 1,272 to 1,045? 162WH Does she agree that it makes no sense to lose modern, purpose-built facilities such as Borehamwood Care Village when the population is getting older and frailer?
§ Jacqui Smith
I accept, and have already said, that it is important to maintain the necessary capacity to provide stability for older people.
The care home sector can be assured that its services are very important and will continue to be needed in the future. Authorities need to do some long-term, sustainable planning. Short-termism is difficult for providers in the care home sector. It is important for commissioners and local authorities to have a strategy in place in order to provide care services for local people for years to come. That is why we established the strategic commissioning group, which I chair and which aims to give much greater direction to the commissioning of care services for adults—in particular, for older people.
We recently published an agreement between all the parties involved in the planning and delivery of care services in a document entitled "Building Capacity and Partnership in Care". That details the responsibilities and expectations of central and local government, providers and the NHS. It stresses the need for long-term contracts to ensure that there is planning in the system and that we do not end up with precipitate closures, such as that threatened for Borehamwood Care Village, which can have a very damaging effect on residents.
The document also seeks to push those involved to be a little more imaginative and to think of new ways of providing care that can help people to maximise their independence. I would like to underline the importance of that. It is time to move the policy on and to stop squabbling about how many nursing homes have or have not closed. All our efforts, and the extra resources made available by the Government, need to be concentrated on planning to deliver the services that older people want—not just the services traditionally provided—in the right amounts and at the right time.
I give the hon. Gentleman my commitment that the Government recognise the need to develop new capacity so that older people are able to maintain the independence that many of them have told us they need. I have given examples of how the additional investment in Hertfordshire is enabling that to happen. At the same time, we must recognise that what is crucial to the provision of services, whether it is from local authorities or the private and independent sectors, is the stability and certainty felt by older people. In conclusion, I join the hon. Gentleman in commending the campaign to safeguard the important provision of Borehamwood Care Village. I hope that a common-sense way can be found to ensure that residents receive the stability and continuity that we would all want for them.