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Care Homes

It is not sustainable, and the situation is going to get worse, as I shall discuss later. It is very much a growing problem in our ageing population. The lack of specialist nurses comes out in Laing and Buisson's report, which I shall discuss in a moment. CSCI points out that in 2007-08, 1.75 million older people and people of working age used different social care services, and that £16.5 billion was spent on social care for adults. Other moneys provided through private expenditure and top-ups added up to a further £5.9 billion, so we are talking about fairly large sums of money, and even the Government projections predict higher figures. The university of Kent's personal social services research unit says:""The numbers of functionally disabled older people in England are projected to"" double""from approximately 2.3 million in 2002 to approximately 4.6 million in 2041"." It says:""To keep pace with demographic pressures over the next 40 years, assuming unchanged rates of functional disability"—" that is a big if—""residential and nursing home places would need to expand by around 115 per cent. and numbers of hours of home care by around 100 per cent. The numbers of staff working in social care for older people would need to increase by around 110 per cent. between 2002 and 2041"." Also, expenditure for the same period""would need to rise by around 325 per cent. in real terms…to meet demographic pressures and allow for real rises in care costs of 2 per cent. per year for both social care and health care."" In the long term, that means that care expenditure would need to increase""from 1.4 per cent. of gross domestic product in 2002…to 2.6 per cent. in 2041."" I hope that the Minister has his crystal ball and will say what the Government are doing to lay the foundations for that necessary growth in residential care. If the Government are not certain that they want to believe university of Kent figures, Age Concern says that significant funding is required to meet our obligations to older people and that expenditure of £7 billion to £8 billion now should rise to £14 billion to £16 billion in 2026. That is a shorter time span, but it is still virtually a doubling of the figure of about 1 per cent. of GDP. Not to miss out on the matter, the Joseph Rowntree Foundation has had its own research done, again by William Laing of Laing and Buisson. Laing states that about £540 million of extra funding is still needed in the system for local authorities to fund a modernised care home sector. Since that report, the Minister has announced £520 million of funding, but that is for different expenditure and is not the same expenditure that Laing and Buisson said was missing last September. The care sector faces problems across the board. Before I get into the detail of private care homes and the problems that they face, I will mention charitable care homes. The Charity Commission wrote to me about this debate. It said that there are a number of issues, but that the key issues identified in its survey,""which would affect care homes, were funding (whether full costs were paid by the public body and whether contracts were short term), independence (whether the charities felt that they could still take decisions independently), and mission drift, (whether the charities were being led by available funding, rather than their charitable objectives)."" Lack of funding is a key issue in relation to that. I particularly thank the Local Government Association, which provided the most extensive brief for the debate, for its work on the matter. It has pointed out that there are currently 448,000 care home places in England and that 231,000 of those adults are financially supported by councils. If we consider how councils are paid, we will see that some of the 217,000 remaining places were the subject of a contract between councils and care homes to provide intermediate, respite care or other temporary placements. However, as I said, the majority of people arranged to pay for their own care. Between 2006-07 and 2007-08, the unit cost paid by councils to care homes increased by an average of 7 per cent. However, there is a wide variation between councils and the type of care purchased. The greatest increase in unit cost was between 11 and 14 per cent., which went to care homes providing nursing care for those with physical or learning disabilities. Contracts and fees are a matter for local negotiation and councils with limited budgets—increasing by 1.2 per cent. in real terms over that period—need to negotiate fee levels carefully in relation to quality of care. The Minister might wish to address how the rising fee levels and costs of care homes are not matched by Government grants to local authorities. That situation puts stress on social services departments. The Minister might say that that is new, but I can take him back to one of my earliest questions in the House when I asked the then Health Minister, who is now Secretary of State for Communities and Local Government, about a statement from the 15 social services departments in the south-west. The directors of those 15 social services departments said that there was pressure on elderly care and that the budget constraints were such that their obligatory, legal duty to provide services for children meant that they were having to divert funding from elderly care to child care. That led to a lack of funding. At that point, I think that the estimate was £1 billion of underfunding. As I mentioned, the Joseph Rowntree Foundation has said that the figure has been reduced to about £500 million of underfunding, but there is still a big hole. That means that people are not necessarily getting the level of care that they feel they deserve, having worked all their lives. We might not necessarily have much sympathy with care homes when we say that we want to improve standards and we expect them to improve the services that they offer, but care homes have their own problems. Some care homes improve services willingly and some do so while pointing out that having the additional funding to improve standards would be beneficial and appreciated. However, some care homes say that other problems have been created for them—for example, the bureaucracy that is put in their way and problems relating to employment issues. When the Government decided to crack down on immigration and change the rules, I doubt whether there was an MP with a care home in his constituency who did not find a care home worker on his doorstep saying that their work permit would not be renewed and that they would be sent back home to the Philippines or wherever. Migrant workers comprise a significant proportion of the social care work force. The Association of Directors of Adult Social Services estimates that one in two care staff in London is a non-EU citizen. The Government published the shortage occupation list for tier 2 of the points-based immigration system in November 2008. The list contains skilled occupations where vacancies can be filled by migrant workers from outside the European economic area. The LGA welcome the fact that skilled senior care workers are included in the tier 2 list, but to be "skilled" requires that the individual must earn at least £8.80 an hour after deductions for accommodation, meals and so on. There is also a requirement for a national qualifications framework level 3 or above. Martin Green, the chief executive of the English Community Care Association, has said:""We cannot understand why skilled work riders and frozen fish cutters are deemed to be skilled workers without an attached required salary while senior care workers will in essence be prevented from entering the country to undertake the valued work that those currently here already do."" Although people might say, "Yes, we recognise that this is a skill and accept that the qualifications are necessary," the salary level being put with such jobs is causing problems in the care sector. I ask the Minister to consider that if £8.80 is the requirement and that is based on the industry, why is it that those who run care homes—certainly those in my constituency and I believe those in other constituencies—will say that that figure is more than they are currently paying their European qualified staff for work? The amount seems to be set at an arbitrary level that is designed purely as a cut-off point to stop people coming into the UK or to be used as an excuse at a later date to remove care workers from the UK. I will come on to dementia in a moment because it is particularly important that there is not a continual change in care home staff who work in that area. The LGA has questions about funding. It says that""adult social care services are funded through a combination of central and local government funding"" and that total adult social care spending for 2008-09 was £13.78 billion. Of that figure, central Government general grant funding was £6.29 billion, specific grant funding was £2.15 billion and the contribution from local government £5.33 billion, which is approximately 20 per cent. of total council tax receipts. The Government are applying greater pressure and saying to councils, "You must limit your council tax increases." However, as I said, council tax funds a service that increases in cost, in real terms, by 7 per cent. a year. That is rather more than the amount by which local authorities are being told that they are allowed to increase council tax and by which they are trying to increase it. Even greater pressures are being applied to local authorities. They are being told that they cannot raise the level of council tax—they are not allowed to increase the element that they control—but that the Government will not adequately increase funding for care. The people who will lose out are those in care, because, at the end of the day, we are squeezing the care homes. The surveys clearly say that where there is poor care, the residents blame the low wages that some of the care homes have to pay because they are not funded to pay adequate wages. It is still true that people can earn more money at night stacking shelves in large supermarkets in my constituency than they can earn during the day caring for people in homes. Many young people will opt for the easy job in the evening rather than the job during the day. I wish briefly to discuss Laing and Buisson's report. I have not been able to see the detailed brief. Someone in my office went online to see whether the full report was available and found that apparently we have to pay £100 to see it. I assume that a copy will be available for Members in the Library and that we will be able at some point to read it without having to spend that money. It did not seem practical to pay £100 to read a thick wodge of a report all the way through this morning. Some quotes from the report were put on the website, and there was also a stimulating discussion of the issue on Radio 4. The most telling point was that there is not enough training in the sector. A statistic from the radio programme—I have this as close as I could get it—is that only one third of the homes that are designated to care for Alzheimer's patients are providing staff with the necessary specialist training. That is a severe condemnation of our current system. As I said earlier, when discussing other issues, there is improvement, but the Government need to grasp the report that will be published today, listen to the Alzheimer's Research Trust debate this afternoon and come up with answers about how we can make further improvements. The Minister has already stated in his response to the report:""The national dementia strategy will improve the quality of care in care homes."" That quote was on a website this morning. That is fine. The strategy is there, and the 17 points are vital. We buy into them—no problem at all—but my purpose in going through all the funding arguments that I raised earlier is to say that, unless funding follows, the strategy is not worth the paper it is written on. I beg the Minister to step up his argument with the Treasury that this issue should not be forgotten. Alzheimer's is probably the disease that most of us fear getting. To most people, cancer is a big fear, but the idea that we could slowly lose our mental capacity puts dread into the hearts of most people. The issue must be fully and properly addressed. The majority of care is done in the community—people are looked after in their home—but a significant number of people are in care homes, and there will be a substantial increase in the number who will need to go into them. Unless we start saying that the money will follow, those people will lose out. I mentioned immigration policies. The Alzheimer's Society website gives three principles for good-quality care. The third states:""Staff caring for people with dementia should be trained in supporting people with dementia."" As I said, that is not happening adequately at present. It goes on to state:""Continuity of care, which allows relationships and trust to build up between the person with dementia and care staff, is also important."" I would ask the Minister to come to south Devon to visit the care homes in my constituency, to look at the bonding between care workers and residents, and then to go back to the Home Office and ask the immigration officials whether it is really right, for the sake of the figures, to send those care workers home because care homes will not be able to pay them £8.80, and his colleagues in the Treasury will not provide the funding. I would ask the Minister to think about the family who have grown reliant on and developed friendships with care workers, to look them in the eye and say, "Terribly sorry," and then tell them that the person whom their mother or father has grown to depend on and with whom they have developed a relationship, the person who engages with their mother or father every day, who speaks to them and encourages them so that they are not left to rot—the worst that we could do for people with dementia—or left on the shelf but can have a reasonable quality of life, will be sent back to the Philippines, China or wherever. I ask the Minister to visit the care homes, speak to the people and then tell the Treasury and the Home Office that that is not good enough.