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Care Homes

I am delighted to take part in this debate, and I, too, take particular interest in it. I have a 99-year-old father whose birthday we celebrated yesterday. He is looking forward to his 100th birthday and already has me organising for it. He is in a nice St. Monica Trust care home in Bristol, which is a model that many others could follow. Not every area offers such an opportunity. I thank the hon. Member for Teignbridge (Richard Younger-Ross) for choosing this subject at this time. Besides my personal interest in it, I have several constituency cases, which the Minister knows something about and which I shall discuss with him in confidence. These things are difficult and we have to be careful about what we say. To add to the list of events taking place today, the all-party group on dementia will be taking evidence on the future of dementia care, so it seems that the hon. Gentleman has hit the jackpot: there is every possible reason for today being a good day to debate residential and nursing care. I agreed with nearly everything that the hon. Gentleman said. I probably err on the side of caution when criticising particular nursing and residential care homes. Some in my constituency have shut, and for good reason. Sadly, I have also lost some good care homes for various reasons, but I support the Government's strategy and look forward to the care Green Paper, whose publication is imminent—no doubt my hon. Friend the Minister will say when it will be published. We need that Green Paper, because anyone who is involved in this area needs to know what the Government's direction of travel is, particularly in respect of funding to support the strategy. I believe that we all agree that nursing and residential care are underfunded, and that the time bomb that we face means that they will be ever more so. The trend is inevitable and relentless. We have moved on from the small, neighbourhood family-run care homes that started the process, long before Government became interested and when not that many people thought about going into care homes. I would argue strongly that many people who went into care homes did not need to; it was just perceived to be the best way to give care. We know otherwise now. We have moved along the continuum to a much smaller number of larger care homes that are not necessarily locality based and many of which are in the not-for-profit area, as the hon. Gentleman said, but some of which are still private. There are now several different models and the state has begun to get involved again. Having in a sense washed its hands of the matter from the 1980s on, the state has had to recognise, because of the shortfall, that it cannot entirely leave its responsibilities. Because of the changes, we have had to look quite hard at three key issues that always underwrite the social care we are debating. One is running costs, and certainly the cost of charging, which I know about very well. Another is location—as neighbourhood homes have gone, we have had to consider where people will go if they want to stay locally. There are still good examples of local care homes, such as Uplands, run by Lynne Gardiner, in my constituency. That is an ideal location for people who have lived in the area and want to stay in the locality in the remaining years of their life. However, for every place with an Uplands, there are many other areas that have lost such locations. The third issue, which the hon. Gentleman talked about, is staffing. I shall intertwine that into my short speech, because staffing is everything. We should also consider management. I think that we would all agree that a weakness in the area we are discussing is the fact that good managers are at a premium, and good managers who can be retained are at even more of a premium. I know of some cases that I think are good examples of the problems. I hope that the Minister may want to examine not the particular cases, but the context that they give for understanding how the care sector operates. I call the first the Crystal Fountain case. It is a real-life case and I am still critical of the organisation. Crystal Fountain care village was set up in my constituency. I believe that it got planning permission on the basis that it would provide a continuum of care from some bungalows and houses, with support, through more sheltered accommodation to, ultimately, a care home at the centre of the care village. Two years ago, having achieved planning permission, it announced that it was closing the care home, which is a purpose-built facility. The residents, and certainly the relatives of the residents who remained there, were very disappointed, to put it mildly, because they felt that they had purchased their place on the basis of a continuum of care. The disappointing thing was that there was nothing that could be done about it. The company decided to charge individuals in the care home facility for every facet of the care on offer. That was clearly likely to mean that much more money could be made out of the individuals, but those people felt completely let down by the changed nature of the care. I suggest to my hon. Friend the Minister that we need to match planning and delivery to the eventual care outcome. Otherwise, we end up with a deficient number of care home places, which causes upset and removes any semblance of choice. Another concern that I have is about the remnants of the outcomes of outsourcing stage 2 homes from the county councils, which always had the responsibility. That happened in the 1980s and we had a pretty bloody set of consequences in Gloucestershire. There was a takeover—in an in-house bid for an outsourcing contract, if that is not a contradiction in terms. Former social services staff ran an outfit called Coverage Care. The idea was that they would pay to take on remaining residents, but would rebuild and refurbish homes, and pay a bounty to the county council. It all ended in tears, but I will not go through the history of it. Now, thankfully, a much better organisation—the Orders of St. John Care Trust—runs the homes. The old problems of homes in need of refurbishment remain, however. Where is the money to come from? The Orders of St. John has some ambitious plans, but I have now been talking to the trust for 18 months and there is not apparently a great deal of movement. That may be because of the market at the moment, but if there is a commitment to improving the quality of the care, we need to know where the funding will come from. I am asking the Minister to help me with that dilemma. If the money is put in and is then reflected in increased fees, a quite difficult problem will result. Obviously, the self-funders will be the ones to pay for the increase. However, adult care—social services as was—must also make a commitment to make up the additional fees. That is problematic in the context we are discussing and such matters are not always as easy as they sound. We want better quality, but we certainly want to know how it will be paid for. In my area, the cost of care has risen dramatically, which leads to unavoidable consequences. Sometimes, one wonders whether people who should be in care are not, because they do not want to pay. That can be a problem.