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DELEGATED LEGISLATION
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
Local Government
- That the draft Local Authorities (Mayoral Elections) (England and Wales) Regulations 2002, which were laid before this House on 19th December 2001, be approved.—[Dan Norris.]
ADJOURNMENT
- That this House, at its rising on Thursday 14th February, do adjourn till Monday 25th February 2002.—[Dan Norris.]
Elderly Care (Isle of Wight)
Motion made, and Question proposed, That this House do now adjourn.—[Dan Norris.]
10.29 pm
Mr. Andrew Turner (Isle of Wight): On 6 December 1999, Councillor Buster Bartlett, who was alerted by the proprietors of Fernleigh residential home in Ventnor to the fact that the Care Standards Act 2000 would cause its closure, wrote to the Prime Minister. In his letter, he asked:
- "If the occupants have no complaints, why allow this upheaval to be imposed to the worry and distress of the occupants? . . . It seems that this new legislation, if carried out to the letter, will see the demise of care homes on the Island, with the loss to the applicants of what they treasure most—a place they call their home."
- "A very difficult and escalating problem with regard to provision of nursing and residential home care . . . particularly acute in the nursing home sector, where another home is . . . threatened with closure."
- "The home is currently being kept going for a limited period with subsidy from the Social Services Department. Quite simply this is because we have no beds elsewhere on the island to put displaced patients."
- "There is a political dimension to this in that we do not have the option of buying care from homes located across a shared local authority boundary, since we have none . . . The problem is primarily one of money . . . From the base date of 1st April 1993 . . . the fees paid by the Council . . . have been uplifted in line with the cost of living index. As you know, wage inflation has significantly exceeded this . . . Fees no longer equate to costs; profit for many homes . . . is non-existent."
I ask the Minister to consider clarifying the enforcement responsibilities of the National Care Standards Commission, permitting a pause on implementation of the standards to allow Isle of Wight council and providers to sort out investment problems and assisting the council to meet providers' reasonable costs by paying realistic fees.
The Isle of Wight is unique. It is a beautiful constituency, a unitary authority and one of the poorest areas in the prosperous south-east. Its gross domestic product is less than 75 per cent. of the national average. One in four of its population are elderly. Of course, it is also an island, so we cannot export our old people to be looked after elsewhere. It had been apparent for a long time that a bed crisis in our care homes was imminent. According to Isle of Wight council figures, between 1998 and 2001 bed numbers fell in residential homes from 1,948 to 1,791 and in nursing homes from 445 to 356.
The position has not been helped by a significant social services overspend in 2000–01 and a rather curious budget-making process last year. The whole process,
including select committees, led to the executive agreeing a budget well above the standard spending assessment for social services. That was followed the same morning by a full council meeting, at which the budget was reduced back to the SSA level with seven of the 12 executive members voting in favour.That left Charles Waddicor, our director of social services, with an almost impossible task. By April 2001, a serious bed crisis was looming. Another overspend was forecast. Quick action reduced the forecast overspend to about £500,000, but it did so at the expense of more rigorous assessments for home care, excluding many needy pensioners, an almost total stop to placements in residential care and a bed-blocking crisis at St. Mary's hospital.
After a visit by the social services inspectorate, the Government provided £326,000 in discharge money. Both I and the council are very pleased to have that money, which we welcome. It helped to rescue the island from an impending disaster. Of the 30 beds that were blocked by mid-December, 21 have now been freed. We are also grateful for the £690,000 subsequently announced for 2002-04. It means that the Isle of Wight council can afford to buy places, but the problem has now shifted, because there are insufficient places to meet demand. Nursing home beds are down 33 per cent. in the past three years and 10 homes now provide 294 beds. Our most recent loss was that of the St. Lawrence nursing home, which closed despite every bed being filled. It was run by Medina housing association. It was not run for profit and was losing £40,000 to £50,000 a year.
The result, according to the chief executive of St. Mary's, is that since Christmas another 30 medical outliers are occupying beds in surgical wards, at a cost to the national health service of £1,200 a week, compared with the cost of a bed in a nursing home of £380 a week. The knock-on effect is delayed admission for others. I visited someone last weekend who had had two hip operations cancelled.
That is where the crisis is impacting on the Government's cherished waiting-list, waiting-time targets. Beds cannot be unblocked where there is nowhere to put people.
Last month, the island's joint registration and inspection unit published a report that had been requested by the nursing and residential homes on the impact of national minimum care standards. Some of the examples of the unit's findings were that 60 per cent. of homes had no passenger lift and 36 per cent. did not expect to be able to meet the door-width standards by the target date of April this year.
Since the completion of the survey, there has been closure or notice of closure of other homes, leading to the loss of 114 beds, and the target date is only 60 days away. These are part of a total of 14 per cent. of all homes that said that they would close within two years, with the loss of 450 beds. It was described by the new social services portfolio holder as
- "beyond crisis into melt down",
There are four main reasons for the closures and the lack of capacity, the first of which is a skills shortage. The hospital is already recruiting nurses from the Philippines. Secondly, cost pressures are driving people out of business. Thirdly, there is uncertainty over funding and care standards.
Qualified staff are difficult to recruit. Those who are employed are leaving for less stressful jobs in supermarkets, in retailing or in tourism. Tesco offers £1 an hour more than registered care homes to care assistants. There are cost pressures, such as wage inflation, which this year is 5 per cent. There is the working time directive and four weeks' paid holiday. The cost of the latter to the Fernleigh residential home would be the equivalent of an additional member of staff for a year.
There is also the cost of the new standards. The physical care standards are one-off costs for nursing homes of £3,000 per resident, or £84,000 for the average home. The position of residential homes is similar. The one-off cost to residential homes is estimated at £1.2 million. Peter Davies, the director of Kynance care home in East Cowes, tells me that the cost to him of the capital works will be £79,000. The annual recurrent costs of applying the new staff standards in nursing homes are £950 per resident, or £26,000 per home.
Those standards can be afforded only if a profit is being made and there is a reasonable certainty of continuing in business long enough to ensure that the money is paid back. For many island residential and care homes, that is not the case. There is inadequate funding to offer a fair return on investment.
I refer the Minister to some figures that I provided her with for 40-bed and 28-bed nursing homes. Forty-bed homes are the largest on the island and 28-bed homes are the average. The figures show that the average-size home makes a loss even before the proprietor and his wife have taken a wage. The largest 40-bed homes provide nothing like an adequate return on investment, even with a proprietor and wife's combined salary of as little as £32,000 a year.
Even if the council increases the fees by 18 per cent.—it is proposing 15 per cent. for nursing homes—the average homes will make a loss. The largest would make a return that could be described only as adequate, and that is before the capital cost of implementing the care standards is taken into account.
Although there is a current surplus of places—the social services department and the care sector have imaginative proposals for providing more domiciliary care and very sheltered housing—even the council accepts that there could be precipitate closures instead of planned contraction.
The uncertainty about the future scope of care standards is making things worse. I plead with the Minister to put an end to the uncertainty referred to eloquently, almost desperately, by Richard Jones, the chairman of the Isle of Wight registered care homes association. He said:
- "It is now nine weeks until 1st April when, in common with all homes, I will be hit with the Care Standards Acts . . . With such a short time before implementation . . . it is unbelievable what we still don't know. The following come to mind immediately
the full extent of the legislation involved (the NCSC has made no contact whatsoever with homes, nor has the DoH)
the required staffing numbers
fees to be paid by IW social services from 1/4/02
number of residents requiring care for the coming years, although the Director of Social Services has stated his overall aim of reducing numbers.
And we are expected to run professional care homes while in this state of uncertainty!"
- "In summary, I have no knowledge of the interpretation of legislative requirements from 1st April, nor is there anybody to ask until 1st April! I have no idea what fees will be paid by the local authority from 1st April. I have no idea how many residents I should plan to care for from 1st April."
Councillor Roger Mazillius, chairman of the Isle of Wight social services committee, was told in a letter from one of the Minister's officials that
- "Ministers are confident that . . . any improvement in the quality of care homes necessary will be achieved smoothly, and that stability in the care home sector and sufficient capacity is maintained while the changes are made."
- "It will be open to care home owners to agree that they satisfy the requirements"—
- "by means other than those set out in the standards . . . It will be for the regulator to decide in the particular circumstances of each individual home whether the home conforms to the standards necessary to meet the assessed needs of residents."
- "Some residents will die earlier than expected because of the trauma involved."
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