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Care for the Elderly (Kent)

Volume 523: debated on Tuesday 8 February 2011

Thank you, Mrs Brooke. I am deeply obliged to you for giving me an extra two minutes for this debate. I am delighted and proud to have secured a debate on this important issue, which matters to all residents in Kent. I shall focus on my constituents and those of my hon. Friend the Member for Dartford (Gareth Johnson).

This matter is extremely dear to the hearts of my constituents. Securing a safe, loving home is of the utmost importance for any family member hoping to make the final years of their relation, normally their parents, nice and happy. It is not always easy, and once people find a good home, they want their family member to settle there for a long time, and not have the disruption of moving from one home to another.

That was the experience I had with my father, who was in residential care for some 10 years. For the last 10 years of his life, he suffered from Alzheimer’s. He barely recognised me and could not communicate very effectively. I had to look after him and ensure that his needs were met. That experience coincided with the period between 1997 and 2002, when regulations were changed and care homes were closing all around Kent. I had to move him from home to home, trying to ensure that he had the love, care, support and, in particular, stability that older people need in residential care.

Hon. Members will recall that we lost some 2,000 care homes during that period. My father’s experience, which was by no means unique, left me with a passion for ensuring that we look after older people who should have dignity in their final years, and the stability and care that they deserve.

I thank my hon. Friend for allowing me to comment. I am clearly not from Kent, but I have a huge interest in the issue that he raises. Does he agree that providing a service for the elderly, particularly those who suffer from neurological illness, is one of the greatest challenges for the current Government over the next few years, and that over the past two decades the British Parliament simply has not met that challenge?

I strongly agree. The population is ageing, and we know that the need for care of the elderly will increase, not lessen, over time. With the triumph of longevity comes the downside that people may well require more care—respite and day care but also residential care—for longer, and that will have a cost. There will be an expense to society, but society can rise to the challenge by ensuring that services are of the standard that we would expect. My hon. Friend’s comment is particularly relevant, given the announcement that Sampson Court, the much loved care home in my town of Deal, is to be closed by Kent county council.

Sampson Court provides a range of services—palliative care, day care and respite care—and specialises in dementia and separate elderly mentally infirm care. It is extremely important to the community and loved not only by residents but by their families, all of whom have been passionate in their support for keeping that important community facility open. Despite that, Sampson Court is no longer classed as meeting care standards—hon. Members will recall that the previous Government introduced the decent homes standard—and because it does not have en-suite bathrooms and the building is costly to maintain and in need of renovation, Kent county council says that it is too expensive to make those changes and that it cannot continue to run the home.

That decision was a challenge to the community, which started a consultation. The community has worked hard and, led by Councillor Julie Rook in Deal, has made a passionate case for not closing the home—a petition with 5,000 signatures was delivered to the council—and for finding an alternative way forward. A transfer of going concern has been raised as a possibility.

The parents of my constituent, Mr Hawker, receive care at Sampson Court. He wrote to me:

“Sampson Court is in no way beyond the end of its life at 25 years old…it’s well maintained, clean and hygienic, and en-suite facilities would be actually hazardous to those who cannot even use a toilet without assistance such as my father who has dementia and is incontinent.”

Kent county council has cited European Union procurement rules as a reason for not doing a transfer of going concern. It says that it is extraordinarily costly to do such a transfer under those rules, and that, because of the complexity, the only realistic possibility is simply to close the home and sell the site, despite the potential interest of other care home operators who might like to take it on.

My constituent Gareth Fowler, whose mother has been at Sampson Court for four years, asked the council representative at a public meeting during the consultation process where the 15 EMI residents would go. The council had no answer other than “the local area”. Mr Fowler rang every EMI care home in the local area, but none had any space. If a decision is taken to close a home, there must be an alternative. There is great concern among my constituents that there is no alternative place for them to go to.

My constituents point to the Kent county council consultation, which states:

“People rightly expect more choice in their care”.

There is no doubt that its decision has left less choice, not more. I would ask the Minister to review whether Kent county council has an effective alternative plan for elderly people. Mr Fowler’s experience suggests that it does not. Sampson Court is a much-loved community resource that is fully workable. That begs the question, why can it not be retained, if not by Kent county council then by another body, to ensure that we have proper care for the elderly in Kent?

As well as criticising Kent county council, I want to be positive about it. I understand the challenge to its budget, the challenge in meeting the decent homes standard, and the challenge of the EU public procurement regime, which is expensive and, frankly, gold-plated—it ought to be minimised. Can anything be done about public procurement in this kind of case?

The other case I have been making to Kent county council is that it could transfer the home, not as a going concern in the market but to a community interest company. That is where my interest particularly lies. Allowing a community outside the regime of Government, the procurement rules and all the regulations to take it on would enable the expertise of local care home operators to be captured so that a home could continue to operate on that site in the future. I am asking for Government support and guidance on how Sampson Court might be transferred to a CIC in partnership with local care home operators.

Hon. Members will no doubt know that a CIC could provide the benefit and excellence of a care home in a local community. It would have flexibility and access to a range of financing options, and would be a solution to the decision that Kent county council has made. It would mean that local people can come together and work to secure a community takeover that would bring the community together, provide better value for money and ensure more freedom to offer extended services. We could turn a community resource that is fast disappearing into one that is expanding.

We should not lose community resources such as Sampson Court, but this debate is not just about Sampson Court or care for the elderly in Kent. I bring the matter to the Minister’s attention because I suspect that this is a wider issue across counties and the country as a whole, and that there are many similar cases involving aged buildings, the decent homes standard and EU public procurement rules. Many communities are in the same boat, so the national picture needs to be examined to ensure that there is effective transition—and enough care for the elderly across the whole of Kent.

Local GP, John Sharvill, wrote to me. He said that, without a doubt, Sampson Court

“is an excellent institution providing fantastic care...there is no other home in this area which provides the level of care that they do in the spacious, airy, surroundings they provide”.

Using the community right to challenge and the community right to buy under the Localism Bill, soon to become an Act, may provide a way forward. There is a right for voluntary and community groups, social enterprises, parish councils and local authority employees to challenge a local authority on delivery of a service by expressing an interest in running a service for which they are responsible. The local authority must consider and respond to such a challenge, which may trigger a procurement exercise for the service, in line with relevant procedure, in which the challenging organisation could bid, alongside others. Such rights are part of the Government’s aim to create a big society. The Minister of State, Department for Communities and Local Government, my right hon. Friend the Member for Tunbridge Wells (Greg Clark), is sitting next to me. He has an interest in the Localism Bill, which is currently before the House.

When listed assets—either the freehold or a long leasehold—come up for disposal, communities will be given the chance to develop a bid and raise the capital to buy the asset when it comes on the open market. However, there are issues with that, which I would like to flag up. First, the local authority does not have to seek out possible community owners, and there is no compulsion for it to do so. That means that communities may struggle if they are up against the local authority, especially as there is no independent monitor to judge a community bid against a local authority’s plans. Secondly, if a local authority wishes to proceed with a sell-off, there is no provision for a temporary stop, a break for consideration, or a certain designated time that would allow community groups time to put together and advance a bid.

John Porter of the “Bowles Lodge Stays!” campaign, run elsewhere in Kent, also flagged up those kind of problems. He pointed out the difficulties he had over the care of his mother, Vera Woylor, who is an 89-year-old resident of the care home and does not want to move. On her behalf, he has made a strong case to Kent county council, which does not think that the right process has been followed. The ideal would be to enable continuity of care. Such issues need to be addressed, and community interest companies should be encouraged.

Ministers may consider the matter to be simply a local issue, but given the terms of the Localism Bill it is a wider national issue of how we can encourage takeovers by community interest companies and what we can do to simplify EU public procurement regulations to ensure that homes, such as Sampson Court and others across Kent, give continuity of care and love under new ownership if they cannot remain under that of Kent county council.

I congratulate my hon. Friend the Member for Dover (Charlie Elphicke) on securing this debate on an issue that is clearly important not only for Dover and Dartford but for the whole of Kent.

I hope that I will be forgiven for speaking about the Manorbrooke and The Limes care homes, which are the two affected in my constituency, because the principles that affect them are similar to those that affect homes around the entire county. I have visited both care homes and have met the staff and residents. They are two types of care home and offer two distinct services to the residents of Dartford.

First, The Limes is a care and day centre that offers an almost unique service in Kent. Many of my constituents have benefited over a considerable number of years from the service it provides because it allows patients who would otherwise need to remain in hospital to be discharged into its care, thereby relieving pressure on the local hospital in Dartford, Darent Valley hospital. It had to deal recently with extra pressure after the A&E department at nearby Queen Mary’s hospital closed its doors, and I fear that the closure of The Limes can only add to the pressure on it. Patients who might otherwise have been discharged to The Limes will either have to remain at Darent Valley hospital or find alternative care home provision. Clearly, that provision will be harder to find if care homes are closed around the county.

The “Save The Limes” campaign group has been passionate in standing up for the care home, and none more so than Laura Whitehead and Karen Baldwin, who I am pleased are engaged enough with the campaign to make the trip to Westminster for the debate my hon. Friend secured. They have made it clear that it would be a huge mistake to close The Limes. It has been claimed that it is very expensive to run, and the line that Kent county council has used time and time again is that it costs an inordinate amount of money, but in my experience the staff have not been given the opportunity to reduce the costs of care provision at the home. They certainly have not shown any reluctance or unwillingness to modernise or introduce efficiency savings. They simply have not had the chance to show that they can make savings.

The situation for Manorbrooke is similar. It is a residential care home earmarked for closure by Kent county council. The plan is for it to be demolished and a more modern facility built on the same site in the manner described by my hon. Friend. It would mean the residents having to leave their home at Manorbrooke, move elsewhere and then move back to Manorbrooke a couple of years later once the building work is complete. That would mean three different homes in two years. Surely, our elderly deserve better. Yes, the homes will be larger, with gymnasiums and even internet cafés, but we are talking about people’s homes, and that goes to the heart of the debate. No one in this Chamber or Palace would want their home taken from them, and yet that is precisely what is happening in care homes across Kent. The residents in Manorbrooke and The Limes are happy where they are—they are very happy—and they want to stay there.

Yvette Knight, who is in Strangers Gallery, has worked extremely hard to keep the care home open, and has approached the issue with a dignified and commendable attitude; as has the local county councillor, Penny Cole, who has worked tirelessly on this issue. Those who support The Limes and Manorbrooke are enormously frustrated by the whole closure programme. Surely, land could be purchased to build a new care home before the closure of the existing home takes place. One home in Kent could have been closed for that to happen, and the money used to purchase land as part of a rolling programme. That would have prevented anyone from losing their home and having to go elsewhere while other homes were built. I hope that even at this late stage, the homes can be saved and an alternative solution found by the county council, if necessary with support from central Government. I understand what the county council is trying to achieve, but I feel that the planned process of closure is wrong—very wrong. A rethink is needed.

It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Dover (Charlie Elphicke) on securing the debate. He, like the hon. Member for Dartford (Gareth Johnson), has used it to ensure that those responsible for making the decisions are properly held to account and the issues are fully aired and in the public domain. The summing up given by the hon. Member for Dartford underlines the important contribution that a debate in Parliament can make to illuminating an issue and ensuring that local decision makers account to their public for their decisions.

The hon. Member for Dover raised an issue that is causing a great deal of concern to his constituents, the hon. Member for Dartford and many other Kent residents. He talked specifically about Sampson Court and identified the commitment that he and his constituents feel towards that facility. It is a much loved, long-standing part of the community. Both hon. Gentlemen talked about the passion displayed by those campaigning on these issues.

The county council has already taken decisions on this and other home closures of the sort about which the hon. Member for Dartford spoke. Parliament has given the responsibility for taking final decisions on care home closures to councils not to Ministers. I know from my constituency work just how upsetting care home closures can be. Clearly, in the event of any care home closure—I will not prejudge where a subsequent challenge to the decisions in Kent would get to—our first thoughts have to be about the welfare of those who live in the homes and use the services, as has been clearly described by the hon. Member for Dover who talked about his father and about the representations received from constituents. I realise that for residents and families associated with the care homes, this is an unsettling time. Moving home when a person is elderly or frail can be hugely distressing and potentially damaging to their health. If badly handled, it can actually foreshorten life—I make no bones about that.

I have asked Kent county council for reassurance about its plans to reduce the disruption and harm to residents who will be transferred as a result of the decisions that it has made. As I understand, the council is currently assessing the needs and preferences of all residents and services, and it is doing everything in its power to accommodate people’s wishes. For example, it is ensuring that people are not moved to a place that is different from the place their friends from the home are moved to. If people want to stay together, they will have the opportunity to do so.

The council also told me that the families or advocates of those affected are being kept informed during the process. That is crucial, although some of what I have heard during the debate suggests that there are different opinions about that statement, and from some of the body language, I see that others share that feeling. The council hopes to support residents to move at a pace with which they are comfortable, and evidence from past closures demonstrates that that is crucial for minimising the effects of such a move. The sense that there is an arbitrary timetable can have a significant impact on the health and well-being of an individual.

I am told that all residents and service users will be found places in centres and homes of an equivalent or higher standard. I do note, however, the representation made by the hon. Member for Dover about the experiences of his constituents and the lack of assurance that they have received so far in their efforts to discover an appropriate home for their loved ones. The council has said that, within reason, service users will not lose out financially, and that an independent arbiter will deal with any disputes over costs associated with the move.

The hon. Gentleman was right to say that we must put this into a national context, and across the country all councils are having to grasp the nettle and take painful decisions to reshape social care around the changing needs of their population. We need a broad strategic shift towards preventing and postponing dependency, and promoting greater independence. That includes ensuring that the services available are the right services for a particular point in a person’s journey with a degenerative neurological condition, such as dementia, for example, which he mentioned. Earlier diagnosis is key to sensible planning and it is important to ensure that we deliver the right care at each stage of the journey taken by an individual and their family carers. That means that over time, councils need to spend less on care services where there is overcapacity, and free-up resources to invest in more personalised support.

This Government have no ideological opposition to residential care, although there is a sense that that was the case in the past under previous Administrations. There will always be a need for good-quality residential and nursing care in our communities, and anyone who has had a long-term engagement with the sector—as I have, and I am sure other hon. Members have—will know how much it has changed over the past 20 years. The level of need and dependency of residents has risen significantly, and the length of stay has shortened.

Currently there are approximately 50,000 vacancies in care and nursing homes across the country. According to the recent “Care of Elderly People UK Market Survey” by the independent health care analysts, Laing and Buisson, the level of spare capacity in the care home sector is currently 10% nationally. That carries a significant opportunity cost and locks a public resource that could be released and spent more effectively on early intervention and more personalised forms of care.

We should be clear that these closures are not—or should not be—a question of budget pressures forcing the council’s hands. The money for social care is there. The Government made a clear choice on decisions about funding critical services, and despite inheriting the largest peacetime deficit in our history and the largest structural deficit in Europe, and despite paying £120 million a day in interest repayments on the national debt, we have chosen to protect the care and dignity of older people. In the spending review, we made it clear that an extra £2 billion a year for adult social care would be available by the end of the spending review period. Furthermore, £1 billion of that would be added to the local government formula grant, which comes on top of the existing £1.3 billion social care grant. That means that total grant funding from the Department for social care will reach £2.4 billion by 2014-15. For those keeping up with the numbers, the other £1 billion will be transferred from the NHS and spent on social care measures that also support health.

That settlement is frontloaded, so that extra resources are put into the system at the beginning of the spending period. It means that considerable amounts of extra investment are available now. Kent county council has already received £1.4 million in November to improve re-ablement services, and £4.1 million in January as part of a national investment of £162 million to cope with winter pressures facing social care services. From April, it will get an additional injection of £16.2 million, which is its share of the £648 million that we are allocating via primary care trusts to support social care. That is on top of the extra funding for social care that we are putting into the local government finance settlement—a share of the £530 million extra available nationally next year, rising to the £1 billion I have just mentioned.

My understanding from briefings I have received is that Kent county council’s approach is not a sudden, hasty, knee-jerk response to tighter financial circumstances. The proposals are part of a long-term plan in Kent to improve care and meet the changing needs of the local population. The council published its “Later Life” plan in 2009, and it has been working over the last two years to restructure and transform services to put more emphasis on prevention and practical support.

Services need to be tailored to people’s circumstances and population need, and I emphasise that residential care is part of that mix and must be carefully thought through when services are designed. We need services that deliver value for money in a climate where we expect higher demand as the population ages, and we want good quality services—whether provided in the public or independent sector—that are well equipped to give people the choice, comfort, compassion and independence they deserve.

The council argues that the facilities at Sampson Court no longer meet the standards we should expect. The hon. Gentleman has rehearsed that argument and stated his concerns. The council also argues that the building would require extensive refurbishment to bring it up to scratch, and that the money could be better used in other ways. The council’s view—painful though it clearly is—is that closure is the right way forward. I understand that many people will disagree with that, and believe that alternatives have not been adequately considered—the hon. Gentleman referred to the petition collected by Councillor Julie Rook. The Government are keen to give communities the opportunity to run community facilities. That is what the Localism Bill currently making its way through the House attempts to put in place. That Bill also seeks to reduce the barriers that enable a variety of organisations, including community groups, to provide services.

The council’s view is that it has been through an extensive consultation process and considered the alternative options. The 11 care home changes have been debated in the council’s chambers, and the proposals have been the subject of the council’s overview and scrutiny committee. I know that there are great concerns among those who have led the campaign against the closures, and I am told that lawyers have been instructed to look at pursuing the matter through a judicial review. In that way, the process that the council has gone through can be tested, and if it is flawed, the decisions will be reopened and further options considered. However, that is not a matter for me as a Minister; it is about deciding whether the process has been properly followed, and a matter for judicial review. Parliament has not given Ministers that power, and the Government have made it clear that in the past, far too much rested on the desks of Ministers in Whitehall and other officials.

During conversations with Kent council over the past few days, the director of adult social services said that the council would be pleased to continue discussions with the hon. Gentleman and his colleagues, to see whether further points of concern can be addressed. In conclusion, I hope that we have covered some of the issues raised, but in the end, this matter must be resolved locally.