Residential Care (Birmingham)

8 February 1999

 Dr. Lynne Jones (Birmingham, Selly Oak): I am grateful for the opportunity to raise the anxieties felt by residents of Goodrest elderly persons home in my constituency, their families and residents of other homes that Birmingham social services committee proposes to close or privatise.

I shall begin on a positive note. Birmingham city council has an excellent scheme for the development of extra care sheltered housing for elderly people. Under such schemes, individual residents have their own flat and their own front door, but where extra care is needed, it can be tailored to the specific needs of the individual and can change when the person's needs change, as he or she becomes more frail.

There is no argument in Birmingham about the development of the schemes. There are already 11 schemes providing 426 flats. I fully support those schemes, as the first two began when I was chair of housing in the mid-1980s, so I claim to be responsible for the development of the schemes. They are excellent, and Birmingham has been praised for them. There are various new developments on stream, and it is hoped that by the millennium or soon afterwards there will be 26 schemes running, providing a total of 1,030 flats.

By their nature, those are mixed developments. Although there are already several hundred such flats, I understand from the social services department that only 26 places have so far been allocated to those assessed as being in need of residential care. The provision is thus good for the future, but it is not particularly relevant to existing residents of elderly persons homes.

Over the years Birmingham city council has closed a number of homes, many of them in unsuitable locations. One was at Highbury hall, the former home of the Chamberlains. That building is now much better developed as a conference centre. It was right for the council to close that home. Over the years non-purpose-built homes that were not entirely satisfactory have been closed.

I had hoped that my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) would be present for the debate, but unfortunately he has been held up in his constituency, which includes the Longbridge area. I am sure that hon. Members and my hon. Friend the Minister understand that he would have liked to participate and is equally concerned about the proposals.

Birmingham city council has 35 residential homes for elderly people. Only 14 of the homes so far have been refurbished to bring them up to the standards rightly demanded of the private sector. A further four homes already meet registration standards, although they are in need of refurbishment. That leaves 17 homes that need considerable upgrading. The social services department reckons that it needs to spend 19 million to bring them up to scratch. Local residents have queried that figure, but even if it were halved, it would be a substantial sum.

The social services department is in a difficult position. Central Government, who control the capital spending of local authorities, have not allocated to it that level of resource. In recent years the problem has got worse. Until 1995-96 the previous Government allocated about 2.5 million for social services capital schemes. Since then the sum has steadily decreased. In the forthcoming year the allocation is a mere 838,000. I know that the leader of the council has made representations to the Secretary of State and expressed her concerns.

In the forthcoming financial year, only 100,000 will be available for new schemes -- the rest of the money is already committed to existing schemes. The council has had to devise means to deal with the problem, which unfortunately involves closing several homes. It is proposed to retain and refurbish only four of the homes. The rest are to be sold to the private sector, to be privatised, or -- as in the case of Goodrest elderly persons home -- are to be demolished, and the site will be used for extra care sheltered housing.

The council will be left with eight homes for elderly people. The council says that it has a role to play in providing residential care, especially for those suffering from dementia. As hon. Members know, there is a growing elderly population, many of whom will unfortunately suffer from dementia.

In a report produced last year, the Royal College of Psychiatrists and the Royal College of Physicians stated that the figure of 700,000 elderly people currently suffering from dementia is set to rise to about 1 million in 30 years. The report called for a national framework of provision. It pointed out that the policy of contracting out institutional long-term care to the independent sector was imposed by the previous Government in order to transfer costs from the health budget to the means-tested social services budget. The report further stated that there is no evidence that the care provided is comparable in quality, safety and cost to that which can be provided by statutory services.

The report went on to deal with problems of abuse of elderly people in residential establishments. It identified abuse as a matter of growing concern and pointed to various risk factors -- poor working conditions for staff, inadequate numbers of staff, inadequate supervision and training of staff, and inappropriate mixes of residents with different care needs.

I do not want to cast doubt on much of the excellent provision in the private sector. In Birmingham, as in other areas, the majority of residential care is provided by the private sector, but there are considerable concerns about the quality of provision in some homes.

In respect of these risk factors, there is grave concern about the rates that those homes are either prepared or able to pay their staff. I emphasise the words "able to pay", because I have been approached by proprietors of excellent private homes in my constituency who are extremely concerned about the rate of pay for each resident that they receive from the social services department, which has continued to pressurise them to reduce costs. The proprietors say that -- because of the growing dependency of many elderly people who are discharged, often from hospital, into their care -- they are not able to provide for their needs with the weekly allocation given to them by the social services department.

That means that many of those homes -- some because they have no choice and others because they wish to profiteer -- are paying appalling rates and using staff who have little training and are not committed to the work. Looking after elderly people in residential care settings is a difficult job that requires dedication and a great deal of skill, whether or not the elderly people are frail or suffering from dementia.

This morning I went to my local jobcentre to look at the vacancies for care assistants in private homes. The rate of pay varied from 3.10 an hour to 4.15 an hour for those trained to national vocational qualification standards and prepared to work shifts. One home was offering 3.60 an hour to experienced workers, including working nights and weekends. It does not require any stretch of the imagination to understand that those rates of pay are simply an insult to the work that is required to look after our elderly people.

Birmingham social services department pays its staff 4.35 an hour, which is not exactly rich pickings. It pays slightly higher rates for weekend and evening work and double time for night shifts. I think that those workers deserve that level of pay, and probably more. That level of pay, and more, ought to be provided for those who look after elderly people in our residential homes.

The residents of Goodrest home are extremely concerned about the closures. Occupancy in the homes that are run by Birmingham social services department is slightly under 100 per cent., because a number of places are reserved for respite care. Some elderly people, from time to time, need to go into respite care to give their carers a break or if they are ill and need residential care. Those places will also be put at risk by the closures, but -- because there is no longer any slack in the system following previous closures, including the closure of one of the other elderly care homes in my constituency a couple of years ago, again to widespread concern among the residents and the local community -- there is no slack in the system and there are next to no places available in other council-run homes. Even if people wanted to take up such places -- which they do not, because they want to stay in their homes and they value the care that they receive -- that choice would not be available to them.

Residents and their relatives are extremely concerned about their future. A meeting was organised last November by the local councillors -- in Birmingham we have a system of ward sub-committees -- and held at the home concerned in my constituency. Most of the residents attended, as did their relatives and members of the public. A vote was taken and it was unanimously decided that people wanted to stay in their home. They valued the quality of the care and feared what the alternatives might be.

It was made clear when the vote was taken that people would have to move out if refurbishment took place, but they would be able to move back later and maintain contact with friends and family during that process. Even though there would be disruption, there was overwhelming desire to stay in the Goodrest home. From letters that I have received from relatives of my constituents in other homes, I know that such desire is felt elsewhere.

During the discussion, the assistant director of social services was asked what provision could be made for people if the closure went ahead. The assistant director made clear -- this is in the minutes of the ward sub-committee meeting -- that it

"was not possible to give any guarantees about the standard of care to be provided to residents in the future".

He added that

"the Department would be doing its utmost to seek to achieve the best possible care provision available at the time",

although that was likely to be in the private sector. There was no guarantee about the quality of care.

It is known that those homes are likely to employ staff on the rates of pay that I have mentioned, and there will probably be a lower ratio of staff to residents, so it is understandable that people fear for the future. They have been given no guarantees. Even if they had been, they would have wanted to stay in their home.

There is demand for these places in Birmingham, which is shown by the fact that the homes are full, and we will have a growing elderly population. Over time, provision in extra care sheltered housing will be available for the frail elderly, but there will be growing demand for residential accommodation for elderly people suffering from dementia and other symptoms of confusion.

The local residents and the carers have set about campaigning to keep their homes open. I pay tribute to the dedication of those local people and the relatives of residents living in Goodrest. The residents are not able to campaign, but their relatives are doing an excellent job on their behalf. They are collecting petitions and this Saturday was one of many on which they have spent hours in the cold and the wet collecting signatures to get public support for keeping their homes open. That is happening across the city, and they will be lobbying the social services committee when it meets next week to take decisions.

The consultation has shown that there is demand for homes that are run by the social services department. We know that most of those homes are already in the private sector. It is important, not only for the care of the residents, but for the well-being of all elderly people, to retain a proportion of such care in the public sector. That sets standards and acts as a benchmark for other provision. It also gives support to inspection regimes, which, I know, are having their hands tied.

Issues have been raised by my hon. Friend the Member for Newport, West (Mr. Flynn) -- I have taken them up with the social services inspectorate in Birmingham -- in respect of monitoring of the administration of medication to residents.

It is clear that the monitoring of these private homes is unsatisfactory in that regard. A gun is being held to the inspectors' heads. They cannot close these homes because there is no alternative provision. That is another reason why we should maintain places in the public sector.

The local authority cannot raise the capital because of Government restrictions on capital spending. That is nonsensical. We are encouraging private provision, but to make places available the private sector is required to raise capital. It is more expensive for the private sector to raise finance than for the local authority to do so.

In the long run it is economic nonsense to close these homes. They provide an excellent quality of care, and residents, their families and the people of Birmingham want them kept open. They are looking to their local councillors, local MPs and the Government to get together to ensure that Goodrest and other homes for the elderly in Birmingham stay open. I hope that the Minister will have something positive to say about meeting their needs.

 

Mr. Richard Burden (Birmingham, Northfield): I apologise for my late arrival in the debate. As my hon. Friend the Member for Birmingham, Selly Oak (Dr. Jones) said, I was unfortunately detained by what could not honestly be described as a little local difficulty at Longbridge -- a major crisis facing the whole of the Mdlands. I hope that the House will forgive me for my late arrival.

I congratulate my hon. Friend on securing the debate, and on her description of the issues facing elderly persons homes in Birmingham. I should like to make a few comments, which will be fairly parochial, as one of the homes affected is in my constituency. I shall illustrate some of the general problems facing elderly persons homes in Birmingham and some of the issues at stake.

The city council and the social services committee in Birmingham in particular face formidable problems. Over the years, they have attempted to establish an imaginative policy for the care of the elderly, in consultation with the health authority and others, under the "new homes for old" strategy. In principle, that strategy is valuable, because it emphasises partnership and the need for quality and choice in the care of the elderly. It emphasises the right of people, as they reach old age, to have the quality of care where they need it and the choice of care in all possible situations.

Frankley in Northfield became part of Birmingham in 1995: it was formerly part of Bromsgrove. Lyttleton house is an elderly persons home in Frankley which has provided a valuable community resource, and has been well regarded by people who live in the area. It is one of the homes that did not meet registration standards under the social services review. In the early part of last year, it was recommended for closure. The issues surrounding that home are much the same as those described by my hon. Friend for other homes, especially the Goodrest home in her constituency.

The "new homes for old" strategy adopted by Birmingham city council is about providing diversity in choice for elderly people in the city. However, I have been worried about the way in which the debate has gone in the past year in Birmingham. Under the most recent review of elderly persons homes, the selection of which homes should change their character, which should be recommended for closure, which should be offered other options and which should be refurbished seems to be linked to the current financial situation of the homes and the refurbishment costs estimated by the city council, rather than to the clear estimate of needs in the community and how those needs relate to the needs of communities elsewhere.

The city council and the social services committee have a genuine desire to consult local people about their proposals. Unfortunately, that genuine desire to consult has not always been matched by action on the ground. Questions have often been asked by local residents. In my area, an action group was formed to campaign for Lyttleton house, and the social services department has been asked about the plan for closure. Although answers were given, sadly they led to more questions about the cost of refurbishment, occupancy levels and so on. In Birmingham, we need a little more clarity about the review, and about how the current provision of elderly persons homes fits into that review.

The "new homes for old" strategy is sound. The responses to consultations have not related to that strategy. The committee's response to the comments on Lyttleton house, which included a 10,000-name petition of local people who want to save it, has been to suggest that, rather than closure, perhaps it could be considered for sale as a going concern. There may be arguments for that, but it prompted another round of consultation. Local people did not know whether they were coming or going. They were told that the home in which their relatives lived and which they valued was earmarked for closure. They were consulted, they gave their views and they were then asked whether, rather than closure, they wanted it to be sold off as a going concern.

The meetings of local people that I attended did not have confidence that their comments would have an impact on the decision-making process. I say that not to criticise or to have a go at the social services committee, because it is faced with a difficult situation in a difficult financial climate, and there are various competing pressures on it. But the difficulties faced by the social services committee are nothing compared with the difficulties faced by the residents of those homes and their relatives. They are told about the cost of refurbishment and that the need in their area is not easily equatable with the need elsewhere, but they are the ones that have to make decisions and advise their relatives for whom places such as Lyttleton house and Goodrest are their homes.

On 17 February, the social services committee in Birmingham will again meet to consider the future of elderly persons homes. I do not underestimate the difficulties that it faces, but I want to use the opportunity of this debate to suggest to the committee that it may be worth while pausing a little longer and thinking in a more joined-up way about the future of those homes.

For the homes that are threatened with closure, the solutions may not be limited to the straight choice of closure or sale to a purchaser as a going concern. We should think a little more flexibly and creatively about the way in which we provide elderly care in Birmingham. There should be more discussions with the health authority and other partners to see how the principles of the "new homes for old" strategy can be taken forward in practice. I want that imaginative strategy to succeed in Birmingham, but it will work only if its principles are reflected in the practice of the department on the ground. When the social services committee meets, I hope that it will consider proceeding along those lines.

I echo the point made by my hon. Friend. The local authority's ability to act is often circumscribed by the financial climate. Perhaps greater flexibility in that financial climate would enable it to be more creative, which is what we all want.

 

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Dr. Jones) on securing time for tonight's important debate; she clearly feels strongly about the issues. I also congratulate my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) on his thoughtful comments.

My hon. Friend the Member for Selly Oak raised a number of issues relating to the provision of residential care in Birmingham. In particular, she discussed arrangements for the local authority's so-called part III homes, standards of care, and roles for the public and private sectors as providers.

In Birmingham, as elsewhere, residential care is an integral part of community care. Before I deal with the specific issues raised by both my hon. Friends, it may be helpful if I say a word about the wider context in which the debate should be seen. As I am sure my hon. Friends are aware, the aim of community care is to provide the support that frail or vulnerable people need if they are to live in their own homes or in homely settings, retaining the independence, dignity and quality of life that come from being a part of the community. That means that local authorities must provide a balanced range of services that are accessible and adapted to meet the needs of individual service users.

We take no ideological view of who the provider should be. We see no reason why good-quality, cost-effective services cannot be given by the public sector, the private sector and voluntary providers. We recognise the important contribution that each must make. The important issue is not that of who provides a service, but that the service itself is of high quality, is responsive to users' needs and wishes, and delivers the best possible value for money. That means that local authorities must be rigorous and skilled purchasers of services from independent providers, and equally rigorous and skilled managers of their in-house services. In both cases, authorities must be committed to putting users' needs first, delivering top-quality services and ensuring that resources go as far as possible.

The local authority has the lead in planning and commissioning important services. The role of Government is to provide a legal as well as a financial framework within which those important services can be delivered. Let me say a little more about that wider framework, and about what we as a Government are doing to promote quality and value. The key elements include promoting partnership working -- effective arrangements between agencies working locally, and the development of national standards and objectives for social services. We are doing that now, for the first time. We also want to encourage more effective commissioning, and we are providing the resources that authorities need to commission and deliver services effectively.

As I am sure my hon. Friends will know, over the next three years 3 billion of additional revenue will be devoted to social services. Let me mention some of the important initiatives with which we are taking forward our agenda. We are determined to improve partnership working between social services and the national health service, because people's needs do not recognise organisational boundaries. In the case of older people particularly, they are often complex: they change, both in the short term and over a longer period. Following a period in hospital, people may need additional support -- from the community health service, for instance -- if they are to return home; or they may need residential care places if discharge is not to be delayed, and if unnecessary readmission is not to be caused. We need to consider residential care provision within the broader context of community care services, mapping out the key links with other agencies.

When residential care is planned, what is important is effective joined-up thinking in the wider community care and health context. The interdependence of health and social care makes it essential for the provider agencies to collaborate effectively in service planning, commissioning, assessment and delivery -- and, not least, in funding.

Section 28A of the National Health Service Act 1977 has long been a key funding mechanism enabling health authorities to support the work of social services. Not least, that includes supporting residential and nursing home placements -- for example, through the provision of "dowries" and similar payments in respect of people transferring from long-stay hospitals, or through the support of innovative cross-agency services.

I am sure that both my hon. Friends will know that, in the Health Bill that we published recently, we outlined the way in which we intend to legislate in order to ensure that more effective working between social services and the national health service becomes the norm. First, we are determined to remove whatever legal obstacles might obstruct effective working between the NHS and social services. Secondly, in our executive letter entitled "Better Services for Vulnerable People", we set out the medium-term agenda for people with continuing health and social care needs. Further guidance on the better services initiative was issued in August by the NHS executive and the Department's social care regions.

The circular asked local and health authorities to proceed in three important areas. First, there were the joint investment plans that will provide a national framework for multidisciplinary assessments of older people in acute and community health settings, jointly with social services, and the development of a range of recuperation and rehabilitation services for older people. Joint investment plans will constitute a distillation of the health improvement plan and community care planning information. They bring together in a single document the joint information needed for health and social services to deliver on their respective responsibilities. The recent guidance requires health and local authorities to have joint investment plans in place by April this year, as a minimum, for older people, including those with mental health problems.

Multidisciplinary assessments, by health and social services, have always been a joint responsibility within community care. More effective multidisciplinary assessment means better co-ordination of care services. In the community, it may avoid unnecessary hospital admission and allow older people to remain in their own homes for far longer; in the hospital setting, good multidisciplinary assessments may avoid an unnecessary admission subsequent to institutional care. Similarly, we hope that the development of recuperation and rehabilitation services will enable people to return to the community sooner, and to remain in their homes for longer.

Thirdly -- perhaps this is our most important proposal -- we intend to modernise social services. This is a key theme in the recent social services White Paper, which provides a context in which services such as residential care must be seen and developed. We are talking about maximising independence rather than supporting dependency, with the new emphasis that we intend to place on rehabilitation, recuperation and prevention services.

The White Paper, however, does not stand alone. It is part of the Government's overall strategy to improve health and social services. Together with the document "The new NHS" and the Green Paper "Our Healthier Nation", the social services White Paper provides a foundation for the future of health and social care.

My hon. Friend the Member for Selly Oak raised the issue of standards of care and inspection in care homes. That is a key issue, and, indeed, a key element of the White Paper. Local authority-provided residential care homes are not currently required to be registered in the same way as independent homes, but local authorities are required to inspect their homes, and to apply the same standards to private and public provision. When local authority homes are below standard, we expect authorities to take appropriate action to bring them up to scratch. It is only right for vulnerable people in local authority homes to expect the standards that authorities apply to the independent sector.

There are many problems with the current regulatory system for social services, and we want to put those problems right. We are committed to reforming regulatory arrangements for social services, and our proposals have been set out clearly in the White Paper. We want to create independent regulatory bodies, which will be called the commissions for care standards and which will be responsible for regulating all residential care homes, including local authority homes as well as nursing homes, children's homes and other care services such as domiciliary care agencies.

We are also committed -- my hon. Friend the Member for Selly Oak may be interested in this -- to the development of national regulatory standards that can be applied to all care homes. As a first step in the development of national standards, we commissioned the Centre for Policy on Aging to advise us on standards for older people in residential care. The CPA recently submitted its report to the Government, and we intend to publish the standards for consultation shortly. I assure my hon. Friend that we are determined to set standards that will consider the quality of care that is needed for vulnerable people.

My hon. Friend spoke at length about the particular circumstances of social services in Birmingham.

As I am sure she will be the first to acknowledge, spending priorities vary from area to area. As I have said, of the authorities locally, local authorities are best placed to assess those priorities. I have described several ways in which we are supporting them in delivering quality, cost-effective services. Clearly, though, a crucial factor in the equation is money. Commissioning services means committing resources. Committing them wisely means planning ahead. We are aware of the strains on social service budgets, and we have demonstrated our intention to ensure that social services receive priority among the many services that receive Government support.

My hon. Friend the Member for Selly Oak will be aware that the outcome of the comprehensive spending review provides significant increases in resources for local authority social services -- as I have said, almost 3 billion extra over the next three years and an additional 500 million in the current financial year. The increased resources mean that social services departments will be able to plan ahead, knowing that there will be increased funding in each of the next three years. They will have the resources that they need to provide effective and integrated services to vulnerable people in society.

I should like to return to the specific question of residential care homes and, in particular, the arrangements that my hon. Friend the Member for Selly Oak has described affecting Birmingham. As I have said, resources nationally for social services are being increased by 6.1 per cent. next year. That is significantly above inflation. We are targeting a large proportion of that increase at improving the services for older people through better planning and delivery of services across the interface between the health service and social services through improved rehabilitation services.

Older people make an enormous contribution to national life. The Government are determined to ensure that their wishes and needs are taken seriously. We also intend to ensure that older people are valued and can play their full part in society.

As I have mentioned, the recent White Paper set out what the Government propose to do to modernise social services. People generally want to live in their own home if they can, and the Government intend to put greater independence at the heart of social services for adults. However, we recognise that, for some people, care in a residential setting will be inevitable and appropriate.

A recent survey by Birmingham social services showed that some people in residential homes were inappropriately placed and capable of managing their lives better at home. It was believed that, given improved rehabilitation services, many of those people would not need to go into residential homes in the first place. I am sure that my hon. Friend the Member for Selly Oak would want to ensure, if possible, that that happened.

Birmingham health authority is developing a proposal whereby social services would pay a premium for short-term stays in residential homes if they offered rehabilitation services that enabled the person to return to their home eventually. Birmingham health authority is also running a pilot along those lines for people with specific health needs.

 

Dr. Lynne Jones: All that my hon. Friend has explained on the Government's strategy is commendable, as are the additional revenue resources, but it has been made clear that the residents of the homes that are to be closed will not be offered a place in their own home. Many have left their homes. They have no home. The extra care sheltered housing is not on offer to them. The issue is not about the revenue cost -- the day-to-day cost of running the home -- but the cost of the refurbishment and capital expenditure. That is the important issue. I would be grateful if he would say a few words about that.

 

Mr. Hutton: I do intend to say a few words about that, but I am sure that my hon. Friend and I are at one on the general direction that we want to take, which is to promote wherever possible independence and independent living. She was anxious -- I think that it was her main concern -- about the quality of care that her constituents could face in the private sector. She expressed anxiety that there would be no guarantee that they would receive a comparable quality of service. I accept that one of the Government's responsibilities is to take action to set standards and to ensure that they are sufficiently high. We take that responsibility seriously.

That is why we have commissioned the work from the Centre for Policy on Aging to help us to set a proper standard that we can apply across the spectrum, but we intend -- the Government have made it clear; I hope that I have done so tonight -- to ensure that, in developing those new national standards, we consult as effectively as possible with all providers, in both the public sector and the private sector.

My hon. Friend the Member for Selly Oak referred to capital. She may be interested to know that I had some correspondence with the leader of Birmingham city council about the issue. Figures from the Department of the Environment, Transport and the Regions have shown that, from 1995-96 to 1999-2000, Birmingham has had approximately 230 million made available to it from central Government for capital programmes, and between 6 million and 10 million in usable receipts.

We have told Birmingham city council that we are anxious to encourage local authorities to make full use of the private finance initiative. We are keen for authorities to seek partnerships with the private or voluntary sector because, in many cases, as my hon. Friend may be aware, such partnerships can offer very good value for money in the provision of services and capital investment.

My Department has PFI credits available for the current financial year. If Birmingham city council is interested in exploring that option with us, we would be interested in hearing from it.

 

Dr. Jones: That is an interesting proposal, but I understand that that has been explored. In relation to the total capital programme, obviously Birmingham is a big city and it has a big capital programme, but the fact remains that the allocation that the Government have earmarked for social services has declined and is very small.

 

Mr. Hutton: I would hate to have an argument with my hon. Friend about the level of social services expenditure. I am sure that she would acknowledge that over 500 million of additional money has been put into social services in England, Wales and Scotland this year. That is a significant increase. The local government financial settlement for Birmingham shows that, overall, resources increased by 4 per cent. this year, which is above inflation.

We could go on arguing around those points. I do not think that it would be fruitful to do so, but, as I have said to the leader of Birmingham city council, we are interested in exploring with the council any opportunities for private finance initiatives. We still look forward to hearing any confirmation from the council that it wants to explore that with us.

My hon. Friend the Member for Selly Oak was right to say that the social services department has been considering the future of all of its own residential care homes for older people. Some homes have been sold and some have been refurbished. The overall strategy included upgrading some of the homes to meet registration standards, and receipts from the homes that have been sold contributed significantly to that upgrading. The strategy also includes providing for a range of alternative care provision, to residential care in which people can still have their own front door and receive the degree of care and support related to their needs.

My hon. Friends the Members for Selly Oak and for Northfield both mentioned the development of extra care sheltered housing, which now has 11 schemes in operation, with a further three new build schemes planned for 1998-99. As 12 more schemes are in the pipeline, there will be a total of 1,030 flats by 2001.

The strategy employed by the social services department has been in line with that of many other local authorities that have divested themselves of in-house residential provision for older people. The social services committee has approved the strategy, and there has been a formal process of consultation with all stakeholders before any decisions have been taken on the future of each home.

I understand that arrangements for all but eight of the authority's 35 homes have now been satisfactorily resolved. The social services department is currently out to consultation on the final eight homes, and findings and any final proposals will be reported to the social services committee for a decision, on 17 February. Any homes that are sold to the independent sector will be subject to the process of registration and inspection that -- I should like to ensure my hon. Friend the Member for Selly Oak -- will ensure the quality and standard of care available

Birmingham is not alone in reviewing its provision of residential care. Local authorities across Britain have been examining ways of improving services, to put together imaginative and innovative care packages for the benefit of care service users and their families. Whatever decisions an individual authority makes when considering changes to the extent of their provision of residential care, the welfare and wishes of residents and staff of the residential care homes concerned must be taken fully into account.

Regional offices of the Social Care Group monitor developments of that nature and keep Ministers fully informed. However, as I am sure that both of my hon. Friends will accept, it is essentially a matter for the local authority concerned to decide how best to meet the need for social services, including residential care, in their own area.

Taken together, the measures that I have outlined will help to improve both the quality and the delivery of social services across Britain. The Government are committed to ensuring that we have first-class social services that provide flexible user-centred care to those who need it. I assure both my hon. Friends that that applies as much in Birmingham as it does anywhere else in Britain. I assure them also that I shall continue to take a close interest in the issues that both of them have raised in this debate.

Question put and agreed to.

Adjourned accordingly at half-past Eight o'clock.

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