Care for the Elderly

Before the motion is moved, I will advise the House how I intend to conduct the debate. Given that the first two motions on the Order Paper refer to the same fields of endeavour, I propose to take both in the context of one debate. The first motion will be moved, and when the proposers of the second motion are here, it will be moved. When it comes to the vote, each will be taken seriatim — the Minister having had an opportunity to respond.

On a point of order, a Cheann Comhairle. Can you give us some guidance on the second motion, which notes the decision of the Scottish Parliament to provide the elderly with free nursing and personal care? Technically that is not correct. We have since been informed that, while Scotland has agreed to pay for the nursing aspect, it has decided to set up a working group to consider the personal care element. We are in favour of debating the motion, but, technically, the second part is not correct.

That sounds like excellent content for a speech in the debate. While motions may be competent, some of their content may not, in fact, be correct. That may be what the Member is suggesting in this case. I will leave it to be decided in the debate and for the Minister to respond to.

I beg to move

I am sure that we are all grateful to be here this morning given the traffic conditions — I certainly had difficulty in getting here. I seek the support of the Assembly for this motion and, indeed, for the next motion entitled ‘Care for the Elderly’ brought to the Assembly by our Colleague, Mr Nigel Dodds.

In relation to old age, the Royal Commission’s report on long-term care is a very thorough and detailed document, with some 196 pages of very relevant information. It contains some 24 recommendations. The Commission concludes:

It makes it clear that the need for change is pressing, and I hope that the Assembly will give its full blessing to those sentiments today. I am grateful that the Minister of Health, Social Services and Public Safety is present this morning to listen to the debate. I was encouraged by her response to my question on the Floor of this House on 15 January 2001, when she said:

That was a very positive response by a caring and sympathetic Health Minister, which we must all welcome.

The Westminster Government have responded reasonably positively to many of the recommendations in the Royal Commission’s report, including free National Health Service nursing care from October 2001. However, they have not embraced the recommendation that personal care should also be freely available, determined only by need. The report states:

This must surely be unfair, and it will lead to inequalities if the Government make this division. However, let us give some credit to the Government for what is called "Care in the Community", even though, like for so many other things, funding for it falls far short. At least "care in the community" provides care that allows elderly people to remain in their own homes and with their families for as long as is humanly possible.

Unfortunately, the time comes — for one reason or another — when care in either residential or nursing accommodation is required. At that time, the question of who will pay for the service becomes apparent. Growing old should not mean growing in fear — worried about how one will pay the cost of needing to live the rest of one’s life in dignity.

For many years, elderly members of society have been afraid that, with ageing, they will be forced to sell their homes and all their possessions, and that they will have to use their savings to provide for the basic needs of old age.

The Royal Commission’s report admits that many old people find the current system of provision unfair and feel that it is failing to meet their reasonable expectations. Many believe that they have paid into a system, through the National Insurance scheme, which they were led to believe would look after them in later life, whatever their needs would be.

At a key point in their lives, people find that they are expected to pay, out of the assets that they have accumulated over a lifetime, for care that they had expected previously to be free. This must surely result in a sense of betrayal. The Assembly must therefore ask for the provision of nursing and personal care that will be provided on the basis of need and nothing else.

As I have said before, in many ways the problems that elderly people face are part of the larger problem of an inadequately- funded care in the community programme. The Treasury has not provided the resources necessary to allow people to be cared for in their homes — be that because they are disabled, mentally ill or elderly. As the money has not been provided, the Government have declared that the needs brought on by age do not entitle somebody to the basic help required to live a dignified life. This approach means that they do not have to fund it. That is wrong and immoral.

As Age Concern stated recently

We should not make the lives of elderly people more difficult by denying them their basic rights to the care that they need. However, this is what we are doing. Indeed, as the Scottish health boards’ network reported in September 2000

That is simply not good enough. We must stop providing for the elderly on the basis of what is available or what we want to pay for, and start to provide on the basis of what the elderly need. We should stop putting people in nursing homes because there are insufficient resources to support them in their own homes. In the final analysis, if a nursing home is required it should be funded entirely from taxation.

The Government’s response to the Royal Commission’s idea of providing care on the basis of need is to argue that although the Government have the money to do this, making personal care universally free is not the best use of resources. They prefer not to spend money on ensuring that the elderly can live lives that are as independent and fulfilling as possible. This response is unfair.

Take, for example, the case of someone suffering from Alzheimer’s disease, a medical condition that leads to increasing levels of disability and the inability to care for oneself. Dementia is also one of its symptoms. Sufferers’ needs may not be assessed as being health needs. The funding system does not view a high level of nursing care as one of their requirements. Therefore dementia sufferers might receive little or no NHS funding. The Government are refusing to fund the care needed to alleviate this symptom. This is in complete contrast to the Government’s treatment of the symptoms and consequences of any other disease. Surely something is wrong with that analysis.

The Government’s response is to say that they do not need to provide for old people’s personal care requirements because the elderly can provide that for themselves. I say to Westminster that that is wrong. I hope that our Health Minister will accept my argument and act accordingly.

We must also treat the elderly with respect, dignity and fairness as well. We must provide for their needs. Scotland reached that very conclusion after examining the problem. Its Parliament, not its Executive, decided that more resources should be spent on providing personal care, not just for the elderly, but for all those who need it. I understand that Wales would like to do the same thing. We in Northern Ireland owe our constituents the same concern and action. We must implement the Royal Commission’s report, provide free personal care, and support the elderly and those who care for them. Put simply, the essence of the commission’s many recommendations is a question of equality for everyone and privilege for none.

We thank the Royal Commission for its work. I hope that the Assembly will support both this morning’s motions. All elderly people will benefit. We should remember that we will all be elderly some day.

The Prime Minister, Tony Blair, said before the last election that he did not want to live in a country where the only way pensioners could get long-term care was by having to sell their homes. I hope that he will ensure that that cannot happen before the next election.

The motto of the author of the report is:

I hope that the Health Minister accepts this noble motto and that we can advance the findings of the Royal Commission. I trust that Members will support the motion.

I am sorry that I was not here for the early part of Mr McCarthy’s speech. However, I endorse everything that I did hear. This is a very important debate. The long-term care of the elderly is one of the issues that should be at the top of the agenda for the Assembly and the Executive. Many people will be aware of the importance that the Scottish Parliament placed on this subject and of the fact that, to a large extent, it has dominated the politics of that region for some time.

When myself and my Colleague Mr Paisley Jnr tabled the motion, one of the issues that we wanted to address — as, I am sure, did Mr McCarthy — was the fact that, although the Royal Commission report was published in 1999 and the United Kingdom Government responded in July 2000, it is now February 2001 and a spokeswoman for the Department of Health, Social Services and Public Safety is telling us that it is still working on "a detailed response to the Royal Commission’s long-term care for the elderly." I presume that that means its report.

In the ‘Belfast Telegraph’ of 26 January 2001 that spokeswoman went on to say

I welcome that commitment in so far as it goes, but I hope that the Minister will give some firm proposals today or at least give us an idea when that may be expected. The elderly and those who are in need of care in Northern Ireland are entitled by now to know exactly the direction in which we intend to go as far as the Royal Commission’s report is concerned. Some of the issues that were outlined have already been prominent in the debate.

A growing proportion of the Province’s population is elderly, and, according to Help the Aged in Northern Ireland, the vast majority who are in need of long-term care are older people. About four per cent of those in need of long- term care are over 65, and 16% of those over 85 are likely to need some form of support. The issue for elected representatives is simple. Many, if not all, elderly people have contributed through taxes and National Insurance to what they believed would be a system that would ensure that when they were old and in need of help due to disease or disability, the state would be there to help them.

We found that in many cases where care is needed they have been asked to pay for that and, in effect, to pay twice. As an Assembly of elected representatives, we have a duty to address that. The prospect of having to use up all their savings and sell the family home to pay for what, in many cases, they rightly regard as care that should flow from their particular condition, disease or disability has caused great distress and anxiety amongst older people and their families.

Mr McCarthy has already mentioned people with Alzheimer’s disease. That is a classic example. Under the proposals in the response issued by Tony Blair’s Government to the Royal Commission’s report, care provided by nurses in certain conditions will be given free of charge. However, the sort of care that people suffering from Alzheimer’s need as a result of their condition may not be covered. That is simply unacceptable. We have to address that as a matter of urgency.

Like the Royal Commission, we recognize that there are certain costs that we can reasonably expect people to meet. The Royal Commission divided the issue of care into a number of categories. It said that living and accommodation costs were the sort of costs that you could reasonably expect people to contribute to. However, when it came to nursing and personal care, the Royal Commission said that those costs should be met out of general taxation. There may be different views about the way to pay for this care. Should it be paid for from general taxation or through some sort of voluntary or compulsory insurance scheme? I believe that general taxation is the right approach. Whatever approach one has the fact is that elderly people in need of nursing and personal care should not be expected to pay for it.

We have seen a lengthy debate in Scotland on this issue. The Scottish Executive, having come under considerable pressure not least from within its own coalition where the Liberal Democrats exerted considerable pressure on the Labour Party, were forced into a position where they had to recognise that simply allowing free nursing care without free personal care would be running away from the recommendations of the Sutherland Report and the obligations that society has to our old people in need of care.

They have now set up a working group and have importantly, gone further by saying that they accept, in principle, the obligation to meet the cost of personal care. That is the way the Assembly should go. We should accept, in principle, that this is the right approach. We are not saying that we should set down timetables and deadlines today. We are saying to the Minister that she should accept that this is the will of the Assembly. We are saying that we as the Northern Ireland Assembly, on behalf of Northern Ireland and the people we represent, believe that people are entitled to free nursing and free personal care if they are elderly and in need of that care. It used to be a great saying in the Labour Party — I do not know whether it still believes it in England and Wales in light of the response to the Royal Commission’s report — that health needs should be met from the cradle to the grave and that they should be free at the point of use to all.

It seems to me that that principle has been abandoned. We in Northern Ireland need to address the issue, and that is why I welcome the debate.

I hope that we can concentrate on the principle at issue. Some Members may trot out excuses and arguments about why we should not go down this line; that would be to let our elderly population down. We are not saying "Let us spend more, more, more", without considering the finances. We recognise that all such things have costs. We recognise, for instance, that treating people who have cancer, heart disease or other health problems costs money. Is anyone seriously suggesting that we should look at the matter in terms of people’s wealth or of the cost? Of course, we must address that issue, but the health needs of the population are the most important thing, and we have a duty to meet those needs as far as possible. No Member would ever argue that, because cancer treatment was becoming more and more expensive, we ought not to treat people. It will take time and hard work, but we must address the issues.

We could say many things about the Royal Commission’s report. The report does not deal only with nursing and personal care; there are many other proposals in it that, I hope, the Minister will also address. My motion concentrates on the issue of free care because that is a matter of particular concern to many elderly people in the Province. I welcome the proposal that, for the first three months, people will not be forced into making a decision that means that they must sell the family home and that there will be a period during which they can change their minds. That is an important recommendation, although the capital limits should be increased to make the idea more realistic. In Northern Ireland, the current limit beyond which people are asked to pay in full for care is £16,000 in savings or the value of their homes. That figure is far too low and should be increased considerably if people are to avoid being forced to sell the family home.

There is also the suggestion, included in the Royal Commission’s proposals, that there should be a national care commission. In other jurisdictions it has been agreed that a commission to set standards and monitor developments should be set up. That is an important proposal, and we should give priority to it in Northern Ireland.

Today’s debate is, essentially, about principles. It is about whether the Assembly will set out the direction in which it wants the Department and the Minister to go. If we were to adopt a different course from that followed by the Scottish Parliament, our senior citizens would have every right to ask why they were being treated differently from their Scottish counterparts. They are entitled to receive the same, not as a handout but as a birthright.

Since the debate began, I have received a number of requests to speak. Given that the debate has a time limit, Members should restrict their comments to six minutes.

Even then, all Members will not get a chance to speak. However, I must restrict the time for speaking, particularly as some Members have made quite a struggle to get here this morning.

I endorse what Kieran McCarthy and Nigel Dodds have said. My Committee hopes that the Minister — together with the support of the Executive Committee — will implement fully the findings of the Royal Commission on Long Term Care for the Elderly. If we cannot look after our own folk then we should not be here. I am reminded of the words of an anonymous poet as regards an elderly person living in a small cottage in a rural area:

Our senior citizens need two things above all else. One is to retain their independence, particularly because of pride and self-esteem, and the second is to remain living in their own community. The Assembly will surely support both those things.

There are some important points as regards helping elderly people remain independent. For example, how many elderly people are wearing spectacles that they have had for years? How many of them have not had eye tests? How many elderly people have defective hearing? Sometimes it can be caused by something simple such as a plug of wax, which is easily dealt with. Ill-fitting dentures can also be a major problem, and there may be a need for chiropody services.

How many elderly people live alone and do not eat proper foodstuffs? They need at least one proper meal per day. Urinary tract infections are most common in the elderly, as is incontinence. Diabetes is also a problem, and some people say that if you live long enough you will get diabetes. It is something that must be detected in elderly people.

In the home, an extra banister on the stairs would help some people, and they should not have to wait two years for an occupational therapist to make such a recommendation.

Any two of the points I have made — for example, failing eyesight and defective hearing — can lead to confusion in people. There is also the situation as regards the carer — often an unmarried son or daughter — who is trying to do their best to look after the elderly person. As situations develop we enter the stage of crisis management, in which the emphasis can lie in getting the elderly person to move into some form of institutional care. Carers must be looked after also.

The Royal Commission on Long Term Care for the Elderly reported in March 1999. It had been set up by the Government to recommend a sustainable and affordable system for funding long-term care, and it spent slightly more than one year considering the matter.

The report identified the current funding system as a source of considerable grievance among elderly people and their relatives and that there were many inequalities. There were 24 recommendations. The two major recommendations were that personal care following assessment should be free of charge and that a National Care Commission should be established to monitor trends and set standards.

The Scottish Parliament voted to accept the Commission’s recommendations and has since set up a working party to consider how they can be implemented. None of the Royal Commission’s 24 recommendations have been implemented in Northern Ireland. With its unique integrated health and social services, Northern Ireland has an ideal opportunity to ensure that nursing and social care should be regarded as a seamless continuum, all free at the point of delivery.

I realise that time is running out. Concerning home care, much greater investment is needed to help elderly people to stay mobile and independent. Home care is a crucial service. It needs to be funded to a level that enables the elderly person to be comfortable and secure, and to have a decent quality of life.

My final point is that an effective primary care service is essential to promote the health, well-being and independence of older people. There is currently a major debate on the future of primary care. As an integral part of that, and in relation to the Minister’s document ‘Building the Way Forward In Primary Care’, it is important that we have a bottom-up approach — a primary-care-led Health Service. That way we can have what we want — a first-class service for elderly people. If it can be done in Scotland, we should be able to do it in Northern Ireland.

I support the motion and most of what has been said. I will draw attention to some of the recommendations, which should, with one possible exception, be accepted. I will come to that. The most important recommendation deals with making personal care available after an assessment. Nobody could object to that, provided that we can find the funds to cover both the medical and personal care. We have to do that in the context of a finite budget, and some consideration must be given to where the money will be found. It is still unclear how much money will be required for the personal care element.

A case can be made for the costs of medical care to be paid by the National Health Service for elderly people in residential care, because if they were in hospital the medical care would be free.

The Scottish Executive — not without reservation — have agreed to the payment of personal care for all. They have agreed from October 2001 to free National Health Service nursing care. In implementing a wider package of measures, the Scottish Executive are hoping to bring the maximum benefit to the greatest number of people. As some Members know, the Scottish Executive have decided to set up a working group to look at the implementation of the personal care proposals. That group will report in August.

I would like the Northern Ireland Minister of Health, Social Services and Public Safety to set up a working group here to consider the details of the Scottish proposals for personal care and to look at the implications for our budget of such proposals being implemented in Northern Ireland. The Royal Commission’s recommendation is that the Government should ascertain precisely how much money goes towards supporting older people in residential settings and in their homes. Undertaking that is quite a complex task. We must give some thought to devising a community care policy that will help as many elderly people as possible to stay in their own homes. The value of an individual’s home was referred to earlier, and the recommendation in the Royal Commission’s report is reasonable and should be accepted here.

There can be no argument with other measures that refer to bringing about increased efficiency and improved quality in the system, including emphasis on a more client-centred approach.

The majority of the recommendations have been broadly accepted by the Government in London and by the Scottish Parliament. There is therefore no case for their not being accepted and implemented in Northern Ireland. The exception to which I referred is recommendation 7, which calls for the resources that underpin the residential allowance in income support to be transferred to local authorities. I am not sure about the implications of that for our centralised social services system. There may well be no need to implement that recommendation in Northern Ireland.

I thank the Members in whose names these motions stand for giving us an opportunity to debate this important issue. We are dealing with one of the most vulnerable sections of society. We have already talked about children, now we are talking about the elderly. No one wishes to deny the elderly the care that they deserve in the twilight of their lives. Mr Dodds laid the foundation for our debate when he said that we were debating the principle. There are financial issues, but it is imperative that we consider seriously the principle of caring for the elderly.

It is an indictment of this generation that the elderly have to sell their possessions to pay for care, especially when we recall that they were given the assurance of free care when they reached the twilight of life. The Assembly should take on board the principle that our generation can do something about the problems of the elderly.

I am glad that the Care Standards Act 2000 has brought into being the National Care Standards Commission. Will all of that Act apply to Northern Ireland? If not, the Minister should give priority to such a measure for Northern Ireland. If we wanted, we could follow the establishment of the Scottish Commission for the Regulation of Care by putting in place a structure that would allow us to address the problems that we are debating.

The Care Standards Act 2000 will allow for the publication of statutory guidance on fairer charging arrangements for services provided at home. As we consider the care needs of the elderly, we must remember that they need two types of care, either away from home — in a hospital or in a nursing home — or in their own home. I am sure that all of us are largely happy with the way in which our elderly people are cared for in nursing homes. However, there are many questions about the care of the elderly in the community. I am glad that Dr Hendron has introduced the idea that meeting the needs of the elderly should be enshrined not only in community care but in primary care, which is where most of the elderly first have their needs considered. Has the Department examined the financial implications of adopting the Scottish model? What areas would be deprived of finance, if we were to go ahead with the proposal that free care be given to the elderly?

I am glad that we have been given this opportunity. Those who are in charge of community care should consider ways of providing further help to old people who live at home, perhaps by increasing the amount of time during which home helps would be available. Then we should consider the establishment of a commission to examine all the needs of the elderly.

Go raibh maith agat, a Cheann Comhairle. I thank Mr Dodds and Mr McCarthy for giving us the opportunity to debate the matter. I met an old friend recently and asked him how he was. He said that he was "walking slow and going fast". That is the plight of many of our older generation. Nigel Dodds is quite right to point out that the principle of socialism "from the cradle to the grave" has been jettisoned, by and large, by the Labour Party. However, that should not hinder us from adopting that very worthy socialist principle in the House. Care for the elderly should be the prime objective of any caring society. Indeed, it is the hallmark of a caring society.

Again, I congratulate Nigel Dodds for setting down very realistic parameters within which we can achieve a proper scheme for caring for the elderly that is financially viable and worked out. It is sad in many ways that we have to talk in such terms when we talk about care for the elderly.

Today, there will be a seminar about bonded slaves. In many ways, our old people are bonded slaves because they are expected to give up their state pension and their private pension. Their houses are put at risk — it is not just their own house but also that of their spouse — and can be taken from them to pay for the care that they are entitled to in a nursing home or in some other form of residential care.

We know that we are reaching a very high age profile in our society because of the medical care available. We should be thankful for the medical care, which is providing us with an older generation. However, that brings with it the responsibilities we owe to those who are growing old because of the medical care they have received. However, when they get older and are expecting to enjoy their retirement or old age, many are unfortunately afflicted with illnesses. A man who reaches 75 will spend seven years in illness — a woman, 11 years. We have to factor in all of that when the Assembly is considering its attitude to the care of older people.

As we have said, we accept the principle of caring for our old people. We also accept that it is going to cost money and that we have to find the money to care for those who have given so much to our society. They have contributed not just in their own way but have given children to this society. Those children have made this society and are still in their own ways trying to create a better society.

I support the motion. I again thank Kieran McCarthy and Nigel Dodds for giving us the opportunity to debate the essential issue of caring for the elderly. I ask the Minister to look sympathetically at the issue and treat it urgently within the parameters we have set down.

I commend Mr Dodds and Mr McCarthy for putting down these motions. They are very important motions, and it is most important that we debate the issue of care for the elderly.

I am sure that we are all aware that the majority in need of long-term care are older people. About four per cent of those aged over 65 and 16% of those aged over 85 are likely to be in need of some form of support and care. With an ageing population, it is expected that the number of people who need support will rise substantially over the next 30 years before levelling off.

When I was researching this very important subject I noticed a presentation by the Healthy Life Expectancy programme to the Royal Commission on Long-Term Care, in which it said that it was:

It continued

It further said:

It was also very interesting to note that the National Association of British Steel Pensioners recommended changes in care for the elderly. Its view is that good health is necessary to the enjoyment of retired life and that the elderly should have equal access to high-quality health-care and freedom from the worry of having to pay for long-term health-care. Among the association’s recommendations — and this point was also made by the Chairperson of the Health and Social Services Committee — is that NHS spectacles, frames and lenses be provided free for older people. I trust that the Department of Health, Social Services and Public Safety will take this and all the other recommendations on board. The association also called for the provision of free dental treatment for the elderly; NHS treatment according to clinical need; and the outlawing of age discrimination.

Many of the recommendations of organisations such as this should be taken on board as soon as possible. The Royal Commission on Long-Term Care has outlined three key principles, the first of which is as follows:

The Commission also concluded that

It is incumbent upon all Members, the Department and the Minister to take note of this very important debate. We must examine all of the issues raised and make the right decisions for the elderly here. Elderly people across Northern Ireland have been the rock and the steadfast element of this Province for many years. It is most important that we look after them. After all, they have looked after us.

I commend once again the Members who moved these motions and trust that all of these issues will be taken on board by the Department and the Executive.

There is no doubt that our elderly citizens are not getting the attention they deserve from the Health Service in Northern Ireland. We need to address their needs rather than short-change them. However, we should not underestimate the excellence of geriatric services, generally, in Northern Ireland.

The elderly care department of the Ulster Hospital is at the centre of the development of stroke services in the Province, particularly through the Northern Ireland Multi-disciplinary Association for Stroke Teams (NIMAST). The new treatment of thrombolysis for acute ischaemic stroke, if licensed, will provide a catalyst for a major change in the way that acute stoke patients are treated both in hospital and in the community.

A recent Stroke Association survey and Royal College of Physicians national stroke audit indicated that Northern Ireland has the highest percentage of organised stroke unit care in the United Kingdom and that standards of care for strokes are extremely high. The recently published Royal College of Physicians of London guidelines for strokes will further challenge both purchasers and providers in Northern Ireland and, I hope, result in further improvement in standards. NIMAST is committed to working closely with the Royal College to try to ensure regional implementation of those guidelines, so that the older people of Northern Ireland have the best possible chance not just to survive a stroke but to avoid permanent disability and institutionalisation as a result. Furthermore, the osteoporosis unit in Belfast City Hospital’s Wakehurst unit is the best in Ireland, and its personnel are world-class. Modern developments in treatment are having, significant effect on the well-being of all elderly people here.

Dementia — a serious condition which affects older people — has already been mentioned. The most common form of dementia is Alzheimer’s disease, followed by vascular dementia and Lewy body disease. There are others that I have forgotten; my memory is not what it was. Frequently patients display features of two or more of these types of dementia at the same time. The diagnosis and management of dementia has always been a priority of the Department of Geriatric Medicine at Queen’s University, Belfast, and the availability of new treatments for new forms of dementia means that early diagnosis and distinction between types is now much more important.

The elderly people of Northern Ireland who have received such expert care in geriatric hospitals should receive the same standard of care in the community. We need to look closely at a more effective integration of health and social care services.

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