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Mr. Morgan: I sorry that I have to cross swords with the Minister, but he is wrong. Should he check before the Under-Secretary of State for Wales replies to the debate, he will find that my argument is not ill founded.
Mr. Gareth Wardell: The crucial point behind the remarks of my hon. Friend is that, if it was decided under
the old system that existed until a few months ago that an elderly person needed to be discharged to a private nursing home, that person would now be asked whether he would prefer to be means-tested or not. If he said that he preferred not to be means-tested, the health authority would face the dilemma of either having to keep that person in a bed or paying for him to go to a nursing home.
Mr. Bowis indicated dissent.
Mr. Morgan:
My hon. Friend is right, and I am pleased that he has clarified the matter for the Under-Secretary of State for Health, although I note that the hon. Gentleman is still shaking his head. I hope that the advice offered by the Welsh Office Minister will clarify the matter for the Minister responsible for England. I can only express a certain amount of gratitude for the fact that he is not responsible for Wales.
A level playing field must be established between domiciliary and residential care. That is at the heart of the debate. The orders for England and Wales apply only to people going into nursing homes or old people's homes. They do not apply, and do not increase the capital disregard for those who come out of hospital, or who have never been in hospital, who require domiciliary care. The orders do not have any effect on that care, except perhaps by moral suasion or implication, without any force of law.
The statute that we will pass just has an impact on people going into old people's homes and residential care homes. That poses a real problem for the Government, because true community care must involve the domiciliary care package. I would go further, because I believe that it must give preference to domiciliary care to be true community care.
The Government have always had the problem of not being sure whether nursing care homes, some of which often consist of 50 beds or perhaps 100 beds, or old people's homes are equivalent to community care. What is the difference between a cottage hospital, which is not considered to offer community care, and a large nursing home with 50 or 100 beds? The latter is considered to be equivalent to community care--search me why--and the other is considered as NHS institutional care. That distinction is rubbish.
The actual community care that we should provide is domiciliary care, yet the order does not refer to it. The least we could ask for is a level playing field. One may want to increase the capital disregards so that people do not have to sell their houses, or get rid of the savings that they might otherwise be able to pass on to their children, to fund long-term care in a nursing home or in an old people's home, but why on earth should not the same rules apply, with the same force of statute to raise the capital disregards, to domiciliary care packages? Let us at least have a level playing field. In my opinion we should go beyond that; domiciliary care should come first, because it represents true community care.
I hope that the Minister will address that problem. Perhaps he will give the Government's up-to-date thinking at this crucial stage, when they are devoting so much effort, as late as Friday, into trying to explain how wealth will still cascade down the generations in a way that is compatible with their thinking on community care. We want to know their thinking on such care.
Does it include domiciliary care in one's own home? Just as important as passing on one's home to a child or grandchild is the right to stay in that home until it is
medically unavoidable that one has to have institutional care in, for example, an old people's home or a nursing home. We heard nothing about that from the Minister. He simply throws around the phrase "community care" but does not say why the measures that we are discussing avoid domiciliary care, which is where the interface exists between the NHS and social service departments.
There has been a major withdrawal by the NHS from long-term care provision and even from care in the community. District nurses no longer carry out such a wide range of functions as they used to. There is now an absurd distinction between social bathing, usually carried out by home carers, and medical bathing, which has to be done by district nurses. I am told that, at least for men, the distinction is based on whether the bathing includes bathing below the waist. If it does, it must be done by a district nurse.
A constituent of mine has severe leg ulcers. If they are suppurating, the dressings are changed by the district nurse; if they are merely quiescent, they are changed by the home carer. That would have been absurd five years ago, but the NHS no longer provides what used to be considered the proper caring component of the NHS district nursing function.
Why do the Government consider it wise for the NHS to withdraw from that sphere and leave it to the local authority when, at the same time, they are doing absolutely nothing to change the capital disregards for local authorities when they--the local authorities--come to decide whether they should be means-testing the person involved?
My hon. Friend the Member for Stockport (Ms Coffey) was right to say that there is no rhyme or reason in the Government's explanation of how they have calculated the amounts to be given to English and Welsh authorities. It is a wholly improper procedure. The purpose of the statute is to compensate local authorities for the income that they will lose because of their inability to means-test people with an income of less than £8,000 or less than £16,000.
The measure is meant to compensate them, but it will not, because the calculation is made on the original needs basis, which has nothing to do with the compensation requirement. Some authorities will gain and some will lose, but the outcome bears no relation to the intention behind the measures. Just as people were supposed to be checking what public expenditure was used for, these measures may finish up before the Public Accounts Committee as legislative absurdities. I hope that the Minister will deal with that point.
The point made by the hon. Member for Ynys Mon (Mr. Jones) was also well taken. In some areas there are many private nursing homes, but in others there are not. That is a big problem. I have already referred to the important point made by my hon. Friend the Member for Gower.
On the same day the Government laid the English and Welsh orders, the Treasury Select Committee had asked the Government whether it was true that the Government had not properly estimated the additional expenses faced by local authorities. It had been estimated that the cost of changing the capital disregard would be £60 million. The Committee said that it thought that the Government had underestimated the amount. The Treasury wrote back to the
Committee in January, saying that there was no problem and that local authority social service departments would be able to act as "gatekeepers". The Committee replied that it did not think that that was the case and asked the Government to check with local authorities and talk to social workers.
The ultimate humiliation for a Government who sometimes pride themselves on being careful with public expenditure occurred on 18 March when--[Interruption.] Before the Under-Secretary of State for Wales cheers, perhaps he had better listen to what the Treasury said to the Treasury Select Committee, on the same day that the orders were laid, and on this very subject.
Paragraph 51 of the Government's response to the Treasury Committee's report on this year's Budget states:
What we are doing tonight is not the full story. At a later date the Government will have to come back with a different figure, and apologise to the House for having got their figures wrong in the first place. Why did they get their figures wrong in the first place? Because, as always, they did not ask the people who would be affected. They did not ask the local authorities what figure they would face as a result of the change in the capital disregard.
The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards):
When I faced the hon. Member for Cardiff, West (Mr. Morgan) across the Dispatch Box yesterday in connection with a different matter, I hoped that I would not have to see him again before Easter. Sadly, however, that was not to be.
As usual, Opposition Members have found little positive to say, but the plain fact is that our community care reforms are working. It was clear from the speech of the hon. Member for Darlington (Mr. Milburn) that he does not appreciate that the policy must be planned over 10 years before its full fruition: we are not even a third of the way through that process. More people are being cared for in their own homes or in homely residential care in their local communities, and they have more choice about how they receive the care that they need. That is what people want, and that is what our policies are delivering for them.
Let me deal with some of the serious points raised by Opposition Members. The hon. Member for Ynys Mon (Mr. Jones) said that the capital limit special grant in Wales was underfunded, and that he had spoken to some county councils in Wales. We also asked councils to give us their estimates of the costs that they would face, and they came up with a figure of roughly £3 million. In fact, we are providing £3.88 million, which is more than they asked for.
Before the hon. Gentleman suggests that our method of calculation underestimated future demand for places, let me tell him that we considered not only the current
number of people in care but the potential increase for most people who would now find it a more attractive option, because they would not have to contribute. I hope that that sets his mind at rest.
The hon. Gentleman asked about additional mid-year funding. We shall look at the outcome at the end of this year, and if there are lessons to be learned, we shall consider the funds that we shall provide in 1997-98.
The hon. Member for Stockport (Ms Coffey)--who seems to have lost interest in the debate for the moment--was rather critical of the formula on the basis of which her authority claimed to have been disadvantaged. As she will know, Stockport is a member of the Association of Metropolitan Authorities, and the formula that was used was recommended by the association. She will not need me to tell her that it is controlled by her party. I suggest with respect, therefore, that she write to her representatives on the authority and complain as bitterly to them as she did to the Government earlier.
With regard to resources for her authority, between 1990-91 and 1996-97, total personal social service resources for Stockport have increased by 58 per cent. in real terms. In the past year, total resources for community care have increased by 10 per cent.--the same as elsewhere in England, so her authority has not been disadvantaged.
The hon. Member for Gower (Mr. Wardell) was, as usual, meticulous in his approach. He told us the touching story of his visiting hospitals to ask patients questions, but the first question that he should have asked--and I am sure I know what the answer would have been, almost universally--was whether they wanted to leave hospital. The vast majority of people in hospital want to go home or just to get out. If he knows of anyone who would prefer to be in hospital than to go home, I should like to know who it is and what the circumstances are.
"The Government has now consulted with the local authorities and has listened to their views on the net increase in costs they face as a result of the increase in the disregard levels. In light of further evaluation of the information provided by the local authorities, the Government has decided, subject to Parliamentary approval, to make an increased provision available to local authorities. This provision will be charged to the Reserve, and will not therefore add to the planned total of public expenditure in 1996-97."
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