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Mr. Dorrell: There are niceties to the specific commitment in the terms that my hon. Friend asks for, but I have given the clear commitment to introduce legislation during 1997. I invite him to draw the same conclusions about the implications of that commitment as I asked my hon. Friend the Member for Halesowen and Stourbridge (Mr. Hawksley) to draw a moment or two ago.
Dr. Lynne Jones (Birmingham, Selly Oak): The distinction between social and health care is entirely artificial for my constituents, who are having to sell their homes to pay for long-term nursing care. It has, sadly, become the accepted wisdom that the taxpayer can no longer afford the welfare state from cradle to grave, yet as citizens we are told that we can afford premiums of up to £10,000, or--according to Private Patients' Plan, which has operated the blueprint for this consultation--monthly premiums of £70. In the wings, of course, we have the insurance companies, waiting to cream the profits. This week in The Independent on Sunday, insurance companies told us that they pay out only 70p for every pound that they collect.
Why does not the Secretary of State offer the people of this country the choice that a majority of them want:to pay for their health care through national insurance or the tax system? In the end, the premiums will be a damn sight cheaper than the costs listed in these booklets or in his consultation document.
Mr. Dorrell:
The hon. Lady and her colleagues on the Labour Front Bench have to come clean. If they are in favour of universal provision of social care, they should say that that is their policy--it is the policy of the hon. Member for Bolsover (Mr. Skinner)--which will cost an
Mr. John Butcher (Coventry, South-West):
I congratulate my right hon. Friend. May I warn him--perhaps he does not need any warning--that he is dealing here with a very emotional issue, which, if misrepresented or distorted, could cause a great deal of distress? Will he therefore spend a great deal of time on television and radio over the next three to four hours? If the hon. Member for Peckham (Ms Harman) runs true to form, she will spend that time frightening the daylights out of elderly people.
I also tell my right hon. Friend that, in addition to the hon. Member for Birkenhead (Mr. Field), many of us are curious about the cost-effectiveness and quality of life implications of offering incentives, either through the taxation system or through cash, to relatives who wish to care for their elderly relatives up until the very last moment--the point at which 100 per cent. nursing care is required. That may save money and help the elderly to stay in their homes for longer.
Has my right hon. Friend seen the very interesting and somewhat destabilising research that shows that nicotine, as a drug, can prevent the onset of senile dementia? Does that not raise some rather interesting ethical and life style questions for the elderly?
Mr. Dorrell:
I am not proposing to offer any scientific advice on any subject today. The advice is clear: smoking is bad for health. That advice appears in different forms on every cigarette packet. The hon. Member for Peckham can relax about that. I shall be interested to examine evidence that my hon. Friend may wish to send, but, for the moment, scientists' advice is very clear about the health effects of smoking.
My hon. Friend is absolutely right to say that, if the hon. Member for Peckham runs true to form, she will be looking for means of scaring people. She thinks that she has already found that means because she has latched on to the idea that this is a £10,000 bill, but the proposals make it explicitly clear that there is no minimum amount and that any family with any amount of savings that they wish to protect can benefit from the provisions of this scheme. She will be misleading the public if she continues to return to that figure.
Mr. Dafydd Wigley (Caernarfon):
Does the Minister realise that a large proportion of the widows in my constituency do not have £5,000 with which to buy an annuity? Will he clarify one point that has not been touched on--the position of those who are under 65 but who have been hit by strokes or by other disabling conditions? Are they brought into the provisions or not? There does not appear to be very much reference to them.
Mr. Dorrell:
The answer to the hon. Gentleman's second question is yes, there is no age-qualification bar to the proposals.
On his first point, he is precisely right. That is why I have set my face against proposals that offer partnership only to those who can afford to buy total exemption. I am determined that that product should be available to all
people with savings that they want to protect, however small. Any attempt by any politician to mislead the public about that matter is blatantly dishonest.
Mr. Nigel Spearing (Newham, South):
Does the Secretary of State for Health agree that health care for the frail aged, whether in home or at home, is but a section of the much broader post-war solution that we thought we had for social security as a whole? Does he agree that his Government cannot deliver that security when their policies are, unfortunately, delivering greater insecurity of employment, greater insecurity of income and even greater insecurities for existing homes for the frail and elderly, such as the Sally Sherman home in Newham? How can we place confidence in a scheme for old age that increases the participation of the City and the use of premiums when, in fact, the Government cannot deliver security now?
Mr. Dorrell:
The hon. Gentleman has asked a very wide-ranging question. I pause simply to observe that security of employment and job prospects are better here than they are in any other major European Union country, because our economy is working more efficiently than most comparators elsewhere in Europe. As for his point about the welfare state and its structure, he must recognise that there is a difference between health and education--the two elements of the post-war welfare state--which are provided on a universal basis to a high standard and are largely free to those who need them. That is the commitment that this Government honour on health and education.
In the rest of the welfare state--through social security, social services and housing--ever since the war the commitment has been different. The commitment has been to a safety net to ensure that no one has an unacceptably low standard, but to encourage the individual to improve on that minimum. That is the basis of the post-war welfare state, which is respected by these proposals but which is called into question by some of the questions from Opposition Members.
Mr. Jeff Rooker (Birmingham, Perry Barr):
There is a well-known reluctance among people to plan for strokes, for the onset of Parkinson's disease or for other such
I ask the Secretary of State to consider how the House legislated in the past to force on people one of two pensions--the state earnings-related pension scheme or an occupational pension--on top of the state pension, because people are reluctant to plan and save for a pension. The House had to do that, with a degree of consensus, because it was the only way in which we could ensure that people avoided dropping through the safety net. There should be an element of that in this scheme, because some people will refuse to take up such a scheme on the basis that it will never happen to them--or they refuse to think about it at all.
Does the Secretary of State maintain that there was a golden age of NHS long-term care? There was not. There were long-stay geriatric wards--with 20 to 30 beds in a ward--where families, if they could, dumped their elderly relatives so that they could get their hands on their relative's house. The quality of care for our constituents' parents was abysmal. Now, the majority of people can, if they wish, stay in small wards, and the majority stay in single rooms. The quality of care is now vastly superior to what it was. I do not make a distinction between the public and private sector when I say that, but we must not lead people to believe that there was a golden age of long-term NHS care as opposed to other forms of care--that would be to set out a false prospectus.
Mr. Dorrell:
The hon. Gentleman is powerfully right, and I refer his colleagues to his final remark. I should like to add one further element to what he said about the supposed golden age on which people look back. In addition to the people who received poor care in NHS geriatric hospitals, many tens of thousands could not find care either in such hospitals or in part III accommodation run by local authorities. That waiting list has been abolished by the changes introduced over the past17 years.
Madam Speaker:
Order. We must now move on; I am sure that we shall return to this matter.
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