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Mr. Clifton-Brown: May I make a point on that very subject of funding? Is my hon. Friend aware of a serious report in today's Times? It states that, according to the Royal College of Nursing,


    "Christine Hancock, general secretary of the RCN, said that the way health authorities used criteria to exclude the vast majority of nursing home residents from long-term NHS care amounted to 'wholesale rationing in the NHS'."

Is that not wholly contrary to what Ministers, including the Prime Minister, have been saying? Unless further funds can be found for the health service, there will be no real solution to the long-term care problem.

Mr. Hammond: I have seen the draft report from the Royal College of Nursing, which will be published tomorrow, and I will shortly deal with the implications of the Coughlan judgment and access to long-term care.

The Government find the report's principal recommendation unacceptable, but they have not had the courage to say so openly. Only the persistence of the grey lobby has prevented the ball from being lost in the long grass--and, if I may say so, only the repeated insistence of Opposition Members has eventually given the House an opportunity to consider the matter.

Mr. Desmond Swayne (New Forest, West): Is my hon. Friend aware of the recommendations of the Select Committee on Health consequent on the report? It said:

Does my hon. Friend think that there might be anything in the fact that the Select Committee happens to be abroad while we are holding this debate?

Mr. Hammond: The Secretary of State feigns amazement, but my hon. Friend is right. The Health Committee clearly stated that failure to act urgently on the commission's recommendations would be a gross dereliction of duty. I was looking forward to hearing whether the hon. Member for Wakefield (Mr. Hinchliffe), the Committee's Chairman, regards the Government as

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guilty of that charge. Sadly, as we know, the debate has been timed to ensure that some of the most well informed and interested Members who would have wanted to contribute cannot be here. Most notably, some Labour Back Benchers who are critics of the Government on the issue are not able to take part in the debate. I look forward to a discussion with the hon. Gentleman, when he returns, to find out his view on that issue.

One suspects that the only debate on the royal commission report that really mattered happened long ago in the Treasury and that the conclusion of that debate was clear some time before the public even saw the report. As I have said, one might speculate even that the Secretary of State for Health, then Chief Secretary to the Treasury, would almost certainly have been the one wielding the veto.

Meanwhile--we must never forget the point--each year, some 40,000 home owners whose plight the then Under-Secretary of State, the right hon. Member for Brent, South, so touchingly acknowledged in May 1997, have been forced to sell their homes to pay for long-term care. Another 100,000 homes have been lost as another early pledge gathers dust.

Mrs. Humble: How many people were saved the indignity and distress of selling their homes by the Conservative Government's proposals to increase the limit to £16,000 in the early 1990s?

Mr. Hammond: A number of people will have been saved that indignity and distress by the increase in the limit. It is self-evident that if the thresholds are increased, fewer people will be caught by the trap. At the general election, the previous Government proposed immediate relief--not a total solution to the problem--which the Labour party rejected outright with the promise that it had a comprehensive solution. Two and a half years later, 100,000 homes have been lost and no comprehensive solution is available.

Dr. Palmer rose--

Mr. Hammond: I allow the hon. Member for Broxtowe to intervene and tell me what the royal commission said about those proposals.

Dr. Palmer: The royal commission said:

I also note that a later paragraph casts considerable doubt on the £40,000 figure.

Mr. Hammond: I wonder whether the hon. Gentleman believes that everything in the royal commission report should be accepted. Is he arguing that all the report's arguments should be accepted by the Government and the House? I do not accept the royal commission's analysis of the previous proposals.

As the hon. Gentleman knows, the private insurance industry feels that it was not given an adequate opportunity to present its ideas to the royal commission. The royal commission rightly observed that private insurance could never be the complete solution. The industry itself has acknowledged that, but it feels that it

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was not given an adequate opportunity to put the case for a mixed model of private insurance and public provision. Now the Secretary of State has effectively told us that the Government are considering going down the route of private insurance.

The range of options is no different from what was available in May 1997. The only difference is that 100,000 people who could have benefited then from change have already lost their homes. "The debate" is code for delay and indecision, while a private battle rages between the Treasury and the Department of Health over who should take the rap.

Mrs. Sylvia Heal (Halesowen and Rowley Regis): The hon. Gentleman appears to be concerned about people losing their homes as a result of the cost of long-term care. I suggest that he refresh his memory as to which party was in power when many long-stay national health service beds were closed and care was transferred from the NHS to local authorities, which marked the beginning of the policies that he is now criticising. I remind him, in case he has forgotten, that it was, of course, the Conservative party.

Mr. Hammond: The hon. Lady is right, but that is not the point that we are discussing. I shall come to the demarcation line between NHS continuing care and social care provided by local authorities in a moment.

I make no apology for concentrating the greater part of my remarks on the Government's inaction in response to the royal commission's principal recommendation, which is about funding. However, the report also deals with other vital issues that remain largely unaddressed as a result of the Government's paralysis over the principal recommendation.

The provision of care--what type of care, what type of choice and who should provide it--is as important as the means of paying for it. I was pleased to hear that the Secretary of State agrees that choice is the key. We must never forget that in discussing long-term care for the elderly we are talking not about statistics or units, but about individual people--and elderly people at that, who almost by definition have clear and precise ideas about what they want and do not want. No single model of care will provide adequately for such a disparate population. It is essential that in structuring a funding system we should seek to stimulate choice and diversity in supply so that provision is responsive to the needs and wants of the individuals who will use it.

There is a consensus across the House that the promotion of domiciliary care--care for people in their own homes--is greatly preferable where practicable. All the surveys show an overwhelming preference among elderly people for staying in their own homes for as long as possible. I was interested in the Secretary of State's announcement on standards for domiciliary care and his allusion to the possibility of a short-term disregard at the beginning of a period of care to avoid what might be termed accidental institutionalisation of people because they needed to leave their homes for a relatively short period. It was disappointing that the Secretary of State had nothing concrete to say on that, even though the press had been speculating that the Government might be able to make an immediate announcement.

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The Government have rightly recognised the vital role of voluntary carers in supporting the elderly, among others. How best to support them--whether to provide support directly or through more effective respite provision--is a matter for debate. There is broad consensus that support for carers is not only a moral imperative, but economic common sense, recognising the huge burden of work that they shoulder, unpaid and often unsung. I hope that the Secretary of State will acknowledge that we confirmed to his predecessor our broad support for the initiatives on that.

There has been a significant transformation in recent years, as local authorities have increasingly retreated from the direct provision of accommodation. However, thereis still a significant amount of local authority accommodation in the system. We support the Government's proposals, subject to seeing the details, to level the playing field by requiring local authority care homes to meet the same standards as those operated by the independent sector. I should like an assurance that the final standards that the Secretary of State alluded to will be available before the House has to consider the forthcoming Bill on care standards, so that if, as we suspect, the detailed standards are to be introduced by regulation, we might at least have an idea of the standards that are to be imposed later when we consider the principal provisions of the Bill.

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