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Mr. Hammond: The hon. Lady may be interested to know that I visited Blackpool recently and was told all about the scheme. I have just been told that at least one other county council in the south of England is actively considering it.

Mrs. Humble: Where Blackpool leads, the rest of the world follows. This is a serious matter because there is over-provision in residential care and elderly people often do not know what to look for in choosing a care home. Too often, they look at the furnishings and the depth of the carpet instead of asking about the care provided.

Such schemes are an excellent way forward, as are the other proposals announced by the Government today. Long-term care is complex. There are no easy answers, but it is incumbent on us to review and revise the current confused situation to make it fair and acceptable to all.

2.46 pm

Mr. Paul Burstow (Sutton and Cheam): This is an important and, I hope, informative debate on long-term care and the Government's position. From what the

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Secretary of State said earlier, we appear to have moved from the phase where the Government fly kites about what they will do to the phase where they consult and review, but not yet to the stage where they actually do anything. That concerns many who expected the Government to move ahead on such questions, not least the person who said:


    "I don't want to live in a country where the only way pensioners can get long term care is by selling their home."

That is what the Prime Minister told the Labour party conference in 1997.

Since then, at least 100,000 people have been forced to sell their homes to pay for their care. Those people had every right to expect that things could only get better after the general election. By the end of this Parliament, the essentials of our long-term care system will remain the same. We will have had a lot of consultation but not much delivery.

What the Secretary of State said was welcome in that it removed some of the veils behind which the Government have been working--feverishly, I hope--to respond to the royal commission. Unfortunately, it was little more than window dressing because it ducked some of the fundamental questions that were raised and, I believe, answered in the report.

I start with a proposition that I hope all hon. Members can agree with: the current system for funding long-term care cannot continue. The status quo is not an option because we are all living longer. As the Secretary of State rightly said, that should be a cause for celebration, but too often the talk is of crisis, demographic time bombs and tidal waves. Such language is unhelpful and divisive because it sets generation against generation and sets older people apart. What is more, it is not true.

The trends are clear, but they are not new. We have had birth certificates to enable us to plan for many years. We know that over the past 100 years, the number of people aged over 85 has increased 15 times. By 2050, there will be three times more people over 85 than today. The demographic time bomb is not ticking; it has already gone off.

As things stand, the way in which long-term care operates robs people of their dignity and drives them into dependency. Care is means-led, not needs-led. Who pays for care depends on where they are being cared for. The economics of health and social care are warped and twisted. Putting means testing at the front end of assessment drives people into high-dependency, high-cost institutionalised care. As a result, the NHS and social services are locked in a vicious circle of crisis management. Bed blocking, cost shunting and buck passing are the hallmarks of the system. This drives standards down, wasting resources and delivering poorer outcomes for many people.

However, what would another Tory term have delivered? The boundaries of state-funded care would have been even more tightly drawn than they were during the previous 18 years of Tory government. The destination of Tory social policy was a residual welfare state, based on exclusion, stigma and less eligibility. If the Conservatives had been re-elected, the fate of the public sector would have been to be the 21st century administrators of a new poor law. Before the general election, the Conservatives set out plans for a private,

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insurance-based solution to finance long-term care costs. Those plans were complex, as the royal commission rightly pointed out. It noted:


    "it was difficult to see where the benefits lay, and to whom."

The American experience of schemes similar to those proposed by the Conservatives shows that take-up has been low. In practice, many current pensioners would be too old, too poor or too poor a risk to qualify for immediate private cover. However, as we have heard today, the Secretary of State wants to examine how the private sector can make itself more attractive through the insurance packages that it offers. If that is to be so, I hope that proposals will soon be introduced for the proper regulation of the insurance market in long-term care. At present, the market is unregulated. If it is to be successful, the industry must be regulated to provide people with security and certainty.

We are only halfway through this Parliament. What have the Government done so far? They set up the royal commission, and the Liberal Democrats very much welcomed that. The royal commission reported in March--almost nine months ago. The Government wanted the commission to report quickly, and the commission delivered its report in 14 months. When will the Government deliver? We have been told that they will produce a White Paper, but when will action flow from that White Paper?

By the end of this Parliament, the essentials of our system of long-term care will remain unchanged. Each year, 35,000 to 40,000 homes will continue to be sold to provide care that many people thought would be provided free when they needed it. More than 100,000 have been forced to sell their homes since the then Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), announced the royal commission. How many more must sell their homes before there is any action?

Dr. Palmer: We heard earlier in the debate that, despite their rhetoric, the Conservatives are not ready to respond to the royal commission's report and that they may be ready to do so only at the next election, although the tenor of their response was against the majority report. Do the Liberal Democrats have a view? Do they accept the majority report, the minority report or neither?

Mr. Burstow: The hon. Gentleman asks a fair question. For the past three or four weeks, I have been making applications for an Adjournment debate on the Coughlan case and its impact on long-term care. I should welcome the opportunity to have such time allocated to me so that we could debate the issue on my terms. In today's debate, the Government are setting out what they are doing, so we must test them on their proposals. The Liberal Democrats welcomed the royal commission and its terms of reference; we believe that provides a foundation on which we can build a modernised--to use the Government's word--long-term care system.

It is no wonder that Labour Members do not want to dwell on their policy, because too many aspects of it will cause great concern to people outside this place--not least the majority members of the commission. The majority members will feel that much of their work--especially in respect of their main recommendation on personal care--has been jettisoned as a result of the statement made by

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the Secretary of State today. I shall return to that matter. I hope that the Minister will be able to reassure us when he replies to the debate--[Interruption.] If he wants to intervene now to tell us that personal care costs--not just nursing care costs--will be included under the six points that the Secretary of State set out earlier, that would be most helpful.

The Minister of State, Department of Health (Mr. John Hutton): I am glad to correct the hon. Gentleman's wholly false assumption on that matter. Most of his remarks have been completely inaccurate and wrong. We have not ruled anything out today, and we have not ruled anything in. He is quite wrong to infer from my right hon. Friend the Secretary of State's speech that we are not giving full consideration to all the royal commission's recommendations.

Mr. Burstow: I am grateful for that non-statement--the Government are not ruling things in and they are not ruling things out--

Mr. Hutton: Will the hon. Gentleman give way?

Mr. Burstow: Perhaps the Minister would at least allow me to finish the sentence. I shall then be happy to take his intervention.

I listened to the Secretary of State's speech. He spoke explicitly about looking at nursing care and then about definitions. Did he mean that the definition question extends to the possibility of widening the definition of nursing care to include personal care?

Mr. Hutton: The hon. Gentleman is making heavy weather of this matter.

Mr. Kirkwood: No, he is not.

Mr. Hutton: With respect to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), the hon. Member for Sutton and Cheam (Mr. Burstow) is making heavy weather of the matter. I tried to make it clear to him and to the House that we are considering all the royal commission's recommendations, including the one to which he refers. I cannot make it clearer than that.


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