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4.30 pm

Rev. Martin Smyth (Belfast, South): I follow the hon. Member for Stourbridge (Ms Shipley), having served with her in seeking to bring the Protection of Children Act 1999 into being. As she spoke, I thought of long-term care for children with handicaps and the proposals for means-testing income with regard to the house that they might need.

A person wrote to me from the Foyle constituency urging me to bear it in mind that means testing was unnecessary because those who had the funds would go ahead. They were not prepared to wait for things to happen, whereas those who did not have the money or facilities required immediate help.

On long-term funding, the hon. Member for Dunfermline, West (Ms Squire) reminded us all of the problem of relying merely on insurance provision. I know that we are all glad that she has done the five-year sentence and look forward to her presence in the House for many more years.

From the poignant contribution of the right hon. Member for Tonbridge and Malling (Sir J. Stanley), we all learned a lesson. It was the House of Commons that

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passed the legislation in question. A Government of whom he had been a supporter, if not a member, brought it before the House. The tragedy is that, often, in passing legislation, we do not think about its impact on the community out there. It is a salutary lesson that we should bear in mind.

There is much excellent care and provision for the elderly, but the right hon. Member for Tonbridge and Malling reminded us of the old saying that we are living in a generation of people who know the price of everything and the value of nothing. I have had to deal with young colleagues in the ministry who thought that paying attention to young people was all that mattered. I used to tell them to be careful. I told them that, if young people saw them ignoring their parents because they were concentrating on them, the parents could suddenly say, "Can we rely on them to look after us when we get older?" The Government have to look at the whole span. We may look for support from the younger generation, but we should also care for the older generation.

I am a little concerned. We welcome the fact that, as of today, Northern Ireland has devolution, but I am not convinced by some proposals. I understand the Secretary of State's view that the standards should be for England, but in my view, they should be for the whole kingdom. We should all have the same standards to aspire to. I hope that there will be not the lowest, but the highest common denominator--something that we build on, rather than trying to get away with what we can.

We have to bear it in mind that human beings look after themselves to a large extent. I am reminded of a person who did not live in my constituency, but who looked after her parents. Then, after years of caring for them, she required a break. She went on holiday. Her parents were looked after by her brother and sister-in-law, who suddenly discovered that it upset the routine of their home, so they put the parents in a residential home.

When the daughter came back, she was heartbroken, especially when she saw the conditions at the home, but it was the brother who had put the parents in. The authorities hid behind that fact.

We complained about the conditions at the home. The authorities replied that the home had a clean bill of health and that the general practitioner who was responsible for it had said that it was all right. Ultimately, they closed it: we were right and they were wrong. The GP was receiving a retainer fee of £3,000 a year to say that it was all right. We have to deal with human nature and to provide the standards that our people expect in relation to long-term care in the community.

There is a division between health and social care. Again, we have to be careful. Some time back, legislation was passed that did not permit local authorities in England to purchase provision outside England.

We had an interesting development. As we all know, we are a mobile people. People come to England to work from Scotland, Northern Ireland and Wales. I think of an individual who spent many years in England working. Then he was incapacitated and put into a home. No one around there really knew him. Cousins and others in Fermanagh would have been delighted to have him close to them, so that they could give him some back-up. Although the provision there was cheaper for the local authority and better for him, it was not allowed in law to purchase the provision to allow that person to go back to

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his native heath, where family would be around to help him. In legislating, we have to be careful that we do not get so parochial that we hive off the different regions, forgetting that we are one common family.

I make a plea about financing and the concept of preserved rights. A voluntary home that was started by a Church of Ireland rector for people with profound learning difficulties has been going for some 25 years. It never had a ha'penny from the state to help with capital or running costs. Different authorities purchased its places, which have been kept at a certain limit.

The clergyman concerned has run voluntary efforts, raising, for example, £70,000 last year primarily to increase patient comfort and to give those people the quality of life that he believes they should have as human beings; but he cannot run the home on the amount that is received through purchase of the provision by the different boards--12 places with preserved rights were purchased by the Department of Health and Social Services. That is happening throughout the country. We have to re-examine it, so that we deal with people according to their needs.

We speak of community care. Is the problem affecting just Northern Ireland, or is it affecting other areas? One of the difficulties for people who would love to remain in their homes is that the adaptations required in their homes are so long in coming that they think that they will be dead before they get them.

One of the weaknesses is that occupational therapists' waiting lists are so long that they prioritise. I have asked how they prioritise. It seems that, as people come in, they add them to the list. That is not proper prioritisation, although it might seem fair.

A constituent of mine, a woman of 90, is blind. Her sister of 84 has a severe back problem. The OT said that they could handle the heater--one of those solid fuel things. I tried to move the thing myself. I know a little about fires and plumbing because that was my father's trade. My first Sunday work was helping him to do some maintenance work at the York street spinning mill. An 84-year-old with a back condition was expected to cope with the heater by herself. Then we were told that the problem was that there was no gas in the area. We knew that. The nearest gas point was two miles away, but no one wanted to put the oil in.

Having fought the good fight, the ladies now have a measure of comfort, but they should not have had to fight that good fight and a Member of Parliament should not have to act in that way. The servants of the state should at least be aware of human needs and should seek to help rather than sticking to red tape.

I understand the financial pressures on the Government when considering long-term provision for the elderly, but tell that to people who read about the billions of pounds in the national insurance fund. They wonder what it is there for if not to provide for the generation who were partly responsible for amassing it.

4.41 pm

Ms Ann Coffey (Stockport): I congratulate the members of the royal commission on the work that they put into producing their report, which deals with some

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difficult and complex issues for today and tomorrow. Those issues deserve consideration. I also welcome the Government's announcement of the establishment of a national care commission, which will regulate and improve standards nationally. That is long overdue.

I welcome the royal commission's call for the modernisation of long-term care in a framework of fairness, recognising that that involves shared responsibilities between the individual and the state. Funding arrangements should be affordable, sustainable and fair to present and future generations of older and working people.

Older people are not a homogenous group. With today's increased life expectancy, they are not even all of the same generation. The people we call pensioners can range in age from 65 to 90. That covers different generations with different life experiences that have shaped different attitudes. Every one of them is an individual with his or her own life story, successes, failures, family experiences and financial circumstances. In recognition of that, the commission emphasises that older people are contributors to society. They are carers, members of voluntary organisations, and neighbours who do a good turn for each other. Some of them have part-time work, but they are also enjoyers of society--they use leisure facilities, they go to the cinema, the theatre and the pub down the road and they go walking. They want the same opportunities as the working-age population. The Government must ensure that they have them. That is why I welcome the better government for older people initiative, which shares that view of older people.

Being old should not take away the right to be treated fairly or the right to exercise choice, but neither should it take away the responsibility to contribute. The royal commission considered the funding of long-term care, looking at elderly people's expectations for dignity and security and the constraints of public funds. That is the agenda of rights and responsibilities.

In looking at funding issues and sustainability and affordability, the commission tried to take a long-term view, while admitting the difficulty of that. The future is more unpredictable than ever, because we need not only to take into account medical advances, economic changes and the impact of technology, but to try to predict people's expectations and behaviour in 50 years. The challenge of the next century will be to maintain social cohesion. We need to hold together the rights of the individual and the expectation that we all have to control our lives and exercise choices with the responsibilities that we each have to others in a fair society. That can involve contributing financially for the good of others and limitations on our personal freedom. That is a tension in any democratic society.

I shall judge one of the royal commission's main recommendations on the criterion of fairness and balancing everybody's rights and responsibilities, examining whether it achieves a partnership between the state and the individual and, most importantly, whether it targets resources while ensuring that everybody gets a first-class service. The recommendation is that personal care, whether in a residential setting or in the home, should be provided free of charge irrespective of people's income, but that housing and living costs should continue to be means-tested and paid for by general taxation on the basis of an assessment of need.

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In arriving at its recommendation, the commission commented on two general resentments from the public against an expectation that the welfare state should provide from the cradle to the grave, including care. There is resentment that some get for free that for which others, because of thrift, have to pay. It is also generally perceived as unfair that some are forced to sell their house and what they regard as their children's inheritance to pay for long-term care.

Residential care has never been free. It has always been means-tested. Before the National Health Service and Community Care Act 1990, when older people decided that they needed nursing or residential care, the Department of Social Security provided a grant if they did not have the resources to support themselves. That means test has been applied to my certain knowledge for 20 years. I applied it as a social worker in 1971 and it still exists. For 20 years, people have been liable to lose their homes if the means test shows that they have sufficient resources. That is nothing new.

The argument for means-testing is that it is a good form of targeting resources on those in need. However, older people, particularly the poor, have powerful memories of the means test of the poor laws, when means-testing was synonymous with descent to the workhouse and was a mark of shame. I do not accept the argument that it stops people saving, which is the new argument against means-testing. People save because they want the choice that saving brings, and the independence that it provides. Of course there are people who do not save, but there are also people who cannot save because, during their working lives, they have not had the means.

The royal commission's main recommendation is free personal care. It provides for a partnership between the state and the individual. Housing and living costs would be the individual's responsibility, after means-testing. Personal care would be provided irrespective of income. It certainly creates equal treatment, but the problem is that that effectively passes the funding of the current private provision into the public sector, without one extra bit of care or improvement in care being provided. That does not deal with the savings issue, because people would still have to sell their homes to pay for their living and housing costs when they get below the capital limit. For domiciliary care, there are practical problems of implementation.

One of those problems would be that, at the moment, we have the attendance allowance, a direct payment for care needs which people can choose to spend as they wish--on care, on paying home helps or paying informal carers to do tasks for them. It gives them the choice. Logically, if one accepts the royal commission's recommendation, the attendance allowance for care costs would have to be withdrawn, so the choice would be taken away from the elderly. That would not be popular.

There is an argument over what constitutes social care and health care, and it has been raging for several years--particularly when changes in technology or in what professionals do change the boundaries. However, the argument over what constitutes personal care--which the royal commission defines as being care which involves touching people--and what constitutes indirect care is also difficult. In accepting the royal commission's argument about making personal care free, we would not

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escape the difficulties of deciding where the boundary is, or about what should be paid for and what should not. It simply puts that into another area.

The National Health Service and Community Care Act 1990 wanted to develop alternatives to residential care and to increase choice for older people. The evidence is that community care has increased, but the concern is that provision is pooled for those with greater care needs. One can hardly be surprised about that. There are arguments about the importance of early intervention--in domestic help and other support--to enable people to retain their independence. There is concern that those sort of services are disappearing.

If the royal commission's recommendation is accepted, it would make the position worse because personal care would be free and the kind of domestic help which people describe as important would be subject to a means test. Those on low incomes would not then have the attendance allowance to enable them to pay. It might have the opposite effect to what is intended.

The main difficulty I have with the recommendation is that free personal care would not provide any extra care--even in the community or in the home--and would not benefit those on low incomes, as they already have free provision. More importantly, public funds would be diverted from raising standards in homes, which I believe to be a matter of priority, the essence of social justice, and fundamental to decent care for all our elderly. That is the essential fairness that old people, whatever their situation, need and deserve. They deserve and need good quality domiciliary and residential care, and we have not got there yet. It requires money--it requires public funds and investment. I believe that if public funds are available, that is where they should be directed as a priority.

There is an issue of how care is paid for. There must be a partnership between the state and the individual. However, I do not believe that free personal care achieves that partnership. The system could be made fairer, and could achieve a better balance between the benefits that people get from their savings and the contributions they then have to make from their own resources. The case has been well made.

The Government could look at freeing up equity schemes where older people might have choice about how they use their capital resources to fund long-term care. I do not believe that there is one solution, and we need a range of options to enable people to have choices and to make plans about how they fund long-term care. A multiplicity of provision would enable people to make those choices. I believe that they would welcome that.

I welcome the White Paper "Modernising Social Services" and the Government's intention to regulate, to have independent inspection, to encourage flexibility in the provision of care and to introduce nationally required standards which all homes will have to meet and from which all people would benefit. That is making progress on the road to social justice for the elderly.

I welcome the Government's intention to legislate for joint budgets, which will help the development of community care. It is an exciting proposal. I have noticed the feeling of excitement in my constituency at the possibility of working across agency boundaries and at being able to achieve a common objective without being constrained by an agency. As the legislation stands, it is still constraining. Legislation that allowed joint budgets

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would release a lot of creative talent among the people working in the agencies, and I have seen an example of what can be achieved by working in that manner. Last year, a hospital--not one in my constituency--used some of the winter pressures money to employ a social worker in the casualty department. That social worker worked with a nurse and, when elderly people were admitted to casualty after a fall or some other accident, all the outside agencies were involved to try to return them home as soon as possible--which is what they wanted.

I hope that such initiatives will be carried further after the legislation for joint budgets. When I was in the casualty ward of the hospital I mentioned, I noticed how many elderly people were admitted after falls. As we all know, this is the time of year when the leaves fall from the trees and make the pavements difficult to walk on. Clearing pavements of leaves tends to be bottom of a local authority's priorities, but it could result in huge savings for health authorities. Under joint budget arrangements, perhaps health authorities could pass some money to local authorities which could sweep up the streets so that nobody would fall. That seems to be a simple answer to the problem, but it cannot happen at the moment. The Government's legislation would allow it to happen and would have a huge impact on the way in which agencies work together and the value for money provided. Millions of pounds is spent in each of our constituencies and we can all think of ways in which it could be better spent. The artificial boundaries between agencies is one factor that prevents that from happening.

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