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Dr. Palmer: Does my hon. Friend agree that the process works both ways? For example, the National Institute for Clinical Excellence is considering whether treatment for multiple sclerosis will enable social services to reduce the amount of care they need to provide. Joint planning of social services and health could mean money flowing both ways, rather than one donating it to the other. I understand that some counties in Sweden have carried out successful experiments of that kind.

Ms Coffey: I am sure that all hon. Members could give further examples, not to mention the people who work in those agencies. The freeing up of that creativity will have a major impact on the quality of life for the people they work with.

I welcome the announcements by my right hon. Friend the Secretary of State because they will make important progress towards improving quality of service for older people, and I look forward to more announcements to come.

4.58 pm

Mr. Archy Kirkwood (Roxburgh and Berwickshire): We have just heard a fascinating speech from the hon. Member for Stockport (Ms Coffey), who has previous professional experience and who, in her current position as a Parliamentary Private Secretary in the Department of Social Security, might have had a glancing involvement in some of the Government's discussions--

Ms Coffey indicated dissent.

Mr. Kirkwood: I accept that that was not the case. I am not saying that the hon. Lady was not the author of

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her own speech, because she spoke with passion and brought experience to the argument. My point was that it was interesting that she and my close friend, Lord Lipsey--who was the author of the main part of the dissenting note in the royal commission's report--have come to roughly the same conclusion.

The arguments made by the hon. Lady sought to attack the main recommendation of the royal commission, and Lord Lipsey, who has good contacts at all levels in the Government, took the same view. I fear that they may have predicted what we are going to get, and the hon. Lady's speech may have been the most honest of the afternoon. The argument is between the main and the dissenting points of view, and I can tell the Minister that I am happy to engage in that argument. However, I am grateful that he cleared up the point on which the Secretary of State left me in some doubt.

The Secretary of State certainly left some doubt in my mind about what the Government intend to do. However, there is certainly no doubt in my mind that the royal commission's report is an excellent and ground-breaking piece of work, not just for its volume of recommendations but for its three volumes of appendices. I sat down last summer and read it all. I must admit that that was the first time in my parliamentary career that I have read a report all the way through. Although I have forgotten much of it--my excuse is that the Government have taken so long to stage this debate--I learned a lot from it and it certainly repays careful study.

I hope that we will not concentrate solely on the recommendations as that would not do justice to the work that went into the report, which was done in a very short time by a group of exceptional people. We shall not do their work justice if we concentrate on the political points that have been discussed today, important though they are.

When it came out, the report received a disappointingly dusty response from the former Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). If today's statement had been made nine weeks after its publication, I for one would have been delighted and would have said that it provided something for us to work on. I should have been happy to enter into some of the discussions that must take place.

However, a gap of nine months between the publication of the royal commission's report and today's announcement is too long. We have lost quite a lot of time. A White Paper will be published in the summer. In his report, Sir Stewart Sutherland said that many of the royal commission's recommendations could be implemented without primary legislation. However, given the three-year departmental spending review, the Government have no realistic chance of achieving in this Parliament the primary legislation needed to establish the care commission and the necessary reform of the funding system.

I welcome much of what the Government are doing. I was a fellow Lib-Lab co-conspirator with the former leader of my party, my right hon. Friend the Member for Yeovil (Mr. Ashdown), but I do not keep diaries, so the Government need not worry about any revelations that I might make. However, although I think that the Government are doing much good work, I do not think that it will now be possible to deal with these matters properly until the next Parliament.

It is legitimate for the Government to say that they tried to deal with a previously intractable problem by setting up a royal commission. I was prepared to accept that at

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the last election, but at the next election the Government will be saying that the response to the White Paper will come in the Parliament to follow. The process of delay will continue, with the result that the momentum will slip seriously. That is to be regretted.

I believe passionately that to do justice to the report, the House has to decide whether the hon. Member for Stockport is right, or whether I am right. That key question must be decided. If we do not find the necessary funds, a huge opportunity will be missed.

The hon. Member for Belfast, South (Rev. Martin Smyth) made an excellent speech. He has much experience in these matters. The trends in the national insurance fund must be examined. We must be a little careful about the idea that the fund has a surplus of £12 billion. That is easily said, and £12 billion sounds like a lot of money. However, the Government Actuary believes that if current trends prevail, there will be the possibility that the level of individual contributions to the national insurance fund could be reduced.

As the hon. Member for Stockport knows better than most, there is a projected underspend at the Department of Social Security of about £7 billion over the next three years. The Select Committee on Health looked into the matter and was quite robust about how the necessary funds should be secured.

Sir Stewart Sutherland has himself suggested recently that increasing inheritance tax could provide a potential source of additional revenue, although it clearly would not be able to realise the whole cost of £1 billion. In that context, it is not helpful to talk about an end cost of £50 billion in 50 years. Of course one has to be prudent, but it does not further the argument to talk about Monopoly money figures such as that, which are totally meaningless.

I do not doubt that the sums of money involved are large, nor that such matters must be considered very carefully, but the reaction of the great British public should also be taken into account. I hope that the Minister will look at the British social attitudes survey that was published recently. The copy that I have ordered has not arrived yet so I am quoting from press reports, but the survey apparently makes it clear that a significant majority of British people want more money to be spent on education, health and the long-term care of the elderly--even if that means increased taxes. The survey also states:

That is what the focus groups tell pollsters. I do not know why the Labour party is not picking this up. It has a national network of focus groups. Some of these questions should be put through that process. People do not want to pay taxes for nothing, in a profligate, unfocused way. However, I bet a monkey to a mousetrap that if the question were properly constructed and taken to a properly constituted focus group that was told what we would have to spend to achieve our end, we would get a majority. We would need to promote the argument but we could win a majority in favour of moving in the direction that I have described in the longer term. If the Government were prepared to do that, I would support them.

The current system is not fair. If any hon. Member doubted it, Sir Stewart Sutherland's royal commission demonstrated it beyond peradventure. The system is

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unjust and insufficient. Eloquent speeches from hon. Members of all parties made that point. The right hon. Member for Tonbridge and Malling (Sir J. Stanley) made one of the most powerful speeches that I have heard for a long time. I am sorry to keep referring to her, but the hon. Member for Stockport may have a role in this. The long title of the Child Support, Pensions and Social Security Bill that was published yesterday suggests that it might admit of a new clause that could deal with preserved rights and section 43 of the National Health Service and Community Care Act 1990. Can she write that down and take it to the Department? If she does not get an answer soon, we will start tabling written questions. The right hon. Gentleman's speech deserves some positive response. I will happily sign up to such a new clause if he succeeds in tabling one.

We all have constituency stories and I want to mention my local circumstances to underscore the urgency of getting something done. Starting from now, with a White Paper in the summer, it will take at least two or three years before we get beneficial outcomes that change things on the ground. Some 70 or 80 families in my region of south-east Scotland face terrible decisions each year about selling their houses to pay the costs of long-term care.

The hon. Member for Stockport is wrong to say that the main majority recommendation would not produce new resources. Nor is she right to say that it is simply a question of this always being the system. When the current system was introduced in 1948--she is right that as a social worker in 1971, she was applying it--people were not paying as much as £1,600 a month in long-term care costs or living to 96. Events on the ground have overtaken available provision. If we do not recognise that, it will be another 10 years before we do anything about it. I find that an intolerable prospect. Thankfully, I have never had an eviction from a home take place before my eyes. I hope that it never happens, but it is a real and corrosive problem.

The hon. Member for Dunfermline, West (Ms Squire) spoke well. She has had a good track record on the subject in her time in the House. Trying to talk people through the implications of care costs is corrosive. People end up feeling let down, if not, as she eloquently said, betrayed. That is happening in the borders now. I checked before the debate and found that 28 NHS beds are blocked. What does it cost to leave 28 people languishing in long-term NHS hospital wards when they could perfectly well be put in residential nursing places in south-east Scotland? The care homes are all full up. If we multiply those local figures to a national level, we would find that such care costs a fortune. We cannot ignore those costs lightly.

Several hon. Members mentioned respite care. The Government allocated £140 million for carers, which will be most helpful. Although it has not yet started feeding through the system, it is a step in the right direction. I endorse the eloquent and passionate plea made by the hon. Member for Stourbridge (Ms Shipley) on that matter. In the borders, we do not have the means to take the pressure off, for example, families who have to deal with youngsters with multiple disabilities. Those families are deeply affected and concerned. Science enables some of those young people to outlive their parents. It is devastating for parents to know that when they die, they will bequeath the state a complex set of different

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problems, and they cannot even receive a little respite care to enable them to pick a way through their domestic difficulties.

By the summer--between now and the publication of the White Paper on this subject--several of the private residential homes in my constituency will have closed. There will be shutters on the windows and the staff will have had to go to the jobcentre. That will put more strain on a hard-pressed local authority. Those are urgent problems--they are happening now. Families hit by such problems--often unexpectedly--are devastated, as the right hon. Member for Tonbridge and Malling so eloquently explained.

We have no time to lose. I welcome the Government's statements on standards, care, consultation and so forth. However, they must make haste to introduce legislation. I am a passionate advocate of the primary recommendation for funding made in the royal commission's report. I will argue the case for finding that money with anyone, at any time and in any place. The money will not be easy to find; perhaps we shall have to make do. In five years' time, the hon. Member for Stockport and I will meet and she will no doubt say, "I told you so." Perhaps she will be proved right, but I am not yet conceding the argument. I hope that other Members on all sides take the same view.

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