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5.57 pm

Mr. Edward Leigh (Gainsborough): This is a sensitive subject. It is easy for us to assuage our consciences by speaking in debates such as this or writing reports, but we shall each be judged on what we do to help our own elderly relatives by looking after them and visiting them.

I say that because I am critical of the royal commission's report. I consider it irresponsible. I know that it is well researched, and that those who were asked to be members of the commission put a great deal of their personal time into its work, but I see no chance of the report's being implemented by any political party that is likely to take power. That is why I think it irresponsible. Politicians as a race are derided, but they are not part of a debating club; they must propose solutions that are capable of being implemented. No serious politician would come up with a proposal whose implementation would cost £1 billion now, rising to £5 billion or £6 billion over the century. Some doubt has been cast on those figures, but they are based on demographics.

If the report were ever implemented, however, it would not just be demographics that would result in such enormous expenditure; perceptions and behaviour would be changed. I think that the report is wrong--not factually wrong, but in a sense morally wrong, and dangerous and irresponsible for that reason. I believe that those who wrote the note of dissent were more courageous, fairer and more realistic. I was not surprised that neither the Secretary of State nor my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) were prepared to commit themselves to carrying out the royal commission's proposals. Even the Liberal Democrats, who are usually anxious to please everybody, tiptoed back from that precipice.

The proposals are not going to be put into effect. We have heard metaphors about long grass, but this is not a ball lying in the long grass--it has already been chucked out of the stadium by the Treasury. That is not a criticism, because I think that the Treasury is right.

We should be realistic. No one denies that the issue causes a tremendous sense of grievance, but that is what the real world is about. Means testing is rough justice, but it broadly works. I do not understand the principle of believing that people have to be responsible for their care and their housing throughout their life--until the unique moment when they reach retirement age, when, whatever their resources, the state should be willing to care for them. That does not seem morally right or justifiable--or even to make sense.

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Implementing the proposals would require massive resources. If elderly people are in need, it does not matter whether they have been improvident. Are we going to deny them resources because we are worried about people who are angry because they want to inherit an entire property from their parents? Of course children want to inherit their parents' property, and of course they resent the fact that when their elderly parents go into a nursing home the state says that the family home has to be sold to pay for the care; but why should we satisfy those children and deny other elderly people who have nothing? Those are the people we should be spending our resources on.

Dr. Evan Harris (Oxford, West and Abingdon): I apologise to the House for not having been here earlier. I was in a Delegated Legislation Committee during the early part of the debate. Does the hon. Gentleman recognise the fairness of the case for helping those who were told that they would be provided for by the state, including those who fought in the war? Is there not a legitimate case for realising their expectations of help without forcing them to sell all their possessions?If £1 billion is too much for the Conservatives, is there any amount that they would spend to bring back fairness for those people?

Mr. Leigh: I understand from the report that we already spend about £11 billion. If the report were implemented we would spend a lot more. I accept that a myth has been propagated. There is profound misunderstanding about the contributory principle. Every poll carried out on the subject shows that people think that what they pay in national insurance contributions covers all the welfare that they might receive and their health care costs. It does not even begin to pay for those services. We have to be honest with people about the real world. We do not have enough money to meet people's expectations. The more people's expectations are raised and their behaviour is changed, the greater the trap we end up with.

I am prepared to accept some compromises. The real political world tells me that a lot of what was talked about in the note of dissent is sensible. Perhaps the present cut-off point of £16,000 causes enormous resentment. Perhaps people who live in modest houses are being made to pay too much. Perhaps we should phase the threshold in more slowly between £10,000 and £30,000. Perhaps people are being forced into nursing homes and having to make their decisions too quickly. As the note of dissent says, they should be able to take out a loan based on their equity so that nobody is forced to sell a home. Perhaps we should look at the real cost of nursing. Those who wrote the note of dissent said that providing that facility free might cost only £100 million, which might be affordable.

Mr. Kirkwood: I well understand the point of the hon. Gentleman's thoughtful speech, but how does his pragmatic approach to the proposals in the note of dissent answer the problem that if I am disabled as a result of a heart attack, nobody looks at my bank balance, but if I

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get dementia, my credit card is taken from me before I am given treatment? How will his pragmatic approach deal with that essential question of fairness?

Mr. Leigh: Those who wrote the note of dissent answer that point. There is no entirely logical answer to the hon. Gentleman's fair question. Everyone understands the principle that people are entitled to free health care. It is based on clinical need, not their resources, but we have to draw the line somewhere. If people--I think they understand this--need clinical care, that will be provided free. If they go into a nursing home and need general care, that will not be provided free.

I know that this is messy and illogical, but it is all we can afford, so why not just be honest with people? If we were to--of course, we will not--go down the path that the royal commission recommends, a general expectation would build up in people's mind that, when they were elderly, the state would be prepared to care for them. That may be a civilised thing to contemplate. If we lived in a Scandinavian country, where people are genuinely prepared to pay 60 per cent. of their income in taxation, we could tread that road, but in this country people are not prepared to pay much more than 40 per cent. in taxation. That is why the new Labour Government have decided--or so they claim; we will not get into that argument--not to increase taxation. That is the real political world. No future Government would commit themselves to that level of expenditure.

We should say honestly to people that the family must help. And we must reinforce the contributory principle, which both parties have attacked over many years. That is why the report of the Select Committee on Social Security, chaired by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), is important. We must try to rebuild the contributory principle; and we must be honest with people about social insurance.

We were prepared to create the immensely unpopular Child Support Agency. We said that the state would no longer provide; the father would provide. That was intensely unpopular. We have to be prepared to do the same in relation to long-term care. I will not make myself any friends by saying that, but I firmly believe that it is the truth.

6.7 pm

Mrs. Sylvia Heal (Halesowen and Rowley Regis): I welcome the opportunity to contribute to the debate. It is right and appropriate that the House should deal with long-term care, which is of concern to many of our fellow citizens. The issue is likely to affect any one of us: we may require care, or provide it for a spouse, partner or relative.

It is sad that our society's success in reducing mortality and increasing life expectancy has not been a cause for celebration. Instead, the predominant concerns of the media, health planners, policy makers and politicians has been the cost of the growing older population and whether the country can afford to pay for pensions and health care. That often results in older people being seen in a negative light. That is not only ageist but sexist, because women are likely to live longer than men.

Such attitudes ignore the contributions of older people. Many provide care for their spouses or for neighbours and friends--that is particularly the case when members of a

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family live many miles from the relative who requires the care. Those of us who value the enormous contribution that older people have made and continue to make to society want to ensure that they feel respected, valued and cared for, with choice and dignity in the later years of their life.

The previous Government's policy in the early 1980s was to reduce the services that local authorities provided, just when demographic changes and changes in the national health service produced increased demand for residential and nursing care for a growing number of elderly people. The result was that people were no longer able to rely on the welfare state and the NHS to provide them with that free care--something about which today's pensioners still feel angry and betrayed. We will all have heard senior citizens recalling a lifetime of working, making national insurance contributions and paying taxes in the belief that care would be provided free of charge if they should ever need it.

The previous Conservative Government's policies on continuing care shattered that belief. In the 1980s, we saw the reduction of long-term NHS beds and local authority provision, and the growth of private sector residential and nursing homes. I recall clearly in the late 1980s and early 1990s that, when businesses of every description were going bankrupt and collapsing around the country, the one growth industry was private residential and nursing care. People with little or no experience of providing care became owners of residential and nursing homes. I recall someone I knew who went from owing a garage and selling second-hand cars to opening a residential care home.

The balance of long-term continuing care has been changed radically in recent years. Whereas the majority used to be looked after in either an NHS hospital or a public sector care home, and the minority in the independent sector, the position is now reversed. People are concerned about the quality and cost of residential care and the loss of savings. In many cases, people are concerned about having to sell their homes. Many children are disinherited by a parent entering a care home. Although some are phlegmatic, others are angry. Usually, it is the parent who is angry, because he or she wanted to pass on an inheritance to the next generation.

Let us not forget that some of those who would benefit from the savings are not well provided for. Some will have been carers of that relative, with little or no opportunity to save for themselves. We want to make sure that we can provide good quality care for the elderly and examine how costs can be shared between the taxpayer and the individual. The royal commission was given that task. The report, published earlier this year, made a number of recommendations. The three principles involved in the commission's approach to funding are as follows: that responsibility should be shared between the individual and the state; that any new system should be fair and affordable; and that any new system should be transparent in respect of resources, entitlements and personal responsibility.

The key factor that the commission recommends is the exemption of personal care from means-testing, to make it free to all those who are in need. When Ministers are considering the Government's response to that aspect of the report, I urge them to give serious consideration to this point. I recognise the difficulty of defining personal care, but I urge Ministers to tackle the matter and come

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up with a solution. They will know, as I do, that there are many organisations working with the elderly and with carers' groups--as well as individuals--who feel that time is no longer on their side. I have every confidence that the Government's decision will be based on fairness and equality.

My right hon. Friend the Secretary of State rightly reminded the House that continuing care is not provided exclusively for older people. There are many younger people with a congenital disability, or who, as a result of an accident or long-term illness or disability, require continuing care. They may have younger families to support and therefore have additional responsibilities and demands made upon them. Clearly, first-class domiciliary and respite care for them and their families is essential.

Funding is an important aspect of long-term care, as has been said. For those who are able to remain in their homes with support, the role of carers is important. The Carers National Association--an organisation for which at one time I was privileged to work--estimates that 80 per cent. of long-term care is provided by carers' relatives or by friends of those who need support. Much of the care for older people is provided by people who themselves are over 65, and in many cases it is only when the carer becomes ill and is unable to continue caring that help is sought from the community or social services. It clearly pays to support carers practically and financially. Together with all the many carers in this country, I was delighted when the Government came into office and began to acknowledge the contribution that carers make.

Fine words are not enough. It is not sufficient to say that carers are a hidden army who have worked very hard. They want a positive, practical response to the huge contribution they make. Therefore, the launch of the national carers strategy was widely welcomed. Also welcome was the provision of £140 million to fund short-term breaks. If there is scope for any extension of that money, that will also be warmly welcomed.

Many carers are either unable to work or can manage only part-time employment. I ask my hon. Friend the Minister to assure me and the many carers who will be listening to or reading this debate that a review of their benefits, which recognises the value of what they do, will take place. Most people want to stay in their homes for as long as possible, and giving people the choice and the support they need to remain there is an important principle. To achieve that requires a good partnership between the health authority, the local authority and the voluntary sector. I am proud to say that both Sandwell and Dudley in my constituency contain some first-class examples of how that partnership is working and supporting some of our senior citizens in their homes.

Sandwell is a health action zone and it has discovered that the very elderly population--those over the age of 85--is rising significantly. Between 1997 and 2011, the number of very elderly people is expected to increase by 37 per cent. It is therefore important to have a well-thought-out strategy. Sandwell's age well strategy aims to increase the expectation of good health and social well-being later in life. It is about older people being involved and consulted about what strategies will benefit them and enable them to stay in their homes.

Some of the solutions have been so simple and obvious that they have been overlooked in the past. The focus is on enabling people to remain in their homes, so the

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strategy has introduced respite care and a specialist health rehabilitation team; and a housing scheme for Asian elders. It has extended the availability of the community alarm scheme and introduced a new gardening and handy person scheme in conjunction with Age Concern to address the issues that can present problems to older people staying in their own homes.

The other borough in my constituency, Dudley, has also been innovative in its approach to try to ensure that people do not have to go into long-term care and to encourage them--through extra support--to try to stay in their homes. In April, it introduced the extra care housing initiative, which is a partnership approach in which the housing department provides the housing provision elements, while the social services department--in partnership with health colleagues--provides the extra care element through care assessment processes and home care schemes.

That scheme has offered prospective tenants sheltered accommodation with wardens who have an enhanced care role as an alternative to residential care. It provides a package of recuperation and rehabilitation that enables older people to achieve a maximum independent life style within a supported environment. The Government are encouraging such schemes by modernising social services and providing resources, and many Labour-controlled authorities are responding.

I welcome the announcements made today by my right hon. Friend the Secretary of State, many of which are based on aspects of the royal commission's report. I want to highlight the long-term care charter, the national service framework for older people, and the insistence on monitoring home care services. In the past, those aspects of care have been neglected.

This Government will be judged on many things at the next election, and one will be their response to the demands for long-term care. The hallmarks of this Government have been fairness and social justice, and I have no doubt that those same hallmarks will be evident in their approach to the problem of long-term care.


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