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6.20 pm

Mrs. Caroline Spelman (Meriden): It is not the Opposition's job to respond to the royal commission's recommendations. That is the Government's job, and I am disappointed that the key points of the commission's report have not been addressed. We are working on our own policy for long-term care which will go much wider than the terms of reference given to the royal commission, but perhaps that is one of the privileges of opposition. However, we shall certainly take account of the needs of young people who need long-term care. They should not be forgotten in any debate on this subject.

This has been a strange sort of debate, with hon. Members on all sides of the House describing the problems accurately. The debate has been interesting, too, as many hon. Members have lobbed into the arena their suggestions for tackling the problems that they have described. They have had the freedom to do so because the vacuum at the heart of the debate is the fundamental question of funding.

I am sure that many hon. Members would agree that they have presented their personal ideas on the matter rather than the official lines adopted by the parties to

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which they belong. Perhaps the debate has been all the better for that, but the curious effect has been to create the impression that we have prowled around the central question of funding without discovering what the Government intend to do about it.

The welfare state was set up to provide a cradle-to-grave formula for care. There is no point in wasting time discussing how miscalculations were made at that time, but those miscalculations mean that the wrong expectations were set for a fifth of our population. The debate is serious because it concerns so many people.

I expect that the politicians of the time were tempted to oversell their policies somewhat. That problem exists today and probably will persist in the future, but the difficulty left for today's politicians is serious, and it is getting worse.

There has been a consensus in the House in support of the hon. Member for Dunfermline, West (Ms Squire), who said that we have a moral obligation to the wartime generation, if I may call them that. The people of that generation are the ones who feel most keenly that their expectations have been dashed.

In both the majority and minority reports from the royal commission there is a worrying note of complacency about the affordability of long-term care, which is based on the fact that the threat of a demographic time bomb has been exaggerated. However, other key social trends in British society will affect our ability to afford the quality of long-term care that we would like to provide for those who need it.

The effect of increasing job mobility and of more women going out to work will inevitably cause a reduction in the level of informal care provided, especially for older kith and kin. Another, darker trend in British society--family breakdown--will also affect our ability to pay for long-term care.

One in three marriages now end in divorce, and the proportion is rising. More relationships are informal than used to be the case but, sadly, they are also prone to fracture. In families that are constituted along less traditional lines, the sense of obligation to older family members is becoming weakened. Will step-grandchildren feel the same obligation to care for the grandparental generation? Will children feel the same sense of obligation to the absent parent, be it father or mother?

The burden of such broken family relationships and of the weakening of the obligation of family bonds will be borne by the state. While the demographics may prove to be more predictable, the new social interpretation of honouring thy father and mother could turn out to be much more difficult for Governments to cope with. The hon. Member for Kilmarnock and Loudoun (Mr. Browne) may find that the £6 billion assessment of what theroyal commission's recommendations would cost the Government in 2051 turns out to be wildly inaccurate because of the loss of informal care. We were rightly given a timely reminder by the hon. Member for Belfast, South (Rev. Martin Smyth) that we must be realistic when dealing with human nature.

We do not start from a strong position in 1999. There is already a significant gap in funding. All over the country, there tends to be a shortfall of about £50 in the funding of residential care. To take only a couple of examples, in Cornwall the cost of residential care averages £252 a week but funding from social services is

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£208. In Birmingham, the figures are £290 and £230. That gap presents politicians and relatives of people in residential care with the problem of who should pay. The money comes from family members if they are willing to pay; sometimes they are not. That causes enormous friction in the family. It also places the elderly resident in a predicament that can become embarrassing in a care home setting. If residents still have faculties, they worry about the shortfall from week to week.

Mrs. Virginia Bottomley (South-West Surrey): Does my hon. Friend accept that that is a particular problem in some of the high-cost home counties, where the independent sector, to provide a quality service--but one that hon. Members will feel is appropriate for older people--pays 30 per cent. above normal rates for care staff and nurses? In the home counties, the health service gets no London weighting allowance. Those areas are penalised for being prosperous without any recognition of the enormous cost of care. The crisis for the elderly is probably more acute now in the home counties and the officially prosperous areas than anywhere else in the country.

Mrs. Spelman: I thank my right hon. Friend. In this debate, several examples were given of how that is inextricably linked with the standard spending assessment, which varies around the country. The problem is aggravated in counties where assessments are unsatisfactory. She provides another example of a badly affected county.

How is the funding gap filled? The resident or the resident's family often have to dip into residual capital. The lower threshold of £10,000 introduced by the previous Government has not proved sacrosanct in reality.

There is some dispute over the number of homes sold annually to pay for residential care, but I hope that no one disputes that it is happening. The hon. Member for Broxtowe (Dr. Palmer) used the word "agony" to describe the reaction of some people whose expectations are dashed and who find that they cannot pass on to their offspring the things that they have worked, scrimped and saved for all their lives. It is to try to underpin a savings culture that the Conservative party has been keen to encourage people to make savings and to avoid policies that would reward profligacy. As the savings ratio is going down, we urge the Government to pay attention to the matter.

Our document "The Common Sense Revolution" sets out some of the steps in our consideration of long-term care for the future. Long-term care partnership is a cornerstone of our ideas. We propose that for every £100 of insurance bought by individuals, £150 of their assets would be protected. In case that proves too ideologically difficult for Labour Members, I refer them to the comments on the report on long-term care made by the former Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). He said that the Government would

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    Given those remarks, there can be no major ideological objection from Labour Members. Indeed, we are encouraged to hear that the Government are willing to explore that avenue.

Dr. Palmer: Will the hon. Lady give way?

Mrs. Spelman: I should prefer to continue, as we have only limited time for the debate.

The hard facts are that 500,000 people are in long-term care--150,000 of them in nursing homes--and, of that number, 42,500 are funding their own care. While the commission was holding its consultations and producing its report, 75,000 homes were lost. If we are prepared to be honest, we know, as politicians on the doorstep, that people find that situation unacceptable. Rather like explaining the facts of life, I have had to justify, painfully, to elderly constituents--indeed, to my own relatives--the fact that almost all their assets have had to be used for funding their care. There is not much dignity for elderly people when youngsters have to tell them that.

There is even less dignity in the situation described so movingly by my right hon. Friend the Member for Tonbridge and Malling (Sir J. Stanley)--the disparity experienced by those who have preserved rights but are evicted from nursing homes where they have lived for a long time. It is worth making one point that he did not make in order to increase the note of urgency in his request to the Government: when elderly, frail residents are moved from one establishment to another, unfortunately some of them do not long survive such an upheaval late in their life.

Given the family unfriendly life style of most Members of Parliament, there is a high chance that many colleagues who have spoken brought some of their personal experience to the debate. Nearly all of us brought experiences gained in our professional capacity. We are concerned when we visit a nursing home and see that something is going wrong--perhaps it was the stale smell of urine, or the vacant look of residents with nothing more stimulating than a flickering television to look at. Perhaps it was the undetected toothache of an elderly resident that resulted from malnutrition, or toenails uncut because chiropody services have to be paid for--that is a false economy because it impedes mobility.

It is not hard to see what we would do better, as a blood relative facing that situation, but, in so many cases, for practical reasons, care has to be delegated. We therefore repeat our request to the Minister that when he reconsiders the care standards Bill, extra attention will be paid to the regulation of the quality of care provided. Perhaps the Minister could confirm that when he winds up the debate.

We question the focus of the document "Fit for the Future?". As the hon. Member for St. Albans (Mr. Pollard) pointed out, the document's proposals would saddle those who provide nursing care with some most unwelcome burdens. It is the quality of human care that is important, not the room sizes, the allocation of wardrobe space, the position of windows or the number of double or single rooms.

The training of care assistants is minimal. My researcher described how, during one of her vacations when she was a student, she was put straight to work in a residential nursing home with no training at all. It would be so different if we heeded the words of my hon. Friend

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the Member for Broxbourne (Mrs. Roe), who suggested that training should include palliative care, which is such an important part of quality long-term care.

Moreover, vulnerable adults are often involved. We gave assistance to the private Member's Bill, introduced by the hon. Member for Stourbridge (Ms Shipley), that became the Protection of Children Act 1999. I listened with great attention to what she said about the need to legislate for vulnerable adults, and I should like to place on the record the fact that it was my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) who tabled an amendment to that Bill to try to ensure that adults of diminished capacity--I think especially of those who suffer from dementia, who often make up a large number of those in long-term care--might be protected by legislation as a matter of urgency. Proper training and checking of the suitability of those who care for people with long-term needs is an imperative.

An older person living in their own home, in need of long-term care, may be subjected to all sorts of indignity: a veritable army of different carers calling during the day, chopping and changing, with no continuity. Demarcation may be a distinct problem when, for example, a home help cannot help someone with a personal care issue. The service is provided at the convenience of the service provider rather than at the convenience of the person to whom that service is administered. Not every grown-up with all their faculties wants to be put to bed at 9 o'clock in the evening. Recipients of long-term care often feel more done to rather than done with.

In the few moments that remain to me, I shall return to a point raised by my hon. Friend the Member for Bromsgrove (Miss Kirkbride) regarding value added tax. Apparently, under the regulation of the private recruitment industry proposed by the Government, there will be a shift in employment responsibility from the elderly or handicapped person requiring a carer in the home to the agency supplying the carer. Agencies will then incur irrecoverable VAT charges. Naturally, the costs will be passed on to the client--hence the term "granny tax".

We have taken advice from Queen's Counsel, and we believe that the Government have the possibility of obtaining an opt-out from the sixth VAT directive as a result of article 13, which permits an exemption for

We would most strongly urge the Government to seek such an opt-out because, probably alone in Europe, we have so much private provision of domiciliary help compared with other European Union member states. It is absolutely in our national interest to request such a derogation, which would protect our elderly and vulnerable from that unnecessary tax.

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