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Dr. Brand: I am grateful to the hon. Gentleman for giving way, unlike his colleague the hon. Member for Woodspring (Dr. Fox). Is the hon. Gentleman clear about what Conservative Members would do regarding the commission on long-term care? We have heard an explanation of how difficult it is to distinguish between personal care and nursing care, but no commitment has been made on whether to accept the majority, the minority or none of the report.
Mr. Burns: I hope that the hon. Gentleman will bear with me, as I should like to develop my argument a little further before specifically answering his question.
The Government are funding only the nursing care aspect. Before expectations are raised too much, it is important to remember that individuals in particular financial circumstances must contribute towards the cost of personal care and accommodation while they are in a nursing home. Similarly, the age-old problem of costs remains in respect of residential care.
The Government are going to follow the example of my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), the last Conservative Chancellor of the Exchequer, by increasing capital limits. They propose also to introduce a disregard from the means test of the value of people's property for the first three months that people are in a residential home. Undoubtedly, that will provide some relief, but, in some ways, the Government have missed an opportunity and only scratched the surface of the problem. The three-month disregard on the value of an individual's property means that if a person spends more than three months in a home--albeit that that is a welcome break--the same old problems will be perpetuated after that period. People will have to sell their homes to finance their residential care until their assets come down to the capital limits.
Another age-old problem will also be perpetuated. I genuinely do not know how it can be avoided, in respect not only of residential care but of other social security
issues. I refer to a feeling of unfairness among people who have been sensible all their lives, saved money and put away savings for a rainy day. Such people can feel that they are being penalised: because they have been careful, cautious and sensible, they will not receive the same financial help as those who have not put aside any savings and who will automatically qualify for state assistance and benefits. I am sure that all hon. Members encounter that feeling among constituents who visit them in their surgeries or write to them. I am not suggesting--
The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley): The hon. Gentleman described his policy as a missed opportunity for the Labour Government. Will he explain why his party missed the opportunity during its period in office to disregard the value of a home as we have done? Will he also explain--this is perhaps more important than that party political point--his party's current policy on that?
Mr. Burns: I am grateful to the Under-Secretary, as he anticipates precisely my next point. I was starting to say before he intervened that I was not suggesting that the solution was simply to spend £1 billion of taxpayers' money to pay all the residential costs of those who live in residential homes. I believe that there is genuinely a third way--I hope that that will appeal to the Under-Secretary. The third way was a proposal made by the previous Conservative Government in a White Paper that was published, if I remember rightly, in January 1997. It proposed the creation of a proper insurance scheme that operates on a voluntary basis. Such a scheme would ensure that members of the public who want to do so can take out an insurance policy at whatever level they want, in order to provide for the financing of their long-term care in a residential home. That could allow them to bypass the means test so that they do not have to sell their homes to finance their long-term care.
If the Conservative party had been re-elected and appropriate legislation had been put before the House, the White Paper proposal would have ensured that individuals or families were encouraged to take out policies. Like many changes, the proposal would have involved a change of culture. The best way of ensuring that a necessity such as preparing for one's old age is ingrained in an individual early on is to promote awareness from a young age. The younger one is when taking out a policy before retirement, the cheaper the premiums will be. Personal pension provision has ballooned during the past 20 years or so and, as the educational culture has changed, people have become far more sensitive to and interested in what will happen to them when they reach the age of 65.
Of course, people who are 20 or 25 years old do not have a care in the world. For them, the age of 60 or 65 is so far away that they do not think about it and are not concerned. Private pension provision has shown that if people are educated and provided with a proper explanation, they become more interested and concerned and want to provide for their financial well-being later in life. An insurance policy for long-term care would have
gone the same way, if it had been properly marketed and explained. To my mind, that is the way we should have proceeded--the third way.
Dr. Brand: Would such an insurance policy cover all existing long-term care costs, and would it include medical and nursing costs? Would it distinguish between personal and nursing care--the problem highlighted by the hon. Member for Woodspring? Furthermore, would it extend Conservative policy on insurance-based national health services?
Mr. Burns: It is nothing to do with an insurance-based national health service. I was explaining the policy with which we would have proceeded in 1997 for meeting the total costs of residential and nursing care, if we could have introduced the legislation. To be fair, I appreciate that the royal commission did not consider the idea of voluntary insurance policies attractive. It is perfectly reasonable for the royal commission to express that view if it wishes, but I personally think it is wrong. It is a missed opportunity, especially in comparison with doing nothing except introducing a three-month disregard, however helpful that is in the short term.
Finally, I should like to deal with the procedures for assessing somebody's needs under provisions for free nursing care. The Government are working on plans to make assessments more uniform across the country through a new assessment protocol. I believe that the work is currently being carried out by the chief nursing officer for England, with help from a variety of organisations, including the royal colleges, the Alzheimer's Society, Age Concern, Help the Aged and other relevant bodies at the sharp end of helping the elderly in long-term care. Those organisations rightly want to achieve a fair process with a standard form of assessment that avoids the wide variations that often arise now.
It will be interesting to see how the policy will work in reality. I suspect that one major problem will be the ability to distinguish between nursing care and personal care. In his typically frank way, the previous Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), said before a Select Committee that he thought it impossible to offer a definition that distinguished between the two. However, I understand that current Health Ministers do not share that view and that they are far more confident of being able to produce a definition. It will be interesting to see whether their definition is viable and works in the way that the current Department of Health team believes it will.
I wonder whether the assessment procedures relating to the provision of care will be more successful than the existing regime, which has input from both the NHS and social services and represents a natural conflict of interest. For example, if a local NHS or social services budget is severely under strain, a way of saving money is to assess that an individual's need is for residential care rather than nursing care. In many cases, an assessment could go either way, but the pressure, owing to budgetary strains, is to ensure that residential care is chosen because it will save money from hard-pressed budgets. I am not sure how the Government's proposed changes will prevent that conflict of interest and stop people being assessed for residential care when they should be in nursing care.
The Secretary of State said that there would be no cap on the cost of nursing care for the individual patient. That is a laudable aim. However, I wonder whether it can be
sustained. Nursing costs will be totally uncapped, which means that the global nursing cost budget could skyrocket. If costs were to skyrocket beyond the Department of Health's estimates, and if the Department's budget were under severe strain, would the Government be able to perpetuate that open-ended commitment? Time will tell.The Government are a little over-optimistic to believe that they can continue with a scheme that gives unlimited funding to every individual requiring nursing care. That is unrealistic. The Department of Health might think that it is the right way to proceed, but I suspect that, at some point, the Treasury might not be quite so happy with such a scheme.
Much of the proposed health legislation will require careful reading of the small print when the Bills are published, and as they progress through the House. The Government have been timid, and they have missed opportunities on funding and on the provision of long-term care. The Secretary of State was over- enthusiastic in his reading of this morning's newspapers, which suggested that this was a modest Queen's Speech in preparation for an early election. Rather than address the minutiae of the Government's proposals for the new Session, he decided to take a broadbrush approach and make a rather dishonest party political speech with the aim of winning votes rather than the arguments pertaining to the proposals.
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