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Mr. Nicholas Soames (Mid-Sussex): On a point of order, Mr. Deputy Speaker. You will be aware that the close friends and associates of the Deputy Prime Minister have today organised a tube strike that has caused the most appalling suffering and inconvenience to the travelling public. There have been scenes of complete carnage on the streets and the strike has been a grotesque inconvenience. Have you received an indication from any Minister, however lowly, of a wish to explain to the House what has happened and what has been done to try to restore the travelling privileges of the British public?

Mr. Deputy Speaker (Sir Alan Haselhurst): As the hon. Gentleman might suspect, no such information has been supplied to me. However, his remarks will have been heard.

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Care for the Elderly

Mr. Deputy Speaker (Sir Alan Haselhurst) : I should inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.

7.13 pm

Mr. Paul Burstow (Sutton and Cheam): I beg to move,

That this House welcomes the NHS Plan's commitment to a care system founded on the principles of equity and fairness; regrets that the Plan discriminates against older people with chronic and long-term illness by continuing to means-test them for their own care; believes that the Plan creates a fault-line between nursing and personal care; further believes that the Plan fails even to provide nursing care free on the basis of need, limiting the concession to registered nurse time; and calls on the Government to implement the Royal Commission's proposals for personal and nursing care to be provided on the basis of a person's assessed need instead of means.

Three and a half years ago, the Government established the royal commission on long-term care. Liberal Democrats welcomed the initiative, which offered the prospect of a fresh start and an end to the scandal of people being forced to sell their homes to pay for their care. The royal commission was asked to conduct its inquiry and report quickly, and it did so. In little more than a year, it published a detailed report that analysed the problems, offered a practical blueprint and set out how long-term care could be reformed for the future. The report was published in February 1999, and it is now more than three years since the commission's work was initiated. In those three years, a discredited and unfair system of means testing has remained in place, people's means have determined the care that they receive and more homes have been sold to pay for care.

The royal commission said that charges for personal and nursing care should be scrapped. Liberal Democrats agree. We recognise that charges

"increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy"

and that they

"discourage the use of necessary services."

Those are not my words, but those of the NHS plan. We should be mindful of them in this debate.

Those who argue for means-tested care say that personal care has always been means tested, but that is not true. This debate does not concern luxury goods and services that people choose to obtain, but essential and intimate care--tasks that frail, sick or disabled people would carry out for themselves if they had the necessary strength, will or knowledge. Long-term care is a contingency, not a probability. Its costs fall disproportionately on the sick, frail and disabled. That is why the royal commission said that personal care should be free, but on the basis of an assessment of need.

Care costs will not run out of control. As royal commission member Claire Rayner said in a letter published in The Times today, the tasks in question include

"intimate personal care such as washing, feeding and help with lavatory needs".

People will not demand to be washed more often or to be helped to be fed more regularly merely because the service has become free. Care costs will balloon only if the level of unmet need in this country is far greater than

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the current Government or any previous one have been willing to admit. The royal commission did not say that all costs should be paid by the state. It made it clear that the board and lodging costs of care should be met by individuals and said that we should expect to need to meet our housing costs throughout our lives. Liberal Democrats believe that the costs of care are a risk that should be met collectively.

By rejecting the royal commission's central recommendation, the Government are continuing a means test that discriminates against older people with chronic and long-term illness. The Government's position is clear: wealth, not health, will determine what care a person receives. If one has lifetime savings of £18,000 in a bank account, a pension or a home, the Government's message is clear. They say, "Don't get frail, sick or old, because if you do, you'll be charged." Our care system should not be a substitute for our tax system. If the Government want to redistribute money from the wealthy people in this country, they should not use poor health as the criterion for accessing it. Our care system should transfer wealth from the well to the sick, with no ifs or buts along the way.

What are the Government doing in practice? They would like hon. Members and people outside the House to believe that they are acting on the royal commission's proposals for free nursing care, but that is not the case. They have chosen a very narrow definition of nursing care and their proposals do not even make all nursing procedures free at the point of delivery. Only the costs of registered nurse time that is spent providing, delegating or supervising care will be met by the NHS, which will not pay for the time of the health care assistant or care worker who carries out the bulk of long-term care work.

That most mean of definitions, which treats nursing as registered nurse time, is clearly provider based and is a long way from being people centred. How are the Government to disentangle the costs of nurse-provided care from those of nursing care that is provided by others? Care homes will find themselves forced to measure costs and to cost the amount of nursing time that somebody receives. That will produce a system that is not only costly and bureaucratic, but which rewards dependence and drives people into dependency.

Mr. Adrian Sanders (Torbay): Is my hon. Friend aware that many people in residential care require more nursing support as they get older, but not enough to justify their being transferred to the nursing care sector? That is imposing on the residential care sector great cost burdens that are not reflected in the income that it receives.

Mr. Burstow: My hon. Friend makes a valid point. Indeed, in many cases it is entirely appropriate for people to continue to live in what they regard as their home, rather than to move to another place to receive nursing care, and for the care to be brought to them. There is a problem with the fees for many residential homes, which is one of the reasons why there has been a collapse in confidence in the residential and nursing home sectors--a collapse that has led to the closure of many nursing homes.

Mr. John Bercow (Buckingham): I am grateful to the hon. Gentleman for giving way because I think that he is making some sensible points. Does he agree that the

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Government's arbitrary and capricious distinction between nursing and personal care is rejected not only by the Liberal Democrats, as he made clear, and the official Opposition but, at least as importantly, by the Royal College of Nursing and the Patients Association?

Mr. Burstow: It is certainly rejected by a long list of organisations, including the RCN, Age Concern and Help the Aged. However, perhaps the speech of the Conservative spokesman, the hon. Member for Meriden (Mrs. Spelman), will establish whether the Opposition view the distinction between the two items as capricious. We need a clearer idea of the Conservatives' policy on long-term care.

Mr. Bercow: Our policy is very clear.

Mr. Burstow: I have seen the future of care, and it is a barcode. In the USA, a definition similar to that proposed by the Government has resulted in a barcode system being used so that care homes can electronically account for the time spent by members of staff, and residents can be billed accordingly. In some states, care staff carry hand-held barcode readers and laminated sheets of barcodes for residents' names, each task that is performed and the start and finish times.

A health care assistant will arrive to help Mrs. Smith, for example, to get up in the morning. She will scan the barcode for Mrs. Smith, the barcode for the start time for the job, the barcode for dressing and the barcode for the finish time. At the end of her shift, she will go to the desktop computer and download the data from her scanner so that, task by task, the care that Mrs. Smith receives can be itemised, analysed and charged. In America, that was described as a pioneering system for managing nursing time in care homes. I think that it simply turns care homes into supermarkets and care into a commodity.

Mr. David Heath (Somerton and Frome): My hon. Friend is describing an absolute dystopia. With conditions such as dementia, is there any realistic distinction between nursing care and personal care? They seem to me to be exactly the same in many instances.

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