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The Minister of State, Department of Health (Mr. John Hutton): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
- "welcomes the NHS Plan's commitments to a care system founded on the principles of equity and fairness; welcomes the measures the Government has announced to reform the funding of long term care and to invest in new health and social care services for older people; notes that this matches the extra spending on long term care recommended by the Royal Commission; believes that the implementation of free nursing care on the basis of need and not ability to pay will bring an end to a major injustice affecting tens of thousands of older people in nursing homes; welcomes the new investment announced in the NHS Plan of £900 million annually by 2003-04 in new intermediate care services for older people; supports the priority the Government has rightly attached to improving front line services for older people; and calls on the Liberal Democrats to set out what services they would cut in order to fund their proposals."
As the primary user of long-term health and social care services, older people account for approximately 50 per cent. of the resources that are consumed in health and social care services in England. They occupy approximately two thirds of general hospital beds and are responsible for at least 50 per cent. of the recent increase in emergency hospital admissions.
As a society, we face the challenge of ensuring that, in future, health and social care services better meet the needs of older people to lead healthy independent lives, thus avoiding unnecessary institutional care and the costs associated with it. We must find a fairer way of funding long-term care for older people. It should strike the right balance between what the state should fund and the responsibility of the individual, ensure that people are not forced to sell their homes to pay for their long-term care costs, and that older people lead healthier lives for longer.
All that obviously requires major new investment and the redesigning of our care services--I am sure that the hon. Member for Sutton and Cheam accepts that--and the Government are committed to doing it. That is why the NHS plan outlined a major expansion in care services for older people: £900 million by 2003-04 and a further £360 million a year on making the funding of long-term care fairer. It will not be possible to achieve those objectives if we divert spending elsewhere.
Mr. David Hinchliffe (Wakefield): My hon. Friend mentions fairness. I accept that the Government have inherited a problem that the previous Conservative Government created by withdrawing free long-term nursing care from the health service and introducing privatised social and nursing care in care and nursing homes. Is it fair or right that people who have paid all
their lives and expect to receive free NHS long-term nursing care have to pay for it again because of the previous Government's withdrawal of free NHS care?
Mr. Hutton: The answer is no, it is not fair.
Mr. Hutton: The hon. Gentleman must be patient. I will tackle that shortly, but I have only just started my remarks. I intend to deal with continuing long-term, NHS-funded care later.
Dr. Peter Brand (Isle of Wight): The royal commission correctly pointed out that there is no prospect of a demographic time bomb and that most of the expenditure on health and personal care happens during the last six months of people's lives, irrespective of age. That weakens the Minister's argument about the awful prospect that the Government cannot cope without extraordinarily high expenditure.
Mr. Hutton: The hon. Gentleman knows that I have a lot of respect for him. I do not mind repeating that tonight, even if it embarrasses him. However, I was not making the argument that the hon. Gentleman suggested. If he will bear with me, he will follow my comments more clearly.
There is no demographic time bomb; that is not the heart of the Government's response to the royal commission. I shall return to that point shortly. However, I am sure that the hon. Gentleman knows from his practice that the health and social care needs of frail older people in our ageing society are becoming more intense. People often require nursing and residential care much later and their needs are more intensive and extensive.
Priorities lie at the heart of our debate. There are no easy choices, and it is foolish to pretend otherwise. Those difficult choices have been recognised by the Scottish Executive, and they include the impact on other spending priorities and the benefits system, to which the hon. Member for Sutton and Cheam did not refer. However, the hon. Gentleman, in an otherwise characteristically good speech, fell into the trap. Liberal Democrat Members try to pretend that there are no difficult choices. The system that the hon. Gentleman advocates, as he rightly said, would still involve a means test, and the difficulty of defining personal care would remain. He will need to spell out his proposals in more detail in future.
Making personal care free does not avoid boundary issues between what is free and what should be means-tested. It simply shifts the boundary. If food preparation, which is a daily cost that everyone has to bear, were charged for under the hon. Gentleman's proposals--as I think he would say that it should be--but help with eating were free because that might be considered to be personal care, he must say at what stage help with eating would become free. Would it be when the care worker lifted the food on to a fork or spoon, or when he or she put the food into a liquidiser?
The hon. Gentleman will need to be able to devise an accurate way of distinguishing between food preparation that he thinks should be treated as personal care and food preparation that should not. I look forward to hearing his answer. It is inevitable that his system would be based on
a list of tasks. Any such list would generate controversy and argument about what should be included and what should be left off.
Mr. Burstow: The Minister is developing an important point about definitions. Does he agree, however, that the Government have ducked the debate about definitions by saying that the registered nurse's time will be free and that the decision will depend on what the registered nurse does? For example, if the nurse put the food into the liquidiser, the service would be free, but if a care assistant did so, it would not be.
Mr. Hutton: The hon. Gentleman has put forward such arguments before, and he is wrong. I shall explain why in a second.
Given the simplistic way in which the hon. Gentleman has presented some of the choices, it strikes me that his arguments are more opportunistic than principled. That is made even clearer when we consider the record of the hon. Gentleman's party on the matter. The Liberal Democrats' manifesto at the previous election contained no hint that they believed that personal care should be free. Exactly the opposite was the case. It might be a long time since the hon. Gentleman has looked at his manifesto, and it might be inconvenient for him and his right hon. and hon. Friends to do so.
Mr. Archy Kirkwood (Roxburgh and Berwickshire): We have taken the royal commission's recommendations into account.
Mr. Hutton: I shall come to that point in a second, if the hon. Gentleman will bear with me.
I quote from page 39 of the Liberal Democrats' manifesto:
- "We will introduce national charging and eligibility guidelines to ensure a 'level playing field' of provision and charges . . . We will, as resources allow, raise the threshold at which older people are required to make a contribution to their long-term care."
When the hon. Gentleman was a Liberal councillor in Sutton--
Mr. Burstow: I wondered when we would get to this.
Mr. Hutton: Indeed; I think that it is worth getting to. When the hon. Gentleman was a councillor, I understand that it was his party that first introduced means-tested charges for home care services. A little less posturing from him on the subject would, therefore, be advisable. No one has a monopoly on compassion--certainly not the hon. Gentleman and his party.
Mr. Burstow: I wondered when the Minister would get to that part of his speech, because I had heard that his officials had been busy winding up council officers in Sutton on Friday to provide him with a brief for this debate. His facts are incorrect. The charging policy was first introduced by the council in the early 1980s, when the Conservatives were still running the borough.
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