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Dr. Brand: Will the Minister give way?
Nor would the proposals of the hon. Member for Sutton and Cheam benefit the least well off as seven out of 10 people in residential care already have all or some of their personal care paid for. Instead, his proposals would lock in place the existing range of often inadequate
services that have frequently been criticised by many older people. They would not allow us to develop a wider range of services much more effectively to meet the health and social care needs of older and disabled people.
Dr. Brand: The Minister clearly recognises that personal care is very much part of keeping someone at home, hence the teamwork of an integrated intermediate care package. If that would work for a short-term intervention under his new proposals, does he believe that lots more people could be kept at home by taking away the main barrier to them accepting help, which is usually personal care rather than nursing care--their fear of means-testing?
Mr. Hutton: I have tried to deal with that point, but it strikes me that the hon. Gentleman and his party have a simple choice. They have not made themselves clear, however. In response to the royal commission, we are making £1.4 billion worth of extra money available to improve long-term health and social care services for older people, including £360 million that will go to address the unfairness of the means test. As I understand it, his party wants all that and another £1 billion. That is the position of the hon. Gentleman and his hon. Friends. They have not said that tonight, but that is absolutely their bottom line.
The Liberal Democrats want to accept all our proposals and then say to the Government, "Can we have another £1 billion as well?" We have been round that course many, many times. All Labour Members and some Opposition Members will be aware of the argument that the Liberal Democrats have an uncanny ability to spend the same billion pounds in about 14 different directions, while saying to people, "We won't have to put up your taxes." Well, I have to say to the hon. Member for Sutton and Cheam that he and his hon. Friends have to grow up on such issues in politics. It is all right to blame everyone else--they are good at that--but they have to take responsibility for their own decisions. He should say clearly that they want the £1.4 billion and another £1 billion. That, at least, would be progress. I suspect that that is their real position, although he did not say so. Perhaps the hon. Member for North Devon (Mr. Harvey) will make that clear later.
We are investing £360 million in a full year--by 2003-04--to make the funding of long-term care fairer. We shall extend free nursing care to all settings, and I shall discuss that in a moment. We shall take action to ease the burden of residential care costs. We shall act to prevent people from having to sell their homes against their wishes on admission to care or during their lifetime. We shall tackle the unacceptable variations in charges for home care.
My hon. Friend the Member for Wakefield (Mr. Hinchliffe) will be interested to hear that new guidance is being prepared on NHS continuing care responsibilities, which will help to deal with concerns being expressed about the needs of those with chronic illness.
People often feel rushed into selling their homes when they enter care. That adds to the stress of what is certain to be a difficult time. It can also remove the possibility of returning home if the situation improves. That is why, from April, for the first three months after admission to a
care home, the value of a person's home will be disregarded from the means test. That will allow valuable time for the person and the family to take stock and keep their options open. A person who goes into care owning a house, but with few other assets, will save between £2,000 and £2,500 during the first three months of the stay and we estimate that about 30,000 older people will benefit from that change.From October, councils will be given an additional £85 million over three years to encourage them to offer deferred payment arrangements for those entering care. That will mean that, following admission, people will not be forced to sell their homes during their lifetimes against their wishes. In addition, our proposals to extend free nursing care to all settings recognise the need to remove the major anomaly whereby people in nursing homes are charged for care from nurses while those in all other settings receive it free on the NHS.
Subject to the passage of the Health and Social Care Bill, which is before Parliament, from October everyone who needs the care of a registered nurse will have it paid for by the NHS. That will include registered nurse time spent on providing, planning, delegating or supervising and monitoring care and meeting the costs of specialist equipment used by those nurses.
Mr. Mark Todd (South Derbyshire) rose--
Mr. Hutton: I give way to my hon. Friend the Member for South Derbyshire (Mr. Todd).
Mr. Todd: My hon. Friend is making a powerful and cogent speech, but one thing has been lost on him. I know of no other example in the NHS of the definition of whether a service is free being based on whether the person involved is a registered nurse.
Mr. Hutton: I shall come to that, but I reassure my hon. Friend that that is precisely what the royal commission asked us to consider. In contrast with the points made by the hon. Member for Sutton and Cheam, we have in no way departed from what the royal commission said about nursing care.
Mr. Nicholls: I appreciate the Minister's dilemma and he appears to be doing his level best to address it, but surely it comes down to the fact that there is no watertight acceptable definition of the distinction between nursing and personal care. If he tries to base what he considers to be an improvement on the system of finding a workable watertight definition, either he or his successor will be dragged back to the Dispatch Box to justify that for as long as the Government are in office. Is not now the time to take a deep breath and say that both will have to be funded? Is not that where his logic will take him?
Mr. Hutton: That is an interesting argument from a Conservative Back Bencher. Perhaps the hon. Gentleman ought to discuss the proposal with the hon. Member for Meriden (Mrs. Spelman), who sits on the Front Bench, as I understand that that is not the view of his party. I disagree with him, as does the royal commission, and he might like to refresh his memory by reading paragraph 6.26 of the report.
Of course, the royal commission recommended free personal care--that was its main recommendation--but it made it clear that if we decided not to proceed, introducing free nursing care was none the less still feasible and practicable. The royal commission considered the issues carefully. On that one, it takes a different view from the hon. Member for Sutton and Cheam. It believes, and I agree, that it is possible for the distinction between nursing and personal care to be made and made in the way that we propose in the Health and Social Care Bill.
The hon. Member for Teignbridge (Mr. Nicholls) has made a good point, but we should consider home care services. For example, community district nurses--NHS nurses--can arrive at the home of a frail older person to make decisions about what is necessary for that person's nursing care. Alongside that, social workers make assessments about what is personal care.
To the hon. Gentleman and those who say that it is impossible to make this distinction, I say that it is not. It happens and it can be made to work. I accept the wider point that the hon. Gentleman makes--that, ultimately, the argument about being unable to make a distinction is made by those who favour free personal care. However, it is a fundamentally dishonest argument because, as I said earlier, the argument about free universal personal care does not avoid those boundary issues and disputes coming to the surface. There would be just as many difficulties surrounding the definition of free personal care and the hon. Member for Sutton and Cheam has tried to gloss over those. I do not believe that those boundary issues disappear simply by making all personal care free alongside nursing care.
The changes that we are making to free nursing care will save a person up to £5,000 of the annual fees for a year's stay in a nursing home. That means that residents in nursing homes will, in the future, be treated in the same way as people who are being cared for at home--with NHS services and equipment being provided according to need, not according to their ability to pay.
That major reform is long overdue. The hon. Member for Sutton and Cheam could not find it within himself to say anything positive about the reform. He shakes his head; he thinks that there is nothing positive about it. That speaks volumes about his attitude to this whole debate tonight. It is not principle that he is pursuing, but political point scoring--once a Liberal Democrat, always a Liberal Democrat. [Hon. Members: "Hear, hear."] What I am trying to say is that leopards do not change their spots.
The assessment of an individual's current and future nursing care needs will be undertaken by NHS staff using a standard approach, which will ensure that people with the same level of need receive the same level of care. As I said to the hon. Member for Teignbridge, I do not believe that it is impossible to develop a fair system of assessing nursing needs. The royal commission accepted, at paragraph 6.26 of its report, that even if we rejected its recommendation on personal care, making nursing care free should still be pursued. That is what we intend to do. We are working with the Royal College of Nursing and others to ensure that the assessment process will be able to take into account the particular needs of individuals.
It is wrong to suggest, as the hon. Member for Sutton and Cheam again tried to do, that the reforms will not be needs-led. They will be. No artificial limit or ceiling will
be placed on how much nursing care a person needs. The hon. Gentleman expressed concern about how we have defined nursing care, implying that we have chosen a deliberately narrow concept of nursing for these purposes. That is absolutely not the case. The only suggested definition of nursing care was put forward in the minority report. We have taken that considerably further in clause 48 of the Health and Social Care Bill. It is very clear from the majority report that it, too, was concerned about people being charged for the services of a registered nurse. The hon. Gentleman should look at paragraph 6.22 if he has any doubts about that.The hon. Gentleman referred to the Tory Opposition. It has all gone very quiet over there. They are the ones who devised the present unfair system of funding long-term care. They cut 40,000 beds from the NHS, many of them long-term care beds for the elderly. They charged people for their nursing care. They had 18 years to devise solutions, but failed spectacularly to do so. Their only suggestion was to extend long-term care insurance, which was rejected by the royal commission in one sentence as being
- "complex and difficult to see where the benefits lay and to whom."
- "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."--[Official Report, 2 December 1999; Vol. 340, c. 519.]
- "Over the next few months the Party will develop new areas of policy which will be ready well before the next general election".
At the beginning of my remarks, I said that this debate was about choices. For us, the choices are about where best to invest the extra resources that are now becoming available to improve the health and well-being of older people.
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