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Mr. Burstow: Will the Minister give way?
Mr. Hutton: No. I have already given way twice to the hon. Gentleman.
It is not easy to strike the right balance between assuring standards of care, extending access to new services, promoting independence in old age and ensuring fairness in what people are asked to contribute and what the state itself should assume responsibility for. However, I strongly believe that, within the resources available to
us, we have made the right choices: to invest more in better front-line services that will give older people greater care and improved health, avoiding institutional care wherever possible, while making the funding of long-term care fairer at the same time; to give carers more support; and to get health and social services working more closely together. I do not believe that making personal care universally free would help us in achieving any of those objectives. In fact, it could be provided only at the expense of these more pressing objectives.We are intent on making fundamental changes to health and social care services for older people, whose lives will be significantly better as a result of the decisions that we have taken.
I hope that my right hon. and hon. Friends will reject this motion tonight.
8.6 pm
Mrs. Caroline Spelman (Meriden): It has been an odd evening because various alliances have formed and then dissolved. I suppose that I should feel vaguely flattered that the hon. Member for Sutton and Cheam (Mr. Burstow), the Liberal Democrat spokesman, chose to use 80 per cent. of his speech to attack the Conservative party. I suppose that that is a veiled form of flattery.
I found myself in agreement with much of the Minister's speech. It was only towards the end of it that a partisan element crept in. Perhaps the House should not be surprised that it is occasionally possible for the official Opposition and the Government, who have a much stronger possibility of, and closer responsibility for, government than the Liberal Democrats have, to weigh up matters carefully and come to similar conclusions.
I certainly did not know that a Liberal Opposition day meant a day when the Government were hardly mentioned at all as a target of analysis. It was literally in the last minute of his speech that the hon. Member for Sutton and Cheam made some analysis of Government policy. Given the brevity and lightweight nature of his speech, I should have thought that some of it might have been devoted to analysing the policy of the Government of the day.
The Minister stole some of my best lines when he looked into the Liberal Democrats' record in local government, where they get a little closer to real power. I need not repeat the damning analysis of what in practice Liberal Democrats decide to do with limited resources when they get into a position where they are able to decide how to spend them.
Dr. Brand: Will the hon. Lady give way?
Mrs. Spelman: No, I should like to make a little progress.
The important issue underlying this debate is that of funding care for the elderly. I remember saying, when we were debating a statement on the royal commission, that it is rather like a big hole in the ground around which the major parties are circling. The big issues are how to spend this kind of money and what are the wise decisions for the future.
We should not be surprised that there is a minority report within the royal commission report. It may be for the benefit of this debate and that of the Liberal Democrats who skirted over the note of dissent struck by
Joel Joffe and David Lipsey if I repeat what those two people said. They state some important truths that should be read into the record of this debate. The dissenting note makes it clear that
- "To make personal care free for all those who are assessed as needing it would"
- "In essence, it would transfer initially at least £1.1 billion"--
- "rising to at least £6 billion in 2051 from the private to the public purse. This huge addition to the burden on public expenditure would not, however, increase spending on services for elderly people by a single penny."
- "Because it would make personal care free for those who qualify for it, it would add to the demand for such care, imposing an additional cost on top of that driven by demographics."
Mr. Hinchliffe: I shall be dead by 2051, so I take a dispassionate view on this issue. My concern about the figures that the hon. Lady quotes from the minority report is that they assume that by 2051 we will be sticking to what I regard as expensive, outmoded, institutional models of care that other countries have moved away from. I am anxious to know what assumptions she is making. Perhaps she will clarify her earlier intervention, because it baffled me. What assumptions is she making about the future of institutional care? Will we be like Denmark and move away from care homes and nursing homes to support for people in the community or care with housing schemes?
Mrs. Spelman: For once I am grateful to the hon. Gentleman for his intervention, because it brings us on to a helpful point. Changes in society have led to the position that we are in today. Grandparents increasingly rarely live with their children. The hon. Gentleman was quick to condemn the previous Conservative Government. He said that it was entirely their responsibility that we were in this position, but that is factually not true. During the 18 years that the Conservatives were in government, there was a significant shift in our society. Job mobility increased, so people moved away from where their parents live. That is a simple social and cultural change.
I cannot stare into a crystal ball and tell the hon. Gentleman that in 2051--or even 2021, which is a bit more realistic--one of my three children will be prepared for me, as an old lady, to live in their home. They might be living anywhere on the planet. Job mobility and the nature of
business today make it difficult to assume that the clock will be rolled back to a time when grandparents once again live with their children, desirable though that may be in the family context. Therefore, we must consider the placement of a significant proportion of the elderly population in nursing or residential care when they need it.All the health trends show that life expectancy has increased, and a deterioration in health comes towards the end of our lives. What used to be the end of our lives has been pushed back further, and the acuity of care in nursing homes has risen. People in nursing homes and residential homes are sicker than they were, but may not be in those homes for as long as they used to be because the level of care in the community to sustain the elderly until such time as they need that extra shelter of residential accommodation--
Mr. Hinchliffe: Will the hon. Lady give way?
Mrs. Spelman: No, because I have dealt with the hon. Gentleman's point in detail.
This is an important issue, and it difficult to see how the figure in the minority report is an overestimate--quite the reverse. The £6 billion may prove to be an underestimate by that time. It is difficult for any of us to say accurately what that figure will be in 20 years' time. What we can say with more confidence is that such care will cost the state a great deal of money, and the hon. Member for Sutton and Cheam gave no indication of where the Liberal Democrats would find that money. It has to be found, and any utterance about an extra penny on income tax providing the sums involved is unrealistic.
It is interesting to consider how this matter was approached in the Scottish Parliament. As confidently predicted, under devolution different models are emerging. The Scottish Parliament has chosen to go in a different direction. Some Labour Members have gone out on a limb and have supported taking a different direction. Now the Scottish Parliament must find where to make the savings to provide that care. The Liberal Democrats need to do that work, and should have done so before bringing this matter before the House.
It will not be easy to find £1.4 billion. Even if it can be found now, the consequences some way down the road in 2021 or 2051 would alarm any party with a responsible attitude to its role in government. In fairness, the Government have tried to do that. We should not ignore what the Prime Minister had to say on this matter. He said:
- "We believe that the money would be better spent elsewhere in the national health service."--[Official Report, 31 January 2001; Vol. 362, c. 300.]
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