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Mr. Hutton: The hon. Lady said that she agrees with the Government's response to the royal commission. An important element of that is the additional spending on intermediate care services, approximately half of which

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will come from social services spending. I understand that she will not match our social services spending, which is funded through the standard spending assessments. Will she give a commitment to match the rise in the social services SSAs that the Government have made?

Mrs. Spelman: I shall come on to that, if the Minister does not mind. I shall deal with it in some detail, rather than as a response to an intervention.

This is a Liberal Democrat Opposition day, so for their benefit we should bring to their attention matters that may alter their view, and perhaps make them do a 360 deg turn--who knows. The NHS Confederation has said clearly:

I suggest that the Liberal Democrats put that in their pipe and smoke it before they finalise their policy on this subject.

Behind this debate is the problem of how to make services for the elderly sustainable in the long term. We think that the Government, in their Health and Social Care Bill, could have done more to address the longer-term perspective. If the Government and the official Opposition are agreed that the Liberal Democrats are wrong and that the provision of free personal care in England is not the best use of NHS resources, we must find a way to deal with the state's inability to pay.

How do we encourage future generations to make provision for themselves and their loved ones? Not in the way the Liberal Democrats have suggested. If free personal care were extended to England, it would disincentivise those affected and their relatives from taking on that responsibility. It would also lead to disappointment. We are led to believe that free personal services are a panacea, but they are not. They are only a portion of what it costs to provide adequate services for the elderly. The accommodation either in nursing homes or in a residential setting is a significant part--if not the largest part--of the cost of providing care for the elderly.

Mr. Nicholas Winterton (Macclesfield): My hon. Friend will know of my long and deep interest in this subject. Does she agree that the problem arose for two reasons? First, there was the need to provide the elderly with better nursing and social care; secondly, over a period, Government dramatically reduced, by thousands, the number of geriatric beds. No one was asked whether they wanted that to happen. Government made a decision as a result of which many elderly people, whatever their position in life, feel that they are being unfairly treated.

What discussions has my hon. Friend had with groups representing the elderly, and how do those groups feel that the current injustice can be put right? I think that the Government have gone some way down the path, but as yet many elderly people do not consider the proposed solutions to be truly fair.

Mrs. Spelman: My hon. Friend's intervention is relevant, despite straying a little beyond the strict title of the debate.

As I am sure my hon. Friend recalls, a year ago those on the official Opposition Front Bench held an "age summit" with all charities concerned with the provision

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of services for the elderly. It was interesting for us to hear what elderly people would like. Certainly, we heard that they had been led to believe that there would be cradle-to-grave provision, and had found that that was not the case in practice. We also heard, however, that they wanted dignity in old age, and we have a responsibility to try to provide that.

Those requirements must be weighed in the context of the Government's overall responsibility to decide the right priorities for health care, but one thing came over very strongly: people wanted to remain in their own homes for as long as possible, because their own homes tended to be full of memories of raising a family. To maintain them safely in their own homes, however, requires considerable support, and sometimes a difficult decision must be made, often involving medical staff. Although an elderly person would prefer to remain in his or her own home rather than going into institutional care, it may become unsafe for that person to do so.

It is precisely such sensitivities that my party is trying to take on board in crafting its own solution to the problem of long-term care, which we shall present before the election. Of course, if we had the Government's advantage of knowing when the election might be, we should be able to choose the moment much more judiciously.

My hon. Friend the Member for Macclesfield (Mr. Winterton) has reminded me of what Age Concern said to us at the age summit. The Liberal Democrat call for free personal care involves a terrible inconsistency. The provision of free personal care would leave other aspects of essential health care for elderly persons uncovered: chiropody and physiotherapy, for instance, might have to be paid for separately. Even necessities of later life such as incontinence pads are still charged for in nursing homes.

My hon. Friend the Member for Teignbridge (Mr. Nicholls) made a good point. It is sometimes very difficult to find free personal care, or free personal services. For an elderly person with incontinence problems, products such as incontinence pads are essential, and anyone who has had to pay for them will know that they are not cheap.

Moreover, the practice of GPs' charging for call-outs to nursing and residential homes is not covered by this definition. Where do we draw the line in defining what constitutes a personal service provided for an elderly person in care?

Mr. Tom Clarke (Coatbridge and Chryston): I listened with interest to the hon. Lady's response to what I considered to be a comprehensive and convincing speech by my hon. Friend the Minister. She and the House seem to accept that great progress has been made in Scotland. That is marvellous, as the House decided to devolve such matters to Scotland. What the hon. Lady has not yet done, however, is address--as my hon. Friend did--the issue of carers. Will she tell us what commitments her party gave in the consultations that she mentioned earlier to the millions of carers in this country?

Mrs. Spelman: With respect, I did not say that great progress had been made in Scotland. I said that Scottish Members of Parliament had chosen to go out on a limb and make a different decision; they would have to weigh

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up the financial consequences themselves, and establish where they would find the money to pay for a decision that they were free to make.

The role of carers is very important, and is catered for in our comprehensive policy on long-term care. I have already spoken for 20 minutes, and do not want to go into the issue in detail; suffice it to say that carers often bear the burden of providing personal services. Even those not covered by the present definition may have to wait for a registered nurse, but if a member of the family is involved the relative concerned will be more likely to provide personal services, because account must be taken of close family members.

The present definition is shot through with inconsistencies. The Royal College of Nursing is right to say that, owing to those inconsistencies, discrimination is likely. The example has been given of a demented patient who may not require personal services from a registered nurse--but is that patient to be discriminated against in favour of a person suffering from cancer because both happen to be in a health setting in which such services are provided by a registered nurse?

Mr. Burstow: Will the hon. Lady give way?

Mrs. Spelman: No, I am about to finish my speech.

There are terrible inconsistencies, which need to be resolved as the Government work out the practical implementation of their commitment to making free nursing care available.

Mr. Paul Goggins (Wythenshawe and Sale, East): Will the hon. Lady give way?

Mrs. Spelman: No; I am about to finish my speech, and a number of Members wish to speak. This is, after all, a Liberal Democrat Opposition day, and I do not think that the Liberal Democrats would be too grateful if the Minister and the official Opposition spokesman took up most of the available time between them.

Let us return to the people who are at the end of the system, as it were. I have a 92-year-old father and an 88-year-old aunt, both in residential care. They had to use all their capital to pay for their nursing care. I, as a relative, had to explain why that was--why I, with a demanding job, could not care for them in my home. That is not an unusual situation: that is Britain today.

We need a fresh look at the way we care for the elderly in this country. The provision of free nursing care is like a sticking plaster over a substantial problem that needs to be resolved. It would be straying outside the framework of the debate to go into the whole question of why the care home industry is in crisis, why there are bedblockers in our hospitals, and why insufficient funding from central Government has forced local authorities to means-test and constrain elderly people who need services.

The terms of the debate were to look specifically at the Liberal Democrats' pledge, which will no doubt be in their election manifesto, to provide free personal care throughout England. If they want to put that in their manifesto, they will have to be able to say how on earth they will fund it. Nothing I have heard tonight gives any clue as to how they would realistically achieve that. A party that cannot realistically say how it intends to foot such a substantial bill is not fit to govern.

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