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Ms Ann Coffey (Stockport): I am no wiser about the Conservative party's policy now than I was 20 minutes ago.
The Liberal Democrat motion arises, I am sure, out of a genuine wish to consider again the recommendations of the Sutherland report on long-term care, which was published in March 1999, nearly two years ago. I am equally sure that the timing of the debate arises out of the Liberal Democrats' concern for elderly people, not from any opportunist motive on their part. After all, they keep telling us that they are the party committed to raising standards in public life and that the dividing line between them and the Tories is that they are not bandwagon politicians.
The report by the royal commission on long-term care comprehensively examined issues around providing services to support older people in both the community and residential care. The report was thought provoking, particularly in examining existing standards in both domiciliary and residential care, which vary considerably throughout the country.
The royal commission's main task was to look at the provision of care for the elderly at home and in residential care and to recommend how the cost of that care should be sustainably and affordably apportioned between public funds and individuals. "With Respect to Old Age: Long Term Care--Rights and Responsibilities" was the title of the report. I am sure that all of us would want to achieve the objective of dignity and respect for older people. How we treat older people today will determine how we as older people are treated tomorrow.
I welcome the implementation by the Government of the royal commission's recommendation to set up a national care commission, the introduction of the Care Standards Act 2000, which will improve standards of care, the increased investment in prevention and rehabilitation, and the introduction of free nursing care, which deals with a major injustice, where nursing care was free at home or in hospital, but not in nursing homes--a legacy of the previous Government.
Another major impact on improving services will be brought about by the closer co-operation between health and social services through section 31 agreements or new health and social care trusts. The delivery of services by different agencies with different priorities has been a major contributor to bureaucracy and to frustration among many elderly people and their families. It does not make sense to be assessed first for health care and then for social care by different people working in different agencies, often having no communication with each other.
Under the system in Stockport, a social worker based in casualty at Stepping Hill hospital will, when an elderly person is admitted to casualty, assess with medical and nursing staff the need for social care. The result is that the person goes home with a proper package of care that recognises that social and health care are inextricably linked and important for that person's recovery.
Mr. Nicholas Winterton: The hon. Lady is making a rational speech. When elderly people have had a stroke and are discharged from hospital either back to their home or to a residential home, will physiotherapy be available? Is that a social care treatment, or a medical nursing care treatment? The one thing that worries me is the scarcity
of physiotherapy, which can dramatically improve the quality of life of elderly people, whether they be in their own home or a residential or nursing home.
Ms Coffey: I am sure that, like me, the hon. Gentleman looks forward to continuing Government investment in the NHS, which will make the provision not only of health care but of associated services more widely available. As he will be aware, the legacy that the Government have to deal with is one of years of underfunding by the Government of which he was a member.
The royal commission accepted that care in old age must be a partnership between the individual and public funds. I am not convinced that its main recommendation to make personal care free and to continue means testing for other services, including cleaning, housework, laundry, shopping services, transport to day centres and sitting services, necessarily achieves fairness or justice in that partnership.
Fairness must take account of income. To each according to their need, from each according to their means, is the basis of our tax system and public spending. It should also form the basis of redistributing wealth. Everyone should share fairly in the wealth of the country, but in that fair share account must be taken of the individual's wealth and the share that they have already had, which has provided assets and savings for them in retirement and also for their children, who will inherit those assets.
The commission, supported by Liberal Democrat Members, proposes redistributing public money to those who already have private means. I cannot see the argument for social justice in that. It may be an emotionally attractive argument, and in certain Liberal Democrat constituencies it may even be a politically attractive argument, but it is not a just argument. Of course the state must take its fair share of responsibility for care of the elderly, especially for those who cannot provide for themselves, but it is also fair that some account be taken of the private means of the person concerned.
It is right that the state should provide free care in homes for the 70 per cent. of elderly people who have not had the advantage in their working lives of accumulating assets in the form of savings or income. In my local authority, it is about the same percentage for domiciliary care. It is absolutely right that no one should be denied a service that they need because they have no money for it.
The state also provides a non-means-tested, non-taxable benefit in the shape of the attendance allowance, which recognises the extra cost of disability in old age and therefore provides a basic benefit to those in need to help with the costs of care, regardless of income. The proposal supported by Liberal Democrat Members, to give free personal care, would not give one extra penny or provide one extra service for my less well-off constituents. Indeed, it would provide no extra services for those who were well off. Where is the social justice in that?
There may be legitimate arguments about what private assets and what income and capital should be taken into account in an individual's contribution to personal care. I am therefore pleased about the changes on that matter that my hon. Friend the Minister announced earlier. There has to be a fair partnership between the individual and the state in which people do not perceive that they are
unjustly disadvantaged for saving; in which options are available to people to plan for their financial future; and in which the state, in return, as part of that partnership, ensures that the care that individuals are offered in old age provides both dignity and respect, and the same quality of care for those who cannot afford to pay for their own care.If we put on one side the arguments about whether universal provision in a society of unequal incomes is fair, the question becomes one of whether making personal care free would end injustices in provision. We have spent a long time arguing in the United Kingdom about the dividing lines between health and social care, for one is free and one is not, and the unfairnesses that are perceived to arise because of those definitions. However, how much more difficult are the dividing lines between personal care and non-personal care?
Under the commission's proposals, which are supported by Liberal Democrat Members, the provision of meals is a living cost and is therefore not free, whereas help with eating is personal care and is free. Where should we draw the line? If an elderly person needs personal help to eat, that is fairly straightforward--it is personal care. Let us suppose, however, that an elderly person needed more help than just the delivery and serving of a meal--for which they would be charged and which directly involved touching the person, which is the commission's definition of personal care. People may, for example, need propping up with a cushion, or, if they are blind, help with finding a plate or utensil; but otherwise they may be perfectly capable of eating by themselves. Are they receiving personal care or a service that one would expect from a meals on wheels delivery? Is it a mixture of both? If so, how much of it is chargeable?
The hon. Member for Sutton and Cheam (Mr. Burstow) described a system in America that entails metering and clocking on and off. He is simply transferring the problem of defining social and health care to that of defining personal and non-personal care. Staff in care homes will be clocking on regardless of whether care is regarded as personal and free or is not so regarded and is charged for.
I would not like to have to make such an assessment. I worked as a social worker for 20 years, and earlier in my career I did make assessments of the need for services. Assessments are not easy to make because the criteria are not simple or straightforward. It is difficult, not simple, to assess whether to provide personal care. I would also not like to have to explain to an elderly person, or to his or her relatives, the dividing line in the example that I have quoted. What would they say? The comment "this is ridiculous" comes to mind.
Mr. Burstow: The hon. Lady's comment about its being ridiculous is surely the very comment that elderly people will make to a nurse who assesses their nursing care needs and tells them that, on this occasion, a care assistant will undertake the task and that they will therefore have to pay.
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