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Ms Coffey: The motion concerns a proposal that personal care should be free. The hon. Gentleman is simply transferring the difficulty of defining social care and health care to definitions of personal and non-personal care. He does not seem to understand that.
The definitions become even more difficult, as sitting services are excluded from personal care. If, during the sitting services, the person suddenly needs help with the
toilet, does that turn into personal care? Also, we have not mentioned the definitions of "enabling and psychological support" from a "knowledgable and skilled professional" which the commission and the Liberal Democrats say should be free. That is personal care, but the work of a volunteer who is working for an agency with a blind person, but who is also providing psychological support, would not be defined as personal care; that would not be free. We are now in the realms of the wholly ridiculous.Unfortunately, the royal commission was not a lot of help in unravelling this problem; it preferred to stick to the big picture. Nor have the Liberal Democrats been a lot of help. If they had tried a bit of unravelling, they might have come to the conclusion that such a system did not offer, after all, a logical, workable and above all just approach to the issue of funding. Such a system would be quickly bogged down in definitions which would be incomprehensible to the people who are being assessed, and it would be seen as unfair. Definitions would vary from authority to authority, as obtaining universally agreed definitions would be almost impossible. Discontent would be high, as people would see their neighbours getting something for free that they were having to pay for. That is not a good recipe for justice.
Nor am I sure how the funding for free personal care would work. Would local authorities total up the cost of the assessments of need and then submit the bill to the Government? If they did, it would be an extraordinary departure. I cannot imagine even the Liberal Democrats advocating that. Are they advocating something similar to what happens at the moment: an assessment of needs through the SSA, with local authorities having a sum to spend on personal care? I rather suspect that the result of all that would be an assessment judged not by service, but by affordability of service within the inevitable limitations.
The result could be that the services that my less well-off pensioners are now getting free would not be provided to them at all because of tighter criteria owing to an increased demand for a free service; whereas their better-off neighbours might get their personal care free, while buying extra services with the money that they have saved. Is that fair?
Dr. Brand: If the hon. Lady is so concerned about a social services budget closed to any extension to free personal care, is it her understanding that the nursing budget given to health authorities is to be open-ended? Will the Government's definition of nursing care not also have its restrictions?
Ms Coffey: I would have thought it self-evident that all budgets had restrictions. The debate here is about the setting of priorities within a given budget. As the Minister of State said earlier, if we decide to spend money on one area, we cannot spend it on another. However, I am glad that the Liberal Democrats have recognised that budgets are limited.
What will happen under the Liberal Democrat proposal to the attendance allowance, which benefits 1.3 million pensioners and is given to people to help them buy personal care? Is that to be abolished? Is there no longer to be any direct payment system? If personal care is to be free, the allowance becomes unnecessary. That would be extremely unpopular with my constituents, as the
allowance gives them the freedom to make decisions about priorities in their own lives and to decide what care they need. It also enables them to pay for informal care from relatives and friends. I do not think that they will be too pleased to find out the Liberals are planning to deprive them of the allowance.What would be the result of this cynical motion? The expectations of the public would not be fulfilled; their perception is that they would get for free what they now pay for. Try telling care home residents or their families that, contrary to their expectations, not all care in a home is personal care, that they will still be required to pay hotel charges and for some services, and that, if they stay there long enough, their capital will still be exhausted. The fact that some people feel that their houses as capital assets should not be included in any assessment of means will not be dealt with under the Liberal Democrat proposals for hotel and living charges.
The proposals in the motion include no extra investment in services for the elderly, which is what we need above all. We need year-on-year investment. Instead, we would get endless assessments, open to challenge, about what constitutes personal care. The only people who would marginally benefit are richer people.
A system that, in arriving at a fair partnership between the individual and public funding, takes into account the assets that people have accumulated is clearer and more transparent for those who are planning ahead than a system that relies on vague delineations of personal and non-personal care.
Instead of going down a road that is unfair and unworkable and has no basis in social justice, we should ensure that the money that the Government will continue to make available goes into improving the range and quality of domiciliary and residential care services and into making them more responsive to the needs of elderly people and their carers.
That is the ultimate fairness, because rich and poor will have access to equality of services in their old age. The dignity and respect that we accord old people is surely defined, above all, by that.
8.46 pm
Mr. Patrick Nicholls (Teignbridge): I thoroughly enjoyed the speech by the hon. Member for Stockport (Ms Coffey). I was getting quite worried towards the end, because I thought that it would cause us both considerable embarrassment if I had to say that I accepted everything that she said. Luckily, she finally came to the heart of the matter, where there is clear disagreement between us--so let us state it, to reassure us both, and then move on.
I have a great deal of trouble with the idea that, because people have accumulated assets over a lifetime, they should be means-tested in their twilight years. People who have worked all their lives will have contributed in taxes, all the more so if they paid tax at the higher rate. Even with the higher rate tax inherited by the Government from their Conservative predecessors--the top rate is still effectively 50 per cent.--that is a substantial contribution for people of perhaps 85 or 90 to have made during their working lives. On that, if on nothing else, I disagree with the hon. Lady.
The debate has been useful in concentrating on an issue that comes up in all our constituencies. I deliberately said issue, rather than problem. Sometimes, when elderly people listen to these debates--I am thoroughly in favour of elderly people, because I fully intend to be one in due course--they ask why they are regarded as a problem, when in fact they are a success story.
The elderly--if they make it--are indeed a success story. Doing some research for another speech some time ago, I found that the male who was around at the age of 65 to claim the five-bob pension introduced by Lloyd George would, at the time of his birth, have had an actuarial life expectancy of somewhere in his late 40s. Today, people are living to ages unimaginable to our grandparents and great-grandparents. Once upon a time, people would draw their pension only if they lived 20 years beyond their actuarial life expectancy, but these days one can claim one's pension 20 years before it. We have to think through the implications. At times, that may mean some new thinking, which may be extremely expensive.
Even if, in part, I come to a conclusion not dissimilar to that of the Liberals, I hope that it will be accepted that I got there by a different route. I recognise cynicism when I see it. The Minister did an effective hatchet job, in simply doing what any young party worker will have done: anyone who has ever followed a Liberal canvasser down the road and said, "The chap who was in here just now--what did he say?" knows that the answer, in summary, is: anything that people wanted him to say.
Whatever view one may take of the Liberals' conclusions, let us not for one moment mislead ourselves, or let them mislead themselves, into thinking that they come to it from a point of principle. One does not get a point of principle from the political equivalent of what happens when one lifts up a flat stone. As kindly as we can, therefore, let us put the Liberals to one side.
Some members of my party, from what one might call the sado-monetarist wing, might ask how we can justify giving free nursing home care to someone who is very wealthy. What would be the point of allowing someone to preserve assets for their children? If they have the money, they should not be a burden to the state. I accept the logic of that argument to the hilt, but it is no longer accepted by those to whom it must be applied.
Something in excess of 50 years of socialised medicine lie behind us. We cannot put the clock back. People do not think it right that they should, in their twilight years, see the assets that they have built up--modest or otherwise--being used up for care in their old age. We can give them the fiscal logic, but they will not accept it. Eighteen years in the House have taught me that one can, to some extent, lead one's constituents over a five-year Parliament. However, when those for whom one is trying to care, in one's own way as a parliamentary representative, simply say that one is wrong, it is wise, for one's own salvation if nothing else, to listen to them. One may even think that they are right. Over and over, I hear from my constituents that the idea that their assets will have to be used up in their twilight years is not acceptable. We must move away from that idea.
I always enjoy debate with the Minister. He is not at his best when he is trying to be horrid. I, on the other hand, am at my best when trying to be horrid, so perhaps there is no problem. I appreciate his dilemma. To give
him his due, he is dealing with what may be the major part of the issue. Nursing care will be paid for, he says, and that will reassure some people, since it will account, probably, for the lion's share of the cost. The Minister is acting in a fiscally responsible way, saying that if he goes further it will cost a great deal of money. Full marks to him for that: it would indeed cost a great deal.Ultimately, however, how can the Minister or his successors deal with this issue? He began to start snarling and trying to be horrid because, being an honest man, he realised where the weaker point of his argument lay. The definitions that he offered simply will not work. He need not take my word for that--indeed, I am certain that he would not. He quoted the royal commission at me, selectively, just as I could selectively quote it back at him. However, it may be more useful to consider the remarks of Claire Rayner, who works at the practical end of the issue. I do not mean to disparage the Minister by saying that; she simply knows more about the practical end than he or I do. Claire Rayner said:
- "If you need someone to wash you, if you need someone to feed you, if you need"
- "then you are ill. Nobody in good health would want a stranger to do it. It's only when you are so helpless that it is necessary that you need someone to do it, and if that isn't nursing then I don't know what is. Yet the government has decided in its wisdom that it is not and they are wrong."
On the Scottish experience, I speak with all the insincerity I can command in saying that I sympathise with the Minister over the jam into which the Government have got themselves. The difficulty over this issue illustrates the way in which devolution is causing unfinished business. The Labour Administration in Scotland, presumably because they believed it right--and a case can be made--defended to the last ditch the idea that they would not make personal care free. They then realised, however, what happens when one lives in a ditch, and the sort of people with whom one must share one's principles. At that point, they suddenly decided to change their policy.
A remarkable situation will arise. Edinburgh, once the Athens of the north, is set to be the Florida of the north. A marvellous trade in elderly people will be carted over the border.
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