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Dr. Brand: The hon. Gentleman is making a great deal of sense. Does he not agree that the Government's definition would undermine desirable team working between nurses and nursing assistants? They all have high status and do a proper job. However, once nursing actions are carried out by non-registered nurses and people are charged for them, those members of the teams will be treated as second-class citizens.

Mr. Hinchliffe: I agree that that problem will arise.

We must recognise the importance of holistic care. It makes no sense to carve up people's care. People cannot be helped to the toilet in the morning, only then to be told that their hair cannot be combed. I am worried by a further inconsistency in that respect. If the division between

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social and nursing care is to be pared down with regard to people in care homes, will the same principle apply in the national health service? Will people in long-term NHS beds be charged for the personal care element of their hospital care? We need a consistency that has not so far been evident.

I am critical of that aspect of Government policy, but I strongly welcome the £900 million that they are offering for intermediate care. That contrasts with the Tory tax cuts announced today. When people consider Conservative party policy and its promised tax cuts, which will attract elderly voters, they must think through the consequences: cuts in personal social services and more means-testing on care for older people.

I make a plea for us to think radically about preventive measures. I am worried that the debate has been far too concentrated on institutional and permanent care settings. I ask hon. Members to consider what sort of care they want when they can no longer care for themselves. Do they want to end up as my mother did, and sit locked up in a home full of incontinent, deranged people? Is that the best that we can do for elderly people? I want us to move away from such a model.

We now have the opportunities, through developments such as those in communications technology, to maintain elderly people in their homes. We should extend the care-link schemes that apply in so many areas and provide an instant response to requests for home adaptations. People should not have to wait six months to get a ramp, or encounter all the other such nonsense about which hon. Members occasionally hear. Housing-with-care schemes have been introduced in Denmark as an alternative to institutional care. Why cannot we use the equity that elderly people have in their houses to make available intensive care packages that allow them to remain in their homes? More investment is needed in day-care and warden schemes.

Mr. Nicholas Winterton: The hon. Gentleman is, of course, the distinguished Chairman of the Select Committee on Health, which I, too, chaired for a limited time. Will he join me and other hon. Members in different political parties in making representations to the Government on expanding criteria relating to the personal and social medical conditions that qualify for free treatment? He made a good point: providing treatment and care today can prevent worse illness in future. If care is provided now, it can save the health service a great deal of money in due course. Will he join me in making an all-party representation on that issue?

Mr. Hinchliffe: There is more cross-party consensus on the issue to which the hon. Gentleman refers than on many others. Of course, I shall be happy to make appropriate representations. In my surgery on Friday evening, I spent the best part of an hour with a lady who was probably in her early 60s and whose husband has senile dementia. It was extremely difficult to try to distinguish between personal and nursing care in respect of her husband. The woman was dealing with a tragic situation. We must consider the practicalities of the Government's policy, and I shall certainly be happy to support any representations along the lines that he suggests.

Other hon. Members want to contribute, so I shall conclude my remarks shortly. I believe that the Government have taken many positive steps. I shall

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support their amendment because I believe that they are heading in broadly the right direction. I am critical about the difficulty to which I have referred, but I hope that it will be resolved in a positive manner.

I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), will pick up my plea. To me, care of the elderly is essentially a matter of human rights. My human rights are about my independence and my ability to choose what sort of care I want. Care should not be given to me because the private market thinks that the best thing for me when I am ga-ga is to be incarcerated with a number of other ga-ga people in some sort of lock-up establishment. We can do better than that, and I have every confidence that the Government will do so. I wish them well in applying their thoughts to the royal commission recommendations, but I hope that we might go that little bit further in due course.

9.15 pm

Mr. Archy Kirkwood (Roxburgh and Berwickshire): I am pleased to be able to make a short contribution to what has been a good debate. It is a privilege and a pleasure to follow my hon. Friend, if I may call him that, the hon. Member for Wakefield (Mr. Hinchliffe), a fellow Select Committee Chairman, whose distinguished knowledge has greatly added to the debate. He is absolutely right to say that we should not concentrate solely on residential and institutional care. Community and domiciliary care are an essential part of the package of measures that we must implement. He is right also to talk about the need for prevention. The Government have done a great deal about that, and I shall return to the matter in a moment.

The heartening thing for me is that, apart from the hon. Member for Stockport (Ms Coffey), who made a powerful speech, there are not many people who are intrinsically opposed to the principle of personal care provision. The hon. Lady was slightly unfair in accusing us of being cynical in initiating the debate at this time. You will know, Mr. Deputy Speaker, that we receive only three Opposition days a year, and we rightly gave a half-day to the Welsh nationalists. We do not control when we will get these opportunities, but our desire to have this debate was certainly driven by the importance that we attach to the subject.

Not enough consideration was given to the work done by Sir Stewart Sutherland and his royal commission. The report was a seminal contribution to the debate. Some might say that the Government's initial response was grudging. The hon. Member for Sheffield, Hillsborough (Helen Jackson) came up with the idea; it was right to pursue that idea, and the Government seemed to be absolutely committed to it. They then seemed to go very cool when the report was published, and we have had only one debate on the subject, in December 1999. The Liberal Democrats need therefore make no apologies for initiating this debate, which has been very good so far.

The Government are right to claim that they have made progress. Compared with the previous Government, they have made enormous progress. Our motion sets out substantial differences in the directions that we are taking, but ours is a perfectly proper position and we will argue our case eloquently, as the royal commission argued its

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case. We are right to support its recommendations. The Conservatives have a lot to answer for, and if I had more time at my disposal, I could expand that proposition almost infinitely. Like the hon. Member for Wakefield, I watched with dismay the evolution of policy under the stewardship of the previous Conservative Administration.

Having said that, I remember the Prime Minister, then the Leader of the Opposition, making a powerful speech in 1996 at the party conference before the last general election. He said that he was ashamed to live in a country where people had to sell their house to pay for their long-term care. That gave me a lift. I watched his speech on the television, and that was a powerful point well made. Like me, many people had their expectations raised by that statement by the head of the incoming Government and by the establishment of the royal commission. We were right to be disappointed that it took the Government almost as long to read and respond to the report as the royal commission had taken to write it.

The Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), rightly ribbed us about past changes in Liberal Democrat policy. However, for me at least, the royal commission changed everything. There are six volumes of research evidence, and I did not read them all, but those that I read certainly demonstrated that the commission's work changed people's perspectives on this important subject.

The Government have not done enough to consider the options in detail and to debate them in the House. They took the line of least resistance and they split the difference. As I said, they have made progress, and it would be churlish to quibble about that, but they took fright at the amounts of money that they thought, wrongly, were involved. North of the border, research will continue between now and August into the implications and the delivery of the policy of paying for people's personal care. I am deeply disappointed that the Government took fright.

The royal commission showed that providing solutions on an individual basis was not viable. Individual solutions, whether through independent insurance or under other schemes, would not make the necessary provision. Sir Stewart rightly said that the only solution was to pull the risks and cover the costs through general taxation. That is the fairest, long-term solution.

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