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Sir Stewart's point is crucial, and I hope that hon. Members from all parties will consider it. The Government will struggle to deal with fairness in future if their policy continues in the same direction. We have had some exchanges about people's treatment and whether they consider it to be fair when compared with that of others.
Problems of definition will always exist. I respect the hon. Member for Stockport, who knows a great deal about social services from her professional experience. However, it diminished the argument to mention some of the issues that she raised. Boundary problems will always exist, and Sir Stewart Sutherland and the royal commission report recognised that. There are ways round the problem if we act in good faith and with good will.
If the Government's proposals are accepted, we will have a two-tier system. However good it is, it will be unstable in the long term. The Minister was wrong to say that the royal commission had devised the narrow definition of long-term care that he described. Dr. Chi Patel contributed to the minority report. I have talked to Sir Stewart and it is wrong to say that he had such a narrow definition in mind when he considered the proposition for gatekeeping.
If the Government considered the fact that the state already pays 75 per cent. of the costs, there is at least an argument for saying that, as pensioner provision improves in future and people retire with larger occupational pensions, the money available to pay hotel costs may generate more money than was perhaps anticipated five years ago when research for the royal commission report began. I hope that the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), will be able to deal with that point in her winding-up speech. Slide rules should be applied to some of the figures and an option for personal care sometime in future should be kept open. That is all I ask of the Government this evening. If they are prepared to consider that, I will be content with the results of our debate.
Mr. Paul Goggins (Wythenshawe and Sale, East): I thank the previous two speakers for creating space for me to squeeze into before the winding-up speeches. The debate is important and I am happy to have the opportunity to contribute to it. My hon. Friend the Member for Stockport (Ms Coffey) spoke eloquently about the way in which our treatment of older people is a sign of our society's values. It should reflect the way in which we expect to be treated when we are old.
I acknowledge the huge progress in the care of some of my older constituents in the past three or four years. When I was elected as a Member of Parliament, the first issue to hit me was delayed discharges. I remember the letters that I received, the tearful relatives and the patients, whom I visited in Wythenshawe hospital. It was dreadful for them to be trapped in an inappropriate setting. It also prevented others who desperately needed operations from being treated. It was demoralising for the staff because they were not able to give appropriate care in such a setting.
In August 1997, there were 200 delayed discharge patients in Manchester, and there was just £500 a week of new money with which to fund care packages and placements for them. I am pleased to say that, with better management, more cash from the Government and more partnership working, there is now between £6,000 and £7,000 a week of new money in the kitty, and there are only one or two delayed discharge patients. That is an immense step forward, and it has also been repeated in the Trafford area of my constituency.
My hon. Friend the Member for Wakefield (Mr. Hinchliffe) always speaks passionately about the need for prevention in the care of the elderly, in terms of the prevention of the use of the residential care and hospital care options. I concur wholeheartedly with him on that. All our efforts should go into trying to prevent admissions into residential care and hospital care whenever possible. That means more neighbourliness and
When people need to go into the hospital, as the majority of older people will at some stage, the care available needs to be of a high quality. When the treatment is over, the patient then needs to be placed appropriately in the right kind of setting. That might involve residential care or nursing care, but it is to be hoped that the patient will be back home sooner rather than later.
On that issue, I have some good news for my hon. Friend the Member for Wakefield. The Southwold nursing home in my constituency would, in the past, have received patients from hospital who would have stayed there almost for ever. Now, it is sending one in three patients--even some who are quite dependent--home into their own community with a care package. That is an encouraging development in nursing care.
The main focus of the debate is the decision not to provide free personal care to all. It has been made clear from the debate that that is a serious and controversial issue. There are no perfect solutions to such questions. In politics, there are only priorities and hard choices, and I shall briefly cover some of them.
First, the initial cost of the proposal would be more than £1 billion, as my hon. Friend the Minister said. That is a similar investment to the one that the Government are making in the intermediate care package, which will provide 5,000 places by 2003. The first hard question to answer is whether we should provide existing services more cheaply for some, mainly better-off, people or fund new and extended provision for all. As has been said, we cannot spend the same money twice.
Secondly, the £1 billion cost would not remain at that level. The royal commission made it clear that by 2050, the figure would have risen to at least £6 billion. The second question is, therefore, whether such costs would be sustainable. Reference has been made to the negative impact of having a funding regime that would not be sustainable in the long run. That would be totally disruptive to the care of elderly people, and we should shun such an option.
Thirdly, expectations change. That powerful point was made by the authors of the note of dissent to the royal commission's report. Older people will not now accept the care packages that were on offer in the 1960s. Equally, older people in 2050 will not accept the kind of care packages that are available now. The third question, therefore, is whether we should risk putting a cap on quality and variety by enshrining into our system a principle that would never provide enough of the right kind of care in the long run.
The issue is controversial. Difficult choices have to be made, and there will undoubtedly be all kinds of teething problems with the provisions. I acknowledge and accept that there is now a new settlement between the individual and the state in relation to pensions and other matters. It is a settlement that protects the poorest as a first priority, which is just. It asks the better-off to make a bigger contribution, which is fair, and it guarantees quality for everyone, which we all expect. Those principles are reflected in the new arrangements for personal care, and I fully support them.
Mr. Nick Harvey (North Devon): It is a pleasure to participate in the debate, which has been useful to explore the issues involved and to identify where the political parties will position themselves in the run-in to the general election.
As my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) said, the Liberal Democrats do not control the timetable for when we get the chance to raise matters on Opposition Supply days. Nevertheless, events in Scotland are, for Liberal Democrats, a cause for celebration. We celebrate the success of devolution, because those events represent devolution working, and working well, and the fact that people in Scotland will be able to use the long-term free personal care that the Scottish Executive and, in the end, all parties in the Scottish Parliament recognised that it was right to offer. That does not mean that we have to offer free personal care in England, but it does mean that those of us who believe in that have a duty to argue for it in England. That is what we are doing.
It is wrong for people such as the hon. Member for Woodspring (Dr. Fox), who is the Conservatives' key spokesman on these matters, to appear on television to say that it is an absolute scandal that different things will happen in Scotland and in England, only for it to creep out that that is their position as well. The Conservatives in Scotland believe in free personal care, but it has emerged in today's debate, as it has before, that the Conservatives at Westminster do not support it. Small wonder that the hon. Member for Buckingham (Mr. Bercow), who was bouncing up and down enthusiastically at the beginning of the debate, left the Chamber on hearing what his Front-Bench spokesman had to say. I am not surprised by his attitude because he would have been gravely disappointed to discover that that was the position.
The task for those of us in England who believe in free personal care is to campaign and argue for it, and that is what we are doing tonight. I shall address a few remarks to the Minister, who defended the Government's position and said that our proposals are not the right way forward in England.
On the demographic time bomb, my hon. Friend the Member for Isle of Wight (Dr. Brand) made a stout defence. As the Minister said, as time goes on there will be more people of retirement age and in their eighties, but it is equally true, as my hon. Friend pointed out, that the greater part of the expenditure on such care services occurs in the last six weeks of life. Unless the population is bound to expand in some unrecognisable way, the basic costs involved will remain broadly the same.
The hon. Member for Wythenshawe and Sale, East (Mr. Goggins) said that, over time, the original estimate would, in cash terms, reach a sum six times that estimated by the royal commission. Of course it would. Sums increase as time goes on and inflation makes figures rise, but the estimate will remain broadly stable as a proportion of gross domestic product. The idea that there is a
The Government say that they have introduced a comprehensive package of intermediate care and that, somehow, it is an alternative because in this world it is possible to do only one thing or the other--it is not possible to do both, nor should one have the ambition to do so. Let me make it perfectly clear that the Liberal Democrats support the new priority that the Government want to give to intermediate care. We welcomed that on the day that it was announced and we have welcomed it in the House since.
The hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Health Committee, was right to say that we do not want hon. Members to get into the cul-de-sac of thinking that all care has to be residential. The more intermediate, short-term care and longer-term care that we can offer to enable people to be cared for in their own homes, the better that will be for everybody concerned and for society as a whole. We welcome the Government's intermediate care package. We recognise, however, that free personal care involves expenditure over and above that. It certainly does not involve the original £1 billion that the royal commission estimated.
If one was to proceed on that basis, one would be assuming that the free nursing care that the Government are introducing would achieve nothing and that the intermediate care package itself would achieve nothing. Yet the Government's own brief about intermediate care specifies that one of their objectives is to reduce the number of people going into long-term residential care. The Government are clearly confident that that will succeed, and so are we. The cost of introducing a policy of free personal care falls as a result.