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Dan Norris: Exactly how much will it cost for the additional strategy that the Liberal Democrats propose? How will they raise the money, given that one of their proposals is to have a higher rate of income tax for people earning more than £100,000 a year? I calculate that that has been spent 11 times over, given what the hon. Member for Sutton and Cheam (Mr. Burstow) has said. Putting that to one side, how much will the proposal cost the taxpayer?
Mr. Harvey: If one starts with the original royal commission estimate and nets out of that what will be spent on nursing care, taking account of the extent to which intermediate care will relieve some of the pressure on that, the cost will be about £750 million a year. The hon. Gentleman refers to our separate policy of putting a 50p tax rate on incomes above £100,000. Let me point out that that would raise £3.5 billion in a year. He may have counted the money as being spent 11 times over, but even at that rate it can be spent almost five times over and it will pay for a great deal more than that. Nevertheless, I thank the hon. Gentleman for his question.
Both the Minister and the hon. Member for Stockport (Ms Coffey) made some spurious arguments to the effect that it is impossible to draw up a definition of personal care. That is simply not true. The royal commission report had a good stab at doing so. As the hon. Member for Wakefield said, it used as its basic principle the fact that
the person being cared for had to be touched. If hon. Members think that that sounds vague, they should look at the report, which lists exactly what would be provided.I am not saying that a trouble-free list can be drawn up, but it is nonsense to say that a definition cannot be made. Equally, it is nonsense to say that a distinction between nursing care and personal care cannot be made. That does not mean that no difficulties arise. In practice, it will prove very difficult. As my hon. Friend the Member for Sutton and Cheam stressed in his speech, where the Government choose to draw the lines in establishing that definition is not what the royal commission had in mind in its report.
All those involved in this sector, including the Royal College of Nursing and the British Medical Association, in an announcement that it made yesterday, have arrived at the same conclusion: that the Government have opted for a mean and narrow definition. It is based not on the tasks that will be carried out or on the condition of the patient but, bizarrely, on who will carry out the care. It is a most unsatisfactory definition, which will cause many difficulties in practice. However, it is a definition, which proves that a definition can be made.
The Minister made a completely ludicrous point about the activities of the London borough of Sutton in the middle of the Thatcher regime. For goodness sake, a council trying to run its services in the middle of the Thatcher regime when some 85 per cent. of its budget was determined for it by the Government--[Interruption.] As if problems were not bad enough, Lady Olga Maitland was the local Member of Parliament. The Minister cannot suggest that the Liberal Democrats, in proposing an election manifesto, would try to do exactly the same as we did in the 1980s in the London borough of Sutton when Mrs. Thatcher was controlling the budget. The two are not remotely comparable. In any sane country, an organisation as big as a London borough would determine its own policies and raise its own taxes to pay for them. However, Britain does not work like that; everything has to be spoon fed from above. Matters have improved slightly over the years, but not an awful lot.
While we are on the subject of local government finance, the Minister was right to ask the Conservative party whether it would match Government spending on social services. It is worth taking a moment to look at what the Government are doing with social services funding. This year, all social services departments have budgets above the standard spending assessment. Despite that, as of last week they were collectively overspent by £205 million. The settlement for next year will be insufficient to cover repayment of the debt and to cope with the increased demand on social services.
The Government have estimated that their new four-year plan to end bed blocking will cost £900,000. Much of that will have to be paid for out of social services budgets, and no extra is provided for it in this year's budget. Therefore, there is a great gap, so the Conservatives should be able at least to match the Government's proposals. The hon. Member for Meriden (Mrs. Spelman) said that the whole thing comes down to funding. She was right when she said that there is a big hole, but she contrived to dig an even bigger hole and jumped into it. She said that the solution to the funding hole was not provided by the Government's proposals or by the Liberal Democrats' suggestion, because that would "disincentivise" people from making provision on their own account. When we sat on the edge of our seats
waiting to hear her solution, there came absolutely nothing. We were told that the Conservative proposal would appear in due course, and we would have to contain ourselves.It was all too much--or rather too little--for the hon. Member for Buckingham, who fled into the night. The hon. Member for Teignbridge (Mr. Nicholls) is made of stouter stuff. He told us what he thinks the policy should be. It was remarkably similar to the Liberal Democrat policy that we have enunciated this evening. It will be interesting to see whether, come the election, he stands on the Conservative or the Liberal Democrat policy.
Mr. Nicholls: I would not want the hon. Gentleman to go round the west country claiming that he and I are allies. If I came to a similar conclusion, it was because mine was based on principle.
Mr. Harvey: I thought that the bulk of the hon. Gentleman's rather intemperate remarks about the Liberal Democrats were based on the fact that his majority over the Liberal Democrat candidate at the last election was all of 281.
The hon. Member for Stockport irresponsibly set alarms bells ringing by suggesting that Liberal Democrats were arguing for the removal of existing attendance allowances. That is certainly not part of our policy, and it is not how we would propose to pay for these provisions.
The hon. Member for Teignbridge said that his argument was born out of principle. The royal commission went into this matter in great detail, and explored the principles involved. It considered the practical implications and the costings, and plotted those forward over a period of time. It made a recommendation, which we have supported consistently, and I welcome the fact that the hon. Gentleman does so, too. I listened to a couple of interventions from the hon. Member for Macclesfield (Mr. Winterton), and I got the impression that he also supported that recommendation as an issue of principle.
Liberal Democrats have argued this case in England and in Scotland because it is right in principle. It is completely unjust for someone suffering from a long-term, chronic condition, such as dementia or Parkinson's disease, who is in need of personal help with bathing, dressing, their toilet and other necessities, to have to pay for those services. By any common-sense, layman's definition such chronic conditions would ordinarily be viewed as a health problem. All those who have paid national insurance contributions have believed that they have been buying care from the cradle to the grave. It is an injustice and it is wrong in principle that they should be penalised and asked to pay for personal care.
I welcome the commitments made by the British Medical Association. It believes that the Government's definition of nursing care is too limited. Dr. Dearden, the chairman of its community care committee, said:
- "We are pressing politicians to make changes to the Bill so that free care includes personal care as well as nursing care. If someone is unable to wash themselves, use the bathroom or get dressed on their own because of their medical condition, we believe help with these basic things should be free of charge. If individuals have to pay for this increased level of personal care it is akin to a tax on being sick. This goes against the ethos of the NHS."
9.45 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): This has been, mostly, a thoughtful and well-informed debate, and I congratulate those who have taken part. It has been a debate about the challenges we face, and the choices we have to make.
It is clear that we live in an ageing society. Many more people live longer: that is to be welcomed, but the challenge we face is to ensure that our health and social services meet the needs of older people. Older people want to lead healthy and independent lives; they do not want to be in institutions. As a Government, we need to find a fair way of funding long-term care that strikes the right balance--between what the state should provide and fund and what should be the responsibility of the individual, and ensuring that the money, when it is spent, provides better care.
The status quo was clearly unacceptable. We needed to expand services for the care of older people, we needed to make major new investment in those services and we needed to redesign services. We are doing just that. We are providing extra funds--an additional £900 million by 2003-04--for intermediate care and new services, and a further £360 million year on year to finance nursing care costs. We are thinking about expansion and redesign. That is why we have developed national service frameworks for older people, that is why we established the National Care Standards Commission and that is why we are developing intermediate care.
The hon. Member for Sutton and Cheam (Mr. Burstow) rightly described the previous system as discredited and unfair, but I could not agree with much that he said subsequently, other than his expressed desire for a fair and sustainable system. I certainly do not agree with his analysis of the solution. Essentially, he said that he supported everything the Government were doing but wanted more. In a sense I would have been surprised if he had not said that, but it would have been helpful had he recognised that some considerable advances are being made.
I am still deeply puzzled by the contribution of the hon. Member for Meriden (Mrs. Spelman). She described the problem as a big black hole around which we were trying to navigate, and I sense that many of us are trying to navigate around a big black hole following her speech. In fact, she probably fell into the black hole, and we all know what happens when someone disappears into one: it is difficult to get out.
Not the least of the hon. Lady's problems is her continued refusal to clarify the Opposition's policy. She said that she wanted to clarify what her colleague the hon. Member for Woodspring (Dr. Fox) had said about personal care. The hon. Gentleman, however, gave no such confirmation. He said:
- "I welcome the Government's decision to make all nursing care free".--[Official Report, 10 January 2001; Vol. 360, c. 1100.]
The hon. Lady offered no solution, other than saying, "We support what the Government are doing, until we come up with our own comprehensive policy." That is a policy that we were promised as long ago as December 1999, but we still have not heard anything. We wait with bated breath, but, given that social services are such a
vital component, it would be helpful if, for a start, we could hear whether the Opposition will match NHS and social services funding.
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