|Health and Social Care Bill
Dr. Brand: I am slightly confused by the term exploited. The Liberal Democrats in Scotland, and indeed in Wales, are using the powers bestowed on them by the electorate to meet our commitment to that electorate.
Mr. Hammond: I was referring to the Liberal Democrats in England who are exploiting what is going on in Scotland for their own purposesand I am not necessarily criticising that. I am simply observing what is going on. It is obvious to us all that there has been pressure from Westminster on the Scottish Labour party to fall into line with what the Government are proposing. Ministers face a real dilemma. If Labour Ministers in London dictate the Scottish agenda, then devolution will be shown to be a sham. However, if the Scottish people are to receive materially different levels of benefit from the state, that presents a different problem for the Government. It raises a different question. The question that it raises in my mind is for how long the people of England and Wales will accept such a solution, because the arrangements for financing the block grant to Scotland have always been based on the assumption that there is a need to make fiscal transfers between regions of the United Kingdomand now between different countriesin order to address different levels of economic deprivation. In other words, it is a a balancing exercise. People will view that in one light. However, when they see fiscal transfers being made and taxes being set in one country in order to transfer public funding to another country, not to make up for economic deprivation or to balance the situation, but to ensure that people in one country can enjoy a higher standard of public services than people in another countryI suspect that there will be some backlash and some questioning as to whether that is an appropriate way to proceed.
Let me remind members of the Committee of the context in which the debate about devolution and personal and nursing care expenditure is conducted. Health service spending per capita is 20 per cent. higher in Scotland than in England. I have repeated that figure ad nauseam, because it alarms me. It explains why it is affordable in Edinburgh to take some of the actions that the Scottish Executive are considering, and that the Liberal Democrats are pressing them to take. If we had 20 per cent. higher health spending per capita in England, there would be all sorts of options.
Mr. Burstow: Several hours ago, the hon. Member for Runnymede and Weybridge (Mr. Hammond) raised some points about the operation of the Barnett formula. He has tried to bring the subject into a debate that is narrowly drawn around devolution to Wales. Will he set his remarks in the context of the position that his colleagues in the Scottish Parliament have taken, and say whether he has come to the same conclusion as them and favours the implementation of the royal commission's proposals?
The Chairman: Order. It would be useful for me to make it clear that it is possible to debate what has happened in Scotland in the context of the clause. However, if it is debated on this group of amendments, I cannot reasonably allow it to be debated on the next group as well. I am being fairly tolerant in allowing a debate on it now.
Mr. Hammond: I am grateful for that guidance, Mr. Maxton. I carefully considered the structure of the Bill and the amendments to it, and felt that, since the England-Scotland issue could hardly be avoided in our debate, this group of amendments was probably the best one on which to discuss it. Indeed, the hon. Member for Sutton and Cheam mentioned Scotland when he introduced his remarks.
I appreciate the fact that the hon. Gentleman's intervention was mooted some time before he made it, but I think that I have answered his question. I said that the NHS spending per capita in Scotland was 20 per cent. higher than in England. Scottish Ministers, and his and my Scottish colleagues, have a much larger fund to dispose of. If there were no resource restrictions, everyone would like to see the maximum extension of care provision. No one suggests that there is some reason in principle why a narrower definition of what will be provided free of charge is better than a broader one. The issue relates to the opportunity costs of doing so, and the priorities to be set by the Government or parties that have any prospect of being in government.
Mr. Burstow: I am interested in the hon. Gentleman's comments. He seems to have got into the same JCB digger as the hon. Member for Meriden (Mrs. Spelman) when she dug a hole for her party in last night's debate on the issue. On his analysis of the opportunity costs involved, does his party have no commitment to finding additional resources for England, and so rules out the extension to free personal carers, as defined by the royal commission?
Mr. Hammond: The hon. Gentleman obviously hopes that I will wriggle around the issue, but I will not. I was hoping to talk about it in the next debate, but I shall bluntly tell him our view now. With the limited resources available in England, and considering the priorities for health resource spending, we agree with the Government that there are better ways of spending that limited sum on the elderly who would benefit from the change that he proposes.
I will tell the hon. Gentleman later where we disagree with the Government. I do not seek to have my cake and eat it. The line dividing the Committee will change as our debate continues. The difference between the positions that the official Opposition and the Government have to take, and the position that the hon. Member for Sutton and Cheam has the luxury of adopting is the likelihood of the policies advocated being put into effect. It is easy for the hon. Gentleman to tick off a wish list of things that he would like to do, such as to link pensions to earnings or make all personal care free, but he does not have to say how he will raise the resources to do so. He has not told us where he will make cuts in order to deliver his party's wish list.
It is not part of my responsibility to do the Minister's dirty work for him, yet I am standing here doing what I was accused of this morningmaking the case that the Minister will inevitably have to make against the amendments. I hope that I have answered the hon. Gentleman's basic question, but we need to take the matter further in the next debate.
Dr. Brand: I am grateful to the hon. Gentleman for that clarification. Would he clarify another matter, which is to do with resources and devolved governance? Does he suggest that the Barnett formula should be abandoned so that the Scots would not be in a position to have a more favourable package?
Mr. Hammond: It is self-evident that if it becomes obvious to elderly people in England that they have access to a lower level of publicly funded services than elderly people in Scotland, questions will be asked and there will be a groundswell of opinion against that inequity. I have said before that most people accept the principle that, within our United Kingdom, money needs to be moved around to help even out some of the inequities and differences in economic prosperity between the various regions. However, if money is being taken away from taxpayers in one area in order to fund a gold-plated service in another area, questions will be asked.
That goes to the heart of our fundamental concerns about the devolution settlement. If the Government are successful in their objective of keeping the lid on it so that we have devolution in name but not in practice, with similar policies being arrived at by different Parliaments that are essentially seamless, there may not be a problem. However, as soon as we arrive at distinct policies that deliver different services to the different peoples of the United Kingdom, we shall start to see the tensions that we have always predicted would result from the devolution settlement.
Mr. Burstow: I am grateful to the hon. Gentleman for giving way; it might mean that we shall not have to revisit the subject in later amendments. The hon. Gentleman seems to be arguing that people will look across the border to Scotland, envious of what will be thought a better service, but he also subscribes to the Government's view that the policy in Scotland will not result in a better service. He seems to be arguing two entirely different points.
Mr. Hammond: No. The hon. Gentleman must remember the context in which the debate is being conducted in Scotland by his hon. Friends, by my hon. Friends and by Labour Members. Scotland has 20 per cent. per capita more to spend on health, so options are open there that are not available to us in England. It is in that context that the hon. Gentleman needs to view those matters.
The announcements made by the Scottish Executive have, in my view, been rather unclearperhaps deliberately so. I would hate to be ungenerous, but it has not slipped my notice that a general election is in the offing, and it may not be entirely inconvenient to the Government if the Scottish Executive's proposals for Scotland remained woolly for the next couple of months. However, I hope that the Minister will agree with me about the dangers of public reaction in England if there is a clear difference between the two countries in the standard and level of service provided. Can the Minister tell us something about how he sees this issue playing out over the next couple of months, in the context of what he is now proposing in this Bill for England, what the hon. Member for Sutton and Cheam is proposing for Wales, and what his own colleagues in Scotland are proposing for Scotland?
I am sure that we will want to deal with some of the wider issues, although not in relation Scotland, when we discuss the next group of amendments.
Mr. Hutton: May I return the Committee's attention to amendment No. 279 and new clause 11 tabled by the hon. Member for Isle of Wight (Dr. Brand)? Amendment No. 279 would restrict the impact of the clause to England, whereas new clause 11 would give the National Assembly for Wales the power to make an order removing all local authority responsibility for long-term care, except those aspects that relate to board and lodging and residential care. The hon. Gentleman may be concerned about who pays for nursing care and personal care, but sadly his amendment does not say who should provide or resource that aspect of care.
The national health service does not currently have any responsibility to provide such care except when a patient's needs are predominantly for health care, and personal care is incidental to that. The amendment does nothing to impose any duty on the national health service, or on any other agency, to plug what would otherwise be a very substantial hole in community care services in Wales. I accept the point that the hon. Gentleman was making, and I assume that it is more of a probing amendment than a substantial one. None the less, it is worth pointing out that his proposals would leave thousands of people in Wales with no one responsible for funding their personal and nursing care costs. I am sure that that is the last thing he has in mind, but that is what would result from his amendment.
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