Health and Social Care Bill

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Mr. Hutton: This has been a full and comprehensive debate, and I pay tribute to all Members who have spoken. There is disagreement on the matter—that is clear—but no one should question anyone's motives, or the compassion and concern that Members on both sides rightly feel about improving the health and well-being of older people in our society. We have a disagreement about the best way to do that. We have made no secret of our view on such matters, including the choices and priorities that any Government have a responsibility to address as they respond to important issues affecting the future of our society.

We all know that we are living in an ageing society. Before too long, all of us in this Committee—some sooner than others—will have to address those issues in our own lives. We have set out a principled, well-argued case for going down a different road from that suggested by the royal commission. The royal commission did a great deal of important work, and we are grateful to all of its members. However, we have a different way forward. I shall say more on that in a moment.

I want to do two things in responding to this wide-ranging debate. First, I want to address the issues of principle raised by Conservative and Liberal Democrat Members. Secondly, I want to deal with the particular issues raised in the amendments discussed this afternoon.

It strikes me, however, that one thing has been missing from this debate. The debate has followed a traditional line—within two minutes, we were all in our bunkers, firing from our fixed position—and there was no discussion of the wider responsibilities of the NHS in funding continuing long-term health care. About 10 per cent. of residents of nursing homes in England currently have all of their care costs—including personal care and accommodation costs—met by the NHS. According to the guidelines, those people need to be under the supervision of a consultant, specialist nurse or other member of the NHS multidisciplinary care team. The NHS therefore has responsibilities to fund personal and nursing care, as well as long-term care costs, which we discharge currently. I accept, in the light of the Coughlan judgment last year, that there is a need for the national health service to look carefully at continuing health care guidelines, and we are doing that. We shall introduce revised guidelines when that work is completed.

However, there has been a falseness about some of the argument today. Nursing care and personal care have been polarised. The attack from Liberal Democrat Members in particular was that the NHS should have a wider responsibility to meet all the care costs associated with those in long-term residential care, whose needs, in the widest sense, are broadly comparable to those in hospital receiving health care. We completely lost sight of that group of people in today's debate. They were lost sight of in yesterday's debate, too. The issue has been presented starkly and slightly inaccurately to suggest that the NHS has no existing responsibilities for meeting personal care costs, and that the solution proposed by the Liberal Democrats would introduce for the first time an NHS responsibility to meet the personal care costs of people in long-term residential care. That is not so, for reasons that I have outlined: 10 per cent. of those in nursing care currently have all of their costs, including personal care costs, met in full by the state.

It was argued yesterday and again today—the Liberal Democrat view—that the Government should try to provide a solution that will treat the person who is in long-term residential care in as broadly similar a way as possible as a person who is in hospital. In fact, the continuing care guidelines address that issue. I accept that there is an argument about those guidelines in the light of the Coughlan judgment. As I said, we are considering the issues carefully.

The other issue that it is important to address—Conservative and Liberal Democrat Members have made great play about the definition of nursing care under the clause—is the accusation that we have somehow not acted on or taken into account the recommendations of the royal commission in relation to nursing care. The suggestion is that we have chosen a different definition of nursing care than that proposed by the royal commission. I think that the hon. Member for Sutton and Cheam said yesterday that we had done so in the meanest and narrowest way possible. I absolutely refute that allegation. I do so not from the rhetorical position of a Minister who is bound to say that anyway, but on the basis of what the royal commission proposed. In that respect, I pointed out many paragraphs of the royal commission's report to the hon. Gentleman during our debate on the Floor of the House yesterday. I challenge him to find in the royal commission's report a definition of nursing care that includes care provided by a health care assistant. He will have plenty of time over the next hour or so in which to do so, and he can come back and tell us where it is.

Paragraph 6.22 of the royal commission's report states:

    ``At present, if a person receives nursing care—that is care which involves the knowledge or skills of a qualified nurse, either in a nursing home or a home which is registered to provide both nursing and residential care—he or she has to pay for the nursing care as part of the home's fees''.

It is clear to what that refers—care provided by a registered nurse. When other parts go on to deal with the anomalies of the system, it is clear that they are referring to registered nurse care. The only definition that appears in the royal commission's report was that proposed in the minority report, which again referred to the skills of the qualified nurse.

We have tried to take those issues into account, as well as the anomaly and injustice that the royal commission rightly identified, and which others before it recognised too, that it is wrong for people in a residential care setting to have to pay for the services of a registered or qualified nurse when they would not have to pay for those services in any other care setting. Our definition is wider, not narrower, and goes beyond the definition proposed in the minority report by the two commissioners who signed it, in that it provides a more expansive definition of what nursing care involves.

Mr. Hammond: I put it to the Minister that the expression

    ``care using the knowledge and skills of a qualified nurse''

could embrace a health care assistant operating under the supervision of and with power delegated by a registered nurse, a circumstance that is, regrettably, probably more common than we would like, but which recognises the reality of the manpower problem that the nursing profession faces.

Mr. Hutton: I can only tell the hon. Gentleman that we have tried to take into account the royal commission's clearly expressed anxieties about the injustice of people in a care setting paying for the services of a qualified nurse. That is the anomaly that was identified. It is that anomaly that the costings and estimates produced by a good friend of mine, Chai Patel, and by others for the royal commission tried to quantify and deal with.

It is unfair for the Liberal Democrats to suggest that the Government's solution is the least that we could have done. I reject that absolutely. We have tried to consider the issue in the light of the royal commission's recommendations, and we have acted on what we understand to be its anxieties and those of others about the problem.

I reject the argument that the hon. Gentleman has advanced. He said last night that he thought that the Bill was a mean response from the Government. It is not. We genuinely want to remove the anomaly in the charging arrangements, and we are doing so. It was clear from what he said last night that he does not have a word to say about the Bill being a good step forward, because he does not believe that it is. He nods his head; he does not believe that the Bill is a sensible way to proceed. I believe that he is fundamentally wrong. If he is so opposed to the Bill, I assume that he will vote against the clause, which will make free nursing care available to residents in England for the first time. I look forward to seeing how he will vote on the matter.

In clause 48, we have not pushed to one side the royal commission's recommendations but have taken them into account. We have also provided a clear definition of what we are providing and the certainty that the hon. Member for Runnymede and Weybridge, and perhaps the Liberal Democrats, have requested in relation to the definitions.

It is important to provide absolutely clear definitions and a clear boundary in relation to who pays for what under the arrangements. The alternative is not one that any of us would want to embrace—confusion, uncertainty and a lack of clarity about who has responsibility for funding which element of a person's long-term care.

With the greatest respect, none of the amendments, including that tabled by my hon. Friend the Member for Lancaster and Wyre, would provide what Opposition Members have requested, which is greater clarity, certainty and precision in the definitions. For that reason, among others, I shall be asking my hon. Friends not to support them.

Mr. Hammond: Does the Minister accept that, because of differences in the labour market for nurses in different parts of the country, he is in danger of creating a postcode lottery in which the amount of care that is eligible under his proposals will vary from place to place and be determined by whether it is possible to recruit and employ registered nurses to undertake tasks that may otherwise have to be done by health care assistants?

Mr. Hutton: No, I do not accept that. The hon. Gentleman is the architect in his party of the postcode lottery of care.

Mr. Hammond: The Minister is reinforcing it.

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