Health and Social Care Bill

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Mr. Hutton: The hon. Gentleman would say that, wouldn't he?

Mr. Burns: It is the right answer.

Mr. Hutton: Unfortunately, it is not the right answer. The present Government are committed to that level of spending on social services, which will sustain the increased investment in social care services for older people. We have made that commitment, and we will honour it.

Mr. Burns: The Minister says that the Government will honour the total spending. How can the Government realistically give such a commitment if so much of that spending is dependent on what local government may spend in future. No one, not even local authorities, knows what will be spent next year, the year after next or beyond.

Mr. Hutton: The hon. Gentleman has obviously forgotten a lot about such matters since he left Government.

Mr. Burns: Why?

Mr. Hutton: I really do not know why he has forgotten. That is for the hon. Gentleman to explain. The Government are making available those resources for social services spending, and that money will sustain the investment in new health and social care services for older people.

Dr. Brand: We will fund it.

Mr. Hutton: Of course, the Liberal Democrats promise to fund everything from that same penny on income tax. If they ever have the chance to do so, we will watch with interest how that money is recycled around the system. The hon. Gentleman is welcome to be my accountant if he thinks he can spend so much extra money from the same source.

The hon. Member for Runnymede and Weybridge was ducking and diving when I asked him whether an incoming Conservative Government would meet our commitment to invest in social services. The hon. Gentleman whines on about a social services standards vetting system, but that is not the point. We have made it clear that we will make the money available for social services. Would he do the same?

Mr. Hammond: How does the Minister propose to make that money available for social services? Although I do not claim to be an expert on local government funding, my understanding is that about a quarter of it is in the form of ring-fenced grants from his Department and the remainder is part of local authority funding. Local authorities must decide their own priorities in respect of education, social services and so on. Admittedly, they have strong guidance from Government policy announcements, but the money is not ring-fenced. If I am wrong, perhaps the Minister will correct me. Will he also acknowledge that local authorities in aggregate are spending in excess of the SSA for social services?

Mr. Hutton: With great respect, the hon. Gentleman is missing the point. Of course he is right to say that local authorities decide how to use the money. However, he is refusing to be drawn upon my other point. I have given him three opportunities to confirm whether the Conservative party, if it were elected, would make available the equivalent level of resources.

Mr. Hammond: For social services?

Mr. Hutton: Yes. Will he make that level of resources available to local government? We are waiting for the answer. Unless his answer is a clear yes, we are entitled to conclude that he will not make such a commitment.

Mr. Hammond: With the greatest of respect to the Minister, it is no good him trying to read into the record something that is not there. As he well knows, he is asking a question to which there is no answer, because the money that is allocated to local government, whether it comes from RSG or from locally raised resources, is not ring-fenced for specific purposes. The Minister can chunter on—to use his expression—all he likes about SSA for social services. Local authorities see the money available to them as a single pot, from which they will set their own priorities. Neither he nor I can predict what local authorities will spend on social services.

8.30 pm

Mr. Hutton: I wonder why, if that is the case, the hon. Gentleman and his hon. Friends have committed themselves to matching our spending on education. It strikes me that the hon. Gentleman's fox has been shot. I leave others to draw the appropriate conclusions. He knows that he is in a difficult position.

The Chairman: Order. I quite enjoyed that, and it will make good television in the run-up to the election, but it does not have a great deal to do with the amendment.

Mr. Hutton: It is a great pleasure to have my wrist slapped by you, Mr. Maxton. That, too, may be a subject for another sort of debate. I am sure that you are right—it will make good television in the election, because we want to make it clear to people that, like previous Conservative Governments, the Opposition would hit social services spending. We know from our experience that, as night follows day, those who are least well off would suffer the most from the return of Conservative rule.

I am happy to move on from that issue, because we have explored it fully. I would like to return to the principle behind the amendments, and deal with the various points that have arisen. Each amendment seeks to widen the definition of the care that the clause prohibits local councils from providing. Although many of the amendments are not explicit about who should take on the responsibility of providing the care, the implication is that the NHS should do so and that the care should be provided free to users.

The Government have chosen to spend the available resources on improving the quality and the range of services provided for older people and people with disabilities. Those services will help people regain as much independence as possible, will support them in their own homes. They are tailored to people's needs, not to those of the organisations that provide them. Personal care is currently provided on a means-tested basis, which means that seven out of 10 people in residential accommodation receive all or some of their personal care free.

We are making other changes, such as raising the capital limits at which people become eligible for the means test, and disregarding the value of the person's home for the first three months of residential accommodation. The moderately well off will have more of their care paid for from the public purse. We agreed that we should end the anomaly that only people in nursing homes could be charged for the care that they received from a registered nurse, which would be free through the NHS in any other setting. That is the purpose of clause 48.

It would cost more than £1 billion a year to make personal care free to everyone in every setting—a large investment that I am not convinced would do anything to improve front-line health and social care services. The cost would rise steeply in future years. Nobody would receive a better service. That proposal would lock in place the existing, inadequate services that older people currently receive. Not one extra person would be helped to stay in his or her home or to receive a piece of equipment that would transform his or her ability to cope at home. The services would not be extended so that more people could benefit from a greater range of better services.

I accept that there is a difficult choice for our society, but we have chosen to invest the available resources in fundamentally changing the way in which our care system supports older people. It may be difficult for the Liberal Democrats to grasp this point, but given that we cannot spend the same money twice, investing in free personal care would happen at the expense of our objectives for a better range of improved services. We chose investment in new intermediate care services, which will help 130,000 people a year to regain their independence or avoid going into hospital for essential care. Investing in home care services and equipment will help 50,000 more people remain independent in their homes, and investing in new carers respite services will benefit 75,000 carers and those for whom they care. The Government believe that those are the right choices.

I want to turn briefly to some of the amendments that have been discussed tonight, particularly amendment No. 309. Many of the amendments seek to enlarge the range of services that councils cannot provide but without imposing a duty on any other body. The NHS, as I mentioned earlier, can and does provide services ancillary to NHS services under its continuing care responsibilities, when there is a need for high-level health and nursing care. As the hon. Gentleman will be aware, the NHS is not obliged to provide that support in settings when there is no need for those higher levels of NHS care.

Amendment No. 287 seeks to add to the care that cannot be provided by a local council so that a council cannot provide care for certain illnesses or conditions. Why should a diagnosis make the difference to the way in which people with identical care needs are treated? I do not understand the logic behind that.

Amendment No. 288, tabled by my hon. Friend the Member for Lancaster and Wyre, would extend the care that councils cannot provide to those with certain conditions beyond the care provided by a registered nurse. I hope that I have already dealt with the difficulties of deciding which organisations can provide care based on diagnoses. I do not think that that is a sensible way for us to proceed.

Amendments No. 307 and 309 add

    ``any services usually or routinely of a type provided by a registered nurse''

to the definition of nursing care. I have to ask what that means. A nurse is not defined by the tasks that she or he performs, but by skills and expertise. She may take someone to the toilet, not because no one else could help that person to the toilet, but because, while doing that task, she might be able to monitor the person's mobility, communication or continence, and to make judgments about the care that that person needs. In our definition of nursing care by a registered nurse, those things would be included. But taking someone to the toilet would not come under the definition of services include in the amendment, which would mean that some services could not be provided by local councils to people in residential homes or their own homes.

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Prepared 6 February 2001