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Sandra Gidley: I dare say there are countless other examples, but today's debate is not about that. [Interruption.] The Tories say, "Let's not bother." That is because they know that the record does not stand up to scrutiny.

Despite the words of the Government's amendment, they are in no position to rest on their laurels. Before the 1997 election, they promised to set up a royal commission to consider long-term care for the elderly. To give them their due, in December 1997, soon after the election, the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson) said:

"As people approach old age, many become anxious about how they will be looked after, how much it will cost and who will pay. At the general election, we promised that we would establish a royal commission to work out a fair system of funding long-term care for the elderly."

He announced the commission and proudly trumpeted:

"The new Government are keeping yet another of their election promises."

He described the terms of reference and said that the commission had 12 months in which to report. He continued:

"The task of this royal commission is neither simple nor easy, but it is important. The present situation cannot go on much longer. People are entitled to security and dignity in their old age"—

I seem to have heard those words in the past few minutes—

"so we must find a way in which to fund long-term care which is fair and affordable both for the individual and for the taxpayer. With the independent advice of the royal commission, I hope that we shall be able to establish a consensus from which we can fashion a sustainable system of long-term care that will meet the needs of elderly people well into the new century."—[Official Report, 4 December 1997; Vol. 302, c. 489–90.]

At the time, the Conservative's big idea was to fund long-term care through an insurance scheme. The royal commission readily dismissed it. However, the Government, having established the royal commission with their usual fanfare, decided to ignore one of its key findings, which was:

"Personal Care should be available after an assessment, according to need and paid for out of general taxation."

The Government's response to that recommendation was to declare that they were making unprecedented new investment in older people's services, which would more than fund the cost of the royal commission's proposals. However, they subsequently stated:

"The Government does not believe that making personal care universally free was the best use of these resources."

In some ways, I can accept that, but I have heard some worrying rhetoric today. For example, it has been asked, "Shouldn't the rich pay?" The fact is that it is not the rich but people on modest savings who pay. They still have to sell their houses and break into their savings to provide funding in a way that they never expected to have to do. I believe that the Government would admit that that is unfair to many people.

Dr. Ladyman: Seven out of 10 people already get some help with the cost of their personal care. Those who still

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live in their home do not have to have the value of it taken into account when their contribution to personal care is being assessed. The hon. Lady is talking about making personal care free to the better-off. If we had another £1 billion or so, which would be necessary to do that, could she honestly say that it would be better to give the money to people who already have resources than to spend it on enabling more and more people to stay in their homes for longer?

Sandra Gidley: The Minister is merely reinforcing the inverse snobbery that is so prevalent in the Government. Seven out of 10 people may receive some help, but the other three out of 10 are not necessarily wealthy. We shall shortly have the same debate on tuition fees.

What is the point of setting up a royal commission if its advice is to be so roundly ignored? The Government will probably claim that they accepted the bulk of its recommendations, and that it would be wrong to place too much emphasis on this particular one. It might therefore be useful to turn to the statement made by the royal commission on long-term care, which was published in September 2003 and whose purpose was to review the extent to which the long-standing problems in long-term care and its funding had been resolved since the commission reported. The statement points out that the debate about long-term care and its funding is very much alive, that little has been resolved, that Governments in most of the UK still decline to act, and that there is widespread concern. That is the view of the commissioners. The statement also reminds us that this is an important issue not only for older people and their families but for the wider public.

The statement was damning, and highlighted other areas in which the Government's response had been disappointing. The first related to the setting up of a national care commission. The Government will point out that they have set up the National Care Standards Commission, but the remit of that body is much narrower than that envisaged by the royal commission, as its role is merely regulatory and falls far short of the wide-ranging role proposed by the royal commission. The reality is that the establishment of the new Commission for Social Care Inspection will result in a further erosion of the principles originally envisaged by the royal commission.

Ms Munn: My vision is that increasing numbers of elderly people will not need to go into long-term residential care and that they will be able to stay at home, sometimes at a greater cost than would be incurred by their going into a nursing home. How will anything that the hon. Lady is describing help to achieve that goal?

Sandra Gidley: I cannot argue with the hon. Lady's long-term vision, but if she will wait for me to develop my argument, she will see that, while her vision is worthy, it is not being fulfilled by the Government or the party that she supports.

Chris Grayling: The hon. Lady has talked extensively about the recommendations of the royal commission. Has she made an estimate of the proportion of a typical nursing home fee of £500 a week that is taken up by

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personal care, and that she is arguing should be funded? What proportion of such a typical fee does she believe should be paid for?

Sandra Gidley: I am sorry that I do not have detailed figures; I only have the overall costs. I do not know if the hon. Gentleman is referring to our manifesto pledge, but I can assure him that it is fully costed.

The bulk of the report consisted of condemnation of the Government's refusal to adopt free personal care for the elderly. Tempting as it is to concentrate on that aspect of policy, however, it is not the only issue in this very crowded field, and I want to spend a little time examining the Government's record. It is difficult to argue with the assertion that people would prefer to stay at home. Many people would agree with that, but is it actually happening? Is that what the Government are achieving?

It is difficult to get to the bottom of this issue. The latest figures show that, in 2001–02, some 1.4 million people were helped to live independently at home through the provision of a variety of community-based social services. This was an improvement on the 2000–01 figure. A response to a parliamentary question revealed that no figures were available for the years prior to 2000–01. Strangely, however, I came across some figures provided to the Health Committee in the public expenditure memorandum of 2001, which showed that an estimated 1.5 million service users were then receiving community-based care. The reality is, therefore, that 100,000 fewer people are now receiving such care. As the hon. Member for West Chelmsford (Mr. Burns) pointed out, that seems completely contrary to what the Government are trying to suggest.

Although more money is being provided, it is reaching a smaller number of people. I have noted the carefully worded ministerial replies that refer to intensive home care packages. Those have increased, but a definition of "intensive" has been difficult to obtain. The reality is that the number of households generally receiving any sort of care has been reduced. I cannot square that with helping more people to stay at home. Many cases can be cited from around the country in which an older person who lives at home needs a small adaptation but cannot get it until they fall over, end up in hospital and social services come to the rescue. It seems that the system is skewed and is reactive rather than proactive.

The Minister said earlier that people can have home improvements, but in many cases those will take six months to happen, and those six months can be six months of misery. A constituent of mine told me about her husband whose situation meant that they had to have a downstairs toilet. In the interim before it was built, the only way in which they could cope was to have a commode in the main downstairs room. This lady felt that she could not invite any friends home. Is the Minister happy to preside over a situation in which people must wait months to receive the help and care that can help them get on with their lives? I think not. He will surely admit, however, that his priorities are skewed.

We should move on from the question mark over the figures, because that is a relatively small matter. What is of paramount importance is whether people who receive

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domiciliary care packages are receiving the service that they require and that they deserve. A report called "Nothing Personal" by Help the Aged, highlighted certain worrying findings. It found that levels of care often fell short of the hopes and expectations of those interviewed, and staffing pressures meant that the number of care hours that could be provided often met only the bare minimum of needs and sometimes did not adequately cover that. There was a particular problem with low-level users, unreliability and poor time-keeping of care staff left users in substandard living conditions and sometimes even in danger, and a common complaint was that management allowed workers insufficient time to travel between appointments so that they often arrived 10 to 20 minutes later than expected. That problem was exacerbated when users did not receive a single carer regularly, especially if the user's residence was remote or difficult to find. The report also found that the quality of care varied significantly within authorities, some agency workers simply could not cope with the tasks that they were asked to perform, care was particularly unpredictable at bank holidays, and all too often users were let down, especially by agency staff. Some Members will have watched the chilling "Panorama" programme that covered the same subject area. Evidence from Age Concern seems to indicate that that programme did not have to try hard to obtain material and that, sadly, the situations portrayed are commonplace.

I do not want a glib response from the Government saying that the matter is in hand and that all will be well because the National Care Standards Commission now has responsibility for this important area. In theory that is right, because the commission theoretically took over responsibility in April last year. All domiciliary care agencies operating before 1 April last year should have registered by 31 March, and any agencies wanting to set up after that date had to be legally registered before they could begin providing care—[Interruption.] I do not know what the hon. Member for South Dorset (Jim Knight) finds so amusing, but perhaps his constituents can enlighten him as to the reality of some of what I am talking about—[Interruption.] I apologise if he was actually coughing, but I am not sure about that.

The Government made arrangements so that existing domiciliary care agencies can continue operating until their application is determined—granted or refused—and no inspections would take place in the first year. At first glance, that is all very sensible. I draw the House's attention, however, to the reply to a parliamentary question that was tabled on 1 December last year but only answered on 5 January. It asked how many domiciliary care providers have, first, applied for, and secondly, met, the registration standards. The answer was interesting, because although as of 30 November 4,322 domiciliary care providers had applied for registration, only 3,155 of those had been validated and were being processed—which sounds a little vague. Only 243 domiciliary care providers, however, had met the registration standard. That gives rise to the following questions. How many had not met the registration standard? An answer to that would be very useful, and if I do not get one I shall table a parliamentary question

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immediately after this debate. How many had been approved, but have significant action plans in place? And why is it all taking so long?

This morning, I rang the commission, but it could not tell me how many domiciliary care providers had failed the assessments. I hope that the Minister has that information at her fingertips when she sums up. I also searched the commission's website to try to establish the date by which all applications must be processed. The search proved fruitless, but when the question was put directly to commission staff, I was told, "There is no date." I am sure that the Government will admit that this endless procedure is completely unacceptable. Can the Minister explain why no date has been set, and what plans there are to rectify the situation?

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