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Lord Taverne: My Lords, it is hard to find anything in the announcement to criticise. The commission has a
wide remit. It has good names. It includes studying the question of long-term care for young people. It is to co-operate with other inquiries. I have just one question for the Minister. Will she assure us that it is not just the funding of long-term care at which the Royal Commission will look, but how that care is to be provided and the kind of care that will be most effective?
Baroness Jay of Paddington: My Lords, I am grateful to the noble Earl and the noble Lord for their welcome for the Royal Commission, and, in particular, the chairmanship and membership. I shall respond briefly to the noble Earl on how this matter is to be looked at in the context of earlier proposals, specifically the partnership proposals of the previous government. We made clear early on that we did not intend to go ahead with that scheme: in our view, it was a partial solution designed to help relatively few people. I have no doubt that that might be one of the elements thought to be worth considering by Sir Stewart and his colleagues. I imagine that it will come on to their agenda.
On the more general point as to whether the Royal Commission is, in a sense, kicking into touch some of the earlier proposals and acting merely as a delaying exercise to make it possible to postpone some of the choices and decisions between previous and current suggestions about social insurance and other possible ways of funding long-term care, I reinforce the point that the Royal Commission does not have the luxury of a leisurely timetable. It has a clear and practical remit and the requirement to report in about a year.
The Government have already said that they will respond quickly to the commission's findings and take its recommendations seriously. A prompt report from the commission will allow legislation within the lifetime of this Parliament should that be considered necessary. In response to both the noble Earl and the noble Lord, I reinforce that all is on the table. Various schemes have been proposed in the past by the previous government and other distinguished experts. Part of the remit involved in having these individual contributors to the discussion take a fresh look is to assess those proposals further, both in the context of the demographic needs to which the noble Earl referred and the Government's comprehensive spending review and pension review.
The point made by the noble Lord about the type of care as well as the financing of the care is important. It is a valuable point to re-emphasise. The commission will look at types of residential care, types of care through which people are supported in their own homes, and the kind of care that can be provided by a mixture of funding and within the context of individual contributions and state contributions. There is no pre-assumption about the nature of the care which will be provided. As I said when repeating the Statement, our primary concern is to ensure that people can expect both dignity and security as they get older.
4.56 p.m.
Lord Clark of Kempston: My Lords, I welcome the setting up of the Royal Commission, providing that it
reports within 12 months, and the fact that the Minister said that long-term savings must be given every encouragement. Will she explain the logic behind raiding pension funds for the elderly by £5 billion a year, cancelling health care insurance for the elderly, and, finally, yesterday making TESSAs and PEPs less attractive than they were under the previous government?
Baroness Jay of Paddington: My Lords, I say, as the noble Lord would expect, that we have taken the position that those provisions which we have introduced are in the interests of the many and not the few. The ISA scheme which the Government have now proposed is designed to extend the ability to save to those people who we feel will be most vulnerable and in most need of protection as they get older.
Baroness Pitkeathley: My Lords, I too welcome the Statement. There are two main reasons. First, payment for long-term care, as everyone in your Lordships' House will be aware, is currently a mess. Secondly, it affects every man, woman, and indeed, child in this country. I welcome also the establishment of a reference group, particularly with its emphasis on consulting users and carers. Does my noble friend agree that it is vital that any proposal made for changes to funding for long-term care must command the support of the whole nation, as did the original proposals in the 1940s? I welcome the news that the commission will be out and about. Will my noble friend give an assurance that the commission's decisions and recommendations will also be put out to the widest possible consultation before final decisions are implemented?
Baroness Jay of Paddington: My Lords, I am grateful to my noble friend, especially because I know that the organisation which she leads (the Carers' National Association) has been approached to be part of the reference group, and, I believe, has accepted. That is a useful beginning towards establishing an authoritative group of people on the reference group. Of course the point she makes about the need to establish a consensus around whatever proposals are made is well taken.
My honourable friend, Mr. Boateng, the Minister with direct policy responsibility for this area in the Department of Health, has talked elegantly about the need to achieve consensus across the generations before any proposed plans are accepted. On the point of consultation, once the Royal Commission has reported, I am sure that there will be a period for consultation, but I am mindful of the points made by noble Lords about not building in enormous delay. There is, as always, a tension between consultation and action, but I am sure that that will be resolved.
Baroness Thomas of Walliswood: My Lords, obviously I have not had time to read the full document in the Library, so may I ask whether the terms of reference will enable the Royal Commission to look at the interface in terms of care between social services and the health service and, in particular, services such as physiotherapy which are available only to the health
service and which can help to extend elderly people's physical ability to move? Will the Government also bear in mind the importance of preventive care, which has a wider role to play? Finally, will the wider target group include people from the Councils for Voluntary Service which have long experience of co-ordinating various agencies in order to solve problems?
Baroness Jay of Paddington: My Lords, I have the exact terms of reference in front of me. I realise that the noble Baroness has not had the opportunity to read them in the Library. The specific point about physiotherapy is not made, but I would feel that it is encompassed in the term which refers to looking at the strengths and weaknesses of the current arrangements. The one thing that is clear about the delivery of care in the community is the so-called "Berlin Wall" between health and social services. That could be demonstrated to be a weakness of the current arrangements to which I am sure attention will be drawn. With regard to the specific membership of the reference group, the organisation to which the noble Baroness referred does not appear in the list that I have before me, but that does not necessarily mean that it is not included. I believe that the list simply records those who have already been approached.
Lord Borrie: My Lords, when repeating the Statement, I noted the phrase--I believe that I quote it correctly--that the Royal Commission will "have regard to the Government's review of pensions". Does that mean that if the pensions review results in a compulsory element of contribution for the second pension, it will not be appropriate for people to be compulsorily required to contribute towards their possible need for long-term care in old age? If I may phrase the question slightly differently: do Her Majesty's Government agree that there are fewer arguments for compulsion for long-term care contributions because the risk of need for care is less obvious than the risk of need for a pension from the age of 60?
Baroness Jay of Paddington: My Lords, I suspect that my noble friend is asking me to pre-judge some of the intellectual discussions which will undoubtedly form the meat of Sir Stewart's inquiry. My noble friend has put his finger on an important point. At the moment all I can say is that we clearly understand the direct relationship between the Royal Commission and the pensions review. There are obvious links to ensure coherence between the different aspects of the reviews of government policy in terms of the pensions review, a wider look at the welfare state as a whole, and the Royal Commission. As a government we need to ensure that those different groups, all of which are considering the same problem but from slightly different angles, produce a coherent policy in the end.
Lord Swinfen: My Lords, will the Royal Commission consider the position of the dependants of the person who needs long-term care? So often, the cost of such care is so great that it puts the dependants into a serious and difficult financial position which can at
times have detrimental effects on those dependants' health and, as a result, can cost the National Health Service a considerable amount of money.
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