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Baroness Hayman: My Lords, the noble Lord is correct in his analysis of that Royal Commission report is a clear statement that we should not regard the fact that people are living longer as an enormous problem but should ensure that they do so in security and in good health. It is a matter in which each of us has a personal
interest. In that context, the idea of a demographic time bomb is a rather gloomy metaphor. We are almost getting back to the half empty or half full glass which appealed to the noble Lord, Lord Clement-Jones.I am sorry that there was a degree of disappointment inherent in the comment of the noble Lord, Lord Laming, that it is a complex area and that there are no simple solutions. The Government do not distance themselves from the analysis that it is a complex area, and they do not suggest that there are simple solutions. That is very much inherent in what was said by the Royal Commission. It is evidenced by the fact that there was a note of dissent; not all the commissioners agreed. That does not mean that we cannot make progress. It does not mean that we cannot, or would not wish to, go forward with greater clarity about the government position. But it suggests that we would be well advised to have a wider public debate on which to bring forward a consensus as to the best way forward.
Baroness Pitkeathley: My Lords, I wish to thank the Royal Commission, in particular for the open way in which it was able to engage with those organisations which represent elderly people and their carers. That was extremely valuable.
The Statement says that only one in five people will need any form of residential care. Does the Minister agree that nonetheless it is an issue that concerns every family in this country? Therefore the importance of the debate cannot be over-emphasised. Nor should we be too gloomy about the opportunity to reach consensus because it is a concern of so many people.
Does the Minister also agree with me that although some of the issues are complex we must bear in mind the need for openness and clarity in transmitting the decisions which the Government finally make? The real issue which has caused distress over the years is confusion about what is and what is not available. Will the Government consider phasing in the proposals if they are not able to accept them all in one fell swoop?
Baroness Hayman: My Lords, the Government would have to consider carefully the acceptability or otherwise of individual conclusions and the timing of implementation. The commission looks at possibilities of phasing in, recognising the very substantial costs involved.
I accept my noble friend's analysis. Although the figure is only one in five people, no-one knows which one out of the five it will be. It could be any of us or any family. That means that it is a matter of concern to everyone. That is why the Royal Commission recognised it as a community responsibility and in its analysis considered the need to share that risk more widely among the community as a whole.
I agree with my noble friend that more transparency is needed. Uncertainty has added to people's difficulty. There have been obvious inequities between people in different circumstances which have little to do with their
underlying need for assistance. In any response we would aim to provide a more equitable system to those who need it.
Baroness O'Cathain: My Lords, first, what is the Government's reaction to the proposal by the Royal Commission to set up a national care commission? If they agree to it, will it replace the Government's own proposal to set up regional care commissions? Will all the commissions proposed help those who are currently under great stress attempting to fund the high costs of residential care?
Secondly, I wish to bring to the attention of the Minister the fact that it is not necessarily the people in long-term care who have to fund it, but their relatives. Is there any chance that tax relief can be given to those relatives bearing in mind that other European Union countries have that relief? Good long-term care can cost something like £45,000 upwards in pre-tax income. The noble Lord, Lord Clement-Jones, asked the Minister to approach the Chancellor to take action in next week's Budget. Realistically that is not possible. But if the noble Baroness were to do so, perhaps she would consider adding my humble suggestion to the noble Lord's good suggestion.
Thirdly, and finally, will the Government allocate time for a debate on the report of the Royal Commission in this House? That could be part of a wide consultation process.
Baroness Hayman: My Lords, as the noble Baroness knows, allocation of time is a matter for the usual channels in your Lordships' House. But I am sure they will pay attention to her comments. As regards suggestions made on taxation policy, I am sure that my right honourable friend the Chancellor of the Exchequer reads Lords Hansard daily. I shall ensure that the suggestions made are drawn to his attention.
The noble Baroness will understand from what I said that we do not have an instant response to the commission's proposal for a national care commission. As suggested, it would be wide ranging, dealing with complaints, trends and projections, advising on standards of care and training and professional issues. For example, it would require primary legislation. We need to look at it, as I think she suggested, against our commitment to the new national training organisation, the general social care council and the regional care commissions. We would have to assess it against those proposals which were already in the pipeline.
Baroness Turner of Camden: My Lords, I, too, thank my noble friend for presenting the Statement. It is interesting, and I hope that we shall have an opportunity for further debate. Is my noble friend aware--I am sure she is--that the provision of long-term residential care in the past few years has become a highly profitable business? In the London area it will often cost between £400 and £500 a week to provide long-term residential care. If the taxpayer is to pick up a portion of those costs, steps will have to be taken to ensure that we are receiving value for money for that expenditure. Is there
to be any arrangement, and which organisation would be responsible, for monitoring such care to ensure that value is obtained for the money expended?
Baroness Hayman: My Lords, my noble friend has a long-standing interest in these areas. She is right to point out that we are talking about large sums of money. It is important that we consider value for money and the effectiveness of care provided. Various suggestions are made about that. The commissions for care standards will be studying the issue across the board. The Royal Commission suggests detailed provision, in particular in terms of the national care commission, for considering those areas. Perhaps I may write to my noble friend on the details.
Baroness of Thomas of Walliswood: My Lords, as one whose family has had to cope with the matter for a number of years, I agree on the importance of the issue. I recognise, as do many, the importance of the issue for every family in the country.
I was concerned by an opinion which the Minister in the Statement attributed to the commission's report. It suggested that increased expenditure on nursing care for the elderly would not necessarily bring with it a better quality of care. I contest that opinion. One of the difficulties which is faced by relatives whose elderly parent is in care is not knowing who to turn to for correct advice. If a qualified nurse monitored, for example, the level of medicaments prescribed to a patient over a period of time, which is not easy for untrained staff, the results might be not only a better quality of prescription but also a lowering of cost. If the National Health Service had a requirement to consider the need for long-term expenditure on healthcare for the elderly it might be better motivated to intervene at an earlier stage. How does the noble Baroness respond to those comments?
Baroness Hayman: My Lords, I agree with the main points which the noble Baroness makes. Issues such as prescribing policies within nursing homes are of great concern. Some of the commission's suggestions--for example, a national care commission looking at just such issues--would improve quality and might cut costs.
The noble Baroness may have taken from the Statement a comment which was made not in relation to supporting nursing costs and improving nursing quality, but the commission's opinion that if taxpayers' money is used to alleviate the present means test and to relieve the cost to individuals, that money cannot be used to improve the quality of care across the board. That may be an issue of higher priority to elderly people or to the community as a whole. That contrary distinction was being made and not the issue of whether money should be put into improving nursing care.
Lord Peston: My Lords, it is difficult for us to comment on the details of what may be an important Royal Commission report because we do not have copies. However, there are comments in the Statement which are puzzling, to put it mildly. For instance,
I cannot remotely work out how the figure of one in five can be calculated. Essentially, if people live long enough it is 100 per cent. I cannot see how it can be anything other than that if people live long enough.I have a problem in that when we were in opposition our attitude seemed to be slightly different. It was that for the first time a whole generation who had won the Second World War for us experienced full employment and overwhelmingly acquired some assets--notably, their houses--but were suddenly told by the government of noble Lords opposite that because they lived so long, partly due to the NHS, they must use those assets to finance their long-term care. When I was looking at the various nails going into the coffin of the previous government I thought that that would be the one which would ensure that they went and would not be re-elected for some time.
I am concerned because I had hoped to hear from my noble friend--I do not wish to rush her because I know that these things take time--that that is not a path we wish to go down with that generation as opposed to younger people who can prepare for the future on a different basis. I did not hear anything in the Statement to indicate that that is so. I must ask my noble friend to accept that some of us on this side of the House find that disturbing. The costs of care are enormous. I had to meet them precisely on the ground that I did not want elderly parents to believe that their few assets would have to be sold. Other people have had the same experience.
I hope that our new Government will not take the course that appears to be indicated--I know that my noble friend would never be a party to that--and will not follow the policies of the previous government. I hope that they will say to the elderly who are approaching the need for care that they will not have to use the assets, which they have acquired because they have been prudent, in order to finance their care.
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