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Lord Hunt of Kings Heath: My Lords, my understanding is that Scotland has committed itself to a review of existing policies without prejudging the outcome. I have enormous respect for my noble friend; however, the Government believe that their proposals represent a better targeting of resources. Three-quarters of those in residential nursing care already get some or all of their personal care costs from public funds. To make personal care free for everyone would carry high and increasing cost without in itself improving services, and it would consume many of the additional resources that we are making available to people through the NHS Plan, including the important provision of intermediate care.
Lord Astor of Hever: My Lords, as 760 nursing and residential care homes closed last year with the loss of 15,000 beds, does the Minister agree with the chairman of the Nursing Home Association that if the trend continues there will not be any nursing care homes left in three years' time?
Lord Hunt of Kings Heath: My Lords, I do not agree with that assessment. I understand that in some parts of the country a number of nursing homes have come under financial pressure. I also accept that there was a drop in the number of nursing home and residential home care beds between 1998 and 1999, but the picture is very mixed throughout the country. Between 1995 and 1999 there was a net increase in nursing home beds. Laing and Buisson, the consultants who observe the private health care sector, consider that there is still excess capacity in the residential care and nursing home sector in many parts of the country.
Baroness Greengross: My Lords, will the Minister agree that there is enormous anxiety among elderly and disabled people and their families and carers because the Government have not clearly defined what is meant by "personal care"? We know that some care which is delegated, supervised or authorised by nurses will be paid for. But that just increases the anxiety. We must now have clarification.
The Lord Privy Seal (Baroness Jay of Paddington): My Lords, as we have only reached 25 minutes, there is probably enough time for everyone to get in. Perhaps the noble Baroness next, and then my noble friend.
Baroness Knight of Collingtree: My Lords, will the Minister reassure the House that there will not be elderly and disabled people in need of care but unable to get it for reasons of funding or anything else?
Lord Hunt of Kings Heath: My Lords, that is the intent of the policy in relation to long-term care that we announced in the NHS Plan. We want to ensure that people get the right support, not just in nursing residential care homes but also in the community and in rehabilitation programmes. We want to see the development of intermediate care in order to promote independence through active recovery and rehabilitation. We will spend an extra £900 million by 2003 to 2004. We are making strides. I believe we can do more in the future.
Lord Morris of Manchester: My Lords, the House is indebted to my noble friend Lord Ashley for raising this timely and very important question. Can my noble friend the Minister say what work has been done on quantifying and costing to the National Health Service the effects of the inequity of present arrangements? How many NHS beds are now being taken up by people who would be more appropriately cared for in other accommodation if the inequity was removed?
Lord Hunt of Kings Heath: My Lords, it is not possible to answer all those specific questions. The latest statistics show that just under 6,000 people over the age of 75 had their discharge from hospital delayed in the second quarter. Some of that delay was because of issues in relation to social services funding and some was due to people waiting for an appropriate residential care or nursing home place. The sooner we can implement intermediate care to enable people who are unnecessarily awaiting discharge in hospital beds, the better we can provide services to those people through rehabilitation, wherever that is possible, or, if not, in an appropriate nursing home. The quicker we deal with
Baroness Barker: My Lords, will the Minister confirm that if an older person at home receives a change of dressing for an ulcer from a district nurse, that is free, but that the same person in a residential home receiving the same treatment from someone who is not a nurse will have to pay? Does he agree therefore that when such anomalies exist the Government's claim in the NHS Plan that any contribution people will have to make towards the cost of their care will be fair, predictable and related to their ability to pay is in severe doubt?
Lord Hunt of Kings Heath: My Lords, I do not follow the noble Baroness. My understanding is that, for instance, district nursing services will be available in a residential home provided by the National Health Service. In relation to a registered nursing home, the proposals we are making will ensure that nursing care provided by a registered nurse will be available and paid for by the National Health Service.
Moved, That the Commons message of 16th November be now considered; and that the promoters of the Bill have leave to suspend any further proceedings thereon in order to proceed with it, if they think fit, in the next Session of Parliament, provided that notice of their intention to do so is lodged in the Office of the Clerk of the Parliaments not later than 12 noon on Monday 27th November;
That the Bill be deposited in the Office of the Clerk of the Parliaments not later than noon on the second sitting day in the next Session with a declaration annexed, signed by the agent, stating that the Bill is the same in every respect as the Bill at the last stage of the proceedings thereon in this House in the present Session;
That the proceedings on the Bill in the next Session of Parliament be pro forma in regard to every stage through which the Bill has passed in the present Session, and that no new fees be charged to such stages;
That the Private Business Standing Orders apply to the Bill in the next Session only in regard to any stage through which the Bill has not passed in the present Session.--(The Chairman of Committees.)
The noble Lord said: My Lords, Amendment No. 56A takes us back to an issue which caused some concern in Committee and on which I am not sure we reached an entirely satisfactory resolution. It arises from the all-encompassing definition of "accounting unit" contained in Clause 24(11)(a) of the Bill. As a result of that, every constituency association in the country, no matter how small or weak, will be swept up into the provisions of the Bill. With that will come a burden of compliance and bureaucracy backed by criminal sanctions.
The strategic objectives of the Bill are twin-track: first, to restore public confidence by achieving a higher degree of financial disclosure and transparency; and, secondly, to reinvigorate the democratic process by encouraging people to become involved in the political process, particularly at local level. Both those objectives are worthy. One has to support them. But I believe that objective one, the financial transparency and disclosure, is triumphing over objective two, the reinvigoration of local democracy. I am sure that the Minister is keen to preserve local democracy. His replies to points raised in the debate indicate that. Therefore, I wonder why we have this imbalance. In part, it is because there has been a degree of regulatory capture and a desire by officials to make sure that the whole Bill is bullet-proof and boiler-plated. They whisper in the Minister's ear words such as "loopholes" and "after effects unforeseen", and they may indicate to the Minister that that will reflect less than favourably on him when the Bill comes into force.
However, that means that at present there is no one--because by their very nature officials are goalkeepers rather than scorers--to whisper with equal force in the Minister's other ear about the other strategic objective which is equally important; that is, the maintenance of local democracy. Therefore, the amendment is designed to provide that whisper or perhaps even a gentle shout in the Minister's other ear.
There is very little evidence of financial abuse at constituency level. The practical reason for that is that most constituencies in most parties are struggling to find people to participate and to find money to make ends meet. There are occasional problems relating to petty cash, but I know of no example of a constituency problem that has had a national impact. The Minister may have examples, in which case I should be grateful to hear them.
I consider it to be of critical importance that the major political parties maintain a comprehensive national network of constituency associations. It is part of the fabric of our democracy. Choice is essential and choice is made the more apparent if each of the major parties is able to preserve associations in this way. That means that parties have to maintain associations in bad--I mean "bad" in political terms and in no other sense--political areas as well as in good ones. In previous debates I have referred to the Cotswolds/Stoke-on-Trent problem; namely, that being a member of the Labour Party in the Cotswolds or a member of the Conservative Party in Stoke-on-Trent Central can be a bed of thorns. It is perhaps an unenviable task to be a member of such an association where the chance of political success is quite low.
The weight of regulation and potential legal sanction contained in the Bill will fall equally heavily on every association--the small ones as well as the large ones. I cannot help thinking that this may well be the straw that breaks the camel's back. My amendment is designed to exempt constituency associations which have an annual certified income of less than £5,000. They will still be part of the national party, and the national party will be responsible for their behaviour. As in the past, they will still have to meet all the provisions of electoral law when they put forward candidates. But the national party can provide for such associations an administrative umbrella under which they can shelter, thus eliminating a burden of bureaucracy and compliance which they will otherwise face.
I have two final points. First, my amendment specifies that the accounts should be certified. Certification is a concept defined by the Institute of Chartered Accountants. It is not as onerous as completing audited accounts but I am convinced that there should be some independent third party verification.
Secondly, why have I put the figure at £5,000? In the Bill, £5,000 is generally accepted as a level at which individuals should undergo a degree of identification as donors and supporters. Therefore, there is a symmetry with local associations, which are treated in the same way. If an individual who donates £5,000 or more has to be identified but does not have to be identified in the same way if the donation is below that figure, why should that not also apply to local associations?
The Minister may be tempted to say that what is proposed in the amendment, if accepted, will be open to abuse. I have to accept that, technically, there could be some abuse. However, even if one takes a
Lord Mackay of Ardbrecknish: My Lords, I have nothing to add to the remarks of my noble friend Lord Hodgson other than to support them. My noble friend has had a distinguished career on the voluntary wing of the Conservative Party and probably speaks for the volunteers in all the parties in the Chamber. Like my noble friend, I believe that those who struggle in seats where they know they will never have a chance of winning are perhaps the bravest of the foot soldiers in all our parties. At least the people who are struggling in seats which they believe they might win know that one day they may have a chance of victory. Perhaps on other days there will be a chance of defeat, but at least the occasional victory keeps them going. The people who struggle for our parties in the poorest seats deserve special consideration. Like my noble friend, I wonder whether applying to them all the bureaucracy of the Bill is a fair way for Parliament to recognise their efforts on behalf of the democratic process.
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