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Lord Rix: My Lords, before the noble Lord sits down, perhaps I may ask one question. Why does he find it so difficult to place those with severe mental impairment in one category and to say that they are not worthy of being deemed as in need of nursing care as opposed to other categories which are perhaps less severe? I refer to people with cognitive impairment caused by, for example, strokes, Alzheimer's, learning disability, dementia or Huntingdon's disease. Surely it would be fairly easy to deem all of those people as being in need of nursing care wherever they may be living and simple to separate them from other categories of disablement.

Lord Hunt of Kings Heath: My Lords, I was trying to make two points. First, when I discussed enabling free nursing care to be provided in nursing homes, I tried to point out that there is consistency of approach between nursing services that are provided in residential care homes, which are currently provided free by the district nursing service, and that provided in people's homes. The Government have decided that there should be complete consistency with regard to the provision of registered nursing care through all of those sectors. Secondly, in the context of today's debate--we shall doubtless discuss this further in another context--if one seeks to establish whether there are categories of people who should be given free personal care, one runs into great difficulties trying to

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distinguish between people with dementia or learning disabilities, for example, and the other care categories that may be involved. That is why I believe that ultimately the right distinction is that between nursing and personal care. That is the Government's approach.

Lord Archer of Sandwell: My Lords, before my noble friend concludes his remarks, and at the risk of being tiresome, does he accept that there is not only a distinction between nursing care and personal care but that other forms of treatment could be involved? Although such forms of treatment are not administered by registered nurses they are nevertheless as much treatment as nursing care.

Lord Hunt of Kings Heath: My Lords, if we are considering treatment, that would be provided by the NHS under the provisions of the National Health Service Act. However, in this context we are concerned not with care that is provided in homes--a primary health need, as that is defined by continuing care criteria--for, in that case, all such care would be funded by the NHS. Rather, we are concerned with the situation in which the need for nursing care is not continuing care but care that is additional to the need for accommodation and personal care. In that context, the Government's proposals involve a consistent approach across nursing home care, residential care and district nursing that is provided to people in their homes.

On Question, Bill read a second time, and committed to a Committee of the Whole House.

        House adjourned at twenty-eight minutes past eleven o'clock.

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