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Lord Hunt of Kings Heath: In a sense we are having another Second Reading debate. I shall try to be brief in my response because in essence the Government's answer is the same as that given at Second Reading and in the debate initiated by my noble friend Lord Ashley a few weeks ago.

Of course, we are determined to ensure that we do everything we can to improve health and social care for older people. That is why the NHS Plan set out how we would invest £1 billion a year in new services for older people by 2003-04 and a further £360 million in easing the personal costs faced by people entering long-term residential care.

This is a substantial investment of public money. It is also a major step forward in terms of fairness, equity and better care. Clearly, the Government have had to face difficult decisions on where to spend that additional resource. In rejecting, as we have done, the Royal Commission's recommendation on personal care we have taken a deliberate decision to spend the resources available to us on improving the quality and range of services provided for older people and those with disabilities with particular emphasis on services which will help those older people regain as much independence as possible--services which will support them in their own homes, and services tailored to their individual needs.

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As noble Lords well know, personal care is currently provided on a means-tested basis. As the noble Baroness, Lady Barker, pointed out, that means that seven out of 10 people in residential accommodation receive free some or all of their personal care. I understand the point she made. Nevertheless, it is a fact that is often lost in debate on these issues.

It is also wrong to ignore the other changes we are making which I believe are substantial improvements: raising the capital limits at which people become eligible for the means test; and disregarding the value of a person's home for the first three months in residential accommodation which will mean that the moderately well off will have more of their care paid for from the public purse.

I agree with the noble Lord, Lord Rix, that it is a question of cost and priorities. Making personal care free, I believe, would in effect lock in place the inadequate services which older people currently receive. Not one extra person would be helped to stay in his or her own home, or to receive a piece of equipment which would transform their ability to cope at home. The services would not be extended so that more people could benefit from a greater range of better services.

It is a difficult choice but I believe that the Government are right to choose to invest those available resources in changing fundamentally the way that our care system supports older people. I believe that investment in personal care would very much inhibit that.

The noble Baroness, Lady Barker, frequently cast doubt on intermediate care. She asked for transparency. I believe that we have been transparent about our aim: to spend £900 million by the year 2003-04; and, as part of that programme, to enable us to have 5,000 extra intermediate care beds, and 1,700 supported care places enabling around 150,000 more people a year to regain their independence or avoid going into hospital--services which would be provided free. We have a target for the NHS of 1,500 more intermediate care beds in 2001-02 compared with 1999-2000, with an extra 60,000 then receiving intermediate care services.

Health authorities are also planning to provide intermediate care services for an additional 42,000 people in the coming year. We already have examples of imaginative schemes being put into place. They include short-term programmes of intensive therapy and rehabilitation in a residential setting such as a community hospital to enable people to regain the physical functioning and confidence to return safely to their own home. My noble friend Lord Morris may be interested to know that the schemes involve not just nurses, but physiotherapists, occupational therapists, speech and language therapists and members of other professions allied to medicine helping patients regain or maximise their ability for independent living. There are also hospital at home schemes, which provide intensive support in the patient's home and avoid the need for admission to hospital.

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I could quote many examples of schemes that are helping people regain their independence and maintain it for as long as possible. We will build on that, because we are committed to improving services for older people. The National Service Framework for Older People will include setting standards for care. All older people, including those with dementia, can expect improved services.

I listened with great interest to the noble Lord, Lord Clement-Jones. I do not remember him saying anything about money. Although the noble Lord, Lord Beaumont, postulated that the Liberal Democrats had carefully costed their proposals, I have my doubts. If we add up all the Liberal Democrat spending commitments that have been announced in the past few days, it is very difficult to square them with proposals to raise income tax by 1p. It would have been helpful if the noble Lord had come to the debate with some concept of how those extra resources could be raised.

In conclusion on the key debate, we believe that investing in the new, improved services is the right choice. It would be wrong to ignore the extraordinary advance that is being made by ending the anomaly that only people in nursing homes can be charged for the care that they receive from a registered nurse. That care would be free through the NHS in any other setting. That will help 35,000 people at any one time who currently have to pay for their nursing care. They could save up to £5,000 a year during a stay in a nursing home.

I suspect that we shall debate the definition of nursing care at some length in Committee. All that I would say at this stage is that through the definition that we have used in the Bill the Government are simply seeking to create a level playing field. That definition most closely resembles the extra care that a person would expect to receive in a nursing home as opposed to residential care. Of course we shall come back to that.

On the point raised by the noble Baroness, Lady Masham, there are always risks involved in listing the functions of nurses and care assistants or picking a particular illness or the issues that a person is suffering from and asking that question. The appropriate person to carry out that task will depend on the clinical assessment. In a sense, that is entirely consistent with the Bill's proposal on the role of registered nurses in nursing homes.

I was delighted that my noble friend Lord Morris referred to the role of professions supplementary or allied to medicine. I strongly agree that it is not simply an issue of doctors and nurses. The NHS Plan makes it abundantly clear that we see an important role for all the professions involved in wider health care. I have already mentioned the intermediate care role played by many therapists and professionals. I shall be happy to meet with the Society of Chiropodists and Podiatrists to discuss the issues further, particularly the point that he raised about Feet First.

The NHS has a duty to provide healthcare to any member of the public as reasonably required. If the NHS has assessed a health need, residents of care

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homes should already receive NHS services direct from the NHS in the same way as any of us would receive services from a GP, a physiotherapist or other members of the health professions under the responsibility of the National Health Service.

This is a straight issue of priorities. I think that the Government have taken the right decision. It has been a difficult decision, but I am convinced that the change in relation to nursing care provided by a registered nurse, other changes that we have made on the disregard and the massive spending on intermediate care are the best use of the additional resources that we have made available and will achieve much more for the people of this country than simply bowing to the altar of free personal care.

6.30 p.m.

Lord Rix: May I ask the Minister a question for clarification? Let us consider the case of someone who has invested £100,000 in a pension fund and is receiving that pension and their old age pension, but they live in rented accommodation and have £2,000 in their current account and no other liquid assets. How would the £18,500 disregard be calculated in that case?

Lord Hunt of Kings Heath: My assumption is that the calculation is based on the income that is received rather than a grossed up pension, which I think the noble Lord is referring to. I shall write to him if I have got that wrong.

Lord Clement-Jones: I thank the Minister for his reply. I greatly value the support of a number of noble Lords for Amendments Nos. 1 and 260, particularly those on the Cross Benches. I hope that the points made in the debate have helped to overcome the qualms of the noble Baroness, Lady Carnegy, on whether we should be debating the issue at this time of day. I hope that she will join us when we are engaged in happy debate at 2 a.m. on the definition of nursing care.

Baroness Carnegy of Lour: My objection is that any party could table such a clause at any time and include a later clause in the same grouping so that we discussed a clause out of order. If we did that all the time, we should make a tossed green salad of the Order Paper. That is my only point.

Lord Clement-Jones: I hear what the noble Baroness says, but paving amendments are well known and well established as a device for having debate at points convenient to the House.

I shall not run through the contrary arguments to the points put by some noble Lords. The noble Lord, Lord Lipsey, rehearsed a number of arguments that he has used before, including the doomsday scenario on cost and the constitutional case, which the noble Lord, Lord Beaumont, dealt with successfully. If we were never able to override the Commons on a matter of cost, there would be very few things that we could debate without being in fear and trepidation of the

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Treasury. The timetable for debate is largely controlled by the Government. The debate in the Commons was truncated by a new procedure in Committee. Only this House will be able to debate the issues in a proper fashion.

I do not normally accuse the noble Lord, Lord Lipsey, of polemic, but he almost suggested that the Royal Commission was not serious in its conclusions. I found the Royal Commission extremely serious in its conclusions. It determined the priorities and did an extremely effective job; but, of course, the noble Lord, Lord Lipsey, was a dissentient. I do not believe that it can be concluded from the report that Sir Stewart Sutherland thought that money grew on trees. That is a rather dismissive way of considering the report. As regards Sir Stewart's intentions in terms of his party allegiance, we shall no doubt have many happy discussions about that in the future.

The noble Baroness, Lady Ashton, made a much more serious intervention in terms of priorities, and a number of her points need to be answered. If "nursing care" is defined in the same way as the Government have defined it, there are major anomalies because healthcare assistants are not included in that definition. I believe that our proposals will help elderly people at home. They will allow them greater independence.

The Minister's point that our proposals provide no further assistance to older people is totally incorrect. I believe that the provision of free personal care, particularly in a domiciliary setting, will have a major impact on older people. The Minister said that not one extra person would be enabled to stay in his or her own home; that is not the case. We need to ground our case in the preventative value, which we believe is extremely substantial, of having free personal care available.

I accept the Minister's case on intermediate care. As my noble friend Lady Barker said, it is still insufficiently clear exactly what it constitutes or how it will be delivered. But the Government have chosen to use it as their flagship, on which they are spending £900 million. That is a priority that they have set themselves. We have decided to set ourselves an additional priority. We do not decry intermediate care and rehabilitation and everything that goes with it--it is very important--but personal care is also a high priority.

Finally, I cannot expect the Minister to conduct his research into our alternative budget, published only two weeks ago, or to read the very clear statement in it about how we would pay for personal care out of a 50 per cent tax rate on those earning over £100,000, or about the cost, which we estimate will be £750 million per year in the early stages. However, I do not believe that we should be accused of having failed to consider the cost and the tax-raising implications of personal care. We realise that it amounts to a massive commitment, not lightly undertaken. The importance of the issue is one of the reasons that we thought it right to hold this debate in prime time in this Chamber.

I do not believe that the Government's proposals create a level playing field. On the contrary, they create an extremely rutted pitch. The personal care which we

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envisage would level that playing field and deliver the outcome that the Minister believes his commitment to nursing care would deliver. This is a very important issue, especially for all the organisations that have contacted us over the months since the Royal Commission reported its conclusions. There is a huge sense of disappointment in the country about the Government's proposals.

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