| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Hunt of Kings Heath: My Lords, I believe that I have been consistent throughout our debates. I believe that the definition on the face of the Bill is the right one. It will bring many advantages to many people. It will get rid of the present anomaly and it will allow us to ensure that resources can best be spent on intermediate care. Surely, we should invest our additional resources where there is the potential of helping people to be more independent.
Earl Howe: My Lords, this has been an important debate and one of high quality. I want to thank all noble Lords from all sides of the House who have spoken in support of my amendments. I want also to thank the noble Baroness, Lady Masham, who moved her amendment so well and powerfully.
I am grateful to the noble Lord, Lord Lipsey. He spoke of my amendments as opening the floodgates. I greatly respect his views and he knows that, like the Government, I and my party do not favour the provision of free personal care across the board in nursing homes. I repeat that the purpose of the amendments is not to provide for universal free personal care; they have been carefully worded with a view to avoiding that.
The Minister indicated that it would be difficult if not impossible to draw a line between nursing care and care provided by other support workers. I believe that it is difficult but not impossible. Given that the assessment will govern what is and what is not funded free by the NHS, I confess that I do not see the difficulty in saying that, provided a registered nurse carries out the assessment and is content to accept responsibility for the actions of healthcare assistants to whom she directly delegates that work, the system is fair and tightly controlled.
The Minister may have ignored, or at least passed over, the significance in my amendment of one word. It is the word "and" at the end of subsection (2)(a). I suggest that the definition of nursing should not depend simply on the work that
- "is provided, delegated or supervised by a registered nurse",
Before I go further, perhaps the Minister would be good enough to say whether he agrees with his noble friend Lord Lipsey that in his assessment my amendment as it stands would effectively provide free personal care across the board; and, if so, whether the noble Lord's implied estimate of the order of expense that the amendment would involve is accurate. I must take that fully on board in deciding what to do with the amendment. With the leave of the House, can the noble Lord give any further indication of the cost of my amendment?
Lord Hunt of Kings Heath: My Lords, that rather puts me on the spot. I must be careful about how I respond. I estimate that the cost of the noble Earl's amendment would be £250 million to £300 million. I believe that his amendment would introduce enormous anomalies between nursing homes and residential care homes. Free personal care would be introduced in a nursing home but would not be available in a residential care home. I believe that that is likely to be unsustainable. Therefore, I believe that
his amendment leads to free personal care by the back-door. I cannot speak on behalf of my noble friend, but I believe he suggests that if that logic is followed, one ends up with a large bill for free personal care which one might then have to extend to people's homes as well if one wanted to remove all the inconsistencies.
Earl Howe: My Lords, I am grateful to the Minister, who, I believe, makes an extremely important point. I am not so pigheaded as to believe that the wording of these amendments is necessarily perfect. Both the noble Lord, Lord Lipsey, and the Minister have told me that they do not have the effect that I intend. I do not believe that they are right but I must consider that they may be. I take seriously the Minister's statement that the amendment as worded could lead to people being worse off than they are at present and to gaps in service provision. I also must take seriously that there will be a substantial cost attached to this amendment. It was clear to me that there would be a cost attached to it, but I did not believe that it would be of the order suggested, or anything like it.
However clear I may be in my mind that this is an issue of both fairness and practicality, in this House we have a duty to think carefully before pressing amendments which have a major financial impact. I have no wish to make the Government's life easier in any way, but I speak about the role and functions of this House. I do not, therefore, propose to press the amendment today. Between now and Third Reading I shall consider what the Minister has said and look afresh at the wording of the amendment. I reserve the right to return to the issue at Third Reading. In the meantime, I beg leave to withdraw the amendment.
The Deputy Speaker (The Viscount of Oxfuird): My Lords, is it your Lordships' pleasure that the amendment be withdrawn?
6.53 p.m.
On Question, Whether the said amendment (No. 44) shall be agreed to?
Their Lordships divided: Contents, 38; Not-Contents, 81.
Alderdice, L.
Barker, B. [Teller]
Beaumont of Whitley, L.
Blackwell, L.
Bradshaw, L.
Cumberlege, B.
Darcy de Knayth, B.
Dholakia, L. [Teller]
Falkland, V.
Geraint, L.
Goodhart, L.
Greaves, L.
Greengross, B.
Hamwee, B.
Harris of Richmond, B.
Lucas, L.
McFarlane of Llandaff, B.
Maddock, B.
Masham of Ilton, B.
Methuen, L.
Northover, B.
Oakeshott of Seagrove Bay, L.
Phillips of Sudbury, L.
Razzall, L.
Rennard, L.
Renton, L.
Rodgers of Quarry Bank, L.
Russell, E.
Sharp of Guildford, B.
Skelmersdale, L.
Thomas of Walliswood, B.
Tope, L.
Wallace of Saltaire, L.
Walmsley, B.
Walton of Detchant, L.
Wigoder, L.
Williams of Crosby, B.
Williamson of Horton, L.
Ahmed, L.
Alli, L.
Amos, B.
Archer of Sandwell, L.
Ashton of Upholland, B.
Bach, L.
Bassam of Brighton, L.
Berkeley, L.
Blackstone, B.
Borrie, L.
Brooke of Alverthorpe, L.
Brookman, L.
Burlison, L. [Teller]
Carter, L.
Chandos, V.
Cohen of Pimlico, B.
Crawley, B.
Currie of Marylebone, L.
David, B.
Davies of Coity, L.
Davies of Oldham, L. [Teller]
Dean of Thornton-le-Fylde, B.
Desai, L.
Dormand of Easington, L.
Dubs, L.
Evans of Temple Guiting, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Filkin, L.
Gale, B.
Gibson of Market Rasen, B.
Gilbert, L.
Gladwin of Clee, L.
Goldsmith, L.
Grenfell, L.
Harris of Haringey, L.
Harrison, L.
Hayman, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howells of St. Davids, B.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. (Lord Chancellor)
Jenkins of Putney, L.
Lea of Crondall, L.
Lipsey, L.
Macdonald of Tradeston, L.
McIntosh of Hudnall, B.
Mackenzie of Framwellgate, L.
Mallalieu, B.
Massey of Darwen, B.
Merlyn-Rees, L.
Milner of Leeds, L.
Molloy, L.
Nicol, B.
O'Neill of Bengarve, B.
Patel, L.
Plant of Highfield, L.
Puttnam, L.
Rendell of Babergh, B.
Renwick of Clifton, L.
Rogers of Riverside, L.
Sainsbury of Turville, L.
Sawyer, L.
Scotland of Asthal, B.
Serota, B.
Simon, V.
Smith of Gilmorehill, B.
Stone of Blackheath, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Thornton, B.
Turnberg, L.
Uddin, B.
Warner, L.
Whitaker, B.
Whitty, L.
Wilkins, B.
Williams of Mostyn, L.
Woolmer of Leeds, L.
Resolved in the negative, and amendment disagreed to accordingly.
7.4 p.m.
[Amendments Nos. 45 and 46 not moved.]
Baroness Greengross moved Amendment No. 47:
- After Clause 60, insert the following new clause--
The noble Baroness said: My Lords, I am retabling the amendment because I feel that an important improvement for spouses, which I thought had the support of the Minister and his colleagues in another place, is being lost, partly, it would seem, because of the concerns of other departments of state. I pay tribute to the tenacity of my colleagues at Age Concern and in particular Pauline Thompson who has worked very hard on this issue.
In Committee, because it was so late, I was not able to explain as fully as I should have liked why the amendment is so important. It affects few spouses, but it is important to them. In Committee the Minister in his response said that there is a need to look at the links with similar rules in other government departments. He specifically mentioned that there could be significant implications for public spending with a read across to wider social security issues. I do not believe that to be the case. I shall explain why.
The amendment in no way seeks to remove the liability of spouses to maintain each other, or, even more importantly from the point of view of social security spending, to have any impact on the liability of parents to maintain their children. The DSS will still be able to request payment from spouses to contribute to the expenditure that would otherwise be made by that department in the form of income support. I understand that Age Concern has sought an urgent meeting with the Secretary of State for Social Security to clarify that matter.
The word "maintain" generally in people's minds means the everyday things. Indeed, the Shorter Oxford English Dictionary states that "maintain" means to,
The Minister also talked about situations where the spouse is well off, and said that in those cases the spouse should look to his partner as well as to the state. It is a difficult line to draw. However, I would submit
The kind of cases that Age Concern came across in its research involved spouses who had modest savings, and in some cases were living on savings and, indeed, needed to do so. Perhaps I may give the House one sadly typical example of what can happen. It is the case of a gentleman in his 80s. When his wife was in hospital, he was told that the local authority would meet the funding for her nursing home care. In addition to suffering from Alzheimer's disease, she has had several strokes and a number of other medical conditions. The gentleman cared for his wife for about three years before a further stroke last year meant that he could no longer manage.
The local authority is sending him bills of over £100 per week, saying that he must make a contribution to his wife's care. His son reports that the gentleman is very worried and extremely upset. He is not well off. He has a small amount of capital, but it happens to be above the limit at which his local authority starts charging liable relatives. He has saved this money throughout his long working life and needs it to supplement his basic state pension.
His wife is so ill that he cannot see why her care is not being funded by the NHS. Then, to add insult to injury, he is expected to make a very substantial contribution to her care costs. He is still to all intents and purposes a carer of his wife. He visits her every day for at least three hours without fail, he helps with feeding and he gives her drinks to make sure that she does not become dehydrated. Above all, he talks to her about their life together to make her feel reassured and help to keep her mentally alert; as otherwise she would have very little conversation with anyone.
I should like also to clear up a little confusion in my mind caused by the debate in Committee. It may have been because of the time of night! In his response to the amendment tabled by the noble Lord, Lord Rix, about mandatory disregards for carers, the Minister mentioned that he would issue more guidance to local authorities about how to deal with spouses who care. He specifically mentioned respite care, which of course is anyway a service that should not be charged for carers under the Carers and Disabled Children Act. I would argue--and did so in Committee--that spouses whose partners are in long-term care retain a significant caring role, often at considerable physical and emotional expense to themselves.
It is worth remembering that only 10 per cent of those in residential care even have a spouse at all, so 90 per cent are unaffected by the amendment; and that of that 10 per cent a tiny fraction are pursued by local authorities. Age Concern estimates the number at just 300, with varying amounts from £3 a week to, in one case, more than £400 a week. Can the Minister confirm how much he thinks the amendment would cost local authorities? I think that it will be no more than six figures. Only one-third of local authorities--about 30--even have a policy to pursue liable spouses; therefore, two-thirds do not. Of the one-third that do, only 17 currently seek a contribution from a spouse.
If most local authorities do not even pursue liable spouses, let us stop the few that do go on, as the Minister said in Committee, "fishing expeditions", particularly as it will not cost much--well under £1 million--but will end considerable individual distress for those who are affected. I do not believe that there is a read-across to social security spending and so I hope that the Minister can now accept the amendment. I beg to move.
"LIABILITY OF RELATIVES
(1) The National Assistance Act 1948 (c. 29) shall be amended as follows.
(2) Sections 42 (Liability to maintain wife, husband or children) and 43 (Recovery of cost of assistance from persons liable for maintenance) shall cease to have effect.
(3) In section 48(3) (Duty of councils to provide temporary protection for property of persons admitted to hospital etc) omit the words "or from any person who for the purposes of this Act is liable to maintain him".
(4) In section 51(1) (Failure to maintain) omit the words "or any person whom he is liable to maintain for the purposes of this Act".
(5) In section 56(1) (Legal proceedings) omit the words "other than a sum due under an order made under section 43 of this Act".
(6) In Schedule 6 (Transitional provisions) omit paragraph 19.
(7) The Public Health (Control of Disease) Act 1984 (c. 22) shall be amended as follows.
(8) In section 46(5) (Burial and cremation) omit the words "or from any person who for the purposes of the National Assistance Act 1948 was liable to maintain the deceased person immediately before his death".
(9) The Local Authority Social Services Act 1970 (c. 42) shall be amended as follows.
(10) In Schedule 1 (Enactments Conferring Functions Assigned to Social Services committees) for the words "Sections 43 to 45 in column 1" substitute "Section 45"."
"provide ... with means of subsistence or the necessities of life",
and to keep in clothing. Indeed, when the DSS seeks maintenance payments, that is what the money covers. It is of a different order when the local authorities ask spouses to pay for what are essentially the care costs of a resident. That is significantly different from paying ordinary maintenance. Many spouses have to pay for clothes and other necessities because the personal expenses allowance does not adequately cover items needed by a resident.
Next Section
Back to Table of Contents
Lords Hansard Home Page