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Baroness Amos: My Lords, I am not aware of any proposals to diminish transmission to Latin America.

Lord Howell of Guildford: My Lords, while recognising that no government have had a completely marvellous record in funding the World Service--and I hear what the Minister says--is this really the right time to cut 1.2 million listeners out of the short wave system? I refer not just to North America but also to Australia, New Zealand, the Pacific and developing countries. I know that the Minister realises that this is now the cutting edge of cultural diplomacy. Does she recall that on the previous occasion the cost cutters and the budget squeezers were let loose on the World Service the government of the day--I believe that this was in the early 1990s--held a rigorous inquiry to find out what the BBC was up to? Will Ministers in the Foreign Office keep a close eye on the matter this time?

Baroness Amos: My Lords, the World Service and FCO Ministers hold an annual meeting. That meeting took place yesterday. It was agreed that as a result of the initiative we are discussing there would be a review to consider the number of listeners in North America and Australasia. I believe that the noble Lord said that

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1.2 million listeners would no longer receive the service. In Australia the number of short wave listeners has dropped from 1.6 million eight years ago to about 100,000 now. That is the number of people who listen only to short wave. In the United States the figure has dropped to 300,000. Therefore, we are not talking about the kind of numbers that the noble Lord mentioned.

The Earl of Sandwich: My Lords, will the noble Baroness confirm that in countries suffering from extreme poverty and conflict, such as Afghanistan, the World Service is not only maintaining its programme but is supporting it with educational work which has been so valuable to the people there?

Baroness Amos: My Lords, I confirm that in addition to its broadcasting activities the World Service also engages in training to enable the media in certain parts of the world to pursue democratic means in those countries.

Viscount Goschen: My Lords, in the Minister's initial Answer she partially relied on the fact that the Internet is now being used to deliver the service. Will the Minister put that in context and tell the House how many people, as a percentage of the total listener base of the World Service, now access it through the Internet?

Baroness Amos: My Lords, I shall write to the noble Lord on that point. However, in the United States, for example, 168 million people have access to the Internet. The majority of World Service listeners in the United States access it through the Internet. I remind the noble Lord that FM rebroadcasting services are also being actively pursued by the BBC World Service with the aim of ensuring that the world's major cities have coverage through that route.

Nursing Care for the Elderly: Funding

3.4 p.m.

Baroness Walmsley asked Her Majesty's Government:

    Whether they have any plans to cash limit in any way the costs of providing nursing care for elderly people as allowed for in the Health and Social Care Act 2001.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, we shall shortly be consulting on draft guidance to health authorities on people's need for nursing care. We shall be providing additional funding to health authorities for the provision of free nursing care as part of their overall cash-limited allocation. It will be for health authorities and primary care trusts to

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determine individuals' nursing needs. Ultimately, it will be for them to decide how best to use their total funding to meet local and national priorities.

Baroness Walmsley: My Lords, I thank the Minister for that Answer. However, will he tell the House whether the system for funding nursing care will be based on the real cost or the fantasy figures that date back to 1999 on which the Government costed their policy and which will clearly be insufficient to cover the real cost? In view of that, does the Department of Health have Treasury approval for exceeding the provision made in the Comprehensive Spending Review?

Lord Hunt of Kings Heath: My Lords, I certainly do not recognise the term "fantasy figures" as regards the Department of Health. On funding, we believe that there is sufficient provision within the general allocation to fund the free nursing care that will be provided as a basis of the assessment procedure which is now to be worked through. We intend to issue draft guidance shortly. That will give a much clearer indication of both the assessment process and indicative figures. We shall await the response with interest and consider the comments.

Baroness Turner of Camden: My Lords, is the Minister aware of the report that elderly people in nursing homes will in future have to pay VAT on the cost of that care? Will not that extra cost cancel out what has been allocated for nursing care? Is that not a very unwelcome development?

Lord Hunt of Kings Heath: My Lords, I understand that a VAT tribunal has ruled that the activities of Kingscrest, which runs residential homes for children and the mentally handicapped, are not exempt from VAT. The ruling could have serious implications. That matter has just come to our attention. I assure noble Lords and my noble friend that we shall work closely with Customs and Excise to assess the consequences of that tribunal decision.

Baroness Greengross: My Lords, does the Minister agree with me that it would not be possible to cash limit nursing care if it was given on the basis of assessed health needs already provided by the NHS free at the point of delivery in other settings? Would not that be a better way to deliver fairer and better care to people, particularly frail elderly people who happen to be in nursing homes rather than in hospital or in their own home?

Lord Hunt of Kings Heath: My Lords, as the noble Baroness will know, our decision in relation to free nursing care was designed to end the anomaly that applies at the moment whereby nursing care in nursing homes has to be paid for as opposed to nursing care either within the NHS or in residential homes. I believe that the decision we have taken to make nursing care free, using an assessment on which we are working and on which we shall consult shortly, is the most

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appropriate way to deal with the matter. We are due to introduce a scheme on 1st October this year that will constitute an appreciable advance on current arrangements.

Baroness Carnegy of Lour: My Lords, the noble Lord will remember that when the relevant legislation proceeded through the House many of us were doubtful about its definition of "nursing care". The Government insisted that the definition was correct. Are they now redefining it through the draft guidance?

Lord Hunt of Kings Heath: My Lords, that is absolutely not the case. The definition in the Act refers to services provided by a registered nurse involving either the provision of care, or the planning, supervision or delegation of the provision of care other than services that do not need to be provided by a registered nurse. That definition best represents the extra care received in a nursing home compared with a residential home; in other words, the care that can be provided only by a registered nurse. We stick by that definition.

Lord Clement-Jones: My Lords, further to that, will the Minister confirm that the definition of what nursing care will be needed will be at the discretion of the registered nurse making the assessment? The Minister has stated his confidence that the resource will be available but the essence of the matter is the definition of what nursing care is needed.

Lord Hunt of Kings Heath: My Lords, that is why we are working at the moment with organisations such as the Alzheimer's Society, the Royal College of Nursing and other key stakeholders to ensure that we have an appropriate assessment procedure, that there is consistency throughout the country and that the allocation of finance is appropriate and fair to that assessment procedure. The noble Lord will study the draft guidance with interest when it is published. I shall be keen to debate it and to receive comments from noble Lords and other interested parties. We want to make sure that we have a fair and practical system.

Earl Howe: My Lords, the Minister will doubtless recall that during the passage of the legislation concern was expressed by a number of noble Lords reflecting the anxiety of local authorities about the very short time frame available for preparing for the policy's implementation date prior to October 2001. Is the Minister satisfied that the timetable for introducing free nursing care in residential homes is on track?

Lord Hunt of Kings Heath: My Lords, I understand the point the noble Earl raises. Time is short before 1st October. However, it is important that we get the matter right. It is appropriate for us to take a little more time in issuing draft guidance in order to ensure that the arrangements to be introduced from 1st October are as practically based as possible and consistent and fair. It will require a great deal of effort

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to ensure that those arrangements are firmly in place by 1st October, but I am confident that we shall make progress towards that.

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