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House of Lords

Tuesday, 10th December 2002.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers—Read by the Lord Bishop of Guildford.

Free Personal Care for the Elderly

Lord Lipsey asked Her Majesty's Government:

    Whether they are monitoring developments in the Scottish Executive's policy of free personal care for the elderly.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, it is for the Scottish Executive to monitor the implementation of free personal care in Scotland.

Lord Lipsey: My Lords, indeed, but would my noble friend agree that the disquieting but completely predictable reports that demand far exceeds the predictions of the Executive bear lessons also for England?

Is he aware of increasing anecdotal reports that councils in Scotland are slashing services to the poor in order to pay for this uncovenanted hand-out to the better-off? Will he accept my congratulations on resisting the blandishments—with the stout support, I may say, of Her Majesty's Opposition—of those who want free care for all to bankrupt the Exchequer in Britain, just as it is fast bankrupting the Executive in Scotland?

Lord Hunt of Kings Heath: My Lords, it is much better that politicians in Scotland deal with the issues arising in Scotland. I am of course aware of the various media reports. I am also aware of the comments made by the Scottish Executive. However, I believe that ultimately it is better for Scotland to decide on such matters.

As regards England, the Government took the view, and were supported by the noble Earl, Lord Howe, that spending extra resources on personal care would not be wise. It is better to spend the resources on a range of services designed to keep people out of hospital and in their own homes.

Lord Campbell of Croy: My Lords, has there been any noticeable migration of elderly people northwards across the Border?

Lord Hunt of Kings Heath: My Lords, an urban myth suggests that there have been instances of English people fetching up in Scotland in order to take advantage. However, I do not believe that I have seen any figures which will prove that one way or the other.

Baroness Greengross: My Lords, does the Minister agree that many people mistakenly believe that the

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terms "free personal care" and "free nursing care" mean free long-term care? For those in long-term care who are self-funding, average care-home fees of around 400 to 500 a week mean that people in Scotland may still have to find 10,000 or more and people in England and Wales possibly more than 15,000. What proposals does the Minister have to help fill that funding gap across the UK?

Lord Hunt of Kings Heath: My Lords, the noble Baroness is right to suggest that on top of the costs of personal care and nursing care many other costs accrue to residents paying their own fees in care homes. It has always been the position that self-funders should pay towards the cost of their care in such homes. The policy of the Government is to put resources into services such as intermediate care and into supporting social services departments in order to try to minimise the number of people who need to go into care homes. I believe that that must be a key priority.

Baroness Barker: My Lords, is the Minister aware that the press reports referred to by the noble Lord, Lord Lipsey, relate to the situation in only one local authority, which has now been satisfactorily resolved? Given that he cannot monitor but only compare the different systems running in Scotland and England, will his department undertake to provide such a comparison? Will it include the number of older people in Scotland who have been unable to stay in their own homes and the number of older people in England with Alzheimer's disease who are being forced to pay for their "free nursing care" through the increased cost of care homes?

Lord Hunt of Kings Heath: My Lords, I do not believe that that would be a fruitful exercise. The Government have made a policy decision and this House has voted on it. It is that we prefer to put extra resources into wider services such as intermediate care.

The noble Baroness asked about care-home residents who are not benefiting from free nursing care. Early in the year, my honourable friend Jacqui Smith announced a series of measures to deal with that problem, including the development of a core contract that NHS bodies should use as a basis for spelling out how any NHS nursing contribution received by care homes is accounted for. That was done in order to ensure that there is indeed transparency in the system.

Lord Campbell-Savours: My Lords, have we learnt any lessons from the experience in Scotland?

Lord Hunt of Kings Heath: My Lords, the new system in Scotland was introduced only on 1st July this year. It would be better for all concerned to allow the systems in both England and Scotland to settle down before any hard conclusions are drawn. The development of intermediate care is proving very

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successful. In England, our priority must be to ensure that as many people as possible have alternatives to going into such homes in the first place.

Lord Renton: My Lords, will the noble Lord bear in mind that people grow old at different ages? A few are finished at 50 and others go on looking after themselves for as long as they possibly can and may not be finished until they are, say, 95. Public money would be saved if there was not a fixed age for the arrangements which are being discussed.

Lord Hunt of Kings Heath: My Lords, the noble Lord is a shining advertisements for everything he says. Speaking for myself, the more questions I answer in your Lordships' House the older I feel.


2.43 p.m.

Baroness Greengross asked Her Majesty's Government:

    What is their policy on the prevention and treatment of osteoporosis.

Lord Hunt of Kings Heath: My Lords, the National Service Framework for Older People covers falls services, which includes osteoporosis. The national service framework provides a clear basis for delivering improvements in prevention, care, treatment and rehabilitation.

Baroness Greengross: My Lords, I thank the Minister for that positive and informative reply. Does he agree that it is important to take a life-course approach towards tackling conditions such as osteoporosis? Despite preconceptions, osteoporosis is neither a condition that is caused by old age nor does it affect only women. As regards the national service framework, is the Minister aware that the National Osteoporosis Society estimates that, despite the NSF, 90 per cent of sufferers receive little or no advice or therapy to help them avoid repeat fractures? Does not this mean that many unnecessary further fracture repairs have to be carried out, at great cost to the NHS and causing great distress to those concerned and to their families?

Lord Hunt of Kings Heath: My Lords, I agree that prevention is very important. The National Institute for Clinical Excellence is producing guidelines on osteoporosis which I hope will deal with many of the points raised by the noble Baroness. Prevention of osteoporosis is dependent on establishing a maximum bone mass and density in early adulthood and on minimising bone loss later in life. Avoiding risk factors where possible is important, and our recommendations to the public include our old friends of not smoking, avoiding excess alcohol intake and taking regular exercise throughout one's life.

Baroness Gardner of Parkes: My Lords, is the Minister aware that many young people—ballet

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dancers, athletes and people we would think of as being amazingly fit—can suffer from severe osteoporosis because of a very restricted diet?

Lord Hunt of Kings Heath: Yes, my Lords. Although osteoporosis in children is very rare, the noble Baroness is right to point out that it is not confined to older people. That reinforces the point of having good prevention programmes.

Lord Clement-Jones: My Lords, is the Minister aware that one of the key problems suffered by those with osteoporosis is the failure to diagnose their fractures at fracture clinics? Would it not be a good scheme to use nurses with appropriate skills so that fractures are diagnosed good and early and further patient suffering is reduced?

Lord Hunt of Kings Heath: My Lords, I am always keen to see the role of nurses extended, particularly the role of specialist nurses. The review of clinical guidelines by the National Institute for Clinical Excellence will pick up on those points and on the role of GPs and primary care in this area.

Baroness Billingham: My Lords, further to the point about prevention rather than cure, is it correct that regular exercise for all age groups is very important? Are the initiatives being monitored and displayed by the Government and Sport England helpful in this area?

Lord Hunt of Kings Heath: Yes, my Lords. I would encourage local initiatives between the National Health Service, local authorities and sports authorities to ensure that more people take up healthy lifestyles. More importantly, young people should be encouraged to take more active roles by walking and cycling to school, and schools should be encouraged to provide more opportunities for physical education.

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