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Mr. Nicholls: Bearing in mind the fact that the Labour party and the Liberal party are already in alliance in Scotland--I can see that the right hon. Gentleman hankers after a time when they can be allied in this place as well--I do not think that consensus emerged in Scotland; cop-out emerged. The Labour Administration took an honest view, although I do not agree with it, that that was not the right way to order their priorities. They then found that, if they did not do a deal with Liberal Members, they could not continue their Administration. I greatly respect the right hon. Gentleman and always enjoy debating with him. However, I do not think that such deals produce good government or good policy.
Mr. Nicholas Winterton: My hon. Friend advances a strong and positive case. Does he not agree, however, that infirmity and dementia should be treated in the same way throughout the United Kingdom, even in its devolved areas? The taxpayers of the UK as a whole continue to pay for the vast majority of the resources used throughout the country--whether in England, in Scotland, which has its own Parliament, or in Wales and Northern Ireland with their Assemblies. When dealing with what are clearly illnesses--whether on the borderline of social or personal care, or medical care--is there not a need for justice to be perceived?
Mr. Nicholls: The honest answer is yes, I largely agree--except that sometimes we cannot put the clock back. Scotland has its own real Parliament; we cannot put that scrambled egg back into the eggshell. The Scottish Parliament cannot be unmade--it is real.
We must draw a harsher conclusion. If the Scots want to pursue that course, as clearly they do, there really is unfinished business. At present, the Barnett formula--I do not want to digress too much, Mr. Deputy Speaker, but Barnett is about resources and that is what we are debating--ensures that Scotland receives disproportionately more money from the English taxpayer; indeed, it enshrines that. How long will the English taxpayer put up with that? If, ultimately, the Scots really do want to go their own way, they will have to raise their own revenue as well. However, I entirely agree with my hon. Friend that the matter will give rise to great bitterness and division.
The Minister expresses great confidence--or does his best to--that the definitions are workable. However, many of the organisations working in the field do not agree. Organisations that the Minister would usually be able to pray in aid are extremely concerned about what has happened in the light of the Scottish experience. I will not list them all, but in a press release issued after the Scottish debacle, Age Concern states:
The important point about the policy that the Conservatives have been developing--there is no secret about it--is that we are saying, in effect, that we cannot go on in such a way. That is why our policy is right. I pointed out that we have had socialised medicine for more than 50 years. People of my age assumed that we would be looked after from the cradle to the grave, but no one in the House could honestly tell our children that, in due course, at the end of their life, the state will be able to provide them with a standard of care or of residential care with which they would feel comfortable.
I have two children at university and one taking A-levels. I do not pretend for a moment that they can rely on the state's resources in their twilight years. The Conservative party has therefore rightly told young people, who still have ample time, to provide for their twilight years; it is an extremely good idea. We talk about having to pick up the tab now, but we are not talking about doing so for ever; we are saying that the state cannot now go back on the arrangement or understanding that it has entered into with people of a certain age. It would be completely unreasonable to ask hon. Members here today suddenly to make realistic arrangements for their nursing home care, but it should be possible to encourage young people to do so.
In the end, such matters come down to sheer practicalities. If we try to temper principle with definitions, that simply will not work--it will lead to no fate other than the grizzly fate of belonging to the Liberal Democrat party. In the end, it is better to face up to the fact that there are opportunities as well as problems and to say that, between us, we have bitten the bullet on nursing care. I suspect that, in early due course, we shall have to do the same thing on personal care as well.
Mr. David Hinchliffe (Wakefield): I welcome the debate, but I am disappointed that, although the Liberal Democrats initiated it, they have focused too narrowly on institutional care. That has been a weakness in the social policy of successive Governments. We have tended to determine our policies on long-term care according to the demands of the private institutional care sector. I was sad that the hon. Member for Sutton and Cheam (Mr. Burstow) referred to home closures. In many instances, home closures arise from effective alternative policies that enable people to remain independently in the community. I agree with much of what he said, but he focused on the wrong tack.
I agree with the hon. Gentleman that the mess that the Government are trying to clear up arises entirely and directly from the previous Conservative Government's policies on long-term care. I carefully listened to the hon. Member for Teignbridge (Mr. Nicholls), who made some important points in interventions and in his speech. He said that Conservative policy is right. I listened to the hon. Member for Meriden (Mrs. Spelman), who spoke for nearly half an hour, but I have not got a clue about the Conservative party's policy. I intend to send copies of her speech to the elderly people in my constituency who ask
The current difficulties are the direct result of what happened during the previous Government's 18 years. First, they deliberately removed long-term care from the NHS, as the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), outlined. Some 40,000 beds, many of which were long-term care beds, were removed from the NHS. My constituency lost two hospitals that specifically offered long-term and intermediate care for elderly people. One of those hospitals has long been demolished, and the irony is that its site is now occupied by a private nursing home, where people pay for the care that was provided free in the original hospital. Under the previous Government, while free NHS long-term care was being run down, the private care nursing home market was being stimulated through huge public subsidies.
People forget that the private care home industry has been produced not simply by the market; the taxpayer has subsidised its expansion. When I covered community care for the then Opposition Front-Bench team, I calculated that between 1981, when the then Government decided to extend supplementary benefit to top-up fees in private care and nursing homes, and 1993, when they attempted to unravel the mess that community care had become, £10 billion of public funds was spent on pumping money into the creation and extension of the private home care market. That was nonsense. During that time I dealt with numerous individual cases and found that people desperately wanted a small amount of money to stay in their own homes and to remain independent, but they could not get it. Once they had made up their minds to give up the ghost and to go into institutional care, the public money flowed. The policy was absolute nonsense and resulted in the mess that we are trying to unravel now. The previous Government were prepared to support private institutional care but not the preventive alternatives that everyone needed.
I am sorry that the hon. Member for Meriden has disappeared, but I heard her speech so I should not be surprised by that. I do not like talking about hon. Members when they are not present. It is a pity when they cannot remain to listen to the responses to their contributions. The hon. Lady referred to the horrendous costs that people like myself will cause for the state when we are ga-ga in a few years' time. However, her assumptions are based on the most expensive models. She is making all the mistakes that the previous Conservative Government made in their 18 years in power.
The consequence of the privatisation of care of the elderly that took place under the previous Government is that older people pay for care that they have already paid for and that they assumed would be free when they paid for it. As I pointed out to my hon. Friend the Minister, it is wrong in principle and profoundly unfair that people should find themselves in that position. In effect, they are paying twice.
A number of developments have taken place recently. I had a little bit to do with the royal commission, because the Labour party came up with the idea when I was the Opposition spokesman on community care. I claim no credit, because the idea came from my hon. Friend the Member for Sheffield, Hillsborough (Helen Jackson) in
The Sutherland report made some sensible suggestions and, to be fair to the Government, they are implementing many of them. The one issue on which I differ from them is personal care. I thought that the definition of anything involving touch was a sensible way round the nonsense that we have debated for generations on what is nursing care and what is social care. That is an impossible distinction to make. Like my hon. Friend the Member for Stockport (Ms Coffey), I worked in social services so I have experience of assessing people. I know that one cannot draw such a dividing line; it simply does not exist. It is wrong for us to attempt a definition.
The Sutherland report talked about free nursing consistent with that on offer outside in the community. It made sensible proposals on capital limits and property ownership and I welcome the fact that, through the national plan, the Government have acceded to the proposals on free nursing care, capital limits and property.
I was particularly interested in the idea of deferred payments that my hon. Friend the Minister mentioned. They are a sensible way of dealing with circumstances in which people in a care home do not know whether they want to remain there. They should not have just three or six months to make up their minds about giving up the home in which they lived most of their lives. That is intolerable. Deferred payments are a sensible alternative, and I commend the Government on that suggestion.
The issue about which I am most concerned is one that I mentioned in the debate on the Second Reading of the Health and Social Care Bill. Personal care is still to be means-tested. I understand the Government's point that, if they have to decide between offering preventive measures in the community or supporting people in their own homes and only one package of money is available, it makes sense to invest it in preventive measures. If that is the dilemma that they face, I support them in their decision. However, my concern is that it is impossible to offer a sensible distinction between nursing care and personal care.
The Government's definition that nursing care is anything that qualified nurses do will lead to a huge amount of contention and controversy. The definition is open to different and wide-ranging interpretations. I am worried about the pressure that will be placed on nursing staff to accede to requests to undertake functions that are not required of qualified nurses.