Health and Social Care Bill

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Mr. Burstow: The Minister is right to conclude that that is not the purpose of the amendment. Does he agree that this matter should be devolved to the Welsh Assembly so that it can resolve whether personal care should be free?

Mr. Hutton: As the hon. Gentleman is aware, the National Assembly for Wales already has the power to make precisely those decisions. That is why Jane Hutt in the Welsh Assembly earlier this week set out their response to the issues that the royal commission identified. It may not be the hon. Gentleman's purpose in tabling these amendments, but that is the effect that they would have. It would be disastrous for the people of Wales, and I am sure that he will not want to put this to a vote for that reason. The structural changes that could follow if the Government were to accept the tenor of these amendments would be very significant. The local authority social services role would be seriously diminished and, importantly, the integrated community care framework of assessment, care management and monitoring would be dismantled. As a result, the social care service framework would be entirely disjointed.

The hon. Member for Runnymede and Weybridge discussed important, wider issues to do with the funding of long-term care. Most of the comments had more relevance to the decision of the Scottish Executive. He and I have discussed these issues before. I suspect that it is quite a widespread view among his right hon. and hon. Friends that devolution is just about all right as long as everyone comes to the same decisions. As soon as there is any divergence of opinion, they say that devolution is not working. That is a completely bogus argument.

Mr. Hammond: Will the Minister give way?

Mr. Hutton: No. The hon. Gentleman and his colleagues should go away and think about their commitment to the principle of devolution. It strikes me that it is entirely superficial. At the first sign that the Scottish Executive want to make their own decision, he and his right hon. and hon. Friends run around screaming to the rooftops about how terrible devolution is. If I heard his comments rightly, he was holding out the prospect that a future Conservative Government—heaven forbid that we have to face that prospect—would punish the Scottish Executive by withdrawing health and social care services from the block grant, to ensure that they were penalised for funding long-term care. If that is not what the hon. Gentleman is proposing, I would welcome some clarification of his position.

5.30 pm

Mr. Hammond: I certainly did not say that at all, and I confidently predict that Hansard will show that tomorrow. I take exception to the Minister characterising our position as supportive of a sham version of devolution, when that is exactly the charge laid at the Government's door. To make the matter explicit, does the Minister deny that Labour members of the Scottish Executive have come under pressure from members of the Government to withdraw their proposals, water them down, or postpone them, in order to avoid embarrassment for the Government on their proposals in England?

Mr. Hutton: That is a completely ridiculous argument.

Mr. Simon Burns (West Chelmsford): Answer the question.

The Chairman: Order.

Mr. Hutton: With respect to the hon. Member for West Chelmsford (Mr. Burns), I shall answer the question in my own way. He might want to answer the question for me, but that is not how the structure of the Committee works on such occasions.

What the hon. Member for Runnymede and Weybridge said is transparent. He chose his words carefully—he is good at that--but there is no doubt that anyone who heard his remarks would have come to the conclusion that he was saying that the Scottish Executive could have free personal care, but the Conservatives would reassess the Barnett formula to ensure that there was a subtraction from the resources allocated. That is what he meant to say, but he did not have the courage to put it in as many words. He dropped a few hints and lit a few fuses by suggesting that that is what a future Conservative Government would do, and his remarks would certainly have been listened to in Scotland with great interest.

There are disagreements on the issue, not only between the parties, but within them. I understand that the Scottish Tories support the principle of free personal care. The English Tories do not. The Welsh Liberal Democrats have not fully embraced the implications of the Sutherland report. The Scottish Liberal Democrats have, and we now know that the English Liberal Democrats have as well. There are differences between the response of the Scottish Executive and that of the Government at Westminster, but that is the natural consequence of the devolution settlement. The hon. Gentleman has not raised any substantial issue of principle that should trouble or detain the Committee for a second.

Mr. Hammond: I may not have raised an issue of principle, but I have asked the Minister a specific question, which is relevant to the case that he is trying to make. Have Labour members of the Scottish Executive come under any pressure from members of the Government in Westminster to water down, withdraw or delay their proposals, in order to avoid embarrassment to the Government?

Mr. Hutton: No. Let me make it quite clear that it is entirely the responsibility of the Scottish Executive to come to their own decisions on these and any other matters that are devolved.

We will probably have an opportunity to discuss the wider issues relating to who pays for what in long-term care when we debate the second group of amendments. I certainly want to return to that issue, because there are important and serious arguments of principle and practice that we need to have. Those debates will continue.

The amendments would take the wrong direction for Wales. They would open up a black hole right in the middle of community care services in Wales, and they should not be part of the Bill.

Mr. Burstow: It has been useful to air some of the issues related to the interplay of the royal commission's report and devolution. The Minister has advanced the usual argument about the technical deficiencies of an amendment, which is perhaps part of the armoury of a Minister in Committee. On that basis, I am persuaded that the amendment should not be pressed.

However, I am not convinced that the Welsh Assembly has the necessary powers to consider fully the issue of free personal care. We wish to return to that matter. My colleagues in Scotland will be interested to learn that Conservative Members covet the difference in health spending between Scotland and England, and have an implicit desire to equalise that expenditure—presumably downwards, in the case of Scotland. That will be remarked on in Scotland with some interest.

Mr. Burns: May I ask the hon. Gentleman, because I know that Liberal Democrats usually operate straight out of the gutter, to make it clear to his colleagues in Scotland that it was he who used the words ``presumably downwards'', not my hon. Friend.

Mr. Burstow: I shall send my hon. Friends in Scotland a copy of the transcript. They will draw their own conclusions, and I am sure that many others in Scotland will do the same. The words of the hon. Member for Runnymede and Weybridge are more than adequate testimony to the policy that the Conservative party has now espoused. I see that the hon. Gentleman is keen to continue digging that hole.

Mr. Hammond: I am not digging a hole—that seems to be the latest Liberal Democrat catchphrase. I ask the hon. Gentleman to do me the courtesy of urging his hon. Friends to read my words, not what the Minister thinks I wanted to say but did not have the courage to utter. I must tell the Minister that if I want to say something to him, I shall say it to him. The hon. Gentleman has been on Standing Committees with me often enough to know that that is so.

Mr. Burstow: The hon. Gentleman's words are perfectly adequate. I am happy to pass on his words—and his words alone, if that is what worries him. They are more than enough to make the point. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Hammond: I beg to move amendment No. 306, in page 42, line 41, leave out from `person' to end of line 42 and insert

    `the provision of nursing care (whether provided by a registered nurse or not) to any person.'.

The Chairman: With this it will be convenient to take the following amendments: No. 287, in page 42, line 42, at beginning insert

    `care for a prescribed condition or'.

No. 262, in page 42, line 42, leave out `nursing'.

No. 298, in page 42, line 42, leave out from `care' to end of line 6 on page 43, and insert

    `or health care within the meaning of subsection (2)'.

No. 263, in page 42, line 42, leave out `by a registered nurse'.

No. 304, in page 42, line 42, at end insert

    `unless such provision or arrangement is made under partnership arrangements under sections 27, 30 or 31 of the Health Act 1999'.

No. 288, in page 42, line 42, at end insert—

    `(1A) In this section ``care for a prescribed condition'' means any services including—

    (a) the provision of care; or

    (b) the planning, supervision or delegation of the provision of care which is required by a person suffering from a prescribed condition, whether or not the same involves nursing care by a registered nurse.

    (1B) For this purpose a ``prescribed condition'' is any condition which the Secretary of State may from time to time prescribe by regulations.'.

No. 299, in page 42, line 42, at end insert—

    `(1A) In subsection (1) of section 3 of the 1977 Act (which consolidates provisions relating to the Health Service in England and Wales)—

    (a) for paragraph (c) there is substituted—

    ``(c) medical, dental, nursing and ambulance services including nursing care and health care services within the meaning of section 48(2) of the Health and Social Care Act 2001, which are provided in and to residents in local authority, private or voluntary residential or nursing homes.''

    (b) for paragraph (e) there is substituted—

    ``(e) such facilities for the prevention of illness, the care of persons suffering from illness and the after care of persons who have suffered from illness as he considers are appropriate as part of the health service including nursing care and health care services within the meaning of section 48(2) of the Health and Social Care Act 2001, which are provided in and to residents in local authority, private or voluntary residential or nursing homes.''.

    (c) for paragraph (f) there is substituted—

    ``(f) such other services as are required for the diagnosis and treatment of illness including nursing care and health care services within the meaning of section 48(2) of the Health and Social Care Act 2001, which are provided in and to residents in local authority, private or voluntary residential or nursing homes.''.

No. 300, in page 42, line 42, at end insert—

    `(2) In this section—

    (a) ``nursing care'' means any services—

    (i) provided by a registered nurse, or

    (ii) involving the planning and supervision or delegation of the provision of care by a registered nurse, or

    (iii) provided under the supervision or delegation of a registered nurse whether that nurse is present or not present when the service is carried out, or

    (iv) provided by a non-registered staff or care workers following training or assessment by a registered nurse, or

    (v) involving the provision of any equipment or personal aid that has been assessed as needed by a person and which would be provided by or under contract with a National Health Service body if that person did not reside either temporarily or permanently in either a residential or nursing home;

    (b) ``health care services'' means the diagnosis, assessment, monitoring and any care, treatment or therapy which the person is assessed by a practitioner either employed by or working under contract to a National Health Service body as requiring, and which would be provided by or under contract with a National Health Service body if that person did not reside either temporarily or permanently in either a residential or nursing home;

    (3) Any assessment for the provision of nursing care shall be carried out by a registered nurse.'.

No. 264, in page 42, line 43, leave out subsection (2) and insert—

    `(2) The Secretary of State shall by regulations prescribe the meaning of ``care'' in this section.'.

No. 307, in page 42, line 43, leave out `by a registered nurse'.

No. 308, in page 43, line 1, at beginning insert

    `usually or routinely of a type'.

No. 309, in page 43, line 4, leave out from beginning to end of line 6.

No. 225, in page 43, line 6, at end add—

    `(3) The Secretary of State shall make regulations providing that all those involved in community care shall be required to undergo a training course explaining the role and responsibilities of those providing nursing care.

    (4) Before making such regulations the Secretary of State shall consult relevant medical, social and pensioner organisations.'.

No. 301, in page 43, line 6, at end add—

    `(3) In section 22 of the National Assistance Act 1948 (which provides for the assistance of persons in need by local authorities) subsection (2) is omitted and the following subsection is inserted—

    ``(2) Subject to the following provisions of this section, the payment which a person is liable to make for any such accommodation shall be in accordance with a standard rate fixed for that accommodation by the authority managing the premises in which it is provided and that standard rate shall exclude any costs for personal care services, within the meaning of section 48(5) of the Health and Social Care Act 2001.''.

No. 302, in page 43, line 6, at end add—

    `( ) In subsection (2) of section 17 of the Health and Social Services and Social Security Adjudications Act 1983 (which makes provision relating to the financing of certain social services in England and Wales), after ``services'' there is inserted ``excluding any personal care service within the meaning of section 48(5) of the Health and Social Care Act 2001''.'.

No. 303, in page 43, line 6, at end add—

    `( ) ``Personal care services'' means any service or services which a person has been assessed as being in need of under section 47 of the National Health Service and Community Care Act 1990 and which is care provided in respect of the following matters—

    (a) personal toilet (including washing, bathing, skin care, personal presentation, dressing and undressing and skin care);

    (b) eating and drinking (but not the obtaining or preparation of food and drink);

    (c) the management of urinary and bowel functions (including the maintenance of continence and the management of incontinence);

    (d) the management of problems associated with immobility;

    (e) the management of prescribed treatment (including the administration and monitoring of any medication);

    (f) behaviour management and ensuring personal safety (including the reduction of stress or risk for persons with cognitive impairment); or

    (g) associated teaching, enabling and psychological support from a skilled professional, and assistance with cognitive functions to enable a person to undertake personal care tasks himself or with help.'.

 
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