Health and Social Care Bill

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Mr. Hammond: The large number of amendments in this group, which were tabled by various Members, suggests that various issues need to be debated. We shall be dealing with two essential questions, which are linked but separate—the principle of extending free care to include personal care as well as nursing care and the fiscal implications of such a move; and the rather narrow practical issue raised by amendment No. 306.

With your indulgence, Mr. Maxton, I would like first to address some of the wider issues raised by other amendments in the group and then to return to the narrower subject of amendment No. 306 and related amendments. With those latter amendments, we essentially accept the principle from which the Government start but seek to probe the practicality of the distinction that the Government have made. I do not labour under the delusion that the broader debate will be harmonious; but I hope that when we come to discuss the practical working arrangements, we shall have a constructive debate about some of the real concerns that have been expressed in Parliament and outside.

The history of the subject is well known. The Government responded to the debate on the funding of long-term care of the elderly by setting up a royal commission. The commission reported the year before last, following which we waited for a considerable time for the Government to announce how they intended to proceed. I hope that the Minister will allow me to say that, prior to the general election, the then Opposition's stance was a rather grandiose commitment to deal with the problem. The suggestions, solutions, attempts to introduce some measure of alleviation and partial solutions to the problem that my right hon. and hon. Friends proposed were dismissed out of hand. I would be the first to admit, as I have acknowledged before, that those proposals were modest and pragmatic. They have often been criticised, but have not yet been bettered, to my knowledge.

On assuming office, the Government brought with them the implicit promise of a comprehensive and early solution to the problem of funding long-term care for the elderly. They deliberately raised public expectations, and have waited as long as possible before starting to let them down gently. This clause of the Bill is the result of Labour's rhetoric, when in opposition before 1997 and then in government, about the need to solve the problem. It may sneak in under the wire before a general election, depending on the mood in the other place, but it is unlikely to satisfy anyone after all the hype that has surrounded the debate.

The initial expectation among those who concern themselves with the long-term care of the elderly was that the means test would be abolished, and that there would be free nursing and personal care. After the royal commission reported and the Government made it clear that their preference was for the conclusions of the minority report, there was an expectation that nursing care would be free. Many people were disappointed about that. Now we have an extremely narrow definition of nursing care, and that sense of disappointment has been enhanced. There is a serious danger that public expectation will be dashed, even on the limited offer that was made after the Government backed the minority report. There will probably be a serious shortfall on the NHS contribution to the average £100 a week difference between residential care and nursing care.

The Minister would inform the debate if he confirmed the figures that the Government are working with. Last night, he said that the Government's proposals would be worth up to £5,000 a year to someone in nursing care. Clearly, that assumes that, for such a person, the whole of the difference between residential and nursing care would be eligible for funding under the Government's current proposals. So that we can better grasp the significance of the Government's proposals, will the Minister confirm the Department's budget estimates of the cost of providing NHS-funded nursing care in residential and other settings under the proposals? The most important thing for older people and their families in planning to meet their future care needs is certainty. As it stands, the Bill fails that test.

I should like to re-confirm a position that was dragged out of me during the last debate, although I had hoped to make it coherently in this debate. We do not believe that taking personal care out of the means test is the optimum way to maximise support for older people from a limited resource budget. Unmet care needs are significant. The Opposition's view—I think that it is also the Government's—is that it must be right to focus available resources on expanding the total care delivered, even if that means acknowledging that at present the inadequacies and inequities of the means-tested system cannot be addressed by that route.

We would all like the abolition of means testing. It delivers perverse incentives, and so sends perverse signals to people when they plan for their older age, especially in relation to the funding of long-term care. Those signals go directly against the grain of the Government's stated intention to enhance personal saving and secure greater responsibility for personal care planning among the population. The Government are increasing the use of means testing under the new name of targeting.

A question arises over priorities. It is not a question of whether we use the money to support elderly people or for some other purpose. It is a question of how we can best use a given and finite sum of money to support elderly people. In other words, it is about how best to deliver care to elderly people. We concur with the Government's analysis that, given resource constraints, the money that is available would not be best used if it funded the personal care needs of those who already had assets and who, under the current system, were being required to use them.

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I do not want to be partisan on that point, because I am accepting the principle of what the Government are doing. It would, however, have been easy to say that we were going to stand up and be counted for the people who have to use their assets or sell their houses—a group of people who are not poor. It would have been very easy for us to say that. We have taken the view, however, that that would not be right and that we have to look at the care needs of the whole community of elderly people.

In that respect, I was rather injured to read the Minister's suggestion of last night that it was clear to him that it would be Conservative policy to focus any cuts on those least able to bear them. He was clearly referring to social services spending. I hope that he will acknowledge that by supporting the Government's position on the funding of long-term care, we are clearly acknowledging that it would not be right to target the available money on the best off, but that it must be used to broaden the base of care available for those who are less well off.

Divisions within the Committee will change. At the moment, I find myself arguing with the Government, and, implicitly, against the Liberal Democrats. The Liberal Democrats' position usefully allows the debate to take place, but we have to be responsible. We have to consider the fiscal implications of what we propose, as an Opposition, just as the Government have to consider the fiscal implications of what they propose. No-one costs the Liberal Democrats' proposals. No-one gets out a calculator. Indeed, when I was thinking about that this morning I was reminded of the brief period when I worked in Italy where calculators have an extra couple of digits to take account of the lire factor. We would have to distribute such calculators if anyone intended seriously trying to cost Liberal Democrat spending commitments.

Free personal care for all would drive a coach and horses through the Government's budget and through any likely future Conservative budget. It is for the Liberal Democrats to say where the cuts would fall in order to raise the additional funding that would be needed to deliver the policy that they promote, but they did not appear to be eager about doing that at the last election when they laid out their manifesto commitments.

Mr. Burstow: The hon. Gentleman has been reading the Minister's script from last night very carefully and is sticking to it very well. I wonder, however, whether the hon. Gentleman, given his desire to see things costed, could give the Committee a lead by itemising the cuts that would be needed to achieve £8 billion worth of savings.

The Chairman: Order. Not during this debate.

Mr. Hammond: You disappoint me, Mr. Maxton.

Mr. Ian Stewart (Eccles): In answer to the hon. Member for Sutton and Cheam, the Opposition Front Bench spokesman said that he accepted the principle on which the Government had predicated their proposal. However, he also said that his party had differences with the Government. However, he also said that his party had differences with the Government. Will he come to those difficulties?

Mr. Hammond: I shall do that right now. It says here ``but take issue with the Government,'' so I will now take issue with the Government.

I have acknowledged that the Government have taken a difficult decision, and that, after careful consideration, we have decided that we agree that that was the right decision to take, given the resource constraints. We differ from the Government in our contention that the Bill does not address the longer-term issue. There is a need to ensure that, in future, older people are better prepared and have better arrangements in place to cope with their long-term care needs. In that context, I shall welcome clause 54, which is an attempt by the Government to address, via another route, the ways in which long-term care could be funded without precipitating the trauma of asset disposal at the worst possible time for the individual involved.

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Prepared 6 February 2001