Health and Social Care Bill

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Mr. Dawson: Clause 48 marks splendid progress, as a result of which residents in nursing homes have regained their entitlement to NHS services, which will be provided according to their need rather than their ability to pay. That will be of significance to thousands of people over the years. It is a great step forward and is something that should have been done a long time ago for elderly and vulnerable people.

Mr. Hammond: Will the hon. Gentleman give way?

Mr. Dawson: I prefer to carry on and make a little progress, after which I shall give way.

I wish to thank the staff of Methodist Homes, who helped to draft amendments Nos. 287 and 288. They very much reflect my worries about personal care, which go back more than 20 years to when I worked with older people and those with disabilities, particularly when they were being admitted to residential care. My principle was founded in those times. Personal care services should be free at the point of use, as the national health service is. There are certain reasons for that. Help with personal care, washing, dressing, feeding and toileting issues is of obvious fundamental help to people. Such assistance enables people to live comfortably, to keep their dignity—sometimes to regain it—and their independence. Personal care services assist people to live and participate in the world, and should be available as of right. Such services should be provided free because they are an important part of holistic care. They can immeasurably improve the quality of people's lives and can offer choice and reassurance. I support holistic services for whole people.

It really is impossible to differentiate between personal care and health care. By definition, personal care requires physical contact with people, sometimes in the most intimate of situations. It falls within internationally recognised definitions of nursing, but includes functions that are carried out by many people who are not nurses. There is a dilemma between free nursing care and means-tested personal care. Given that nursing care is a service that is provided by a nurse, it is bound to lead to significant anomalies. References have already been made to the health or social services bath. The fact is that someone suffering from dementia in a nursing home would get their care free under the proposals whereas someone with dementia—perhaps with almost exactly the same needs—in residential or domiciliary care would not have that advantage.

I congratulate the Government on having the courage and openness to talk the language of priorities and to address with such clarity such a complex and difficult issue. Amendment No. 288 is intended to build on what is being achieved, and suggests, as resources allow—under a Government committed to strong levels of public expenditure based on a strong, sustainable economy—a way to make significant progress towards the goal of making personal care free. We have had a revelation this afternoon: the Opposition have finally balked at the prospect of their black hole in public expenditure and have decided not to go so far down that route. What I propose has nothing to do with the judicious application of another penny on income tax either, it is only to build on the significant achievements that the Government have already brought about.

Dr. Brand: I would hate the Committee to be misled: our proposal this time is to soak the rich and put some extra money on those people who earn more than £100,000.

Mr. Dawson: I enjoyed hearing that.

The amendment provides the opportunity for Government to list those priority conditions—we can talk dementia, Parkinson's disease or Alzheimer's—for which care would be free, whether it were at home or in intermediate care, residential care or a nursing home, regardless of whether that involved or required a registered nurse. I hope that that list will be developed over time.

The amendment would support ordinary life principles and remove any perverse incentive for someone to move into more formal or intrusive forms of care—taking them out of care in the community simply to achieve financial advantage. It consolidates the excellent work of the Bill in removing barriers between health and social services. It would reflect all the work that has been done in pensions policy to encourage people to make their own savings and provision in the knowledge that that would be affected only by the hotel and accommodation costs of long-term care, rather than having to take on nursing care, with which the Bill deals, or personal needs, with which the amendment deals. It would assist the Bill's clear intention to produce a high-quality system of holistic nursing and personal care, meeting assessed needs in a variety of community settings in flexible and imaginative ways. The amendment is in keeping with the spirit of what the Government are trying to achieve through the Bill and the clause. I hope that it can be supported, as it offers a clear way forward to deal with some fundamental issues.

Mr. Burstow: I shall not say too much about amendment No. 288 for fear of doing harm to the cause that it espouses. It sets out a useful alternative route that might be pursued. I congratulate the hon. Member for Lancaster and Wyre (Mr. Dawson) on tabling it and Methodist Homes on the work that they have done.

I want to comment briefly on issues affecting people with dementia and the care of such people. The hon. Member for Lancaster and Wyre is absolutely right on the need to consider care of dementia sufferers holistically. One cannot simply parcel up aspects of their care. Time and a listening ear is often an essential part of that care. Many specialists in dementia care provision, for a variety of reasons, do not necessarily choose a registered nurse to lead the team or even be part of the team providing specialist support for a dementia sufferer. It would be strange and unfair for providers of care in community or residential settings who have constructed teams that are not led by or do not involve registered nurses—but which are nevertheless highly qualified, skilled and trained—not to have access to even the limited free nursing care arrangements under the clause. I at least welcome the possibility set out in amendment No. 288.

I want to speak to amendments Nos. 299 to 303, and try to explain the intent behind them. They are at the heart of debate. In a way, we had a clause stand part debate on the Floor of the House last night. I want to deal with some of the details. Amendments Nos. 301 and 302 make changes to those sections of current legislation that allow for charges to be made for personal care services, provided under section 21 of the National Assistance Act 1948 in respect of residential services. Those sections are also listed in section 17 of the Health and Social Services and Social Security Adjudications Act 1983. I do not want to keep repeating that, although it is an important piece of legislation. Personal social care services, which would be excluded from charges, are defined in amendment No. 303. They are clearly in line with the definition set out in the royal commission report.

Other services, especially those listed as community care services in the context of the National Health Service and Community Care Act 1990, would or could, under the existing discretions in operation, attract charges. They would be subject to the guidance produced by the Department and to decisions by local authorities. Non-residential services involving a care package that includes services of a domestic nature, such as cleaning, shopping, pensions and so on—the tasks that I identified in the royal commission report—would still be charged for. That is accepted by the Liberal Democrats and the royal commission, and provides a demarcation in terms of the way in which charging would operate.

Residential and nursing home services involving a local authority providing accommodation for a person in need of care and attention that is not otherwise available—housing and living costs are included—can still be charged for under the National Assistance Act 1948. We are not removing from the individual the responsibility for picking up living costs, lodging costs and accommodation costs. We believe that those can properly be left to the individual. When a person is accommodated in a nursing home, the nursing and health elements of the care, under amendments Nos. 299 and 300, would be met by the NHS and therefore free at the point of use, by virtue of the National Health Service Act 1977.

I do not pretend that the amendments were lovingly crafted by my hon. Friend and me; that would be misleading. However, I want to give credit where it is due. The Social Policy and Information Network has spent much time working on such matters and has involved 17 organisations in trying to reach a statutory basis, without the benefit of the full resources of the Department and parliamentary counsel to help draft amendments. It has provided a workable basis for implementing the recommendations of the royal commission.

Amendment No. 299 would establish in primary legislation that the duties of the Secretary to State to provide nursing care were extended to those individuals in residential nursing home settings. The amendment to section 3 of the National Health Service Act 1977 would establish that nursing services provided in nursing homes or residential settings fell within the duties of the Secretary of State. The aim of that proposal is to ensure that nursing care is the responsibility of the NHS and that the social care package purchased by local authorities does not include any elements of nursing care.

6.30 pm

Mr. Hutton: I am listening carefully to what the hon. Gentleman is saying. He talked about free personal care. Has his party worked out precisely how it would quantify the amount of personal care that a person might receive in a residential care home or a nursing care home? How will that be identified? Will it be worked out on the basis of a flat-rate payment to such people, or does he expect the amount of hours of personal care that each person receives to be properly recorded and identified?

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Prepared 6 February 2001