Health and Social Care Bill

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Mr. Burstow: I am genuinely puzzled by the Minister's question, not least because of the firm foundation on which we are basing our amendments. The royal commission makes it absolutely clear that the whole process of assessing need for personal care is just that; an assessment process. I shall refer later to the importance of having a statutory basis for the assessment process. Undoubtedly, needs-led assessment is essential.

Yesterday, in response to an intervention, the Minister made the point that the Government's nursing care proposals are also needs led and that no cash limit is being set on them. Presumably, the Government are envisaging a form of assessment procedure to enable that to happen. We, too, want an assessment procedure.

Mr. Hutton: It is important for it to be clearly understood that the Liberal Democrats are proposing that, for example, one hour of personal care—or six, 10 or 12 hours of personal care—will have quantified. The hon. Gentleman is rejecting funding his party's proposals through a flat-rate payment that would cover nursing and personal care costs.

Mr. Burstow: The Minister is suggesting that there is a flat-rate basis to our proposals. In response to questions that I have tabled, the Government have come up with the basis for costing the policy. They say that they take away the amount that is currently spent on a residential care home from the amount that is spent on a nursing home and that that produces a figure of £100 a week, which is what it will cost to provide free nursing care. Is the Minister saying that that is all that will happen? I do not think that he is.

The Minister has said that the figures are not cash limited and that we have a estimate. The reality is that we must start somewhere, and we start from the propositions set out in the royal commission's report of an assessment of need and its costings. Because we cannot be clear about the Government's assessment of unmet need and what the true level of need is until such assessments are made, we cannot say for certain that the amount of money that they put in or that we would need to put in is what would be needed.

Mr. Hutton: We have made it clear that we want a proper needs-led assessment to be made for a person's nursing care costs. That will be the responsibility of the NHS. The Liberal Democrats in Scotland want to fund that through a flat-rate payment, which the hon. Gentleman has ruled out.

Mr. Burstow: As the Minister knows, working groups are to report back to the Scottish Executive by August. They will be advising the Parliament about how to take such matters forward. His colleague, the First Minister, has made it clear that the Executive are intending to implement in full the royal commission's recommendations. That is far as the Scottish Ministers have gone and is a reasonable position for holding this debate in terms of implementing such policy. If I were a member of the Labour party and wanted to implement the policy, I would expect officials to furnish me with more detail. The way in which we have framed the amendments provides an adequate basis for testing where the Government stand on the matter and the Bill. That is what the Committee is supposed to scrutinise, unless we have changed the procedures and Committees are now intended to scrutinise the Opposition.

Amendment No. 300 relates to the definition of nursing care. The amendment would include those services delegated by a registered nurse to be undertaken by a suitably qualified non-registered nurse. It picks up on the concerns expressed by the hon. Members for Lancaster and Wyre and for Runnymede and Weybridge about who is providing the care. That is an important concern that has been brought to the attention of all members of the Committee by the Royal College of Nursing and many others.

The hon. Member for Runnymede and Weybridge quoted from the RCN brief, from which I would also like to quote.

    ``At present, nursing care is provided free on the NHS to people in hospitals and their own homes, but is means-tested in nursing homes. This means that the only group of people who have to pay for their own nursing care are frail, vulnerable older people.''

The fault line in the Committee lies between those who are prepared to accept a continuation of that means-testing arrangement and those who reject it as unfair and inequitable.

The RCN provides a useful set of case studies to show how the measure might stand in practice. One such case study involved a Mr. Martin, aged 75, who is cared for in a nursing home.

    ``He has had a heart attack and stroke and has furred arteries. He has symptoms of Parkinson's disease. His prostate has been removed, and he uses a catheter. He needs help in moving around. During a typical half-day shift, Mr. M needs the following kinds of care . . . which is always delivered by a registered nurse:

    Administering medication—Mr. M's pulse must be taken regularly because of the nature of his medication . . . Changing catheter . . . Re-ordering drugs.''

Then comes a long list of tasks undertaken in most circumstances, which would not be free in the context of the Bill. Those tasks can be carried out by an NVQ level 3 health care assistant, and include:

    ``Attending to hygiene needs . . . Checking urine pH levels and administering bladder washouts . . . Changing abdominal dressing . . . Checking vulnerable areas . . . for pressure sores . . . Evaluating bowel function and intervening if necessary to prevent constipation . . . Assisting with all eating and drinking, to maintain healthy diet and fluid intake''—

and so on.

Those tasks would not be provided free under the clause before the Committee, but they go to the heart of an individual's dignity. They are not tasks that individuals would choose to have done for them, if they had the knowledge, will or strength to undertake them for themselves. That is why the RCN and many others are worried about the definition that the Government are seeking to impose, and why we have tabled amendments Nos. 299 and 300.

The hon. Member for Runnymede and Weybridge made an important point about nurse shortages and the impact that they may have on the Government's intentions to have a nurse-led assessment procedure for their policy of free nursing care. From work done by the RCN, we know that there is an anticipated shortage of some 57,000 registered nurses over the next four to five years. Out of the United Kingdom Central Council's total pool of nurses, some one in four nurses will reach retirement age over the next 10 years. We know that the average retirement age is 55, so those problems of shortages will become intense, if not severe, over the next five to six years.

The Government do not have enough nurses and will not be able, in my judgment—and in others' judgment, judging by the literature—to find sufficient nurses from abroad, not least because the demographic problems of our nurse work force exist elsewhere. We are competing with other health services that offer far more attractive packages to persuade our trained nurses to go abroad.

Mr. Hutton: Will the hon. Gentleman explain how his proposals would allow the NHS to recruit more nurses?

Mr. Burstow: The problem that I am outlining—and which the Minister does not seem to want to address—is that even if there is extra money, it will be difficult to achieve the recruitment that the Government want over the next few years. It will be hard to fill the extra 2,000 head count number of nursing positions that will be created over the next few years because of the demographic profile of the nursing pool in this country. Even with the best will in the world—so far I think 7,000 extra nurses have been attracted to this country in a single year—unless the level of recruitment from abroad is significantly increased, there will be a shortage. If the NHS is to grab all the extra nurses needed to meet the Government's laudable targets in the NHS plan, where on earth will the extra nurses needed to deliver free nursing in the private and voluntary sectors come from?

Dr. Brand: Is it not true that if our proposals—or the amendment tabled by the hon. Member for Lancaster and Wyre; or the amendments tabled by the hon. Member for Runnymede and Weybridge—were accepted, the NHS could recruit more nursing assistants, train them within a nursing team and deliver the very service that all parties want?

Mr. Burstow: My hon. Friend makes a fair point. The logical destination of the policy that the Government are espousing will probably be that that blurring will have to take place to allow it to work at all. Of course nurses must be an important part of that—our amendments provide a statutory basis for nurse assessments—but a compelling argument has been made by Members on both sides for the need for multidisciplinary approaches to assessment: the bringing together of health and social care assessments, so that we have not different approaches but a seamless assessment as well as a seamless service. Everything that the Government are doing in this area is unpicking that seam and creating two services again by sustaining the divide.

My final point on amendment No. 300 relates to health care and our concern about charges that are already being collected for NHS services. A survey undertaken earlier this year found that one in three care homes for elderly people were paying extra for GP services. The research covered a number of charitable bodies: the Association of Charity Officers, the Occupational Benevolent Fund Alliance and voluntary organisations involved in caring in the elderly sector, such as Voices. The survey found that extra fees ranged from more than £150 per resident to an average retainer fee of around £41 per annum per resident. Those sums are being paid by residents in nursing and residential homes for services already paid for through NHS capitation fees, which is a cause for concern. I hope that we can get clarity, which is the purpose behind paragraph (2)(b) in amendment No. 300.

The amendments are intended to implement the purpose behind the royal commission. We have taken specifically from the royal commission the definition of intimate care—the touching of the person. If the Government are not prepared to accept that—and so far they have not been, although it is the equitable basis on which the issue should be resolved—I hope that the Committee will be persuaded by the amendments tabled by the hon. Member for Runnymede and Weybridge. The Government have taken the view that if people are wealthy but sick, they will pay for their care. We take the view that if they are wealthy, they should contribute to the care of all, whether they be rich or poor. That is the difference between the Liberal Democrats and the Government: we do not want simply to penalise the sick rich, but think that taxation is the way to redistribute wealth, and that wealth can be used to maintain social justice through the health care system.

6.45 pm

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