Health and Social Care Bill

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Mr. Hutton: No, I am not. We are now dismantling such matters from the NHS. We were asked questions on the Floor of the House today that were not connected directly with the issue of nursing care, but about access and availability to new drug treatments. Without rehearsing such arguments, I must say to Conservative Members that they had nearly 20 years in which to sort out the random accessibility and availability of important drugs and treatment in the NHS, and they did not do anything about it. We have tried to resolve such issues with the National Institute for Clinical Excellence and others.

Dr. Brand: Perhaps I can bring the Minister back to the matter before us this afternoon. He is narrowly defining nursing tasks, which would fit in better with the minority report than with the report of the royal commission on long-term care. Should the time come when nursing assistants become members of the RCN, which is being talked about, they would enter a register that gives them a professional qualification. Would they then meet the criteria that the Minister is so keen to stick to? I am concerned about the nursing task, not the exact level of qualification of the person carrying it out.

Mr. Hutton: All Governments must bear in mind such issues and consider the position if matters change. Our definition is not task-based.

Dr. Brand: That is the problem with it.

Mr. Hutton: With respect to the hon. Gentleman, it is a better solution than that which he and his hon. Friends are proposing, which is a list of tasks, some of which would be funded by the taxpayer and some of which would not.

Dr. Brand: Will the hon. Gentleman give way?

Mr. Hutton: No, I shall not give way. The hon. Gentleman has had long enough to develop his arguments. I hope that he will allow me to develop my response to what he has been saying, after which I shall give way to him.

I hope that the hon. Gentleman will understand my argument, although I am not sure that he will. However, I shall try once more. His proposals would not remove the boundary issues and the disputes about who pays for what, which he and his hon. Friends are trying to resolve. I am not criticising him, because he was fair in making it clear that, under his proposals, people would be means-tested for their long-term residential care. Certain elements would be removed from the means test, which is what his party believes in.

From what the hon. Gentleman said, however, about how personal care needs would be assessed, it is clear that he envisages a process that would identify certain tasks. He prayed in aid what the royal commission said about such matters, in that it regards a list of tasks as being the definition of personal care. That will raise difficult issues about what is or is not on the list. I am not saying that the issue cannot be resolved. Of course, it can, but it will not be free of difficulty.

Many people will consider the hon. Gentleman's list of tasks and say that it is not complete and should include other factors. He will face the same allegation that he has made against me—that his proposals are miserly and that his party has used a narrow definition. His proposals would raise many complex issues. I do not believe that they have been resolved fully by the royal commission, and nor is that the view of the Scottish Executive who want to re-examine the definition of free personal care. I shall be interested to see how such an argument unfolds among members of the Liberal Democrat party in England and whether they take a different view from their colleagues in Scotland.

Will the hon. Gentleman's party propose a flat-rate contribution towards the cost of long-term care that will cover nursing and personal care or does it want what he described yesterday as a barcode process, whereby individual tasks and the time to be spent on them must be identified, after which we will end up with a fixed price to be met by the NHS?

Mr. Burstow: I want to take the Minister back to his comments about avoiding having a list of tasks. Clause 48 refers to a registered nurse and involving

    ``(a) the provision of care, or

    (b) the planning, supervision or delegation or the provision of care,

    other than any services which, having regard to their nature and the circumstances in which they are provided, do not need to be provided by a registered nurse.''

Presumably, to make that system work a list of tasks will have to be published to show what a nurse does not have to provide. Will the Minister accept that such a list will have to be published to enable that to happen?

The Chairman: Order. The Minister can have an hour to contemplate that. I am suspending the sitting for one hour for dinner. I shall resume the Chair at 8 pm, unless there is a Division in the House, in which case the Committee will resume at 8.15 pm.

7 pm

Sitting suspended—

[continued in column 435]

 
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