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Session 2000-01
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Standing Committee Debates
Health and Social Care Bill

Health and Social Care Bill

Standing Committee E

Tuesday 6 February 2001


Part II

[Mr. John Maxton in the Chair]

Health and Social Care Bill

[Continuation from column 434]

8 pm

On resuming—

The Chairman: The Minister was about to respond to an intervention from the hon. Member for Sutton and Cheam.

Hon. Members: Where is he?

Mr. Hutton: I am sad to say that the hon. Gentleman is not here, so I shall continue with the speech that I was making before we were interrupted. During our debate, several specific issues were raised that I would like to refer to before we move on to the substantive issues of principle behind some of the amendments.

The hon. Gentleman—I hope that he will be able to shine some more light on the issue when he returns—drew our attention to incidents in which residents in care homes had been charged for services provided by general practitioners. GPs have no basis on which to charge for those services. The National Health Service Act 1977 makes it clear that NHS services are free of charge, so there is no provision enabling charges to be made for GP services in care homes.

I understand that the voluntary organisation that sponsored the report mentioned by the hon. Gentleman drew the problem to the attention of my officials some weeks ago. My officials asked for a copy of the report, so that the specific examples and quotations could be investigate, but we have yet to receive it. I would be grateful if the hon. Gentleman sent me a copy, so that I could make necessary inquiries to find out what has happened in individual cases. There is no basis for charging for those services and if it is taking place we must get to the bottom of it as soon as possible.

The hon. Member for Runnymede and Weybridge made several comments about alternative ways to fund long-term residential care, including the possibility of long-term care insurance. I understand that the hon. Member for West Chelmsford was a strong supporter of the previous Government's partnership proposals for such insurance, and was a Minister when the right hon. Member for Charnwood made them.

I am sure that I will be corrected if I am wrong, but I think that the Leader of the Opposition announced last year that a future Conservative Government would match insurance at a rate of 50p in the pound. However, the 1997 proposals suggested matching insurance pound for pound.

Mr. Burns: I should clarify the matter for the Minister. I feel slightly at a loss, because presumably civil servants from the Department of Health—they may be present—have briefed him on it. I am working from memory, but I think that our White Paper gave two options, and we never decided which option to take for matching as consultation was under way when the general election intervened.

Mr. Hutton: That is an intriguing flash of memory from the hon. Gentleman. I have no reason to doubt that his memory is faultless. It is not usual for White Papers to be the subject of consultation, as I am sure that he knows from his experience in government. However, I am happy to accept that there were two options.

Mr. Burns: The consultation may have been internal. We published the White Paper, but we never gave a definitive answer on exactly what the matching would be, as we would not have needed to do so before we introduced the legislation. That was always going to be after the general election, as we were up against the buffer of having been in government for five years.

Mr. Hutton: Quite. If that is the explanation, it is becoming even more tortuous. The hon. Gentleman said that his party could not make a definitive announcement until detailed legislation had been prepared, but the principle of the detail of legislation is outlined in White Papers. That is the reason for publishing White Papers.

The point that I am making does not require us to explore that line of argument any further. I am, however, interested in exploring the idea that, as I think the hon. Member for Runnymede and Weybridge said, the proposals in question have not been bettered. It strikes me that the Conservative party's proposal to match 50p in the pound was better. The proposals on long-term care insurance that have been mentioned in this debate look slightly ragged in the light of events and the possible explanations of what happened in the past.

The hon. Member for Runnymede and Weybridge quite reasonably chose—as I should have done in his shoes—not to dwell on the fact that the royal commission took a long, careful look at his party's proposals. Rather embarrassingly for him and his right hon. Friends it dismissed them in a sentence as confusing and as failing to make it clear who would benefit from them. We do not need to detain the Committee much longer in consideration of the so-called alternatives to what we are discussing.

Mr. Hammond: Will the Minister give way?

Mr. Hutton: In a moment.

We have carefully studied the regulation of long-term care insurance products. It makes sense to consider the opportunities that those can provide to some people. However, it is false to pretend that the proposals of four years ago offer any meaningful or relevant method to enable most people to fund their long-term care costs.

Mr. Burns: Why?

Mr. Hutton: For the obvious reason of expense. The people about whom we are concerned today are on low or modest incomes. Even the hon. Gentleman is unlikely to claim that his modest proposals would open the floodgates and enable hundreds of thousands of people to take up care insurance. The best that we can say is that they could make a marginal impact. However, the fundamental issues that we have been considering would remain untouched.

Mr. Hammond: I take issue with the use of the word ``alternative''. I did not suggest that it was necessary to explore the ideas in question as alternatives. I pointed out that rising wealth and home ownership would lead to more and more people being affected by the means test and having to contribute to their long-term care. In addition to pursuing the policy that they have presented to us, the Government should actively encourage and assist people to plan and prepare to make a contribution to their long-term care costs, as it is envisaged they will still do under the Bill. Those arrangements would be as well as, not instead of, what is in the Bill.

Mr. Hutton: I am grateful for that alternative, but what other detailed proposals did the hon. Gentleman and his party outline to make the funding arrangements for long-term care more equitable? There were none. The proposals were a state subsidy for long-term care insurance. Perhaps now the Conservative party adopts a more expansive view about how we should tackle such issues. I welcome that progress. However, it would not be fair to say the proposals that we have been discussing were not meant to be the solution to the problems identified by the Conservative Government.

A wider issue underpins much of today's discussion and it concerns the overall method of funding social services generally. We have outlined proposals in the NHS plan for funding a new range of health and social care services, which we think will better meet older people's needs. That is the right way to deal with the problems of older people. There are not enough of the right kinds of services—health and social care—available at the right time and place when older people need them so that they can live independently at home, among their friends and families, for longer. We should all want that, given the choice.

The services in which we intend to invest in the next three years will be a mixture of health and social care services. It is important for the Committee and our wider audience to have a clear idea of what may happen in the next few years, but important to those considerations will be the key positions adopted by the parties and their ability to sustain and fund investment in health and social care services. We heard from the Liberal Democrats—we would expect them to take that view. With the greatest respect to the hon. Member for Isle of Wight, his party wants all of that money to be spent and then, ``Please, Sir!'', it will want more. It wants an extra £1 million—

8.10 pm

Sitting suspended for a Division in the House.

8.23 pm

On resuming—

Mr. Hutton: I was about to make a point about the funding of the extra health and social care services that the Government would like to develop over the next three years. I shall also explain our position on the funding of the long-term care of the elderly. We have made the choice not to proceed with universal free personal care, but to make an equivalent investment in new health and social care services for older people. Underpinning that investment will be a range of new social services for older people. It will be funded through the extra investment identified in the NHS plan and the expanding resources that the Government have committed to improve social services.

This year, £9.3 billion will be made available for personal social services. In 2001-02, that figure will increase to £9.85 billion, and in 2002-03 it will be £11 billion. It is important for the Committee and for those interested in our proceedings and in the well being and welfare of older people to know whether that additional spending would be met by an incoming Conservative Government—should such an event occur. We have tried repeatedly to obtain an assurance from the Opposition that our commitment to spend £9.85 billion on social services next year, and £11 billion the year after, would be honoured by a future Conservative Government. We have received no answer that question. We have received no assurance that the spending would be matched by a future Conservative Government.

Mr. Hammond: The Minister and his hon. Friends have tried that one a number of times. He knows very well that he is asking a spurious question. Some £2.7 billion of the £11 billion to which he refers will be in the form of ring-fenced grants from the Department of Health. The Opposition have given a clear commitment to match the Department of Health spending totals that the Government have set out in the comprehensive spending review. The remainder is local authority spending. The Minister cannot tell me how much local authorities will spend in any given year. He cannot even tell me how much my local county council will spend on social services. I cannot tell him. The county councils themselves do not yet know that, so the question is therefore spurious.


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Prepared 6 February 2001