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Baroness Barker: I begin by thanking all Members of the Committee who have contributed to what the Minister rightly called a very important debate. Many genuinely held points of view have been put forward. I do not intend to speak for long because we have a great deal of work yet to do. However, I wish to raise a few points.

First, I refer to a point made by the noble and learned Lord, Lord Archer of Sandwell. I preface my remarks by saying that I have the utmost regard for the organisation that he represents. I have supported Methodist Homes for the Aged all my life. Within the field of ageing, it is noted rightly as one of the outstanding providers of services for older people. On this occasion, I believe that the noble and learned Lord's argument is wrong, and I support the Minister in not going down that road.

There are many different reasons why older people can end up in the same position. I believe that one of the defining principles of Methodist Homes for the Aged is:

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I say to the noble Lord, Lord Lipsey, that I rather wish that the Treasury had taken that as its approach to the matter.

Lord Archer of Sandwell: I am most grateful to the noble Baroness. It is not a Marxist organisation.

Baroness Barker: It definitely is not. However, it is one of the best organisations at meeting the needs of frail and vulnerable older people in this country.

I believe that the noble and learned Lord's argument is wrong because there is a myriad of reasons why older people can end up with the same need. I understand entirely his point about dementia, but those who suffer strokes, falls, chronic arthritis or the effects of MS can end up with exactly the same needs as someone with dementia. That is the problem.

The noble Lord, Lord Lipsey, talked about costs. The Government's costings, which the Minister trotted out again today, are arbitrary--the £5,000 figure is arbitrary. When we get to the heart of the debate, we shall make it clear that some of the Government's figures do not help us to sort out the problem.

I fundamentally disagree with the Minister's statement that his definition of care is more realistic than those of the rest of us. The definition in the amendment--the planning of care by nurses but the carrying out of that care by care assistants--is the reality for most older people in residential homes. The Minister is simply wrong.

The lack of clarity on nursing care is the point at which the whole of the edifice of the health and social care system that the Government are building will start to fall. Everyone needs to know where they stand. Those Members of the Committee who have tried to sort out care for older relatives or friends know that, when a traumatic incident happens to people in old age that makes them need care, the first thing that one needs to know is what their needs are, what is available and what they have to pay for. The Government's definition of nursing care will not make it easier to do that than is currently the case. I say to the noble Lord, Lord Lipsey, that without the definition of nursing care, even those who want to purchase such care privately will have problems with the proposal.

We have had a good debate and there are extensive concerns in this regard. On another occasion we should have tested the opinion of the Committee but we shall not do so tonight. I urge the Government to go away and to think again about their very mean-spirited definition of nursing care. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 56 [Exclusion of nursing care from community care services]:

[Amendments Nos. 262 to 264 not moved.]

10.15 p.m.

Baroness Masham of Ilton moved Amendment No. 265:

    Page 58, line 24, at end insert "or health care by a person who is registered by any board established under the Professions Supplementary to Medicine Act 1960".

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The noble Baroness said: I move this amendment, which appears in the name of the noble Lord, Lord Morris of Manchester, in the hope that I can obtain reassurance from the Minister. The Clerk tells me that it is in order for me to do so.

The noble Lord, Lord Morris of Manchester, would like to have included the professions supplementary to medicine--that is, physiotherapy, occupational therapy, speech therapy and chiropody--in the Bill. That is very important. On Monday, I believe, the Minister gave some very hopeful signals that that might be done. I thought that it was worth bringing the matter up tonight because an election may be called and anything could happen to the Bill. I look forward to the Minister giving an assurance on this important matter. I beg to move.

Lord Hunt of Kings Heath: The assurance that the noble Baroness, Lady Masham, seeks is that the services of professions allied to medicine will be available to people in homes. They will be available after assessment, as they are in any other part of the health service. An assessment of need will be made and services will depend on the categorisation of that need. That does not mean that services will be available for every resident; it will depend on the assessment process.

Baroness Masham of Ilton: Would it not be simpler to write that into the Bill, to clarify the muddle that there will be in this matter?

Lord Hunt of Kings Heath: The problem is with the architecture of the Bill. The clause says that nursing can no longer be provided by the local authority, but the words "professions allied to medicine" would restrict what a local authority could do for people who were not in a health setting. I would not recommend that route.

Baroness Masham of Ilton: I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 266 to 269 not moved.]

Earl Howe moved Amendment No. 270:

    Page 58, line 31, at end insert--

"( ) Before bringing this section into force the Secretary of State shall consult such bodies and organisations as he shall consider appropriate with a view to determining the funding and other arrangements necessary to implement it."

The noble Earl said: While the focus of our debate on this clause has not unnaturally been concentrated on the definition of the terms used and the separation of nursing from personal care, we must address another issue of real concern. Local authorities are worried about how the provision can be implemented without massively increased bureaucracy for nursing home providers, health authorities and local authorities. The implementation date of October 2001 is seen as wholly unrealistic. The logistical aspects of what is proposed are huge and there is real concern that if the transfer of functions proceeds on the basis

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outlined by the Government, the total amount spent on providing pre-nursing care will increase. The amount of nursing care that it will purchase will decrease.

Amendment No. 270 proposes that, before anything further happens, the Government must get round the table with local and health authorities, as well as the Royal College of Nursing, representative organisations for nursing home providers, and so on, to discuss how the proposals will be funded and implemented.

There are all sorts of unanswered questions. How will the cost of the nursing care element in the nursing home be calculated? Will it be on an actual or notional basis? If we are to avoid postcode lotteries, will national criteria be applied? Who will bear the additional transactional costs that are bound to arise? If local authorities no longer commission nursing home care, how will they ensure best value for hotel and personal care costs in nursing homes, for which they remain liable? How transparent will the process be for the transfer of funding from local authorities to health authorities? What transitional arrangements are needed?

These are only some of the issues causing concern. I hope that the Minister will recognise that there is considerable worry and disquiet among local and health authorities, which are operating in a vacuum in terms of the information at their disposal. They must have information if they are to plan properly. I hope that the Minister will reassure the Committee that the Government will look carefully at the implementation date that has been set. If necessary, I hope that they will put it back a little to ensure that the process of transfer does not end in chaos. I beg to move.

Lord Hunt of Kings Heath: We certainly do not want anything to stop the smooth introduction of this new policy, nor do we want any delay. It would be a great disappointment to many people if we were unable to introduce it by October 2001. Perhaps I can reassure the noble Earl, Lord Howe, that, although he will not be surprised when I say that I am not keen on a statutory requirement for consultation being in the Bill, we are committed to discussing with key stakeholder groups how best to implement the policy. It is in all our interests to ensure that this runs smoothly. Therefore, in the belief that I have expressed on many occasions during our debates that in order to ensure success, you need ownership, we shall consult widely on the implementation of this policy.

Earl Howe: All I can say is that time is of the essence. I accept the Minister's bona fides in this and his assurance that the Government have that in mind but there really is not long now before this all has to roll out. I say again to him that there are some worried local authorities out there. But I thank him for what he said and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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