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Earl Howe: I am grateful, as ever, to the noble Baroness for the clarity and fullness of her reply. I thank her in particular for undertaking to bear in mind the concerns that I have raised in relation to Amendment No. 120 when it comes to formulating the guidance that will be issued. That is most helpful. I shall read her remarks in Hansard.

I suppose that I had not expected the noble Baroness to accept Amendment No. 121. However, I am not sure that, in turn, I accept her argument that, because the clause relates to an extension of the existing provisions of the Bill this did not warrant the affirmative procedure. I agree that the clause allows for an extension of the existing provisions of the Bill—but into new and different territory from that which has been the subject of our debates up to now, and the implications of fines and penalties relating to patients in care homes have to be considered with great care.

I thought that I would forbear from subjecting the Committee to a debate on clause stand part, despite giving notice of my intention to do so. I think that I shall still forbear from doing so. Nevertheless, one of the points I had intended to make was that new principles come into play here. I do not think that it is a silly proposal by any means to ask for automatic parliamentary scrutiny. Nevertheless, I have listened to what the noble Baroness has said. I shall reflect on her response between now and Report. For the time being, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 121 not moved.]

Clause 11 agreed to.

Lord Clement-Jones moved Amendment No. 122:



"PERSONAL CARE
Local authorities are not to charge for care, if that care is—
(a) personal care defined in section 121(9) of the Care Standards Act 2000 (c. 14) (general interpretation etc.) as assistance in connection with bodily functions,
(b) nursing care, whether or not from a registered nurse, and
(c) the care of a kind mentioned in Schedule (Social care not ordinarily charged for) to this Act."

The noble Lord said: We see this as an opportune moment to register the continuing interest of my party in securing free personal care. This will be familiar territory, and not only to the Minister. I see the redoubtable noble Lord, Lord Lipsey, in his place. He has taken part in many debates on this subject.

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Four years ago, the Government established the Royal Commission on long-term care, of which the noble Lord was a dissenting member. Liberal Democrats welcomed the initiative, which offered the prospect of a fresh start and an end to the scandal of people being forced to sell their homes to pay for care.

The Royal Commission was asked to conduct its inquiry and report quickly, and it did so: in little more than a year it published a detailed report which analysed the problems, offered a practical blueprint and set out how long-term care could be reformed and funded for the future. The report was published in February 1999. It is now more than four years since the commission's work was initiated.

Over those years, a discredited, unfair and often unlawful system of means-testing has remained in place. People's means have determined the care that they receive, and more homes have been sold to pay for care. The Royal Commission said that charges for personal and nursing care should be scrapped. The Government themselves recognised in the NHS Plan that charges,


    "increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy",

and that they should,


    "discourage the use of necessary services".

Those are the words of the NHS Plan, but they are in the context of charges for NHS services.

This debate does not concern luxury goods and services that people choose to obtain, but essential and intimate care—tasks that frail, sick or disabled people would carry out for themselves if they had the necessary strength, will or knowledge. Long-term care is a contingency, not a probability. Its costs fall disproportionately on the sick, frail and disabled. That is why the Royal Commission said that personal care should be free, but on the basis of an assessment of need.

Contrary to the statements of some members of the Government and some government Back-Benchers, care costs will not run out of control in those circumstances. As Royal Commission member Claire Rayner said in a letter published in The Times, the tasks in question include,


    "intimate personal care such as washing, feeding and help with lavatory needs".

People will not demand to be washed more often or to be helped to be fed more regularly merely because the service has become free. Care costs will balloon only if the level of unmet need in this country is far greater than the current Government or any previous one have been willing to admit.

The Royal Commission did not say that all costs should be paid by the state. It made it clear that the board and lodging costs of care should be met by individuals and said that we should expect to need to meet our housing costs throughout our lives. We believe that the costs of care are a risk that should be met collectively. By rejecting the Royal Commission's central recommendation, the Government are continuing a means test that discriminates against older people with chronic and long-term illness. If one

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has lifetime savings of 18,000 in a bank account, a pension or a home, one will be charged for one's care. Our care system should not be a substitute for a tax system. If the Government wish to redistribute money from better-off people, they should not use poor health as the criterion for accessing it.

What are the Government actually doing? They would like people to believe that they are acting on the Royal Commission's proposals for free nursing care, but that is not the case. They have chosen a very narrow definition of nursing care, and their proposals do not even make all nursing procedures free at the point of delivery. Only the costs of registered nurse time that is spent providing, delegating or supervising care is being met by the NHS, which will not pay for the time of the healthcare assistant or care worker who carries out the bulk of long-term care work. That most mean of definitions, which treats nursing as registered nurse time, is clearly provider-based and is a long way from being people-centred. How are the Government to disentangle the costs of nurse-provided care from those of nursing care that is provided by others? Care homes find themselves forced to measure costs and to cost the amount of nursing time that somebody receives. This produces a system that is costly, bureaucratic, rewards dependence and drives people into dependency.

It is notable that the Government deleted from the Bill at the very last stages of its passage through the Commons the power to make personal care free. That appears to demonstrate the Government's determination never to implement the Royal Commission's recommendations. I hope that this will, at the very least, be an opportunity for the Minister to set the record straight. I beg to move.

7.15 p.m.

Lord Lipsey: I am delighted to take part in the debate on the Bill. I apologise for not having been present for much of the Committee stage. I am afraid that this was pure cowardice on my part, because I have not wished to expose myself to being torn between my very great loyalty to a Government, of whom I am a supporter, and my feelings about the Bill. To put it as delicately as I can, somewhere along the line Homer nodded. But the red rag has now been waved at the bull, and the bull cannot resist charging.

Most of the arguments about free personal care remain precisely those that we debated during our long excursions into the field of free nursing care. It is wildly expensive, costing, on my latest estimate, some 1.5 billion a year. More importantly, it will rise to perhaps 12 or 15 times that level in real terms by the middle of the century. Every penny of that additional expenditure would go to the better off 30 per cent of the population, as the worse off 70 per cent are paid for in full at the moment. Actually, it would not go to the better off 30 per cent for long, but to their heirs, because we are not, alas, talking about people with a long expectation of life.

With that drain on resources, there would be no more money for carers, no improvement in intermediate care, no additional money for

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rehabilitation and nothing to improve the standard of care homes. Those are causes that Liberal Democrats claim to embrace, but the free care proposal would vitiate every one of them. It would be bad news for older people. This is the cuckoo in the nest that would consume all the available food, leaving the rest of the chicks to starve.

We have traversed this ground before. One thing has, however, changed since our previous debate. The Scottish Parliament, in its wisdom—and because of what I hesitate to call blackmail from the Liberal Democrat members of the coalition—has introduced free personal care. If you had attended to our earlier debates, you would think that by now the streets of Edinburgh would be lined with senior citizens heaping orisons of praise on the MSPs as they move forth to the Scottish Parliament, in view of the huge bounty that has been heaped on their head. That is what they said would happen. When we examine the proposals today, we do not need to gaze into the crystal ball—we can read the book. To quote Macbeth, the bad news,


    "of an hour's age doth hiss the speaker"

when it comes to free personal care in Scotland. It has been a fiasco and a disaster. It is terribly sad when a person's gloomy predictions are borne out, but everything that I and other critics said at the time has been borne out, in spades and more.

Noble Lords will be aware of the survey of the problems of Scottish local authorities. Nearly half reported that despite the large sums that the Scottish Parliament has put aside for free personal care in its first year, it did not have the money to pay for it. What was the response of the Scottish Executive? It said, "You are quite right, there isn't enough money to pay for it after all. We will have prioritisation—we have no fear of that word". The whole point of the free care proposal was that there would not be prioritisation. It was something to which everybody had a right.

I recognise the argument that the noble Lord, Lord Clement-Jones, put so eloquently just now. Everybody would have a right to this—there would be no prioritisation. However, in Scotland there is a new form of prioritisation. At least in England the priorities are determined by people's income. If they have less money, they receive help. That seems to be sensible prioritisation. But the prioritisation in Scotland is not like that; it is simply a case of whether a particular local authority happens to have a load of money or whether it is prepared to drop all other forms of spending to pay for free personal care. It depends on pure chance, which is why the citizens of Scotland are not lining the streets of Edinburgh. They are writing and protesting, because some of them are getting these goodies while others are not. It is an injustice that dwarfs the injustice that preceded it.

What else is happening in Scotland? We all want to live in our own home when we get older and people should be helped to achieve it, but services to old people living in their own home are being slashed. I hear terrible anecdotes of councils telling people living in their own home that they cannot continue to

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provide a home help or the nurse who has been visiting them. When asked why not, the council says that it has to pay for free personal care. That is the priority of Liberal Democrat Members, but it is not mine, nor is it that of the older people affected.

In the meantime, while achieving nothing, this scheme is destroying the Scottish Parliament's budget. Only the other week the arts budget was slashed to pay for it. Some people would think that that was the right priority and some would not. But people in the arts in Scotland are up in arms because they say that Scotland's long-term artistic heritage is being bent to this purpose.

I understand that the Liberal Democrats have pretensions to being the leading party of opposition in this country. That is what its leader says. Perhaps this policy will be successful in that respect, because the noble Earl, Lord Howe, and his party have been robust in rejecting the free personal care proposals. So perhaps the Liberal Democrats will succeed in attracting votes by this policy, although I would prefer to call it buying votes or, indeed, bribing voters with their own money. It may make them the biggest party of opposition, but it disqualifies them from being regarded as a party of government, because government is about priorities and about tough choices. I have agreed with much that they have said about this Bill, but by adopting this proposal tonight they have shown themselves incapable of tough choices and tough decisions and of perceiving the true interests of older people.

I speak to those Benches because there is practically nobody else who still supports this proposal south of the Border. For example, I have noted—and I see the noble Baroness, Lady Greengross, in her place there—that the charities for older people, which are so vocal on this issue, have toned down their views because they see the sheer weight of opposing priorities.

This proposal is no more. It has ceased to be. It has expired and gone to meet its maker. This is an ex-proposal. What is tragic is that the Liberal Democrats, like the pet shop owner in the original sketch, cannot see it.


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