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House of Lords

Wednesday, 3rd December 2003.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers—Read by the Lord Bishop of Portsmouth.

The Lord Bishop of Leicester

Timothy John, Lord Bishop of Leicester—Was (in the usual manner) introduced between the Lord Bishop of Portsmouth and the Lord Bishop of Sheffield.

Long-term Care of the Elderly

2.41 p.m.

Lord Harrison asked Her Majesty's Government:

    How they will respond to the recent report of the Royal Commission on long-term care, published in September 2003, which updated its 1999 report, With Respect to Old Age: Long-Term Care—Rights and Responsibilities.

Baroness Andrews: My Lords, the Government have no plans to respond to the statement made in 1999 by former members of the Royal Commission on Long-Term Care of the Elderly. The Government accepted each of the recommendations of the Royal Commission, except the recommendation to provide free personal care. We stand by that decision. We do not believe that making personal care free for everyone is the best use of limited resources.

Lord Harrison: My Lords, I thank my noble friend for that Answer. Nevertheless, will she confirm that, provided the resources were available, in principle the Government would be in favour of nursing and personal care being free at the point of use in both a residential and a domestic setting? Secondly, will she turn her attention to the particular problem of those who suffer from Alzheimer's disease? As they are treated principally by special care assistants rather than by nurses within the NHS, they fall outside the criteria which would enable them to qualify for free care.

Baroness Andrews: My Lords, I certainly appreciate the compassion that goes into that question. However, my noble friend will know that, when resources are limited, Ministers have to make difficult decisions. We made the decision not to fund free personal care for everyone on principled grounds. We believe it is better and fairer to use the billion pounds that have been saved on a wider and better range of services for elderly people who are less well off. With that investment, for example, we have been able to support a significant increase in the number of elderly people who receive intensive care in their own homes, where the vast majority of them say they want to be; we have been able to put 70 million extra into training social care workers, particularly in

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relation to dementia; and we have been able to increase the help that goes to carers. I believe that, in those very direct ways, we are providing more help for people with dreadful diseases, such as Alzheimer's and dementia.

Lord Sutherland of Houndwood: My Lords, will the Minister take account of two different facts in making her response? In raising this question, I lay before the House my own position as chairman of the Royal Commission in question and chairman of English Care in a non-executive role.

The issue raised by those who signed the document to which this Question refers is not whether the Government have done anything—they have done a great deal and we are very grateful for that—but whether the policy that they have adopted is working. I give two forms of evidence. The first, which comes from the private sector, is that for the last year for which independently verified figures are available, 13,000 beds closed. The second is that the health ombudsman has raised a question about the effectiveness of the Government's policy. The conclusion is that it has caused injustice and hardship to some people. Will the Minister respond to those two points?

Baroness Andrews: My Lords, we are very grateful for the role played by the noble Lord, Lord Sutherland, in illuminating so many aspects of this important area of work.

I take issue with what he said in two respects. The first is in relation to the alleged injustices in terms of home-care provision. After years of unregulated growth and inevitable decline, we are seeing far more stability and growth in the home-care market. Some of that growth has been verified by reviews this year which show that national bed capacity in care homes from all sectors outstrips demand by 10,000. We are also seeing a slow-down in the rate of care-home closures, and that is very good news. Other independent evidence suggests that there are signs of growth in the market. Therefore, I believe that, despite local issues and difficulties, we are looking at a better picture.

In relation to the ombudsman's report, we have taken action to respond to the apparent confusion about NHS long-term continuing care, which goes back a long way in our history of provision. We are now expecting strategic health authorities to agree new continuing-care criteria. We are looking to them to recompense financial injustice and to put right what has been wrong. We have commissioned an independent review to consider progress on continuing care and, indeed, our Community Care (Delayed Discharges etc.) Act, which went through this House earlier this year, insists that all elderly people are now assessed for continuing care before being discharged. Therefore, I believe that we are putting right many things.

Baroness Thomas of Walliswood: My Lords, I welcome what the Minister has said about the relationship between national health and social services funding. Can she confirm that many social services departments in England and Wales are very short of cash and that some of them are running

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deficits? Will the Government consider setting up a review of social services funding similar to the Wanless review on National Health Service funding?

Baroness Andrews: My Lords, we are well aware of the pressures on social services and of the pressures due to the increasing numbers of elderly people and children in need of greater protection. That is why we increased the social services spend over the five years between 1996–97 to 2002–03 by a fifth and why for the next three years we are looking at historic increases of 6 per cent a year. The reference by the noble Baroness to the Wanless commission is interesting. I am sure that the department will consider that.

Baroness Fookes: My Lords—

Lord Lipsey: My Lords—

The Lord President of the Council (Baroness Amos): My Lords, perhaps we can hear from the Benches opposite and then from these Benches.

Baroness Fookes: My Lords, does the Minister have any plan to review the definition of nursing care which seems to cause some confusion?

Baroness Andrews: My Lords, the difference between the two forms of assistance provided is that nursing care is provided by qualified nurses. That is the basis on which we have made the distinction between nursing care and the care that is provided on a personal basis for people who do not need medical intervention. It is a definition that, for example, staff in care homes understand and implement very well. We have no plans to revise it.

Lord Lipsey: My Lords, recently when I was in hospital for a by-pass operation, the great bulk of those on the ward with me were people in their 70s and 80s who were having the extremely expensive, life-transforming operation that will give them many years of extra life. Does that point up the flaw in the majority report of the Royal Commission that was the theme of the minority report signed by the noble Lord, Lord Joffe, and myself, that in the real world of scarce resources there is a stark choice between free care for all, which is very nice, and better care for those who really need it when it is genuinely a matter of life and death?

Baroness Andrews: My Lords, I am sure that all noble Lords are delighted to see the noble Lord back in his place after receiving such excellent treatment from the NHS. I am particularly delighted that he is in his place today, as one of the "genius factors" in the House, so that we can have a debate on the two sides of the Royal Commission. That illustrates just how difficult it is to make decisions, how important it is to be clear, and how important it is to keep policies under review.

Baroness Howe of Idlicote: My Lords, has the Government framed a view on the proposals from the

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Joseph Rowntree Foundation for a national care insurance scheme that would pay for care free at the point of delivery?

Baroness Andrews: No, my Lords. As far as I am aware the Government have not formed a view on that. If I am wrong about that I shall send the noble Baroness a correction in writing.

Deep Vein Thrombosis

2.49 p.m.

Baroness Wilcox asked Her Majesty's Government:

    Whether they are confident that the research programmes currently being undertaken are adequate to enable them to offer the general public clear guidance on the possible risks of deep vein thrombosis when flying.

Baroness Andrews: My Lords, in 2001 the Department of Health issued information and advice to the airlines and the public about minimising the risk of DVT during long journeys. That information and advice is available through health services, the Internet, the airlines and NHS Direct and is kept under review in the light of new research information. Much of the research is being generated by WHO. I am pleased to say that the UK was instrumental in setting up that research and in providing financial support for the work.


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