|Health and Social Care Bill
Mr. Hammond: By taking apart the attempts other members of the Committee to put in place a definition, the Minister is merely is underlining the difficulty of creating a definition of the demarcation between nursing and personal care. Would the Minister address himself to that point as it relates to the example that he has just given? How does it relate to the situation in which a nurse normally provides certain care to a resident and that nurse is off sick? There may be no other staff available, and a care assistant may provide the care on a particular day or evening. Is the Minister seriously telling me that something could be nursing care, paid for by the NHS, on a Monday, while on the Tuesday it might not be categorised as such simply because the person who temporarily provides it is different?
Mr. Hutton: That is quite an interesting example. I would like to have some time to reflect on what that might mean in practical terms. We do not want that type of situation to arise because that would be arbitrary and unreasonable. The example that I gave showed that our definition, which the hon. Gentleman has criticised, is more generous than that which he is offering.
The hon. Gentleman asked me the general question of whether we can distinguish between nursing and personal care in a sensible and practical way. There are disagreements in the Committee about that. I have the greatest of respect for members of the Committee and others who have expressed doubt about whether we can make that distinction workable and practicable, but I simply ask them to read what the royal commission said. We frequently hear the royal commission cited and prayed in aid of to one argument or another. Sometimes members cherry-pick their way through the royal commission to find the argument most suitable for their case. Those who say that that distinction cannot be made should read what the royal commission said, and examine at paragraph 626 of the report.
It is a matter of record, as I said last night, that the royal commission wanted free universal personal care, and that, obviously, was the main recommendation that it made to the Government. The royal commission also made it very clear that if we decided not to proceed with that recommendation, the introduction of free nursing care would be a worthwhile objective, and the nursing care to which it was referring was nursing care provided by a qualified nurse.
I challenge hon. Members' belief that that distinction cannot be made. When community nurses visit sick and elderly people at home, who are also receiving community care services, the distinction between nursing, which is NHS-funded, and personal social services, which are means-tested, is made every day up and down the country. Such distinctions are being made even as we speak.
Dr. Brand: The Minister keeps praying in aid for his proposals the royal commission. However, his proposals concern state registered nurses. The royal commission talks about the skills of a qualified nurse. We may have restricted the registration of nurses and the recognised qualifications for registration of nurses. We used to have state enrolled nurses, who did a remarkable job, but that role is no longer available. There is now a move to create a new body of NHS personnel, who will take over some of the roles that the traditional enrolled nurse used to fill. That nurse was qualified, even though she or he was not registered.
Mr. Hutton: I give the hon. Gentleman full marks for his bravery in attempting to make that argument. However, we tried to take into account the recommendations of the royal commission. It talked about the time devoted by a qualified nurse, and that is precisely what we have done in the Bill. The hon. Gentleman is clutching at straws. His argument is insubstantial.
The hon. Member for Runnymede and Weybridge asked whether the distinction could be made. Of course there are difficulties: I do not pretend otherwise. That is always so with boundary issues, but the Liberal Democrats' proposals would throw up equally difficult boundary issues that would have to be arbitrated on and adjudicated at some point if they were ever put into practice. That would also create a difficulty in Scotland, which is why the Scottish Executive, instead of examining the royal commission report and deciding on its course of action, are revisiting the issue of the definition of personal care, an issue that is not problem-free.
It is desperately important not to pretend that the free personal care option is problem-free. There is a real danger in the way the Liberal Democratsin Committee today and on the Floor of the House yesterdayhave tried to present free personal care as a problem-free zone that will transform the whole basis of the system. It will not.
Mr. Burstow: Of course it would be wrong to present any question around definitions as problem-free, as the debates today and last night demonstrated. I apologise to the Minister for not having been here to hear his response to my earlier intervention, although I gather that he did not actually respond. May I, therefore, put my question again? [Hon. Members: ``Oh no.''] My question was about definitions, and since the Minister has mentioned that in debate, I want to come back to it.
The Minister's definition specifies registered nurse time. He has said that things that nurses would not normally do are not included. That must mean that a list of tasks will exist. Will that be included in guidance? Where can we find that list?
Mr. Hutton: The hon. Gentleman is wrong. I made it clear that the clause, as we have drafted it, does not involve a list of tasks. That is clear to anyone who reads the clause.
The point before us fundamental. Amendments Nos. 301 and 303, to which the hon. Gentleman attached great importance, go right to the quick. They are intended to provide universal free personal care. I will not quibble about the wording of the amendments, which would be a pointless waste of everyone's time. However, the issue of whether personal care should be universally free is complex, and we cannot achieve free care without making difficult choices about public expenditure in other areas.
The hon. Gentleman will not like my next point either, but Liberal Democrats do not make hard choices. They want what we are spending, and then they want more. They offer vague and, in this case, rather absurd methods of funding spending. The official Liberal Democrat health spokesman told us yesterday that the Liberal Democrats plan to fund the initiative by increasing the top rate of income tax, and that has been confirmed again tonight. Are those who pay that not the very people who will benefit from free personal care? [Laughter.] Well, that takes us the hub of the issue. Those who are currently means-tested will get their free personal care, but they will pay more taxes in order to receive it. At some point the hon. Gentleman and his friends must explain how that in any sense represents a benefit for those at the top rate of income tax.
Dr. Brand: Does the Minister not accept that it is right to distribute wealth to make sure that people are covered at their times of need, irrespective of how well off they are? We are talking about providing the same services to everyone, wealthy or poor, but also about making sure that the rich pay more, because they can afford to. That is a good socialist principle, which I thought that the Ministerbeing of the old Labour traditionwould have accepted.
Mr. Hutton: It would be interesting to have an argument with the hon. Gentleman about socialism, but this is probably not the occasion for that debate. I have followed the debate, but it has not been explained to me, or justified to anyone, that the proposal to make universal personal care free is an aspect of wealth redistribution.
Dr. Brand: It is care redistribution.
Mr. Hutton: I do not accept that. The argument has gone round and round. The people to whom the hon. Gentleman would extend free personal care are those who have sufficient means to make a contribution to their care. To extend free personal care to those people, and then increase their income tax, would be absurd, but that is the position that the Liberal Democrats have taken. I look forward to hearing some further explanation in due course.
We have had a long debate, and we have probably come to the end of itat least for tonight. I ask my hon. Friends not to accept the amendments, for the reasons that I have outlined. The choices that we have made, and which I ask my hon. Friends to support and endorse are right for the people of our country. They adhere strictly to the principles of social justice and health equality, which are paramount objectives of this Government. They prioritise investment in exactly the right areas.
All my hon. Friends will have met people in their constituencies who complain about the inadequate range of existing health and social care services. People feel that they are not offered enough choice on how longer they can stay at home before they go into institutional care. We all agree that the objectives of additional public spending in those areas should be to promote the independence of older people, to avoid unnecessary institutional care and to give old people what they want. I know they want, because they tell me. They want the opportunity to spend more time at home and to live longer healthier lives. That has to be right. That is our priority, and those are the principles that I ask my hon. Friends to embrace tonight.
Mr. Burstow: We have had a thorough debate of the issues before us. I shall want the Committee to divide later on amendment No. 300, because we believe that it is very important. We are not in any way convinced by the arguments and rhetoric of the Minster, and wish to press that amendment to a vote.
Mr. Hammond: In the last moment or two of his speech, the Minister managed, ingeniously, to cover ground without once mentioning or implying the involvement of the Treasury in the internal discussions that he and his colleagues will have had. We have saved ourselves the trouble of a clause stand part debate, by dealing with the issue of principle, as well as the narrower focus of the amendments. While the debate has been long, it has not been even-tempered, in so far as it touched on issues of principle.
On the amendments, I hope that the Minister would acceptnotwithstanding the fact that he has not been persuaded to accept any of the amendmentsthat real issues are being debated, rather than philosophical divisions. The amendmentsat least those tabled by Conservative Membersare based on an understanding that the Government have chosen the path down which they will go. We have considered that, and have tried to enhance and improve the working definitions that will be of great practical importance to tens of thousands of people.
The Minister comprehensively sought to demolish alternative definitions offered from various parts of the Committee. He reasserted his view that nursing care by a registered nurse is the correct definition. I can swallow the logic of that definition only if the Minister tells the Committee that the only care that will be covered is care that only a registered nurse can provide legally or in accordance with regulations. If we are talking about any care that can be provided properly by a registered nurse or health care assistant, the Minister must answer our questions. I gave an example, but he said that he wanted time to reflect on it.
It sounds absurd, but if a nurse performs a task five days a week, I would describe that task, in the words of amendment No. 308, as
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