|Health and Social Care Bill
Mr. Hutton: I have had time to reflect. The hon. Gentleman is familiar with the proceedings on the Care Standards Act 2000, so he will be aware that it is a condition of registration for someone who runs a nursing home that he should provide adequate nursing care at all times. If a nursing home fails to do so, there will be a problem with its registration. The person who runs the nursing home is responsible for ensuring that adequate nursing care is available at all times.
Mr. Hammond: I must ask the Minister to take a little trip from the fantasy world where Health Ministers live to the real world, where people have great difficulty in recruiting and retaining staff and where people get flu and go off sick. Is he suggesting that frail, elderly people should be left lying unattended on a bed because the registered nurse whom the Bill insists should be provided by the home's owner to look after them is not there?
Mr. Hutton: Of course I am not suggesting that. It is the responsibility of the person who runs the nursing home to make available suitable nurse cover to meet the assessed needs of the home's residents. Any difficulties should be addressed by, for example, the employment of bank nurses.
Mr. Hammond: I understand the Minister to be saying that the absurd example that I gave could actually happen. If a care assistant undertakes a task, perhaps under the supervision of a nurse who is unavoidably dealing with another urgent situation, the task would have to be paid for and would be subject to the means test of the person receiving the care. That seems even more absurd than some of the other scenarios that we have outlined. When the Minister thinks about that example, he must agree that that is not the right way to go.
I entirely accept that there might be difficulties in defining care
I hoped that the Minister would at least concede that, if the care that was normally provided by a nurse was, in a particular instance and for a particular reason, provided by a health care assistant under a nurse's supervision, he would not penalise the recipient of the care. The Minister seems not to acknowledge that there might be different practices or ways of working for perfectly proper reasons and that one size does not fit all in the delivery of care. There might be tasks that are dealt with in one county, town or care home by a nurse, but which are routinely dealt with elsewhere by a health care assistant. The Minister seems not to recognise that the availability of nurses varies significantly between different parts of the country. As he and his colleagues must know, the pressures on the available supply of qualified registered nurses are intense.
The definition that we seek to write into the Bill represents a practical attempt to probe the Minister on his definition's workability. We are not seeking to expand it in a way that would lead to uncontrolled budget problems, which I am sure lie at the back of the Minister's mind, but are considering at the practical circumstances in which people work, and at situations in which health care assistants provide much care under the direction of registered nurses. We are thinking of a labour market that is very difficult in many parts of the country and asking the Minister to take a slightly more pragmatic approach and ensure that we do suffer unintended and perverse effects by forcing care home owners to hire nurses, agency nurses or bank nurses who are desperately needed elsewhere in NHS hospitals so that they carry out tasks that could be performed perfectly adequately and safely by health care assistants.
The Bill could result in charging an individual who would otherwise receive care free of charge. That would be the worst possible outcome for the individual, the care home providers, the NHS and the wider health care economy. I am disappointed that the Minister has made no gesture towards recognising that there is a problem with the definition that he has proposed, since it is based on who performs a task, rather than defining what the task is. The definition makes no recognition of regional variations or local labour market variations, and it will lead to a great deal of trouble when the Government try to implement it.
Members have tabled amendments to express their concerns, not about the principle, but about the workability of the Governments' proposals and I hope that they will join me in asking the Minister, through a vote on amendment No. 306, to think very carefully about his definition before we reach Report.
Question put, That the amendment be made:
The Committee divided: Ayes 5, Noes 9.
Division No. 7]
Amendment proposed: No. 298, in page 42, line 42, leave out from `care' to end of line 6 on page 43, and insert,
Question put, That the amendment be made:
The Committee divided: Ayes 2, Noes 9.
Division No. 8]
The Chairman, being of the opinion that the principle of the clause and any matters arising thereon had been adequately discussed in the course of debate on the amendment proposed thereto, forthwith put the Question, pursuant to Standing Orders Nos. 68 and 89, That the clause stand part of the Bill.
Clause 48 ordered to stand part of the Bill.
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