Mr John Maxton (Glasgow, Cathcart, Labour)

The Minister was about to respond to an intervention from the hon. Member for Sutton and Cheam.

Hon. Members:

Where is he?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

I am sad to say that the hon. Gentleman is not here, so I shall continue with the speech that I was making before we were interrupted. During our debate, several specific issues were raised that I would like to refer to before we move on to the substantive issues of principle behind some of the amendments.

The hon. Gentleman—I hope that he will be able to shine some more light on the issue when he returns—drew our attention to incidents in which residents in care homes had been charged for services provided by general practitioners. GPs have no basis on which to charge for those services. The National Health Service Act 1977 makes it clear that NHS services are free of charge, so there is no provision enabling charges to be made for GP services in care homes.

I understand that the voluntary organisation that sponsored the report mentioned by the hon. Gentleman drew the problem to the attention of my officials some weeks ago. My officials asked for a copy of the report, so that the specific examples and quotations could be investigate, but we have yet to receive it. I would be grateful if the hon. Gentleman sent me a copy, so that I could make necessary inquiries to find out what has happened in individual cases. There is no basis for charging for those services and if it is taking place we must get to the bottom of it as soon as possible.

The hon. Member for Runnymede and Weybridge made several comments about alternative ways to fund long-term residential care, including the possibility of long-term care insurance. I understand that the hon. Member for West Chelmsford was a strong supporter of the previous Government's partnership proposals for such insurance, and was a Minister when the right hon. Member for Charnwood made them.

I am sure that I will be corrected if I am wrong, but I think that the Leader of the Opposition announced last year that a future Conservative Government would match insurance at a rate of 50p in the pound. However, the 1997 proposals suggested matching insurance pound for pound.

Mr Simon Burns (West Chelmsford, Conservative)

I should clarify the matter for the Minister. I feel slightly at a loss, because presumably civil servants from the Department of Health—they may be present—have briefed him on it. I am working from memory, but I think that our White Paper gave two options, and we never decided which option to take for matching as consultation was under way when the general election intervened.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

That is an intriguing flash of memory from the hon. Gentleman. I have no reason to doubt that his memory is faultless. It is not usual for White Papers to be the subject of consultation, as I am sure that he knows from his experience in government. However, I am happy to accept that there were two options.

Mr Simon Burns (West Chelmsford, Conservative)

The consultation may have been internal. We published the White Paper, but we never gave a definitive answer on exactly what the matching would be, as we would not have needed to do so before we introduced the legislation. That was always going to be after the general election, as we were up against the buffer of having been in government for five years.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

Quite. If that is the explanation, it is becoming even more tortuous. The hon. Gentleman said that his party could not make a definitive announcement until detailed legislation had been prepared, but the principle of the detail of legislation is outlined in White Papers. That is the reason for publishing White Papers.

The point that I am making does not require us to explore that line of argument any further. I am, however, interested in exploring the idea that, as I think the hon. Member for Runnymede and Weybridge said, the proposals in question have not been bettered. It strikes me that the Conservative party's proposal to match 50p in the pound was better. The proposals on long-term care insurance that have been mentioned in this debate look slightly ragged in the light of events and the possible explanations of what happened in the past.

The hon. Member for Runnymede and Weybridge quite reasonably chose—as I should have done in his shoes—not to dwell on the fact that the royal commission took a long, careful look at his party's proposals. Rather embarrassingly for him and his right hon. Friends it dismissed them in a sentence as confusing and as failing to make it clear who would benefit from them. We do not need to detain the Committee much longer in consideration of the so-called alternatives to what we are discussing.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

Will the Minister give way?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

In a moment.

We have carefully studied the regulation of long-term care insurance products. It makes sense to consider the opportunities that those can provide to some people. However, it is false to pretend that the proposals of four years ago offer any meaningful or relevant method to enable most people to fund their long-term care costs.

Mr Simon Burns (West Chelmsford, Conservative)

Why?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

For the obvious reason of expense. The people about whom we are concerned today are on low or modest incomes. Even the hon. Gentleman is unlikely to claim that his modest proposals would open the floodgates and enable hundreds of thousands of people to take up care insurance. The best that we can say is that they could make a marginal impact. However, the fundamental issues that we have been considering would remain untouched.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I take issue with the use of the word ``alternative''. I did not suggest that it was necessary to explore the ideas in question as alternatives. I pointed out that rising wealth and home ownership would lead to more and more people being affected by the means test and having to contribute to their long-term care. In addition to pursuing the policy that they have presented to us, the Government should actively encourage and assist people to plan and prepare to make a contribution to their long-term care costs, as it is envisaged they will still do under the Bill. Those arrangements would be as well as, not instead of, what is in the Bill.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

I am grateful for that alternative, but what other detailed proposals did the hon. Gentleman and his party outline to make the funding arrangements for long-term care more equitable? There were none. The proposals were a state subsidy for long-term care insurance. Perhaps now the Conservative party adopts a more expansive view about how we should tackle such issues. I welcome that progress. However, it would not be fair to say the proposals that we have been discussing were not meant to be the solution to the problems identified by the Conservative Government.

A wider issue underpins much of today's discussion and it concerns the overall method of funding social services generally. We have outlined proposals in the NHS plan for funding a new range of health and social care services, which we think will better meet older people's needs. That is the right way to deal with the problems of older people. There are not enough of the right kinds of services—health and social care—available at the right time and place when older people need them so that they can live independently at home, among their friends and families, for longer. We should all want that, given the choice.

The services in which we intend to invest in the next three years will be a mixture of health and social care services. It is important for the Committee and our wider audience to have a clear idea of what may happen in the next few years, but important to those considerations will be the key positions adopted by the parties and their ability to sustain and fund investment in health and social care services. We heard from the Liberal Democrats—we would expect them to take that view. With the greatest respect to the hon. Member for Isle of Wight, his party wants all of that money to be spent and then, ``Please, Sir!'', it will want more. It wants an extra £1 million—

Sitting suspended for a Division in the House.

On resuming—

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

I was about to make a point about the funding of the extra health and social care services that the Government would like to develop over the next three years. I shall also explain our position on the funding of the long-term care of the elderly. We have made the choice not to proceed with universal free personal care, but to make an equivalent investment in new health and social care services for older people. Underpinning that investment will be a range of new social services for older people. It will be funded through the extra investment identified in the NHS plan and the expanding resources that the Government have committed to improve social services.

This year, £9.3 billion will be made available for personal social services. In 2001-02, that figure will increase to £9.85 billion, and in 2002-03 it will be £11 billion. It is important for the Committee and for those interested in our proceedings and in the well being and welfare of older people to know whether that additional spending would be met by an incoming Conservative Government—should such an event occur. We have tried repeatedly to obtain an assurance from the Opposition that our commitment to spend £9.85 billion on social services next year, and £11 billion the year after, would be honoured by a future Conservative Government. We have received no answer that question. We have received no assurance that the spending would be matched by a future Conservative Government.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

The Minister and his hon. Friends have tried that one a number of times. He knows very well that he is asking a spurious question. Some £2.7 billion of the £11 billion to which he refers will be in the form of ring-fenced grants from the Department of Health. The Opposition have given a clear commitment to match the Department of Health spending totals that the Government have set out in the comprehensive spending review. The remainder is local authority spending. The Minister cannot tell me how much local authorities will spend in any given year. He cannot even tell me how much my local county council will spend on social services. I cannot tell him. The county councils themselves do not yet know that, so the question is therefore spurious.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

The hon. Gentleman would say that, wouldn't he?

Mr Simon Burns (West Chelmsford, Conservative)

It is the right answer.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

Unfortunately, it is not the right answer. The present Government are committed to that level of spending on social services, which will sustain the increased investment in social care services for older people. We have made that commitment, and we will honour it.

Mr Simon Burns (West Chelmsford, Conservative)

The Minister says that the Government will honour the total spending. How can the Government realistically give such a commitment if so much of that spending is dependent on what local government may spend in future. No one, not even local authorities, knows what will be spent next year, the year after next or beyond.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

The hon. Gentleman has obviously forgotten a lot about such matters since he left Government.

Mr Simon Burns (West Chelmsford, Conservative)

Why?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

I really do not know why he has forgotten. That is for the hon. Gentleman to explain. The Government are making available those resources for social services spending, and that money will sustain the investment in new health and social care services for older people.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

We will fund it.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

Of course, the Liberal Democrats promise to fund everything from that same penny on income tax. If they ever have the chance to do so, we will watch with interest how that money is recycled around the system. The hon. Gentleman is welcome to be my accountant if he thinks he can spend so much extra money from the same source.

The hon. Member for Runnymede and Weybridge was ducking and diving when I asked him whether an incoming Conservative Government would meet our commitment to invest in social services. The hon. Gentleman whines on about a social services standards vetting system, but that is not the point. We have made it clear that we will make the money available for social services. Would he do the same?

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

How does the Minister propose to make that money available for social services? Although I do not claim to be an expert on local government funding, my understanding is that about a quarter of it is in the form of ring-fenced grants from his Department and the remainder is part of local authority funding. Local authorities must decide their own priorities in respect of education, social services and so on. Admittedly, they have strong guidance from Government policy announcements, but the money is not ring-fenced. If I am wrong, perhaps the Minister will correct me. Will he also acknowledge that local authorities in aggregate are spending in excess of the SSA for social services?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

With great respect, the hon. Gentleman is missing the point. Of course he is right to say that local authorities decide how to use the money. However, he is refusing to be drawn upon my other point. I have given him three opportunities to confirm whether the Conservative party, if it were elected, would make available the equivalent level of resources.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

For social services?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

Yes. Will he make that level of resources available to local government? We are waiting for the answer. Unless his answer is a clear yes, we are entitled to conclude that he will not make such a commitment.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

With the greatest of respect to the Minister, it is no good him trying to read into the record something that is not there. As he well knows, he is asking a question to which there is no answer, because the money that is allocated to local government, whether it comes from RSG or from locally raised resources, is not ring-fenced for specific purposes. The Minister can chunter on—to use his expression—all he likes about SSA for social services. Local authorities see the money available to them as a single pot, from which they will set their own priorities. Neither he nor I can predict what local authorities will spend on social services.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

I wonder why, if that is the case, the hon. Gentleman and his hon. Friends have committed themselves to matching our spending on education. It strikes me that the hon. Gentleman's fox has been shot. I leave others to draw the appropriate conclusions. He knows that he is in a difficult position.

Mr John Maxton (Glasgow, Cathcart, Labour)

Order. I quite enjoyed that, and it will make good television in the run-up to the election, but it does not have a great deal to do with the amendment.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

It is a great pleasure to have my wrist slapped by you, Mr. Maxton. That, too, may be a subject for another sort of debate. I am sure that you are right—it will make good television in the election, because we want to make it clear to people that, like previous Conservative Governments, the Opposition would hit social services spending. We know from our experience that, as night follows day, those who are least well off would suffer the most from the return of Conservative rule.

I am happy to move on from that issue, because we have explored it fully. I would like to return to the principle behind the amendments, and deal with the various points that have arisen. Each amendment seeks to widen the definition of the care that the clause prohibits local councils from providing. Although many of the amendments are not explicit about who should take on the responsibility of providing the care, the implication is that the NHS should do so and that the care should be provided free to users.

The Government have chosen to spend the available resources on improving the quality and the range of services provided for older people and people with disabilities. Those services will help people regain as much independence as possible, will support them in their own homes. They are tailored to people's needs, not to those of the organisations that provide them. Personal care is currently provided on a means-tested basis, which means that seven out of 10 people in residential accommodation receive all or some of their personal care free.

We are making other changes, such as raising the capital limits at which people become eligible for the means test, and disregarding the value of the person's home for the first three months of residential accommodation. The moderately well off will have more of their care paid for from the public purse. We agreed that we should end the anomaly that only people in nursing homes could be charged for the care that they received from a registered nurse, which would be free through the NHS in any other setting. That is the purpose of clause 48.

It would cost more than £1 billion a year to make personal care free to everyone in every setting—a large investment that I am not convinced would do anything to improve front-line health and social care services. The cost would rise steeply in future years. Nobody would receive a better service. That proposal would lock in place the existing, inadequate services that older people currently receive. Not one extra person would be helped to stay in his or her home or to receive a piece of equipment that would transform his or her ability to cope at home. The services would not be extended so that more people could benefit from a greater range of better services.

I accept that there is a difficult choice for our society, but we have chosen to invest the available resources in fundamentally changing the way in which our care system supports older people. It may be difficult for the Liberal Democrats to grasp this point, but given that we cannot spend the same money twice, investing in free personal care would happen at the expense of our objectives for a better range of improved services. We chose investment in new intermediate care services, which will help 130,000 people a year to regain their independence or avoid going into hospital for essential care. Investing in home care services and equipment will help 50,000 more people remain independent in their homes, and investing in new carers respite services will benefit 75,000 carers and those for whom they care. The Government believe that those are the right choices.

I want to turn briefly to some of the amendments that have been discussed tonight, particularly amendment No. 309. Many of the amendments seek to enlarge the range of services that councils cannot provide but without imposing a duty on any other body. The NHS, as I mentioned earlier, can and does provide services ancillary to NHS services under its continuing care responsibilities, when there is a need for high-level health and nursing care. As the hon. Gentleman will be aware, the NHS is not obliged to provide that support in settings when there is no need for those higher levels of NHS care.

Amendment No. 287 seeks to add to the care that cannot be provided by a local council so that a council cannot provide care for certain illnesses or conditions. Why should a diagnosis make the difference to the way in which people with identical care needs are treated? I do not understand the logic behind that.

Amendment No. 288, tabled by my hon. Friend the Member for Lancaster and Wyre, would extend the care that councils cannot provide to those with certain conditions beyond the care provided by a registered nurse. I hope that I have already dealt with the difficulties of deciding which organisations can provide care based on diagnoses. I do not think that that is a sensible way for us to proceed.

Amendments No. 307 and 309 add

``any services usually or routinely of a type provided by a registered nurse''

to the definition of nursing care. I have to ask what that means. A nurse is not defined by the tasks that she or he performs, but by skills and expertise. She may take someone to the toilet, not because no one else could help that person to the toilet, but because, while doing that task, she might be able to monitor the person's mobility, communication or continence, and to make judgments about the care that that person needs. In our definition of nursing care by a registered nurse, those things would be included. But taking someone to the toilet would not come under the definition of services include in the amendment, which would mean that some services could not be provided by local councils to people in residential homes or their own homes.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

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 John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 Peter Brand (Isle of Wight, Liberal Democrat)

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 John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 Democrats—in Committee today and on the Floor of the House yesterday—have tried to present free personal care as a problem-free zone that will transform the whole basis of the system. It will not.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

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 John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 Peter Brand (Isle of Wight, Liberal Democrat)

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 Minister—being of the old Labour tradition—would have accepted.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 Peter Brand (Isle of Wight, Liberal Democrat)

It is care redistribution.

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 it—at 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 Paul Burstow (Sutton & Cheam, Liberal Democrat)

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 Philip Hammond (Runnymede & Weybridge, Conservative)

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 accept—notwithstanding the fact that he has not been persuaded to accept any of the amendments—that real issues are being debated, rather than philosophical divisions. The amendments—at least those tabled by Conservative Members—are 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

``usually or routinely of a type''

carried out by a nurse. That nurse may be sick or unavailable, or the manpower situation in the area may be such that there are simply not enough nurses to go around. Is the Minister seriously saying that the task cannot be performed on a Saturday night by a health care assistant and still fall within the definition?

Mr John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 Philip Hammond (Runnymede & Weybridge, Conservative)

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 John Hutton (Minister of State, Department of Health; Barrow & Furness, Labour)

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 Philip Hammond (Runnymede & Weybridge, Conservative)

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

``usually or routinely of a type''

provided by a registered nurse and that such care must be defined in a precise legal way. However, we all know what we mean by that, even if we might have difficulty in writing it in a Bill.

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.