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Health and Social Care Bill
8:45 pm
Mr Philip Hammond (Runnymede and 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.