I am very grateful to my hon. Friend the Under-Secretary of State for coming to the House at this late hour to answer the debate. I hope that the people of Wales will take note of how assiduously he carries out his duties even in the very small hours of the morning.
I should make it quite plain that I am concerned only with one specific point and not with the much wider question of the impact on pensioners and others of the changes in the social security system resulting not just from the Social Security Act 1986 but from many other factors, such as the increases in water charges and electricity tariffs, the requirement that all except the very poorest should pay 20 per cent. of their rates and the loss in many cases of rate rebates and lower interest rates for their savings, which is a very heavy factor for other people, but not so much for pensioners. Those factors, which affect the standard of living of many of the poorer pensioners, though not the very poorest, led me to abstain in the vote yesterday afternoon.
My abstention was intended as a criticism not of the DHSS or of my hon. Friend and his handling of these matters at the Welsh Office, but of the way in which they have been forced by the Treasury to make choices which they should not be forced to make in the country's present affluent circumstances. What is more relevant to the particular point that I am making tonight is that they are being driven into an approach which penalises even modest thrift, as part of the process of targeting benefit to the most needy.
I know that that problem crops up over all areas of social security. It is inseparable from any attempt to target help on those who need it most, though I think Ministers, and especially the Prime Minister, would do well to face it a bit more frankly and to admit that targeting benefits inevitably means damaging the people and discouraging the instincts that ought to matter most to a Conservative Government. I have to admit that the problem is one that has baffled Governments throughout the ages when they have set out to relieve poverty or distress.
The specific point that concerns me is the support for elderly people who are discharged from NHS hospitals into private nursing homes. As long as they are in hospital they are accommodated and treated free of charge, apart from an abatement of their pension after eight weeks, which no one will complain about. That is regardless of their means or the means of their spouse. But if that elderly person is discharged from a National Health Service hospital into a nursing home other than one run by the local authority, very different considerations apply. The fairly hefty fees must be paid, and in practice—certainly in my own county of Clwyd and, I suspect, in most other health authority areas—they are paid by the elderly person himself or herself, or by the spouse, if either have savings above the £3,000 level that disqualifies them from income support.
Let me put the case of one of my constituents who prefers not to be named. I shall call her Mrs. X. She is in her seventies and suffers from Parkinson's disease. Her husband is suffering from senile dementia and is being very well looked after in a private nursing home. Her savings exceed the £3,000 limit, so the only help she gets is the attendance allowance, plus her husband's state retirement pension. All this goes towards meeting the nursing home fees. To pay the balance of £110 per week she has to draw on her savings. Last year she spent over £5,500 in this way. At this rate she will soon have no savings left, and only then will she be able to get the fees paid.
One solution is for elderly people to remain in NHS hospitals until they die and for their spouses to refuse point blank to pay any fees for them in nursing homes if they are moved out of hospital. That is what another of my constituents has been driven to do. He is 78 and has looked after his sick wife as best he could for many years, but he is now too infirm himself to go on doing so. His wife was admitted to hospital with fluid on the lung, and while there she first had a heart attack and then broke her femur. Now she is fit enough to be moved from hospital to a nursing home, but the husband wants to know who is to pay the fees. If he uses his remaining savings to do so, she may live a few years but he will be reduced to dependency on the state for the rest of his life.
I might mention another way in which the regulations are hurting people who move out of hospital into nursing homes. The hon. Member for Gower (Mr. Wardell) has been much concerned by this, and I am indebted to him for this example. I have other similar though less clear-cut cases in my own constituency. It concerns an 88-year-old lady who owns her own home and has been in a nursing home since 1985. On 1 April she was informed that she was no longer eligible for income support, presumably because the house she owns, though it yields no income, is a capital asset, valued above £3,000. She is trying to sell the house but she cannot do so. In the meantime, there is no money to pay the nursing home fees of £180 per week. The obvious answer in this case should be a bank loan, but it seems that bank managers are not sympathetic towards cases such as this, and under the new regulations the DHSS seems to have no discretion to help. So what is the poor woman to do?
It may be that my hon. Friend the Minister will quote to me from Health Circular 81(1) and tell me that where a consultant or a general practitioner recommends the transfer of a patient from an NHS hospital to a nursing home the health authority has the power to enter into contractual arrangements with the nursing home to care for that patient, at no cost to the patient or his or her spouse. But the health authority does not have to exercise that power, and certainly at Clwyd it has chosen not to do so. With the other pressures on it, and given the age profile of its area, I can see very clearly why it has so decided.
The solution suggested to me by my constituent Mr. Alun Roberts, to whom I am indebted for much of my information, is that funds should be allocated to health authorities for specific purposes such as this. I am not so sure about that. I can easily envisage other problems which would require specific funds to be dedicated to them, and there could be no end to such piecemeal financing.
None the less, the Government should surely be seeking some way not just of mitigating the very damaging effects that their targeting polices are having on people's instincts for thrift, but£more specific to my purpose tonight£of making it easier instead of harder for elderly people to move out of hospitals and into nursing homes. Even if we consider the matter purely in terms of value for money, it must make sense to encourage people to move out of hospital, where they are very costly to look after, to nursing homes, where they can be looked after at substantially lower cost.
It seems absurd to do anything to discourage that. By withholding financial support from public funds and making what may in the end prove to be a vain attempt to force spouses to spend their small savings to pay the fees, we may well end up by placing a greater burden on public funds. Moreover, we shall have added substantially to the heavy burdens already being borne by the relatives of elderly sick patients.