Elderly (Long-term Care)

– in the House of Commons at 4:08 pm on 7th May 1996.

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Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health 4:08 pm, 7th May 1996

With permission, Madam Speaker, I should like to make a statement about the consultation document, which I am publishing today, setting out the Government's proposals to improve our arrangements for care in old age.

Older people represent the fastest growing section of the community. The proportion of the population aged 75 and over has risen from 4.7 per cent. 25 years ago to 7.1 per cent. today. The figures for those over 85 are even more dramatic: the proportion has doubled from 0.9 per cent. 25 years ago to 1.8 per cent. of the population today.

It is fashionable to regard those trends as a problem that requires a solution. The Government are more optimistic. We unreservedly welcome the fact that medical and social advance allows us to live longer and fitter lives. It requires a particularly perverse nature to regard the prospect of improved life expectancy and improved quality of life as anything other than good news.

But even good news has to be planned for. As life expectancy increases, it becomes progressively more important to ensure that sufficient provision is made to enable retired people to enjoy a comfortable and fulfilling retirement.

The Government believe that the principal responsibility for making that provision must rest with the individual citizen. That is why we have developed a wide range of incentives to encourage people to save for their needs in later life. New rights and flexibilities have been introduced into pension schemes. Savings products, such as tax-exempt special savings accounts and pensioner income bonds, have been developed or made more attractive to encourage people to save during their working lives and provide for their needs during retirement.

There is, however, one cost that can have a dramatic effect on the finances of elderly people, and for which they have often not made specific provision. It is estimated that roughly one in five people who reach retirement age will eventually need long-term residential care, which can cost up to £20,000 per annum or, in some cases, even more. Costs on that scale cause real concern to elderly people and to their families. Furthermore, that worry is compounded by uncertainty, as no individual can be certain either whether they will need residential care or for how long they will need it. The open-ended nature of the potential commitment is a particular source of concern.

Against that background, the Government believe that it is important to provide a framework of support to allow individual citizens to plan their affairs against a more stable background. That framework must balance two objectives.

First, it must continue to offer targeted support to those elderly people who are not able to meet the full cost of their care for themselves. Secondly, it must recognise the contribution of those who do make provision specifically to meet their own needs and ensure that those people secure proper reward for their thrift and responsibility.

The existing arrangements have made possible an unprecedented improvement in provision for the care of elderly people, but they are widely perceived to impose an unfairly onerous burden on those elderly people who do make a contribution to their own care costs.

The Government are determined to address that concern. Last month we changed the rules of the means test, which is used by local authorities to determine entitlement to assistance with residential care costs. We increased from £3,000 to £10,000 the amount of capital that is fully disregarded, and provided for half a resident's occupational pension to be disregarded when he or she has a spouse at home. But we want to do more. The consultation document that I am publishing today therefore offers three new elements in the framework of support.

My first proposal concerns those still in work. Almost 11 million people of working age are members of occupational pension schemes and about 10 million people belong to personal pension schemes. Funded pension provision in Britain is more advanced than in any other European Union country, and it is the financial strength of the United Kingdom pension sector that provides the best assurance to the working population that their financial needs in retirement will be met. The Government believe that there are some significant ways in which pension schemes can help individual citizens to meet their long-term care needs. The Government are therefore seeking views on the possibility that pension schemes could offer variable pensions that involve a smaller initial payment in return for a larger payment later on. We believe that that change would be of considerable benefit to elderly people using their pension funds to help with the cost of long-term care.

My second proposal involves those who are at the end of their working lives and are planning their financial arrangements during retirement. In making their plans they need to make provision for the possibility that they will need residential care, but they will be anxious to safeguard their savings, and often the value of their family home as well. The Government therefore believe that it makes sense both to the individual and to the taxpayer to offer those people a partnership. To the extent that the retired person insures the risk that they will need long-term care, the taxpayer will give extra protection to the assets of the retired person. The consultation document offers two alternative formulations, both of which would have the effect of protecting the assets of those in residential care by an amount related to the value of the insurance policy that they take out.

My third proposal concerns those who are at the point of entering long-term residential care, or are already receiving it. At that point in their lives, it is either certain or very likely that they will need long-term care, but a substantial question mark remains over how long they will need it for. Again, it makes sense to both the individual and the taxpayer to offer a partnership that protects the assets of retired people by an amount that is related to the value of an annuity that they purchase on entering care. The annuity offers the elderly person certainty by providing a commitment to pay a stated amount for as long as he or she needs to fund his or her own care. The consultation document invites views about the level of asset protection that should be available to holders of that type of immediate-needs annuity.

In considering both insurance and annuity products, the Government think it important for the value of the asset protection available to retired people to be related to the value of the policy that they buy. The consultation document sets out more than one option for establishing the relationship, but it does not suggest that purchase of a policy should exempt a retired person from the means test. The reason for that is important. Total exemption could be linked only to an insurance policy or annuity that passed a minimum threshold of value. The result would be to remove any incentive to provide for themselves from those who were not able to afford total exemption. The Government think it important to provide encouragement to save for old age right across the income scale; we are therefore not attracted to a scheme that we believe would discriminate against less-well-off people.

Expenditure by social services departments on the care of elderly people has been one of the fastest-growing commitments of the taxpayer over the past 17 years. In 1979, the figure stood at approximately £1.5 billion in today's values. Expenditure last year was approximately £3.4 billion, to which must be added £1.5 billion of expenditure by the DSS on residential care for the elderly. That makes a total of £4.9 billion—an average annual increase in real terms of more than 7 per cent. every year for the last 17 years. No one can say that this Government are not committed to providing proper social care for elderly people.

Today's announcements make it clear that that commitment continues. We offer a partnership to elderly people and their families. We shall continue to provide a safety net. In addition, we shall ensure that a proper framework is in place to encourage people to provide for themselves, and protect the interests of those who do. That is the proper basis for a free society, and I commend it to the House.

Photo of Harriet Harman Harriet Harman Shadow Secretary of State for Health, Member, Labour Party National Executive Committee

The consultation document claims to be about partnership, but is it not clear from the statement that it is about the individual taking over responsibility? The Secretary of State says that the principal responsibility for making … provision for care in old age must rest with the individual". He says that the Government's role is now nothing more than "a safety net". That is a betrayal. No one told today's elderly that their care was to be their responsibility. No one told them that the welfare state would be only a safety net for them. They were promised care from the cradle to the grave, and that promise has now been broken.

The consultation paper fails to provide the solution to a problem that the Government have created. Will the Secretary of State admit that the lack of proper provision for long-term care has caused an epidemic of insecurity among old people, and that 40,000 people every year must sell the family home to pay for nursing care? Will the Secretary of State also admit that the problem has not been caused by the growing number of elderly people? That steady increase has been known about for many years. The problem is the Government's failure to make proper plans for the care of the elderly. In fact, far from planning for their care, the Government have cut NHS nursing care for the elderly.

Will the Secretary of State confirm that, since 1988, the number of people aged over 75 has remained steady? Will he also confirm that, over that period, the Government have cut the number of NHS continuing care beds by a third from 51,000 to 34,000? Is that not where the care gap has come from? Elderly people have been asked to pay for that care gap, and today they are being asked to pay more—a minimum of £10,000 a pensioner couple when they retire, according to the Government's figures. Today's announcement will be seen as a new Tory tax—a tax on the elderly and a tax on home owners. The Government are saying to elderly couples, "Pay up £10,000 or more or lose your home if you need long-term nursing care."

The £10,000 plan will not solve the problem. Will the Secretary of State admit that, even in America. where people are used to insuring themselves for health and social care, very few people take out insurance for long-term nursing care because it asks them to pay most when they can least afford it—when they are retiring?

What about those who own their own home but do not have £10,000 to spare? What about people who do not own their own home? Will the Secretary of State confirm that, according to the National Association of Pension Funds Ltd., only a minority of people who have an occupational pension would be able to afford to reduce their annual pension to pay for long-term care? Do we not need to pay much more attention to people who need nursing care but who could, with a little extra help, stay in their own homes? What about people in hospital who need short-term residential nursing care to help them get better, not long-term care for the rest of their lives? The right hon. Gentleman's proposals do not provide answers to those questions.

Does the Secretary of State recognise that the Government's short-term, piecemeal approach, in which the consultation document is another step, will not work? We need a royal commission to involve all those concerned in the broad range of social security and health service issues. What people want is the ability to sit down together as a family and plan. They cannot do that now. They want a choice of options for care in their old age. They do not have that now. Above all, they want security. Thanks to the Government, they certainly do not have that now.

Will the Secretary of State act on the Health Select Committee's call for national eligibility criteria for continuing care to end the current lottery, whereby the care that people receive and the price that they pay depends on where they live? Will he admit that the shortage of convalescent and rehabilitation care means that too many people are denied the chance of independence? The reason why today's announcement fails to address the real issues about reforming long-term care is that it is not a serious attempt to rescue the elderly from fear and insecurity—it is merely the Government's attempt to rescue themselves from electoral defeat.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

This is an extraordinary example—the second in a week—of Labour's Front-Bench team not being able to work out its own line. On the lunchtime television news, an argument was going on between the hon. Lady and her hon. Friend the Member for Islington, South and Finsbury (Mr. Smith). In the House this afternoon, the hon. Lady has again described the proposals as a betrayal. On the lunchtime television news, the hon. Gentleman said: Well, I have no particular objection to the basic idea. The hon. Lady said at lunchtime that the proposals were a tax on being old and on being a home owner; the hon. Gentleman had no particular objection to the basic idea.

Opposition Front-Bench spokesmen really should work out their lines before they go public on a television screen or in the House of Commons. When the hon. Gentleman goes to see his hon. Friend the Member for Peckham (Ms Harman), perhaps he will explain to her the difference that she glossed over this afternoon between social care and health care. She led the House to believe that she does not understand that, since 1948, there has been a difference in the funding arrangements for social care, under which support has been means-tested since 1948, and the funding arrangements for health care, which have been a universal, largely free service since 1948. They remain exactly that.

The hon. Member for Peckham talked about the decline in bed space in the national health service. She is right. The House will be interested in the figures. The figures that she quoted are not precisely the ones that I have in front of me, but they are near enough. The number of NHS beds for care of the elderly fell from 55,000 in 1979 to 37,000 in 1995—a reduction of about 18,000. What she did not tell the House was that, in the same period, spaces in residential homes—75 per cent. of which are supported out of public funds—increased from 32,000 to 167,000, or that nursing home spaces increased from fewer than 20,000 to 155,000.

The hon. Lady did not mention the fact that, as I said in my statement, there had been a 7 per cent. per annum real terms growth in public funding for care of the elderly since 1979. It is simply a travesty of the truth to represent that policy as undermining care of the elderly. In the past 17 years there has been an unprecedented growth in the public funds available to support elderly people.

The hon. Member for Peckham went on to peddle the myth—here the hon. Member for Islington, South and Finsbury was just as guilty as she was—that the Government's proposals were linked to a £10,000 charge to elderly people. She might like to turn to example 1 at paragraph 9.22 of the document. I do not ask her to go through all the examples, but simply to look at example 1, which makes it clear that the charge is £5,000 to protect a £60,000 house—£5,000, not £10,000. The more important point is that, as I said clearly in my statement, there is no minimum qualifying amount. Any couples or individuals who have savings or assets that they want to protect can benefit from the scheme. It is simply not true to say that there is a minimum qualifying amount.

Anyone listening to the response of the hon. Member for Peckham would have been hard put to recognise the proposition that in this paper the Government are offering the terms on which the means test will be made more generous to allow more public support to go to those who have provided for themselves in old age. The core idea in the statement is that, in addition to continuing to provide the safety net that has been available and has been developed since 1979, we shall also provide support to those who provide for their own needs. I believe that that is right.

The hon. Member for Peckham concluded with a commitment to a royal commission. It is the saying of a politician who has no ideas. It is one of those great sayings of history: "The cheque is in the post, leave it to a royal commission." That is the hon. Lady's standard of policy-making.

Several hon. Members:

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Photo of Miss Betty Boothroyd Miss Betty Boothroyd Speaker of the House of Commons

May we now have brief exchanges—brief questions and brief answers? A number of hon. Members want to ask questions.

Photo of Mr Nigel Forman Mr Nigel Forman , Carshalton and Wallington

The three proposals in my right hon. Friend's statement are significant steps forward in a difficult area and I congratulate him on that. In financing them, does he recognise that there is bound to a partnership between the general taxpayer and the families of those who need the care? Will explain a little more fully how that can be carried forward?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I am grateful for my hon. Friend's welcome for the document, and I agree about the need for partnership. As I have stressed, the key concern must be to continue to provide the safety net for those who cannot provide for themselves while offering a fair arrangement of partnership between public and private sector for those who can and do save for their old age. Those people have been disadvantaged by the system over the past few years and we offer them targeted assistance in the document.

Photo of Mr Archy Kirkwood Mr Archy Kirkwood Liberal Democrat Chief Whip

It is welcome that the Government have made some proposals because there is much uncertainty and concern about future provision, but I am nervous about the timetable because important work, such as the Select Committee's report and some valuable work by the Rowntree Foundation, will become available in the next few months. The consultation period is only four or five weeks, which is too short. I am concerned about the amount of money involved and whether the scheme will effectively be available to people on ordinary incomes. Example 1 on page 35, to which the right hon. Gentleman referred a moment ago, talks about insurance that would pay out £7,500 a year. What premium would have to be paid to get such a return?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The example in paragraph 9.21 that I cited would involve a cost of £7,500 to provide cover for the rest of the life of the individual. If that person wanted only to protect a £60,000 house—the detail is set out in paragraph 9.22—the single premium would be £5,000. However, the important point is that people who want to protect smaller sums, either because—as the hon. Member for Peckham rightly said—they are not home owners and want to protect a cash nest-egg or because their houses are not worth £60,000, have that option under the proposals. There is no minimum qualifying amount and nor should there be, because it is my purpose to encourage all sections of the community to save to provide something to help them in their old age and to give people a reward when they do so.

Photo of Mr Warren Hawksley Mr Warren Hawksley , Halesowen and Stourbridge

I congratulate my right hon. Friend on his consultation document—it is a move in the right direction and it is right that the problems of financing care should be tackled. I have two points. First, will he develop the further stages of the process and the timing of that?

Secondly, I hope that he will be able to give my constituents an assurance that they will have a choice between council and private facilities in spending the money. Dudley's Labour council claims to be under financial restrictions under care in the community and blames the Government. It has decided to fill its own homes rather than to give the private sector a chance to provide the service. Private homes are often better and cheaper for the taxpayer. Will he assure us that it is a bad use of taxpayers' money to spend more for worse homes, and will he say what he is going to do about it?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

My hon. Friend's second point is important and runs much wider than this issue. It is important to encourage social service departments that are responsible for making decisions about where people go into care to consider honestly the costs and benefits of particular forms of care and not to bias their decisions in favour of their own protected public authority sector. I agree about that, and I give him a complete assurance that, because the money paid out of the insurance and annuity schemes will be the insured person's money, people will be free to use those resources in the home of their choice.

On my hon. Friend's first question about the timetable, the document makes it clear that we intend to make it possible for people to take advantage of the schemes during 1997. As primary legislation is required, he can draw his own conclusions from that commitment.

Photo of Frank Field Frank Field Chair, Social Security Committee, Chair, Social Security Committee

As the introduction of a new national insurance care pension would have rewarded everyone who works hard and saves, will the Secretary of State say what consideration he gave to that proposal, as opposed to the partial proposals that he has talked about today?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I prefer to encourage voluntary contributions—encouraging people to recognise their responsibilities without the use of compulsion, which makes the contributions largely indistinguishable from a form of taxation. I prefer the voluntary approach, and the document makes it abundantly clear that that is the Government's policy. We considered both approaches and opted, as a matter of conscious choice, for the voluntary one.

Photo of Jacqui Lait Jacqui Lait , Hastings and Rye

Does my right hon. Friend accept that many of my constituents will welcome the proposals, particularly his assurance that they will be introduced during 1997? Does he also accept that a number of them will not be able to avail themselves of the proposals and will therefore suffer the problems with social services that have been described? When does he expect to break the hegemony of social services by breaking up their role as judge, jury, prosecutor and inspector?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

My hon. Friend may be interested to know that I announced 10 days ago a series of reviews into the value for money being secured by social service departments. The social service sector is the fourth and often not commented on arm of the welfare state. It is responsible for substantial public expenditure and it is right that the manner and value of that decision-making process should be subject to proper public audit. I announced a series of proposals to secure that in a speech to the Association of Directors of Social Services roughly 10 days ago.

Photo of Mr Alf Morris Mr Alf Morris , Manchester Wythenshawe

What can the proposals do for the more than 40,000 elderly people who have had their homes sold over the heads, in the last year alone, to pay for long-term care? What will they do for their caring relatives, mainly women, again in their tens of thousands, who, after many years of caring for an elderly parent, now find that they have lost their inheritance? Does the Secretary of State recall that it was the plight of caring relatives and their deep sense of injustice that brought this issue to the boil, not only across middle England but all across this country?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I share the right hon. Gentleman's impatience to get these proposals in place so that we can prevent that process from continuing. I simply invite him to address his comments to Labour Front Benchers, who are prepared to appoint a royal commission to examine the subject further before they will tell us what they would do about it.

Photo of Mr Douglas French Mr Douglas French , Gloucester

I congratulate my right hon. Friend on these creative and positive proposals. They will be a great comfort to the elderly and are not at all as the Opposition spokesman, the hon. Member for Peckham (Ms Harman), portrayed them. Does he recognise, however, that insurance companies will need to respond positively and helpfully, which I am sure they stand ready to do, to introduce new products and compliance procedures and to ensure that their product design is correct and produces for purchasers what they believe they will get? Will he give as much attention as possible to the consultation process and consider the publication of draft clauses before the legislation comes before the House to ensure that all the details are properly ironed out?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I can certainly give my hon. Friend the absolute assurance that we shall work closely with the industry and other interested parties to ensure that the issues are fully thought through and ironed out before the legislation is introduced. I will think about my hon. Friend's suggestion on draft clauses. We have already had informal contact with the industry, and we shall continue that with it and other interested parties. I am grateful to my hon. Friend for his welcome and entirely agree with the stress that he places on the need to ensure that we proceed in a proper and open consultative way.

Photo of Dennis Skinner Dennis Skinner Member, Labour Party National Executive Committee

Is not the truth that what the Secretary of State is up to is a big confidence trick on the elderly? On the one hand is someone with emphysema, who is riddled with disease and has to go to hospital incessantly for perhaps five or 10 years in the latter period of his life and, on the other, those with Alzheimer's disease who see their homes being taken away from them. Under this scheme, all those people who are affected will not get a penny piece. As for this insurance scam, the only people who will make big profits are the friends of the Tory party among the insurance companies. One thing is certain and I do not know whether the right hon. Gentleman has ever thought about this, but people ought to understand it—do not buy your council house under the Tories, or you might lose it.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

That was yet another example of the catholic views of the modern Labour party. While Labour Front Benchers are busy trying to reassure those who operate in the market that they understand how the market works and that they benefit from the free-enterprise system, the hon. Gentleman remains the authentic voice of the traditional Labour party—which, whenever a public-private partnership is proposed, can think only of the profits of the private partner. The vast majority of elderly people will feel that, at last, there is a clear route forward. They will draw a sharp contrast between that clear route forward and the fog on offer from the hon. Gentleman and from his hon. Friend—if he is happy to call her that—the Member for Peckham.

Photo of Mr David Martin Mr David Martin , Portsmouth South

I welcome my right hon. Friend's imaginative proposals, in particular his highlighting of the contribution made by private rest and nursing homes to the long-term care of the elderly in Portsmouth and elsewhere—the same nursing homes against which the Labour party continues to have a vendetta. Will he, please, state specifically that he intends that there should be legislation in this year's Queen's Speech so that the proposals produced at the end of the consultation period can be put into legislation as soon as possible?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

There are niceties to the specific commitment in the terms that my hon. Friend asks for, but I have given the clear commitment to introduce legislation during 1997. I invite him to draw the same conclusions about the implications of that commitment as I asked my hon. Friend the Member for Halesowen and Stourbridge (Mr. Hawksley) to draw a moment or two ago.

Photo of Lynne Jones Lynne Jones , Birmingham, Selly Oak

The distinction between social and health care is entirely artificial for my constituents, who are having to sell their homes to pay for long-term nursing care. It has, sadly, become the accepted wisdom that the taxpayer can no longer afford the welfare state from cradle to grave, yet as citizens we are told that we can afford premiums of up to £10,000, or—according to Private Patients' Plan, which has operated the blueprint for this consultation—monthly premiums of £70. In the wings, of course, we have the insurance companies, waiting to cream the profits. This week in The Independent on Sunday, insurance companies told us that they pay out only 70p for every pound that they collect.

Why does not the Secretary of State offer the people of this country the choice that a majority of them want: to pay for their health care through national insurance or the tax system? In the end, the premiums will be a damn sight cheaper than the costs listed in these booklets or in his consultation document.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Lady and her colleagues on the Labour Front Bench have to come clean. If they are in favour of universal provision of social care, they should say that that is their policy—it is the policy of the hon. Member for Bolsover (Mr. Skinner)—which will cost an extra £4 billion of public expenditure. Is that their policy? If it is not, they must not mislead the public that that is the direction in which they are going.

Photo of Mr John Butcher Mr John Butcher , Coventry South West

I congratulate my right hon. Friend. May I warn him—perhaps he does not need any warning—that he is dealing here with a very emotional issue, which, if misrepresented or distorted, could cause a great deal of distress? Will he therefore spend a great deal of time on television and radio over the next three to four hours? If the hon. Member for Peckham (Ms Harman) runs true to form, she will spend that time frightening the daylights out of elderly people.

I also tell my right hon. Friend that, in addition to the hon. Member for Birkenhead (Mr. Field), many of us are curious about the cost-effectiveness and quality of life implications of offering incentives, either through the taxation system or through cash, to relatives who wish to care for their elderly relatives up until the very last moment—the point at which 100 per cent. nursing care is required. That may save money and help the elderly to stay in their homes for longer.

Has my right hon. Friend seen the very interesting and somewhat destabilising research that shows that nicotine, as a drug, can prevent the onset of senile dementia? Does that not raise some rather interesting ethical and life style questions for the elderly?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I am not proposing to offer any scientific advice on any subject today. The advice is clear: smoking is bad for health. That advice appears in different forms on every cigarette packet. The hon. Member for Peckham can relax about that. I shall be interested to examine evidence that my hon. Friend may wish to send, but, for the moment, scientists' advice is very clear about the health effects of smoking.

My hon. Friend is absolutely right to say that, if the hon. Member for Peckham runs true to form, she will be looking for means of scaring people. She thinks that she has already found that means because she has latched on to the idea that this is a £10,000 bill, but the proposals make it explicitly clear that there is no minimum amount and that any family with any amount of savings that they wish to protect can benefit from the provisions of this scheme. She will be misleading the public if she continues to return to that figure.

Photo of Mr Dafydd Wigley Mr Dafydd Wigley Leader and Party President, Plaid Cymru

Does the Minister realise that a large proportion of the widows in my constituency do not have £5,000 with which to buy an annuity? Will he clarify one point that has not been touched on—the position of those who are under 65 but who have been hit by strokes or by other disabling conditions? Are they brought into the provisions or not? There does not appear to be very much reference to them.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The answer to the hon. Gentleman's second question is yes, there is no age-qualification bar to the proposals.

On his first point, he is precisely right. That is why I have set my face against proposals that offer partnership only to those who can afford to buy total exemption. I am determined that that product should be available to all people with savings that they want to protect, however small. Any attempt by any politician to mislead the public about that matter is blatantly dishonest.

Photo of Mr Nigel Spearing Mr Nigel Spearing , Newham South

Does the Secretary of State for Health agree that health care for the frail aged, whether in home or at home, is but a section of the much broader post-war solution that we thought we had for social security as a whole? Does he agree that his Government cannot deliver that security when their policies are, unfortunately, delivering greater insecurity of employment, greater insecurity of income and even greater insecurities for existing homes for the frail and elderly, such as the Sally Sherman home in Newham? How can we place confidence in a scheme for old age that increases the participation of the City and the use of premiums when, in fact, the Government cannot deliver security now?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman has asked a very wide-ranging question. I pause simply to observe that security of employment and job prospects are better here than they are in any other major European Union country, because our economy is working more efficiently than most comparators elsewhere in Europe. As for his point about the welfare state and its structure, he must recognise that there is a difference between health and education—the two elements of the post-war welfare state—which are provided on a universal basis to a high standard and are largely free to those who need them. That is the commitment that this Government honour on health and education.

In the rest of the welfare state—through social security, social services and housing—ever since the war the commitment has been different. The commitment has been to a safety net to ensure that no one has an unacceptably low standard, but to encourage the individual to improve on that minimum. That is the basis of the post-war welfare state, which is respected by these proposals but which is called into question by some of the questions from Opposition Members.

Photo of Mr Jeff Rooker Mr Jeff Rooker , Birmingham, Perry Barr

There is a well-known reluctance among people to plan for strokes, for the onset of Parkinson's disease or for other such illnesses. We will all get old, but most people do not expect those illnesses to happen to them. Ordinary, normal, rational and logical people sometimes refuse even to make a will for that reason, later landing their loved ones with horrendous problems. It is a major difficulty.

I ask the Secretary of State to consider how the House legislated in the past to force on people one of two pensions—the state earnings-related pension scheme or an occupational pension—on top of the state pension, because people are reluctant to plan and save for a pension. The House had to do that, with a degree of consensus, because it was the only way in which we could ensure that people avoided dropping through the safety net. There should be an element of that in this scheme, because some people will refuse to take up such a scheme on the basis that it will never happen to them—or they refuse to think about it at all.

Does the Secretary of State maintain that there was a golden age of NHS long-term care? There was not. There were long-stay geriatric wards—with 20 to 30 beds in a ward—where families, if they could, dumped their elderly relatives so that they could get their hands on their relative's house. The quality of care for our constituents' parents was abysmal. Now, the majority of people can, if they wish, stay in small wards, and the majority stay in single rooms. The quality of care is now vastly superior to what it was. I do not make a distinction between the public and private sector when I say that, but we must not lead people to believe that there was a golden age of long-term NHS care as opposed to other forms of care—that would be to set out a false prospectus.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman is powerfully right, and I refer his colleagues to his final remark. I should like to add one further element to what he said about the supposed golden age on which people look back. In addition to the people who received poor care in NHS geriatric hospitals, many tens of thousands could not find care either in such hospitals or in part III accommodation run by local authorities. That waiting list has been abolished by the changes introduced over the past 17 years.

Several hon. Members:

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Photo of Miss Betty Boothroyd Miss Betty Boothroyd Speaker of the House of Commons

Order. We must now move on; I am sure that we shall return to this matter.