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Care for the Elderly

– in the House of Commons at 6:46 pm on 5th February 2001.

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Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health) 7:13 pm, 5th February 2001

I beg to move, That this House welcomes the NHS Plan's commitment to a care system founded on the principles of equity and fairness; regrets that the Plan discriminates against older people with chronic and long-term illness by continuing to means-test them for their own care; believes that the Plan creates a fault-line between nursing and personal care; further believes that the Plan fails even to provide nursing care free on the basis of need, limiting the concession to registered nurse time; and calls on the Government to implement the Royal Commission's proposals for personal and nursing care to be provided on the basis of a person's assessed need instead of means. Three and a half years ago, the Government established the royal commission on long-term care. Liberal Democrats welcomed the initiative, which offered the prospect of a fresh start and an end to the scandal of people being forced to sell their homes to pay for their care. The royal commission was asked to conduct its inquiry and report quickly, and it did so. In little more than a year, it published a detailed report that analysed the problems, offered a practical blueprint and set out how long-term care could be reformed for the future. The report was published in February 1999, and it is now more than three years since the commission's work was initiated. In those three years, a discredited and unfair system of means testing has remained in place, people's means have determined the care that they receive and more homes have been sold to pay for care.

The royal commission said that charges for personal and nursing care should be scrapped. Liberal Democrats agree. We recognise that charges increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy and that they discourage the use of necessary services. Those are not my words, but those of the NHS plan. We should be mindful of them in this debate.

Those who argue for means-tested care say that personal care has always been means tested, but that is not true. This debate does not concern luxury goods and services that people choose to obtain, but essential and intimate care—tasks that frail, sick or disabled people would carry out for themselves if they had the necessary strength, will or knowledge. Long-term care is a contingency, not a probability. Its costs fall disproportionately on the sick, frail and disabled. That is why the royal commission said that personal care should be free, but on the basis of an assessment of need.

Care costs will not run out of control. As royal commission member Claire Rayner said in a letter published in The Times today, the tasks in question include intimate personal care such as washing, feeding and help with lavatory needs". People will not demand to be washed more often or to be helped to be fed more regularly merely because the service has become free. Care costs will balloon only if the level of unmet need in this country is far greater than the current Government or any previous one have been willing to admit. The royal commission did not say that all costs should be paid by the state. It made it clear that the board and lodging costs of care should be met by individuals and said that we should expect to need to meet our housing costs throughout our lives. Liberal Democrats believe that the costs of care are a risk that should be met collectively.

By rejecting the royal commission's central recommendation, the Government are continuing a means test that discriminates against older people with chronic and long-term illness. The Government's position is clear: wealth, not health, will determine what care a person receives. If one has lifetime savings of £18,000 in a bank account, a pension or a home, the Government's message is clear. They say, "Don't get frail, sick or old, because if you do, you'll be charged." Our care system should not be a substitute for our tax system. If the Government want to redistribute money from the wealthy people in this country, they should not use poor health as the criterion for accessing it. Our care system should transfer wealth from the well to the sick, with no ifs or buts along the way.

What are the Government doing in practice? They would like hon. Members and people outside the House to believe that they are acting on the royal commission's proposals for free nursing care, but that is not the case. They have chosen a very narrow definition of nursing care and their proposals do not even make all nursing procedures free at the point of delivery. Only the costs of registered nurse time that is spent providing, delegating or supervising care will be met by the NHS, which will not pay for the time of the health care assistant or care worker who carries out the bulk of long-term care work.

That most mean of definitions, which treats nursing as registered nurse time, is clearly provider based and is a long way from being people centred. How are the Government to disentangle the costs of nurse-provided care from those of nursing care that is provided by others? Care homes will find themselves forced to measure costs and to cost the amount of nursing time that somebody receives. That will produce a system that is not only costly and bureaucratic, but which rewards dependence and drives people into dependency.

Photo of Adrian Sanders Adrian Sanders Opposition Whip (Commons), Shadow Spokesperson (Communities and Local Government), Shadow Spokesperson (Environment, Food and Rural Affairs)

Is my hon. Friend aware that many people in residential care require more nursing support as they get older, but not enough to justify their being transferred to the nursing care sector? That is imposing on the residential care sector great cost burdens that are not reflected in the income that it receives.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

My hon. Friend makes a valid point. Indeed, in many cases it is entirely appropriate for people to continue to live in what they regard as their home, rather than to move to another place to receive nursing care, and for the care to be brought to them. There is a problem with the fees for many residential homes, which is one of the reasons why there has been a collapse in confidence in the residential and nursing home sectors—a collapse that has led to the closure of many nursing homes.

Photo of John Bercow John Bercow Shadow Spokesperson (Home Affairs)

I am grateful to the hon. Gentleman for giving way because I think that he is making some sensible points. Does he agree that the Government's arbitrary and capricious distinction between nursing and personal care is rejected not only by the Liberal Democrats, as he made clear, and the official Opposition but, at least as importantly, by the Royal College of Nursing and the Patients Association?

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

It is certainly rejected by a long list of organisations, including the RCN, Age Concern and Help the Aged. However, perhaps the speech of the Conservative spokesman, the hon. Member for Meriden (Mrs. Spelman), will establish whether the Opposition view the distinction between the two items as capricious. We need a clearer idea of the Conservatives' policy on long-term care.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

I have seen the future of care, and it is a barcode. In the USA, a definition similar to that proposed by the Government has resulted in a barcode system being used so that care homes can electronically account for the time spent by members of staff, and residents can be billed accordingly. In some states, care staff carry hand-held barcode readers and laminated sheets of barcodes for residents' names, each task that is performed and the start and finish times.

A health care assistant will arrive to help Mrs. Smith, for example, to get up in the morning. She will scan the barcode for Mrs. Smith, the barcode for the start time for the job, the barcode for dressing and the barcode for the finish time. At the end of her shift, she will go to the desktop computer and download the data from her scanner so that, task by task, the care that Mrs. Smith receives can be itemised, analysed and charged. In America, that was described as a pioneering system for managing nursing time in care homes. I think that it simply turns care homes into supermarkets and care into a commodity.

Photo of David Heath David Heath Shadow Spokesperson (Environment, Food and Rural Affairs)

My hon. Friend is describing an absolute dystopia. With conditions such as dementia, is there any realistic distinction between nursing care and personal care? They seem to me to be exactly the same in many instances.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

My hon. Friend is absolutely right. Earlier today, Methodist Homes came to Portcullis House and staged a short play to demonstrate that if we are serious about people-centred care and about removing the divide between health and social care, we need to focus on individual needs. Unfortunately, maintaining a charging system for personal care makes it impossible to provide seamless care to the individual, and the result is discrimination against people with dementia, Parkinson's disease and many other chronic, long-term conditions. That undermines the Government's claim that they want a seamless service, because until they deal with the issue that the royal commission was asked to address, they will not achieve that seamless service.

Following the intervention by the hon. Member for Buckingham (Mr. Bercow), I want to tackle the Conservatives' policy, which he said is clear.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

I will happily take the hon. Lady's intervention because I am interested to hear precisely what the Conservatives' policy is and whether they will be sticking to the Government's spending plans for social services.

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

I can probably save the House a great deal of time by pointing out that during the Second Reading of the Health and Social Care Bill, my hon. Friend the Member for Woodspring (Dr. Fox) made it perfectly clear that we would match the Government on personal care and NHS funding. We share the hon. Gentleman' s concern about the definition of nursing care.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

That is why I felt that the policy was not clear. What the hon. Lady said is as clear as mud. Taking their classic position, the Conservatives want it both ways; they want to be concerned about the definitions, and we share that concern, but they want to stick up for the Government's position on financing care rather than committing themselves to the necessary finance. Are they prepared to find the extra resources to deliver free personal care?

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

We may be taking things out of sequence. I shall make our position perfectly clear. I repeat that we will match NHS spending, as we said on Second Reading of the Health and Social Care Bill. My hon. Friend made it clear that we will match the Government's spending on the provision of nursing care, as more accurately defined, which I shall come on to later. When I make my speech, I will explain the reasons for that position.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

I am grateful for the hon. Lady's further clarification. She has told the House that she and her Front-Bench colleagues wish to sustain the capricious separation of definitions to which the hon. Member for Buckingham referred. By taking the position outlined by the hon. Lady, the Conservatives will stick with the definition, which the Government are introducing, of registered nurse time only and the costings for that. The hon. Lady has well and truly buried the Conservatives' policy on free personal care. The Government's proposals mean that there is no money in the system to provide free personal care, so the Conservatives will not deliver that if they stick to the Government's spending plans, unless they make lots of cuts to other services. I shall come on to that point later.

Until the hon. Lady intervened, it was unclear whether the Conservatives supported the status quo, an insurance-based system, which seems to be their preference for other parts of the NHS, or the Government's position. We now understand that, for the moment at least, their position is the same as that of the Government.

Where do the Conservatives stand on what I regard, using their language, as a stealth tax on the elderly and the sick? We have a tax that penalises people for being sick and disabled. It is clear from reading speeches in this House, the Lords and elsewhere that the Conservatives are all over the place, as we have seen this evening. Despite the hon. Lady's comments, it is hard to find a definitive statement by a Conservative Front Bencher that clearly sets out the party's position on the royal commission's proposals. Even during the Second Reading of the Health and Social Care Bill, the exchanges about the Conservatives' commitment to social services spending made it clear that they were not prepared even to match the Government.

Photo of Dr Jenny Tonge Dr Jenny Tonge Liberal Democrat, Richmond Park

My hon. Friend is being very generous in giving way. Does he agree that it is interesting that the Conservatives' policy, announced today, to make tax free any income from savings for older people, contrasts rather badly with the continuing idea that older people must sell their home, which may be the bulk of their savings, to get personal care?

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

My hon. Friend highlights another inconsistency in the Conservatives' health policy.

Speaking of inconsistencies, the shadow Health Secretary, the hon. Member for Woodspring (Dr. Fox), complained that Labour now has two policies on long-term care and talks of a two-tier health system, but he forgot to mention that a two-tier system is exactly the policy that his party now espouses. In Scotland, the Conservatives have supported the Liberal Democrats and backed the royal commission in full. They will play a part, with the Liberal Democrats and others, in securing free personal care in Scotland.

Until tonight, to find out the position of the Conservatives in England, one had to look to their lordships House for a definitive statement. We should thank Earl Howe, the Conservative health spokesman in the Lords, for setting out that policy. He confirmed that the Conservative party would stick with the Government and implement the same policy.

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge

The hon. Gentleman is characteristically generous. He seems to think that there is something slightly strange about the fact that there might be a difference of emphasis between Conservatives in Scotland and Conservatives here. In the other two Parliaments in this country, the Liberals keep the Labour party in power, but they are pretending today to be opposed to Labour.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

The hon. Gentleman should take up that point with the hon. Member for Meriden, who has effectively attacked his colleagues in Scotland for allowing the creation of a two-tier system. He should check his lines before delivering them in the House.

It is hardly surprising that Conservative Members are all over the place on the subject of our debate—they caused the mess. They closed long-stay wards in the 1980s and 1990s without a thought for the thousands of older people who would have received free NHS care, but were confronted with means-tested care. It was a cost-cutting measure that was dressed up, with warm words, as community care. During their 18 years in government, the Conservatives drew the boundaries of state-funded care ever tighter. Thank God they were not re-elected at the last general election; otherwise, the fate of the public sector would have been to act as the 21st century administrators of a new poor law.

Before the election, the Conservatives set out plans for a private, insurance-based solution to the problem of long-term care. They were complex and, as the royal commission pointed out, it was difficult to perceive the benefits and to whom they would apply. The American experience of similar schemes shows that their take-up is low and that, in practice, many pensioners would be too old, too poor or too great a risk to qualify for immediate private cover.

Those who oppose the royal commission's recommendation to scrap charges for personal care say that it would do nothing to improve services. They are wrong; they have accepted the Treasury mantra hook, line and sinker. Let us consider the report of the Scottish Parliament's Health and Community Care Committee, which undertook a comprehensive inquiry into the royal commission's proposals. It found evidence that convinced all its members that for health and social care to form a genuinely seamless service, the two systems of charging and assessment—indeed, the multiplicity of assessment systems around the country—should be brought together.

The Royal College of General Practitioners presented evidence to the Health and Community Care Committee's inquiry to show that people had refused the most appropriate care in the most appropriate setting because they would be charged. Removing the obstacle of charging would therefore ensure that people received the most appropriate care. That means a better outcome for them and their families.

The Government found money to pay for free television licences for the over-75s. No means test was used. Collective responsibility led to the provision of a welcome universal benefit. They also found the money for a winter fuel allowance. Again, no means test was employed. A universal benefit was provided and collective responsibility acknowledged. If the Government can find approximately £2 billion to fund those initiatives, it must find the political will to take responsibility for the chronically sick and disabled in this country.

When the Select Committee on Health considered long-term care in 1999, it quoted the royal commission chairman, Sir Stewart Sutherland, who said: We need to change. The status quo is not acceptable. That was in April 1999. The Committee's report stated that it supported the royal commission's approach. It issued a warning: Failure by the Government to act urgently would be a serious dereliction of duty. That view was formed two years ago.

Liberal Democrats believe that the royal commission offers a fair, sustainable and workable basis for organising and funding long-term care in the United Kingdom. Instead, the Government, with Conservative support, are imposing an unfair, unsustainable and unworkable system. The message is simple: those who get sick had better get well quickly. Those who do not get better, those who suffer from a chronic disease, dementia or Parkinson's will have their life savings bled away before the state offers a helping hand.

For a Labour Government to do nothing to end such injustice and to take a Parliament in which to do it is a serious dereliction of duty. Liberal Democrats will campaign throughout the country to make people aware of that and to ensure change.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health) 7:34 pm, 5th February 2001

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof: welcomes the NHS Plan's commitments to a care system founded on the principles of equity and fairness; welcomes the measures the Government has announced to reform the funding of long term care and to invest in new health and social care services for older people; notes that this matches the extra spending on long term care recommended by the Royal Commission; believes that the implementation of free nursing care on the basis of need and not ability to pay will bring an end to a major injustice affecting tens of thousands of older people in nursing homes; welcomes the new investment announced in the NHS Plan of £900 million annually by 2003–04 in new intermediate care services for older people; supports the priority the Government has rightly attached to improving front line services for older people; and calls on the Liberal Democrats to set out what services they would cut in order to fund their proposals. It is common knowledge that we live in an ageing society. The hon. Member for Sutton and Cheam (Mr. Burstow) acknowledged that. Today, one member in five of the population is over 60, and the trend is upwards. Many people are living much longer. Between 1995 and 2025, we expect the number of people over 80 to increase by almost half, and the number of those over 90 to double. That reflects the achievements of organisations such as the national health service, social services and the voluntary sector. It is something to celebrate. However, it also poses real challenges and choices.

As the primary user of long-term health and social care services, older people account for approximately 50 per cent. of the resources that are consumed in health and social care services in England. They occupy approximately two thirds of general hospital beds and are responsible for at least 50 per cent. of the recent increase in emergency hospital admissions.

As a society, we face the challenge of ensuring that, in future, health and social care services better meet the needs of older people to lead healthy independent lives, thus avoiding unnecessary institutional care and the costs associated with it. We must find a fairer way of funding long-term care for older people. It should strike the right balance between what the state should fund and the responsibility of the individual, ensure that people are not forced to sell their homes to pay for their long-term care costs, and that older people lead healthier lives for longer.

All that obviously requires major new investment and the redesigning of our care services—I am sure that the hon. Member for Sutton and Cheam accepts that—and the Government are committed to doing it. That is why the NHS plan outlined a major expansion in care services for older people: £900 million by 2003–04 and a further £360 million a year on making the funding of long-term care fairer. It will not be possible to achieve those objectives if we divert spending elsewhere.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

My hon. Friend mentions fairness. I accept that the Government have inherited a problem that the previous Conservative Government created by withdrawing free long-term nursing care from the health service and introducing privatised social and nursing care in care and nursing homes. Is it fair or right that people who have paid all their lives and expect to receive free NHS long-term nursing care have to pay for it again because of the previous Government's withdrawal of free NHS care?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman must be patient. I will tackle that shortly, but I have only just started my remarks. I intend to deal with continuing long-term, NHS-funded care later.

Photo of Dr Peter Brand Dr Peter Brand Liberal Democrat, Isle of Wight

The royal commission correctly pointed out that there is no prospect of a demographic time bomb and that most of the expenditure on health and personal care happens during the last six months of people's lives, irrespective of age. That weakens the Minister's argument about the awful prospect that the Government cannot cope without extraordinarily high expenditure.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman knows that I have a lot of respect for him. I do not mind repeating that tonight, even if it embarrasses him. However, I was not making the argument that the hon. Gentleman suggested. If he will bear with me, he will follow my comments more clearly.

There is no demographic time bomb; that is not the heart of the Government's response to the royal commission. I shall return to that point shortly. However, I am sure that the hon. Gentleman knows from his practice that the health and social care needs of frail older people in our ageing society are becoming more intense. People often require nursing and residential care much later and their needs are more intensive and extensive.

Priorities lie at the heart of our debate. There are no easy choices, and it is foolish to pretend otherwise. Those difficult choices have been recognised by the Scottish Executive, and they include the impact on other spending priorities and the benefits system, to which the hon. Member for Sutton and Cheam did not refer. However, the hon. Gentleman, in an otherwise characteristically good speech, fell into the trap. Liberal Democrat Members try to pretend that there are no difficult choices. The system that the hon. Gentleman advocates, as he rightly said, would still involve a means test, and the difficulty of defining personal care would remain. He will need to spell out his proposals in more detail in future.

Making personal care free does not avoid boundary issues between what is free and what should be means-tested. It simply shifts the boundary. If food preparation, which is a daily cost that everyone has to bear, were charged for under the hon. Gentleman's proposals—as I think he would say that it should be—but help with eating were free because that might be considered to be personal care, he must say at what stage help with eating would become free. Would it be when the care worker lifted the food on to a fork or spoon, or when he or she put the food into a liquidiser?

The hon. Gentleman will need to be able to devise an accurate way of distinguishing between food preparation that he thinks should be treated as personal care and food preparation that should not. I look forward to hearing his answer. It is inevitable that his system would be based on a list of tasks. Any such list would generate controversy and argument about what should be included and what should be left off.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

The Minister is developing an important point about definitions. Does he agree, however, that the Government have ducked the debate about definitions by saying that the registered nurse's time will be free and that the decision will depend on what the registered nurse does? For example, if the nurse put the food into the liquidiser, the service would be free, but if a care assistant did so, it would not be.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman has put forward such arguments before, and he is wrong. I shall explain why in a second.

Given the simplistic way in which the hon. Gentleman has presented some of the choices, it strikes me that his arguments are more opportunistic than principled. That is made even clearer when we consider the record of the hon. Gentleman's party on the matter. The Liberal Democrats' manifesto at the previous election contained no hint that they believed that personal care should be free. Exactly the opposite was the case. It might be a long time since the hon. Gentleman has looked at his manifesto, and it might be inconvenient for him and his right hon. and hon. Friends to do so.

Photo of Mr Archy Kirkwood Mr Archy Kirkwood Chair, Social Security Committee

We have taken the royal commission's recommendations into account.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I shall come to that point in a second, if the hon. Gentleman will bear with me.

I quote from page 39 of the Liberal Democrats' manifesto: We will introduce national charging and eligibility guidelines to ensure a 'level playing field' of provision and charges … We will, as resources allow, raise the threshold at which older people are required to make a contribution to their long-term care. There is no suggestion that personal care should be universally free. I wonder whether the U-turn that the Liberal Democrats have undergone has anything to do with a calculation about perceived political gain. It is not just the Tories who like to leap on bandwagons.

When the hon. Gentleman was a Liberal councillor in Sutton—

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

I wondered when we would get to this.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Indeed; I think that it is worth getting to. When the hon. Gentleman was a councillor, I understand that it was his party that first introduced means-tested charges for home care services. A little less posturing from him on the subject would, therefore, be advisable. No one has a monopoly on compassion—certainly not the hon. Gentleman and his party.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

I wondered when the Minister would get to that part of his speech, because I had heard that his officials had been busy winding up council officers in Sutton on Friday to provide him with a brief for this debate. His facts are incorrect. The charging policy was first introduced by the council in the early 1980s, when the Conservatives were still running the borough.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am aware of that. However, the hon. Gentleman and his party introduced a means-tested charging regime. Before that, the policy introduced by the Conservatives provided for a flat rate. The hon. Gentleman and his party changed the system. They did not decide not to charge; they introduced a different charging policy.

It is also worth bearing in mind that in Wales, the hon. Gentleman's party supports the view that we have taken in England on these issues, which is that the right priority at present is to invest in better NHS and social care services for older people and to end the unfairness of means-testing people for their nursing care in care homes. There are, therefore, disagreements between and within political parties on the issues. It might have been better if the hon. Gentleman had referred to that in his remarks.

Of course, the funding of long-term care must be fair and reasonable. No one disputes that. However, the acid test that we should use in deciding to increase public spending, given what we know about the existing range of services for older people that are on offer, is whether any option leads to improved and better health care for older people. We should also ask whether more older people would receive the help that they need at home to remain independent for longer, surrounded by their friends and family in the community, where they want to be. We need to ask who would benefit from any extra spending and why, because—as my right hon. Friend the Prime Minister made clear last week—we cannot spend the same resources twice. That is how we should judge the proposal that personal care should be universally free.

Photo of Mike Hancock Mike Hancock Shadow Spokesperson (Environment, Food and Rural Affairs)

Does the Minister agree that three significant things have happened since the previous election? First, there has been a recognition that more resources are available, and that we can, therefore, do more; secondly, there has been a royal commission that supports that view; and thirdly, when people come into care now, they do so with greater needs than they did five or six years ago—a point to which the Minister has already agreed. We have not changed; we have simply moved on.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am tempted to offer some comment on the hon. Gentleman's last point. Of course his party has changed its position; he should not worry about that.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The Liberal Democrats have moved on, and they have changed their position. They have moved from a position in which they believed in charging for personal care at all levels—at home and in residential care—to one in which they no longer believe in so doing. We are entitled to ask, when a party changes its position like that, precisely why it has done so.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

No, I will not.

I understand that the point made by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) was that the royal commission has subsequently reported. That is a perfectly fair argument. However, we have to consider not only the rhetoric of the hon. Member for Sutton and Cheam, but his record in local government, where Liberal Democrat councils did not refuse to operate charging regimes. We must consider all the issues in the round.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

No, I will not.

The NHS plan sets out how the Government intend to rise to the challenges. It starts with a vision for improving the health and well-being of older people and of those who care for them. It goes on to spell out a comprehensive programme of service modernisation backed by an investment of £1.4 billion of additional spending by 2003–04. That new investment will fundamentally change the way in which our care system supports older people. In future, we want NHS and social care services to provide a wider range of more flexible care options for older people that will actively promote better health, encourage faster recovery from illness, support independence and avoid unnecessary institutional care or hospital admission.

New services will provide new choices and opportunities that will better meet the needs of older people and their carers. They will also help us to address the many criticisms that older people have made of the NHS and social services and to lay the foundations for a healthier older age. By 2004, that new investment will help an extra 130,000 people a year. By that year, there will be a 50 per cent. increase in the number of people benefiting from community equipment services that will help more people to stay at home safely for longer. Through additional home care support, 50,000 more older people will be enabled to live more independently at home. For many, the new services will prevent or delay admission into costly long-term care. The new intermediate care services will be free at the point of use, whether they involve residential or home-based care. We envisage that the services will typically last for six weeks.

If we are to succeed in refashioning those vital services, we need to ensure that standards of care are universally high and consistently observed. We want older people to have greater confidence in the ability of health and social services to meet their needs more effectively. We want them to have confidence that, in the future, the focus will be on maintaining their independence and preventing unnecessary ill health, and confidence that the care system will be there to support them properly when and where help is needed. We want them to have confidence that care agencies will treat them fairly and view their carers as equal partners. That is why we are doubling the carers special grant from £50 million this year to £100 million by 2003–04, allowing more carers to take a break from their caring responsibilities, and why my right hon. Friend the Secretary of State for Social Security recently announced a £500 million package of extra financial support for carers, which will benefit up to 300,000 carers over the next three years.

The national service framework will back up that investment and modernisation for older people, which will set new national standards for the care and treatment of older people, including those with mental health problems such as dementia.

The Care Standards Act 2000 provided for a new National Care Standards Commission, which will start work next year and operate to standards consistent with the national service framework. In creating a single National Care Standards Commission and broadening its role beyond regulation, the Government responded to the royal commission's unanimous call for a national care commission to take a strategic overview of long-term care to represent the interests of older people.

Those new standards will be sensible and realistic and care home providers will be given sufficient time to prepare for their introduction. Our main priority is to ensure that there is enough capacity across all care sectors, including residential care, to enable older people and their carers to receive the care and support that they need. We are working closely with the independent sector to ensure that that happens.

The NHS plan also commits substantial investment to develop services that will promote older people's independence and respond to an ageing population with more chronic disease. The system of care across the NHS and social services must work together much more effectively as getting older and frailer becomes more common. Partnership is one of the keys to success. I am sure that the hon. Member for Sutton and Cheam will agree that, all too often, older people find themselves in an accident and emergency department or a busy ward at their local hospital not always because they need to be there and not because there is no real alternative, but because there is simply nowhere else for them to go.

The investment that we are making in intermediate care will help to provide a new range of services, which can offer a new alternative. Intermediate care is about providing the right services in the right places and at the right time to meet patient needs—services as close to patients' homes as possible; services in patients' homes where that is appropriate; services that avoid, in some cases, the need for people to enter residential care; services that genuinely promote independence. None of those services will be able to develop if those resources are diverted—for example, to make more personal care free for some people who are charged for it as the hon. Gentleman suggests.

The hon. Gentleman spoke at length about free personal care. Let us be absolutely crystal clear about that. At present, most personal care is provided on a means-tested basis and three quarters of care home residents already receive some or all their personal care free. Those in greatest need of help with care costs receive that help. Of course, we could have chosen to spend the £1.4 billion that we are making available under the NHS plan on implementing the royal commission's recommendation that all personal care, as well as nursing care, should be free irrespective of a person's wealth. That would not have improved front-line services in any way, shape or form. I disagree with the hon. Gentleman strongly on that. Under his proposals, not one extra older person would receive any extra care or any additional support to remain independent for as long as possible.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

No.

Nor would the proposals of the hon. Member for Sutton and Cheam benefit the least well off as seven out of 10 people in residential care already have all or some of their personal care paid for. Instead, his proposals would lock in place the existing range of often inadequate services that have frequently been criticised by many older people. They would not allow us to develop a wider range of services much more effectively to meet the health and social care needs of older and disabled people.

Photo of Dr Peter Brand Dr Peter Brand Liberal Democrat, Isle of Wight

The Minister clearly recognises that personal care is very much part of keeping someone at home, hence the teamwork of an integrated intermediate care package. If that would work for a short-term intervention under his new proposals, does he believe that lots more people could be kept at home by taking away the main barrier to them accepting help, which is usually personal care rather than nursing care—their fear of means-testing?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I have tried to deal with that point, but it strikes me that the hon. Gentleman and his party have a simple choice. They have not made themselves clear, however. In response to the royal commission, we are making £1.4 billion worth of extra money available to improve long-term health and social care services for older people, including £360 million that will go to address the unfairness of the means test. As I understand it, his party wants all that and another £1 billion. That is the position of the hon. Gentleman and his hon. Friends. They have not said that tonight, but that is absolutely their bottom line.

The Liberal Democrats want to accept all our proposals and then say to the Government, "Can we have another £1 billion as well?" We have been round that course many, many times. All Labour Members and some Opposition Members will be aware of the argument that the Liberal Democrats have an uncanny ability to spend the same billion pounds in about 14 different directions, while saying to people, "We won't have to put up your taxes." Well, I have to say to the hon. Member for Sutton and Cheam that he and his hon. Friends have to grow up on such issues in politics. It is all right to blame everyone else—they are good at that—but they have to take responsibility for their own decisions. He should say clearly that they want the £1.4 billion and another £1 billion. That, at least, would be progress. I suspect that that is their real position, although he did not say so. Perhaps the hon. Member for North Devon (Mr. Harvey) will make that clear later.

We are investing £360 million in a full year—by 2003–04—to make the funding of long-term care fairer. We shall extend free nursing care to all settings, and I shall discuss that in a moment. We shall take action to ease the burden of residential care costs. We shall act to prevent people from having to sell their homes against their wishes on admission to care or during their lifetime. We shall tackle the unacceptable variations in charges for home care.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) will be interested to hear that new guidance is being prepared on NHS continuing care responsibilities, which will help to deal with concerns being expressed about the needs of those with chronic illness.

People often feel rushed into selling their homes when they enter care. That adds to the stress of what is certain to be a difficult time. It can also remove the possibility of returning home if the situation improves. That is why, from April, for the first three months after admission to a care home, the value of a person's home will be disregarded from the means test. That will allow valuable time for the person and the family to take stock and keep their options open. A person who goes into care owning a house, but with few other assets, will save between £2,000 and £2,500 during the first three months of the stay and we estimate that about 30,000 older people will benefit from that change.

From October, councils will be given an additional £85 million over three years to encourage them to offer deferred payment arrangements for those entering care. That will mean that, following admission, people will not be forced to sell their homes during their lifetimes against their wishes. In addition, our proposals to extend free nursing care to all settings recognise the need to remove the major anomaly whereby people in nursing homes are charged for care from nurses while those in all other settings receive it free on the NHS.

Subject to the passage of the Health and Social Care Bill, which is before Parliament, from October everyone who needs the care of a registered nurse will have it paid for by the NHS. That will include registered nurse time spent on providing, planning, delegating or supervising and monitoring care and meeting the costs of specialist equipment used by those nurses.

Photo of Mark Todd Mark Todd Labour, South Derbyshire

My hon. Friend is making a powerful and cogent speech, but one thing has been lost on him. I know of no other example in the NHS of the definition of whether a service is free being based on whether the person involved is a registered nurse.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I shall come to that, but I reassure my hon. Friend that that is precisely what the royal commission asked us to consider. In contrast with the points made by the hon. Member for Sutton and Cheam, we have in no way departed from what the royal commission said about nursing care.

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge

I appreciate the Minister's dilemma and he appears to be doing his level best to address it, but surely it comes down to the fact that there is no watertight acceptable definition of the distinction between nursing and personal care. If he tries to base what he considers to be an improvement on the system of finding a workable watertight definition, either he or his successor will be dragged back to the Dispatch Box to justify that for as long as the Government are in office. Is not now the time to take a deep breath and say that both will have to be funded? Is not that where his logic will take him?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

That is an interesting argument from a Conservative Back Bencher. Perhaps the hon. Gentleman ought to discuss the proposal with the hon. Member for Meriden (Mrs. Spelman), who sits on the Front Bench, as I understand that that is not the view of his party. I disagree with him, as does the royal commission, and he might like to refresh his memory by reading paragraph 6.26 of the report.

Of course, the royal commission recommended free personal care—that was its main recommendation—but it made it clear that if we decided not to proceed, introducing free nursing care was none the less still feasible and practicable. The royal commission considered the issues carefully. On that one, it takes a different view from the hon. Member for Sutton and Cheam. It believes, and I agree, that it is possible for the distinction between nursing and personal care to be made and made in the way that we propose in the Health and Social Care Bill.

The hon. Member for Teignbridge (Mr. Nicholls) has made a good point, but we should consider home care services. For example, community district nurses—NHS nurses—can arrive at the home of a frail older person to make decisions about what is necessary for that person's nursing care. Alongside that, social workers make assessments about what is personal care.

To the hon. Gentleman and those who say that it is impossible to make this distinction, I say that it is not. It happens and it can be made to work. I accept the wider point that the hon. Gentleman makes—that, ultimately, the argument about being unable to make a distinction is made by those who favour free personal care. However, it is a fundamentally dishonest argument because, as I said earlier, the argument about free universal personal care does not avoid those boundary issues and disputes coming to the surface. There would be just as many difficulties surrounding the definition of free personal care and the hon. Member for Sutton and Cheam has tried to gloss over those. I do not believe that those boundary issues disappear simply by making all personal care free alongside nursing care.

The changes that we are making to free nursing care will save a person up to £5,000 of the annual fees for a year's stay in a nursing home. That means that residents in nursing homes will, in the future, be treated in the same way as people who are being cared for at home—with NHS services and equipment being provided according to need, not according to their ability to pay.

That major reform is long overdue. The hon. Member for Sutton and Cheam could not find it within himself to say anything positive about the reform. He shakes his head; he thinks that there is nothing positive about it. That speaks volumes about his attitude to this whole debate tonight. It is not principle that he is pursuing, but political point scoring—once a Liberal Democrat, always a Liberal Democrat. [HON. MEMBERS: "Hear, hear."' What I am trying to say is that leopards do not change their spots.

The assessment of an individual's current and future nursing care needs will be undertaken by NHS staff using a standard approach, which will ensure that people with the same level of need receive the same level of care. As I said to the hon. Member for Teignbridge, I do not believe that it is impossible to develop a fair system of assessing nursing needs. The royal commission accepted, at paragraph 6.26 of its report, that even if we rejected its recommendation on personal care, making nursing care free should still be pursued. That is what we intend to do. We are working with the Royal College of Nursing and others to ensure that the assessment process will be able to take into account the particular needs of individuals.

It is wrong to suggest, as the hon. Member for Sutton and Cheam again tried to do, that the reforms will not be needs-led. They will be. No artificial limit or ceiling will be placed on how much nursing care a person needs. The hon. Gentleman expressed concern about how we have defined nursing care, implying that we have chosen a deliberately narrow concept of nursing for these purposes. That is absolutely not the case. The only suggested definition of nursing care was put forward in the minority report. We have taken that considerably further in clause 48 of the Health and Social Care Bill. It is very clear from the majority report that it, too, was concerned about people being charged for the services of a registered nurse. The hon. Gentleman should look at paragraph 6.22 if he has any doubts about that.

The hon. Gentleman referred to the Tory Opposition. It has all gone very quiet over there. They are the ones who devised the present unfair system of funding long-term care. They cut 40,000 beds from the NHS, many of them long-term care beds for the elderly. They charged people for their nursing care. They had 18 years to devise solutions, but failed spectacularly to do so. Their only suggestion was to extend long-term care insurance, which was rejected by the royal commission in one sentence as being complex and difficult to see where the benefits lay and to whom. In our last debate on this subject on 2 December 1999, the hon. Members for Meriden and for Runnymede and Weybridge (Mr. Hammond) mentioned the detailed policy work they were doing on long-term care. The hon. Member for Meriden said: We are working on our own policy for long-term care which will go much wider than the terms of reference given to the royal commission."—[Official Report, 2 December 1999; Vol. 340, c. 519.] The Conservative research department provided a helpful briefing for its Back Benchers on 2 December, which said: Over the next few months the Party will develop new areas of policy which will be ready well before the next general election". There is no sign of them so far, and no one should hold their breath. We heard from the hon. Member for Meriden one of the most disastrous attempts that I have ever heard from a Front-Bencher to explain her party's position. It would have left everyone who heard her remarks slightly the worse for wear. She did not explain her position. The one commitment that we have waited for from the Tory Opposition is a commitment to match our spending on social services. They have spectacularly failed to make that commitment. Anyone with an understanding of Tory social policy knows that, when they are looking around for cuts in public spending, they will punish those who use social services.

At the beginning of my remarks, I said that this debate was about choices. For us, the choices are about where best to invest the extra resources that are now becoming available to improve the health and well-being of older people.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

No. I have already given way twice to the hon. Gentleman.

It is not easy to strike the right balance between assuring standards of care, extending access to new services, promoting independence in old age and ensuring fairness in what people are asked to contribute and what the state itself should assume responsibility for. However, I strongly believe that, within the resources available to us, we have made the right choices: to invest more in better front-line services that will give older people greater care and improved health, avoiding institutional care wherever possible, while making the funding of long-term care fairer at the same time; to give carers more support; and to get health and social services working more closely together. I do not believe that making personal care universally free would help us in achieving any of those objectives. In fact, it could be provided only at the expense of these more pressing objectives.

We are intent on making fundamental changes to health and social care services for older people, whose lives will be significantly better as a result of the decisions that we have taken.

I hope that my right hon. and hon. Friends will reject this motion tonight.

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health) 8:06 pm, 5th February 2001

It has been an odd evening because various alliances have formed and then dissolved. I suppose that I should feel vaguely flattered that the hon. Member for Sutton and Cheam (Mr. Burstow), the Liberal Democrat spokesman, chose to use 80 per cent. of his speech to attack the Conservative party. I suppose that that is a veiled form of flattery.

I found myself in agreement with much of the Minister's speech. It was only towards the end of it that a partisan element crept in. Perhaps the House should not be surprised that it is occasionally possible for the official Opposition and the Government, who have a much stronger possibility of, and closer responsibility for, government than the Liberal Democrats have, to weigh up matters carefully and come to similar conclusions.

I certainly did not know that a Liberal Opposition day meant a day when the Government were hardly mentioned at all as a target of analysis. It was literally in the last minute of his speech that the hon. Member for Sutton and Cheam made some analysis of Government policy. Given the brevity and lightweight nature of his speech, I should have thought that some of it might have been devoted to analysing the policy of the Government of the day.

The Minister stole some of my best lines when he looked into the Liberal Democrats' record in local government, where they get a little closer to real power. I need not repeat the damning analysis of what in practice Liberal Democrats decide to do with limited resources when they get into a position where they are able to decide how to spend them.

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

No, I should like to make a little progress.

The important issue underlying this debate is that of funding care for the elderly. I remember saying, when we were debating a statement on the royal commission, that it is rather like a big hole in the ground around which the major parties are circling. The big issues are how to spend this kind of money and what are the wise decisions for the future.

We should not be surprised that there is a minority report within the royal commission report. It may be for the benefit of this debate and that of the Liberal Democrats who skirted over the note of dissent struck by Joel Joffe and David Lipsey if I repeat what those two people said. They state some important truths that should be read into the record of this debate. The dissenting note makes it clear that To make personal care free for all those who are assessed as needing it would aggravate the financial situation considerably. They continued: In essence, it would transfer initially at least £1.1 billion"— it is a while since the royal commission reported, so we should use the Minister's figure of £1.4 billion, which is likely to be more accurate— rising to at least £6 billion in 2051 from the private to the public purse. This huge addition to the burden on public expenditure would not, however, increase spending on services for elderly people by a single penny. The Minister is nodding: we agree on that analysis. The two continued: Because it would make personal care free for those who qualify for it, it would add to the demand for such care, imposing an additional cost on top of that driven by demographics. The hon. Member for Sutton and Cheam disputes the demographic argument. I do not know his exact age, but I think he belongs to the generation that constitutes a considerable bulge. When he and I reach retirement age, we will put pressure on the system for the provision of services. If we have the good fortune to live to 100—which is not beyond the realms of possibility, given our increasing life expectancy—we will be one of the statistics in 2051 leading to the estimated cost of £6 billion. We are not talking about small sums of money, so we should not be surprised at the significant minority report.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

I shall be dead by 2051, so I take a dispassionate view on this issue. My concern about the figures that the hon. Lady quotes from the minority report is that they assume that by 2051 we will be sticking to what I regard as expensive, outmoded, institutional models of care that other countries have moved away from. I am anxious to know what assumptions she is making. Perhaps she will clarify her earlier intervention, because it baffled me. What assumptions is she making about the future of institutional care? Will we be like Denmark and move away from care homes and nursing homes to support for people in the community or care with housing schemes?

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

For once I am grateful to the hon. Gentleman for his intervention, because it brings us on to a helpful point. Changes in society have led to the position that we are in today. Grandparents increasingly rarely live with their children. The hon. Gentleman was quick to condemn the previous Conservative Government. He said that it was entirely their responsibility that we were in this position, but that is factually not true. During the 18 years that the Conservatives were in government, there was a significant shift in our society. Job mobility increased, so people moved away from where their parents live. That is a simple social and cultural change.

I cannot stare into a crystal ball and tell the hon. Gentleman that in 2051—or even 2021, which is a bit more realistic—one of my three children will be prepared for me, as an old lady, to live in their home. They might be living anywhere on the planet. Job mobility and the nature of business today make it difficult to assume that the clock will be rolled back to a time when grandparents once again live with their children, desirable though that may be in the family context. Therefore, we must consider the placement of a significant proportion of the elderly population in nursing or residential care when they need it.

All the health trends show that life expectancy has increased, and a deterioration in health comes towards the end of our lives. What used to be the end of our lives has been pushed back further, and the acuity of care in nursing homes has risen. People in nursing homes and residential homes are sicker than they were, but may not be in those homes for as long as they used to be because the level of care in the community to sustain the elderly until such time as they need that extra shelter of residential accommodation—

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

No, because I have dealt with the hon. Gentleman's point in detail.

This is an important issue, and it difficult to see how the figure in the minority report is an overestimate—quite the reverse. The £6 billion may prove to be an underestimate by that time. It is difficult for any of us to say accurately what that figure will be in 20 years' time. What we can say with more confidence is that such care will cost the state a great deal of money, and the hon. Member for Sutton and Cheam gave no indication of where the Liberal Democrats would find that money. It has to be found, and any utterance about an extra penny on income tax providing the sums involved is unrealistic.

It is interesting to consider how this matter was approached in the Scottish Parliament. As confidently predicted, under devolution different models are emerging. The Scottish Parliament has chosen to go in a different direction. Some Labour Members have gone out on a limb and have supported taking a different direction. Now the Scottish Parliament must find where to make the savings to provide that care. The Liberal Democrats need to do that work, and should have done so before bringing this matter before the House.

It will not be easy to find £1.4 billion. Even if it can be found now, the consequences some way down the road in 2021 or 2051 would alarm any party with a responsible attitude to its role in government. In fairness, the Government have tried to do that. We should not ignore what the Prime Minister had to say on this matter. He said: We believe that the money would be better spent elsewhere in the national health service."—[Official Report, 31 January 2001; Vol. 362, c. 300.] That was the position taken by the Minister, and we agree with it. The Government have chosen their priorities—that is their prerogative. We would also set our priorities if we were the Government, whereas the Liberal Democrats have abrogated their responsibility for setting priorities.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Lady said that she agrees with the Government's response to the royal commission. An important element of that is the additional spending on intermediate care services, approximately half of which will come from social services spending. I understand that she will not match our social services spending, which is funded through the standard spending assessments. Will she give a commitment to match the rise in the social services SSAs that the Government have made?

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

I shall come on to that, if the Minister does not mind. I shall deal with it in some detail, rather than as a response to an intervention.

This is a Liberal Democrat Opposition day, so for their benefit we should bring to their attention matters that may alter their view, and perhaps make them do a 360 deg turn—who knows. The NHS Confederation has said clearly: We do not support making personal care free as this would consume a significant amount of additional resources without any noticeable improvement in the quality of services. I suggest that the Liberal Democrats put that in their pipe and smoke it before they finalise their policy on this subject.

Behind this debate is the problem of how to make services for the elderly sustainable in the long term. We think that the Government, in their Health and Social Care Bill, could have done more to address the longer-term perspective. If the Government and the official Opposition are agreed that the Liberal Democrats are wrong and that the provision of free personal care in England is not the best use of NHS resources, we must find a way to deal with the state's inability to pay.

How do we encourage future generations to make provision for themselves and their loved ones? Not in the way the Liberal Democrats have suggested. If free personal care were extended to England, it would disincentivise those affected and their relatives from taking on that responsibility. It would also lead to disappointment. We are led to believe that free personal services are a panacea, but they are not. They are only a portion of what it costs to provide adequate services for the elderly. The accommodation either in nursing homes or in a residential setting is a significant part—if not the largest part—of the cost of providing care for the elderly.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

My hon. Friend will know of my long and deep interest in this subject. Does she agree that the problem arose for two reasons? First, there was the need to provide the elderly with better nursing and social care; secondly, over a period, Government dramatically reduced, by thousands, the number of geriatric beds. No one was asked whether they wanted that to happen. Government made a decision as a result of which many elderly people, whatever their position in life, feel that they are being unfairly treated.

What discussions has my hon. Friend had with groups representing the elderly, and how do those groups feel that the current injustice can be put right? I think that the Government have gone some way down the path, but as yet many elderly people do not consider the proposed solutions to be truly fair.

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

My hon. Friend's intervention is relevant, despite straying a little beyond the strict title of the debate.

As I am sure my hon. Friend recalls, a year ago those on the official Opposition Front Bench held an "age summit" with all charities concerned with the provision of services for the elderly. It was interesting for us to hear what elderly people would like. Certainly, we heard that they had been led to believe that there would be cradle-to-grave provision, and had found that that was not the case in practice. We also heard, however, that they wanted dignity in old age, and we have a responsibility to try to provide that.

Those requirements must be weighed in the context of the Government's overall responsibility to decide the right priorities for health care, but one thing came over very strongly: people wanted to remain in their own homes for as long as possible, because their own homes tended to be full of memories of raising a family. To maintain them safely in their own homes, however, requires considerable support, and sometimes a difficult decision must be made, often involving medical staff. Although an elderly person would prefer to remain in his or her own home rather than going into institutional care, it may become unsafe for that person to do so.

It is precisely such sensitivities that my party is trying to take on board in crafting its own solution to the problem of long-term care, which we shall present before the election. Of course, if we had the Government's advantage of knowing when the election might be, we should be able to choose the moment much more judiciously.

My hon. Friend the Member for Macclesfield (Mr. Winterton) has reminded me of what Age Concern said to us at the age summit. The Liberal Democrat call for free personal care involves a terrible inconsistency. The provision of free personal care would leave other aspects of essential health care for elderly persons uncovered: chiropody and physiotherapy, for instance, might have to be paid for separately. Even necessities of later life such as incontinence pads are still charged for in nursing homes.

My hon. Friend the Member for Teignbridge (Mr. Nicholls) made a good point. It is sometimes very difficult to find free personal care, or free personal services. For an elderly person with incontinence problems, products such as incontinence pads are essential, and anyone who has had to pay for them will know that they are not cheap.

Moreover, the practice of GPs' charging for call-outs to nursing and residential homes is not covered by this definition. Where do we draw the line in defining what constitutes a personal service provided for an elderly person in care?

Photo of Tom Clarke Tom Clarke Labour, Coatbridge and Chryston

I listened with interest to the hon. Lady's response to what I considered to be a comprehensive and convincing speech by my hon. Friend the Minister. She and the House seem to accept that great progress has been made in Scotland. That is marvellous, as the House decided to devolve such matters to Scotland. What the hon. Lady has not yet done, however, is address—as my hon. Friend did—the issue of carers. Will she tell us what commitments her party gave in the consultations that she mentioned earlier to the millions of carers in this country?

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

With respect, I did not say that great progress had been made in Scotland. I said that Scottish Members of Parliament had chosen to go out on a limb and make a different decision; they would have to weigh up the financial consequences themselves, and establish where they would find the money to pay for a decision that they were free to make.

The role of carers is very important, and is catered for in our comprehensive policy on long-term care. I have already spoken for 20 minutes, and do not want to go into the issue in detail; suffice it to say that carers often bear the burden of providing personal services. Even those not covered by the present definition may have to wait for a registered nurse, but if a member of the family is involved the relative concerned will be more likely to provide personal services, because account must be taken of close family members.

The present definition is shot through with inconsistencies. The Royal College of Nursing is right to say that, owing to those inconsistencies, discrimination is likely. The example has been given of a demented patient who may not require personal services from a registered nurse—but is that patient to be discriminated against in favour of a person suffering from cancer because both happen to be in a health setting in which such services are provided by a registered nurse?

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

No, I am about to finish my speech.

There are terrible inconsistencies, which need to be resolved as the Government work out the practical implementation of their commitment to making free nursing care available.

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

No; I am about to finish my speech, and a number of Members wish to speak. This is, after all, a Liberal Democrat Opposition day, and I do not think that the Liberal Democrats would be too grateful if the Minister and the official Opposition spokesman took up most of the available time between them.

Let us return to the people who are at the end of the system, as it were. I have a 92-year-old father and an 88-year-old aunt, both in residential care. They had to use all their capital to pay for their nursing care. I, as a relative, had to explain why that was—why 1, with a demanding job, could not care for them in my home. That is not an unusual situation: that is Britain today.

We need a fresh look at the way we care for the elderly in this country. The provision of free nursing care is like a sticking plaster over a substantial problem that needs to be resolved. It would be straying outside the framework of the debate to go into the whole question of why the care home industry is in crisis, why there are bedblockers in our hospitals, and why insufficient funding from central Government has forced local authorities to means-test and constrain elderly people who need services.

The terms of the debate were to look specifically at the Liberal Democrats' pledge, which will no doubt be in their election manifesto, to provide free personal care throughout England. If they want to put that in their manifesto, they will have to be able to say how on earth they will fund it. Nothing I have heard tonight gives any clue as to how they would realistically achieve that. A party that cannot realistically say how it intends to foot such a substantial bill is not fit to govern.

Photo of Ann Coffey Ann Coffey Labour, Stockport 8:29 pm, 5th February 2001

I am no wiser about the Conservative party's policy now than I was 20 minutes ago.

The Liberal Democrat motion arises, I am sure, out of a genuine wish to consider again the recommendations of the Sutherland report on long-term care, which was published in March 1999, nearly two years ago. I am equally sure that the timing of the debate arises out of the Liberal Democrats' concern for elderly people, not from any opportunist motive on their part. After all, they keep telling us that they are the party committed to raising standards in public life and that the dividing line between them and the Tories is that they are not bandwagon politicians.

The report by the royal commission on long-term care comprehensively examined issues around providing services to support older people in both the community and residential care. The report was thought provoking, particularly in examining existing standards in both domiciliary and residential care, which vary considerably throughout the country.

The royal commission's main task was to look at the provision of care for the elderly at home and in residential care and to recommend how the cost of that care should be sustainably and affordably apportioned between public funds and individuals. "With Respect to Old Age: Long Term Care—Rights and Responsibilities" was the title of the report. I am sure that all of us would want to achieve the objective of dignity and respect for older people. How we treat older people today will determine how we as older people are treated tomorrow.

I welcome the implementation by the Government of the royal commission's recommendation to set up a national care commission, the introduction of the Care Standards Act 2000, which will improve standards of care, the increased investment in prevention and rehabilitation, and the introduction of free nursing care, which deals with a major injustice, where nursing care was free at home or in hospital, but not in nursing homes—a legacy of the previous Government.

Another major impact on improving services will be brought about by the closer co-operation between health and social services through section 31 agreements or new health and social care trusts. The delivery of services by different agencies with different priorities has been a major contributor to bureaucracy and to frustration among many elderly people and their families. It does not make sense to be assessed first for health care and then for social care by different people working in different agencies, often having no communication with each other.

Under the system in Stockport, a social worker based in casualty at Stepping Hill hospital will, when an elderly person is admitted to casualty, assess with medical and nursing staff the need for social care. The result is that the person goes home with a proper package of care that recognises that social and health care are inextricably linked and important for that person's recovery.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

The hon. Lady is making a rational speech. When elderly people have had a stroke and are discharged from hospital either back to their home or to a residential home, will physiotherapy be available? Is that a social care treatment, or a medical nursing care treatment? The one thing that worries me is the scarcity of physiotherapy, which can dramatically improve the quality of life of elderly people, whether they be in their own home or a residential or nursing home.

Photo of Ann Coffey Ann Coffey Labour, Stockport

I am sure that, like me, the hon. Gentleman looks forward to continuing Government investment in the NHS, which will make the provision not only of health care but of associated services more widely available. As he will be aware, the legacy that the Government have to deal with is one of years of underfunding by the Government of which he was a member.

The royal commission accepted that care in old age must be a partnership between the individual and public funds. I am not convinced that its main recommendation to make personal care free and to continue means testing for other services, including cleaning, housework, laundry, shopping services, transport to day centres and sitting services, necessarily achieves fairness or justice in that partnership.

Fairness must take account of income. To each according to their need, from each according to their means, is the basis of our tax system and public spending. It should also form the basis of redistributing wealth. Everyone should share fairly in the wealth of the country, but in that fair share account must be taken of the individual's wealth and the share that they have already had, which has provided assets and savings for them in retirement and also for their children, who will inherit those assets.

The commission, supported by Liberal Democrat Members, proposes redistributing public money to those who already have private means. I cannot see the argument for social justice in that. It may be an emotionally attractive argument, and in certain Liberal Democrat constituencies it may even be a politically attractive argument, but it is not a just argument. Of course the state must take its fair share of responsibility for care of the elderly, especially for those who cannot provide for themselves, but it is also fair that some account be taken of the private means of the person concerned.

It is right that the state should provide free care in homes for the 70 per cent. of elderly people who have not had the advantage in their working lives of accumulating assets in the form of savings or income. In my local authority, it is about the same percentage for domiciliary care. It is absolutely right that no one should be denied a service that they need because they have no money for it.

The state also provides a non-means-tested, non-taxable benefit in the shape of the attendance allowance, which recognises the extra cost of disability in old age and therefore provides a basic benefit to those in need to help with the costs of care, regardless of income. The proposal supported by Liberal Democrat Members, to give free personal care, would not give one extra penny or provide one extra service for my less well-off constituents. Indeed, it would provide no extra services for those who were well off. Where is the social justice in that?

There may be legitimate arguments about what private assets and what income and capital should be taken into account in an individual's contribution to personal care. I am therefore pleased about the changes on that matter that my hon. Friend the Minister announced earlier. There has to be a fair partnership between the individual and the state in which people do not perceive that they are unjustly disadvantaged for saving; in which options are available to people to plan for their financial future; and in which the state, in return, as part of that partnership, ensures that the care that individuals are offered in old age provides both dignity and respect, and the same quality of care for those who cannot afford to pay for their own care.

If we put on one side the arguments about whether universal provision in a society of unequal incomes is fair, the question becomes one of whether making personal care free would end injustices in provision. We have spent a long time arguing in the United Kingdom about the dividing lines between health and social care, for one is free and one is not, and the unfairnesses that are perceived to arise because of those definitions. However, how much more difficult are the dividing lines between personal care and non-personal care?

Under the commission's proposals, which are supported by Liberal Democrat Members, the provision of meals is a living cost and is therefore not free, whereas help with eating is personal care and is free. Where should we draw the line? If an elderly person needs personal help to eat, that is fairly straightforward—it is personal care. Let us suppose, however, that an elderly person needed more help than just the delivery and serving of a meal—for which they would be charged and which directly involved touching the person, which is the commission's definition of personal care. People may, for example, need propping up with a cushion, or, if they are blind, help with finding a plate or utensil; but otherwise they may be perfectly capable of eating by themselves. Are they receiving personal care or a service that one would expect from a meals on wheels delivery? Is it a mixture of both? If so, how much of it is chargeable?

The hon. Member for Sutton and Cheam (Mr. Burstow) described a system in America that entails metering and clocking on and off. He is simply transferring the problem of defining social and health care to that of defining personal and non-personal care. Staff in care homes will be clocking on regardless of whether care is regarded as personal and free or is not so regarded and is charged for.

I would not like to have to make such an assessment. I worked as a social worker for 20 years, and earlier in my career I did make assessments of the need for services. Assessments are not easy to make because the criteria are not simple or straightforward. It is difficult, not simple, to assess whether to provide personal care. I would also not like to have to explain to an elderly person, or to his or her relatives, the dividing line in the example that I have quoted. What would they say? The comment "this is ridiculous" comes to mind.

Photo of Paul Burstow Paul Burstow Shadow Spokesperson (Health)

The hon. Lady's comment about its being ridiculous is surely the very comment that elderly people will make to a nurse who assesses their nursing care needs and tells them that, on this occasion, a care assistant will undertake the task and that they will therefore have to pay.

Photo of Ann Coffey Ann Coffey Labour, Stockport

The motion concerns a proposal that personal care should be free. The hon. Gentleman is simply transferring the difficulty of defining social care and health care to definitions of personal and non-personal care. He does not seem to understand that.

The definitions become even more difficult, as sitting services are excluded from personal care. If, during the sitting services, the person suddenly needs help with the toilet, does that turn into personal care? Also, we have not mentioned the definitions of "enabling and psychological support" from a "knowledgable and skilled professional" which the commission and the Liberal Democrats say should be free. That is personal care, but the work of a volunteer who is working for an agency with a blind person, but who is also providing psychological support, would not be defined as personal care; that would not be free. We are now in the realms of the wholly ridiculous.

Unfortunately, the royal commission was not a lot of help in unravelling this problem; it preferred to stick to the big picture. Nor have the Liberal Democrats been a lot of help. If they had tried a bit of unravelling, they might have come to the conclusion that such a system did not offer, after all, a logical, workable and above all just approach to the issue of funding. Such a system would be quickly bogged down in definitions which would be incomprehensible to the people who are being assessed, and it would be seen as unfair. Definitions would vary from authority to authority, as obtaining universally agreed definitions would be almost impossible. Discontent would be high, as people would see their neighbours getting something for free that they were having to pay for. That is not a good recipe for justice.

Nor am I sure how the funding for free personal care would work. Would local authorities total up the cost of the assessments of need and then submit the bill to the Government? If they did, it would be an extraordinary departure. I cannot imagine even the Liberal Democrats advocating that. Are they advocating something similar to what happens at the moment: an assessment of needs through the SSA, with local authorities having a sum to spend on personal care? I rather suspect that the result of all that would be an assessment judged not by service, but by affordability of service within the inevitable limitations.

The result could be that the services that my less well-off pensioners are now getting free would not be provided to them at all because of tighter criteria owing to an increased demand for a free service; whereas their better-off neighbours might get their personal care free, while buying extra services with the money that they have saved. Is that fair?

Photo of Dr Peter Brand Dr Peter Brand Liberal Democrat, Isle of Wight

If the hon. Lady is so concerned about a social services budget closed to any extension to free personal care, is it her understanding that the nursing budget given to health authorities is to be open-ended? Will the Government's definition of nursing care not also have its restrictions?

Photo of Ann Coffey Ann Coffey Labour, Stockport

I would have thought it self-evident that all budgets had restrictions. The debate here is about the setting of priorities within a given budget. As the Minister of State said earlier, if we decide to spend money on one area, we cannot spend it on another. However, I am glad that the Liberal Democrats have recognised that budgets are limited.

What will happen under the Liberal Democrat proposal to the attendance allowance, which benefits 1.3 million pensioners and is given to people to help them buy personal care? Is that to be abolished? Is there no longer to be any direct payment system? If personal care is to be free, the allowance becomes unnecessary. That would be extremely unpopular with my constituents, as the allowance gives them the freedom to make decisions about priorities in their own lives and to decide what care they need. It also enables them to pay for informal care from relatives and friends. I do not think that they will be too pleased to find out the Liberals are planning to deprive them of the allowance.

What would be the result of this cynical motion? The expectations of the public would not be fulfilled; their perception is that they would get for free what they now pay for. Try telling care home residents or their families that, contrary to their expectations, not all care in a home is personal care, that they will still be required to pay hotel charges and for some services, and that, if they stay there long enough, their capital will still be exhausted. The fact that some people feel that their houses as capital assets should not be included in any assessment of means will not be dealt with under the Liberal Democrat proposals for hotel and living charges.

The proposals in the motion include no extra investment in services for the elderly, which is what we need above all. We need year-on-year investment. Instead, we would get endless assessments, open to challenge, about what constitutes personal care. The only people who would marginally benefit are richer people.

A system that, in arriving at a fair partnership between the individual and public funding, takes into account the assets that people have accumulated is clearer and more transparent for those who are planning ahead than a system that relies on vague delineations of personal and non-personal care.

Instead of going down a road that is unfair and unworkable and has no basis in social justice, we should ensure that the money that the Government will continue to make available goes into improving the range and quality of domiciliary and residential care services and into making them more responsive to the needs of elderly people and their carers.

That is the ultimate fairness, because rich and poor will have access to equality of services in their old age. The dignity and respect that we accord old people is surely defined, above all, by that.

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge 8:46 pm, 5th February 2001

I thoroughly enjoyed the speech by the hon. Member for Stockport (Ms Coffey). I was getting quite worried towards the end, because I thought that it would cause us both considerable embarrassment if I had to say that I accepted everything that she said. Luckily, she finally came to the heart of the matter, where there is clear disagreement between us—so let us state it, to reassure us both, and then move on.

I have a great deal of trouble with the idea that, because people have accumulated assets over a lifetime, they should be means-tested in their twilight years. People who have worked all their lives will have contributed in taxes, all the more so if they paid tax at the higher rate. Even with the higher rate tax inherited by the Government from their Conservative predecessors—the top rate is still effectively 50 per cent.—that is a substantial contribution for people of perhaps 85 or 90 to have made during their working lives. On that, if on nothing else, I disagree with the hon. Lady.

The debate has been useful in concentrating on an issue that comes up in all our constituencies. I deliberately said issue, rather than problem. Sometimes, when elderly people listen to these debates—I am thoroughly in favour of elderly people, because I fully intend to be one in due course—they ask why they are regarded as a problem, when in fact they are a success story.

The elderly—if they make it—are indeed a success story. Doing some research for another speech some time ago, I found that the male who was around at the age of 65 to claim the five-bob pension introduced by Lloyd George would, at the time of his birth, have had an actuarial life expectancy of somewhere in his late 40s. Today, people are living to ages unimaginable to our grandparents and great-grandparents. Once upon a time, people would draw their pension only if they lived 20 years beyond their actuarial life expectancy, but these days one can claim one's pension 20 years before it. We have to think through the implications. At times, that may mean some new thinking, which may be extremely expensive.

Even if, in part, I come to a conclusion not dissimilar to that of the Liberals, I hope that it will be accepted that I got there by a different route. I recognise cynicism when I see it. The Minister did an effective hatchet job, in simply doing what any young party worker will have done: anyone who has ever followed a Liberal canvasser down the road and said, "The chap who was in here just now—what did he say?" knows that the answer, in summary, is: anything that people wanted him to say.

Whatever view one may take of the Liberals' conclusions, let us not for one moment mislead ourselves, or let them mislead themselves, into thinking that they come to it from a point of principle. One does not get a point of principle from the political equivalent of what happens when one lifts up a flat stone. As kindly as we can, therefore, let us put the Liberals to one side.

Some members of my party, from what one might call the sado-monetarist wing, might ask how we can justify giving free nursing home care to someone who is very wealthy. What would be the point of allowing someone to preserve assets for their children? If they have the money, they should not be a burden to the state. I accept the logic of that argument to the hilt, but it is no longer accepted by those to whom it must be applied.

Something in excess of 50 years of socialised medicine lie behind us. We cannot put the clock back. People do not think it right that they should, in their twilight years, see the assets that they have built up—modest or otherwise—being used up for care in their old age. We can give them the fiscal logic, but they will not accept it. Eighteen years in the House have taught me that one can, to some extent, lead one's constituents over a five-year Parliament. However, when those for whom one is trying to care, in one's own way as a parliamentary representative, simply say that one is wrong, it is wise, for one's own salvation if nothing else, to listen to them. One may even think that they are right. Over and over, I hear from my constituents that the idea that their assets will have to be used up in their twilight years is not acceptable. We must move away from that idea.

I always enjoy debate with the Minister. He is not at his best when he is trying to be horrid. I, on the other hand, am at my best when trying to be horrid, so perhaps there is no problem. I appreciate his dilemma. To give him his due, he is dealing with what may be the major part of the issue. Nursing care will be paid for, he says, and that will reassure some people, since it will account, probably, for the lion's share of the cost. The Minister is acting in a fiscally responsible way, saying that if he goes further it will cost a great deal of money. Full marks to him for that: it would indeed cost a great deal.

Ultimately, however, how can the Minister or his successors deal with this issue? He began to start snarling and trying to be horrid because, being an honest man, he realised where the weaker point of his argument lay. The definitions that he offered simply will not work. He need not take my word for that—indeed, I am certain that he would not. He quoted the royal commission at me, selectively, just as I could selectively quote it back at him. However, it may be more useful to consider the remarks of Claire Rayner, who works at the practical end of the issue. I do not mean to disparage the Minister by saying that; she simply knows more about the practical end than he or I do. Claire Rayner said: If you need someone to wash you, if you need someone to feed you, if you need help in using a lavatory, then you are ill. Nobody in good health would want a stranger to do it. It's only when you are so helpless that it is necessary that you need someone to do it, and if that isn't nursing then I don't know what is. Yet the government has decided in its wisdom that it is not and they are wrong. Frankly, that sums it up: one need not be a humble country lawyer, as I am, to know the fun that can be had with definitions when we try to work out the difference between nursing and personal care. I am almost tempted to give the Minister the benefit of the doubt by saying: let us try to do that. Let us try to hone the definitions to create some rational way of deciding what is nursing and what personal care. However, I do not think that that will work. At some stage, some Minister will stand at the Dispatch Box—sooner rather than later, I suspect—trying to get to grips with the definition.

On the Scottish experience, I speak with all the insincerity I can command in saying that I sympathise with the Minister over the jam into which the Government have got themselves. The difficulty over this issue illustrates the way in which devolution is causing unfinished business. The Labour Administration in Scotland, presumably because they believed it right—and a case can be made—defended to the last ditch the idea that they would not make personal care free. They then realised, however, what happens when one lives in a ditch, and the sort of people with whom one must share one's principles. At that point, they suddenly decided to change their policy.

A remarkable situation will arise. Edinburgh, once the Athens of the north, is set to be the Florida of the north. A marvellous trade in elderly people will be carted over the border.

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge

I want to hear an interest being declared here, as I give way to the right hon. Gentleman.

Photo of Tom Clarke Tom Clarke Labour, Coatbridge and Chryston

I enjoy many of the hon. Gentleman's comments—especially those on the film industry. On Edinburgh, does he not agree that a consensus emerged in the Scottish Parliament and that it produced good policies? I am sure that he does not want to sound envious, so does he not accept the argument that we in the House should try to raise the standard of provision?

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge

Bearing in mind the fact that the Labour party and the Liberal party are already in alliance in Scotland—I can see that the right hon. Gentleman hankers after a time when they can be allied in this place as well—I do not think that consensus emerged in Scotland; cop-out emerged. The Labour Administration took an honest view, although I do not agree with it, that that was not the right way to order their priorities. They then found that, if they did not do a deal with Liberal Members, they could not continue their Administration. I greatly respect the right hon. Gentleman and always enjoy debating with him. However, I do not think that such deals produce good government or good policy.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

My hon. Friend advances a strong and positive case. Does he not agree, however, that infirmity and dementia should be treated in the same way throughout the United Kingdom, even in its devolved areas? The taxpayers of the UK as a whole continue to pay for the vast majority of the resources used throughout the country—whether in England, in Scotland, which has its own Parliament, or in Wales and Northern Ireland with their Assemblies. When dealing with what are clearly illnesses—whether on the borderline of social or personal care, or medical care—is there not a need for justice to be perceived?

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge

The honest answer is yes, I largely agree—except that sometimes we cannot put the clock back. Scotland has its own real Parliament; we cannot put that scrambled egg back into the eggshell. The Scottish Parliament cannot be unmade—it is real.

We must draw a harsher conclusion. If the Scots want to pursue that course, as clearly they do, there really is unfinished business. At present, the Barnett formula—I do not want to digress too much, Mr. Deputy Speaker, but Barnett is about resources and that is what we are debating—ensures that Scotland receives disproportionately more money from the English taxpayer; indeed, it enshrines that. How long will the English taxpayer put up with that? If, ultimately, the Scots really do want to go their own way, they will have to raise their own revenue as well. However, I entirely agree with my hon. Friend that the matter will give rise to great bitterness and division.

The Minister expresses great confidence—or does his best to—that the definitions are workable. However, many of the organisations working in the field do not agree. Organisations that the Minister would usually be able to pray in aid are extremely concerned about what has happened in the light of the Scottish experience. I will not list them all, but in a press release issued after the Scottish debacle, Age Concern states: Of course we now have a vastly iniquitous situation with older people north of the border enjoying peace of mind when it comes to the costs of care, while in England and Wales older people will still be faced with a complex system which forces them to pay. A significant number of members of the Government and their parents will now enjoy a system which they are unwilling to extend to the rest of us. That neatly sums up the dilemma. It is why I come to the following conclusion on the first limb of the problem: sooner or later, it will be realised that the definition does not work, so the state will have to pick up the tab. So far, so good—but that conclusion would make any Treasury Minister shudder.

The important point about the policy that the Conservatives have been developing—there is no secret about it—is that we are saying, in effect, that we cannot go on in such a way. That is why our policy is right. I pointed out that we have had socialised medicine for more than 50 years. People of my age assumed that we would be looked after from the cradle to the grave, but no one in the House could honestly tell our children that, in due course, at the end of their life, the state will be able to provide them with a standard of care or of residential care with which they would feel comfortable.

I have two children at university and one taking A-levels. I do not pretend for a moment that they can rely on the state's resources in their twilight years. The Conservative party has therefore rightly told young people, who still have ample time, to provide for their twilight years; it is an extremely good idea. We talk about having to pick up the tab now, but we are not talking about doing so for ever; we are saying that the state cannot now go back on the arrangement or understanding that it has entered into with people of a certain age. It would be completely unreasonable to ask hon. Members here today suddenly to make realistic arrangements for their nursing home care, but it should be possible to encourage young people to do so.

In the end, such matters come down to sheer practicalities. If we try to temper principle with definitions, that simply will not work—it will lead to no fate other than the grizzly fate of belonging to the Liberal Democrat party. In the end, it is better to face up to the fact that there are opportunities as well as problems and to say that, between us, we have bitten the bullet on nursing care. I suspect that, in early due course, we shall have to do the same thing on personal care as well.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield 9:01 pm, 5th February 2001

I welcome the debate, but I am disappointed that, although the Liberal Democrats initiated it, they have focused too narrowly on institutional care. That has been a weakness in the social policy of successive Governments. We have tended to determine our policies on long-term care according to the demands of the private institutional care sector. I was sad that the hon. Member for Sutton and Cheam (Mr. Burstow) referred to home closures. In many instances, home closures arise from effective alternative policies that enable people to remain independently in the community. I agree with much of what he said, but he focused on the wrong tack.

I agree with the hon. Gentleman that the mess that the Government are trying to clear up arises entirely and directly from the previous Conservative Government's policies on long-term care. I carefully listened to the hon. Member for Teignbridge (Mr. Nicholls), who made some important points in interventions and in his speech. He said that Conservative policy is right. I listened to the hon. Member for Meriden (Mrs. Spelman), who spoke for nearly half an hour, but I have not got a clue about the Conservative party's policy. I intend to send copies of her speech to the elderly people in my constituency who ask me about Government policy and the alternatives. If they can work out what the Conservatives stand for, they have obviously more insight into her thoughts and ideas than I have.

The current difficulties are the direct result of what happened during the previous Government's 18 years. First, they deliberately removed long-term care from the NHS, as the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), outlined. Some 40,000 beds, many of which were long-term care beds, were removed from the NHS. My constituency lost two hospitals that specifically offered long-term and intermediate care for elderly people. One of those hospitals has long been demolished, and the irony is that its site is now occupied by a private nursing home, where people pay for the care that was provided free in the original hospital. Under the previous Government, while free NHS long-term care was being run down, the private care nursing home market was being stimulated through huge public subsidies.

People forget that the private care home industry has been produced not simply by the market; the taxpayer has subsidised its expansion. When I covered community care for the then Opposition Front-Bench team, I calculated that between 1981, when the then Government decided to extend supplementary benefit to top-up fees in private care and nursing homes, and 1993, when they attempted to unravel the mess that community care had become, £10 billion of public funds was spent on pumping money into the creation and extension of the private home care market. That was nonsense. During that time I dealt with numerous individual cases and found that people desperately wanted a small amount of money to stay in their own homes and to remain independent, but they could not get it. Once they had made up their minds to give up the ghost and to go into institutional care, the public money flowed. The policy was absolute nonsense and resulted in the mess that we are trying to unravel now. The previous Government were prepared to support private institutional care but not the preventive alternatives that everyone needed.

I am sorry that the hon. Member for Meriden has disappeared, but I heard her speech so I should not be surprised by that. I do not like talking about hon. Members when they are not present. It is a pity when they cannot remain to listen to the responses to their contributions. The hon. Lady referred to the horrendous costs that people like myself will cause for the state when we are ga-ga in a few years' time. However, her assumptions are based on the most expensive models. She is making all the mistakes that the previous Conservative Government made in their 18 years in power.

The consequence of the privatisation of care of the elderly that took place under the previous Government is that older people pay for care that they have already paid for and that they assumed would be free when they paid for it. As I pointed out to my hon. Friend the Minister, it is wrong in principle and profoundly unfair that people should find themselves in that position. In effect, they are paying twice.

A number of developments have taken place recently. I had a little bit to do with the royal commission, because the Labour party came up with the idea when I was the Opposition spokesman on community care. I claim no credit, because the idea came from my hon. Friend the Member for Sheffield, Hillsborough (Helen Jackson) in about 1994. It was a sensible way to attempt to unravel the shambles that we had got into because of Conservative policy.

The Sutherland report made some sensible suggestions and, to be fair to the Government, they are implementing many of them. The one issue on which I differ from them is personal care. I thought that the definition of anything involving touch was a sensible way round the nonsense that we have debated for generations on what is nursing care and what is social care. That is an impossible distinction to make. Like my hon. Friend the Member for Stockport (Ms Coffey), I worked in social services so I have experience of assessing people. I know that one cannot draw such a dividing line; it simply does not exist. It is wrong for us to attempt a definition.

The Sutherland report talked about free nursing consistent with that on offer outside in the community. It made sensible proposals on capital limits and property ownership and I welcome the fact that, through the national plan, the Government have acceded to the proposals on free nursing care, capital limits and property.

I was particularly interested in the idea of deferred payments that my hon. Friend the Minister mentioned. They are a sensible way of dealing with circumstances in which people in a care home do not know whether they want to remain there. They should not have just three or six months to make up their minds about giving up the home in which they lived most of their lives. That is intolerable. Deferred payments are a sensible alternative, and I commend the Government on that suggestion.

The issue about which I am most concerned is one that I mentioned in the debate on the Second Reading of the Health and Social Care Bill. Personal care is still to be means-tested. I understand the Government's point that, if they have to decide between offering preventive measures in the community or supporting people in their own homes and only one package of money is available, it makes sense to invest it in preventive measures. If that is the dilemma that they face, I support them in their decision. However, my concern is that it is impossible to offer a sensible distinction between nursing care and personal care.

The Government's definition that nursing care is anything that qualified nurses do will lead to a huge amount of contention and controversy. The definition is open to different and wide-ranging interpretations. I am worried about the pressure that will be placed on nursing staff to accede to requests to undertake functions that are not required of qualified nurses.

Photo of Dr Peter Brand Dr Peter Brand Liberal Democrat, Isle of Wight

The hon. Gentleman is making a great deal of sense. Does he not agree that the Government's definition would undermine desirable team working between nurses and nursing assistants? They all have high status and do a proper job. However, once nursing actions are carried out by non-registered nurses and people are charged for them, those members of the teams will be treated as second-class citizens.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

I agree that that problem will arise.

We must recognise the importance of holistic care. It makes no sense to carve up people's care. People cannot be helped to the toilet in the morning, only then to be told that their hair cannot be combed. I am worried by a further inconsistency in that respect. If the division between social and nursing care is to be pared down with regard to people in care homes, will the same principle apply in the national health service? Will people in long-term NHS beds be charged for the personal care element of their hospital care? We need a consistency that has not so far been evident.

I am critical of that aspect of Government policy, but I strongly welcome the £900 million that they are offering for intermediate care. That contrasts with the Tory tax cuts announced today. When people consider Conservative party policy and its promised tax cuts, which will attract elderly voters, they must think through the consequences: cuts in personal social services and more means-testing on care for older people.

I make a plea for us to think radically about preventive measures. I am worried that the debate has been far too concentrated on institutional and permanent care settings. I ask hon. Members to consider what sort of care they want when they can no longer care for themselves. Do they want to end up as my mother did, and sit locked up in a home full of incontinent, deranged people? Is that the best that we can do for elderly people? I want us to move away from such a model.

We now have the opportunities, through developments such as those in communications technology, to maintain elderly people in their homes. We should extend the care-link schemes that apply in so many areas and provide an instant response to requests for home adaptations. People should not have to wait six months to get a ramp, or encounter all the other such nonsense about which hon. Members occasionally hear. Housing-with-care schemes have been introduced in Denmark as an alternative to institutional care. Why cannot we use the equity that elderly people have in their houses to make available intensive care packages that allow them to remain in their homes? More investment is needed in day-care and warden schemes.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

The hon. Gentleman is, of course, the distinguished Chairman of the Select Committee on Health, which I, too, chaired for a limited time. Will he join me and other hon. Members in different political parties in making representations to the Government on expanding criteria relating to the personal and social medical conditions that qualify for free treatment? He made a good point: providing treatment and care today can prevent worse illness in future. If care is provided now, it can save the health service a great deal of money in due course. Will he join me in making an all-party representation on that issue?

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

There is more cross-party consensus on the issue to which the hon. Gentleman refers than on many others. Of course, I shall be happy to make appropriate representations. In my surgery on Friday evening, I spent the best part of an hour with a lady who was probably in her early 60s and whose husband has senile dementia. It was extremely difficult to try to distinguish between personal and nursing care in respect of her husband. The woman was dealing with a tragic situation. We must consider the practicalities of the Government's policy, and I shall certainly be happy to support any representations along the lines that he suggests.

Other hon. Members want to contribute, so I shall conclude my remarks shortly. I believe that the Government have taken many positive steps. I shall support their amendment because I believe that they are heading in broadly the right direction. I am critical about the difficulty to which I have referred, but I hope that it will be resolved in a positive manner.

I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), will pick up my plea. To me, care of the elderly is essentially a matter of human rights. My human rights are about my independence and my ability to choose what sort of care I want. Care should not be given to me because the private market thinks that the best thing for me when I am ga-ga is to be incarcerated with a number of other ga-ga people in some sort of lock-up establishment. We can do better than that, and I have every confidence that the Government will do so. I wish them well in applying their thoughts to the royal commission recommendations, but I hope that we might go that little bit further in due course.

Photo of Mr Archy Kirkwood Mr Archy Kirkwood Chair, Social Security Committee 9:15 pm, 5th February 2001

I am pleased to be able to make a short contribution to what has been a good debate. It is a privilege and a pleasure to follow my hon. Friend, if I may call him that, the hon. Member for Wakefield (Mr. Hinchliffe), a fellow Select Committee Chairman, whose distinguished knowledge has greatly added to the debate. He is absolutely right to say that we should not concentrate solely on residential and institutional care. Community and domiciliary care are an essential part of the package of measures that we must implement. He is right also to talk about the need for prevention. The Government have done a great deal about that, and I shall return to the matter in a moment.

The heartening thing for me is that, apart from the hon. Member for Stockport (Ms Coffey), who made a powerful speech, there are not many people who are intrinsically opposed to the principle of personal care provision. The hon. Lady was slightly unfair in accusing us of being cynical in initiating the debate at this time. You will know, Mr. Deputy Speaker, that we receive only three Opposition days a year, and we rightly gave a half-day to the Welsh nationalists. We do not control when we will get these opportunities, but our desire to have this debate was certainly driven by the importance that we attach to the subject.

Not enough consideration was given to the work done by Sir Stewart Sutherland and his royal commission. The report was a seminal contribution to the debate. Some might say that the Government's initial response was grudging. The hon. Member for Sheffield, Hillsborough (Helen Jackson) came up with the idea; it was right to pursue that idea, and the Government seemed to be absolutely committed to it. They then seemed to go very cool when the report was published, and we have had only one debate on the subject, in December 1999. The Liberal Democrats need therefore make no apologies for initiating this debate, which has been very good so far.

The Government are right to claim that they have made progress. Compared with the previous Government, they have made enormous progress. Our motion sets out substantial differences in the directions that we are taking, but ours is a perfectly proper position and we will argue our case eloquently, as the royal commission argued its case. We are right to support its recommendations. The Conservatives have a lot to answer for, and if I had more time at my disposal, I could expand that proposition almost infinitely. Like the hon. Member for Wakefield, I watched with dismay the evolution of policy under the stewardship of the previous Conservative Administration.

Having said that, I remember the Prime Minister, then the Leader of the Opposition, making a powerful speech in 1996 at the party conference before the last general election. He said that he was ashamed to live in a country where people had to sell their house to pay for their long-term care. That gave me a lift. I watched his speech on the television, and that was a powerful point well made. Like me, many people had their expectations raised by that statement by the head of the incoming Government and by the establishment of the royal commission. We were right to be disappointed that it took the Government almost as long to read and respond to the report as the royal commission had taken to write it.

The Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), rightly ribbed us about past changes in Liberal Democrat policy. However, for me at least, the royal commission changed everything. There are six volumes of research evidence, and I did not read them all, but those that I read certainly demonstrated that the commission's work changed people's perspectives on this important subject.

The Government have not done enough to consider the options in detail and to debate them in the House. They took the line of least resistance and they split the difference. As I said, they have made progress, and it would be churlish to quibble about that, but they took fright at the amounts of money that they thought, wrongly, were involved. North of the border, research will continue between now and August into the implications and the delivery of the policy of paying for people's personal care. I am deeply disappointed that the Government took fright.

The royal commission showed that providing solutions on an individual basis was not viable. Individual solutions, whether through independent insurance or under other schemes, would not make the necessary provision. Sir Stewart rightly said that the only solution was to pull the risks and cover the costs through general taxation. That is the fairest, long-term solution.

Photo of Dan Norris Dan Norris Labour, Wansdyke

Will the hon. Gentleman give way?

Photo of Mr Archy Kirkwood Mr Archy Kirkwood Chair, Social Security Committee

I am sorry, but I have no time. Other hon. Members want to speak and I am trying to be as quick as I can.

Sir Stewart's point is crucial, and I hope that hon. Members from all parties will consider it. The Government will struggle to deal with fairness in future if their policy continues in the same direction. We have had some exchanges about people's treatment and whether they consider it to be fair when compared with that of others.

Problems of definition will always exist. I respect the hon. Member for Stockport, who knows a great deal about social services from her professional experience. However, it diminished the argument to mention some of the issues that she raised. Boundary problems will always exist, and Sir Stewart Sutherland and the royal commission report recognised that. There are ways round the problem if we act in good faith and with good will.

If the Government's proposals are accepted, we will have a two-tier system. However good it is, it will be unstable in the long term. The Minister was wrong to say that the royal commission had devised the narrow definition of long-term care that he described. Dr. Chi Patel contributed to the minority report. I have talked to Sir Stewart and it is wrong to say that he had such a narrow definition in mind when he considered the proposition for gatekeeping.

If the Government considered the fact that the state already pays 75 per cent. of the costs, there is at least an argument for saying that, as pensioner provision improves in future and people retire with larger occupational pensions, the money available to pay hotel costs may generate more money than was perhaps anticipated five years ago when research for the royal commission report began. I hope that the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), will be able to deal with that point in her winding-up speech. Slide rules should be applied to some of the figures and an option for personal care sometime in future should be kept open. That is all I ask of the Government this evening. If they are prepared to consider that, I will be content with the results of our debate.

Photo of Paul Goggins Paul Goggins Labour, Wythenshawe and Sale East 9:23 pm, 5th February 2001

I thank the previous two speakers for creating space for me to squeeze into before the winding-up speeches. The debate is important and I am happy to have the opportunity to contribute to it. My hon. Friend the Member for Stockport (Ms Coffey) spoke eloquently about the way in which our treatment of older people is a sign of our society's values. It should reflect the way in which we expect to be treated when we are old.

I acknowledge the huge progress in the care of some of my older constituents in the past three or four years. When I was elected as a Member of Parliament, the first issue to hit me was delayed discharges. I remember the letters that I received, the tearful relatives and the patients, whom I visited in Wythenshawe hospital. It was dreadful for them to be trapped in an inappropriate setting. It also prevented others who desperately needed operations from being treated. It was demoralising for the staff because they were not able to give appropriate care in such a setting.

In August 1997, there were 200 delayed discharge patients in Manchester, and there was just £500 a week of new money with which to fund care packages and placements for them. I am pleased to say that, with better management, more cash from the Government and more partnership working, there is now between £6,000 and £7,000 a week of new money in the kitty, and there are only one or two delayed discharge patients. That is an immense step forward, and it has also been repeated in the Trafford area of my constituency.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) always speaks passionately about the need for prevention in the care of the elderly, in terms of the prevention of the use of the residential care and hospital care options. I concur wholeheartedly with him on that. All our efforts should go into trying to prevent admissions into residential care and hospital care whenever possible. That means more neighbourliness and better care in the community. It also means good, professional social work care and nursing care in the community.

When people need to go into the hospital, as the majority of older people will at some stage, the care available needs to be of a high quality. When the treatment is over, the patient then needs to be placed appropriately in the right kind of setting. That might involve residential care or nursing care, but it is to be hoped that the patient will be back home sooner rather than later.

On that issue, I have some good news for my hon. Friend the Member for Wakefield. The Southwold nursing home in my constituency would, in the past, have received patients from hospital who would have stayed there almost for ever. Now, it is sending one in three patients—even some who are quite dependent—home into their own community with a care package. That is an encouraging development in nursing care.

The main focus of the debate is the decision not to provide free personal care to all. It has been made clear from the debate that that is a serious and controversial issue. There are no perfect solutions to such questions. In politics, there are only priorities and hard choices, and I shall briefly cover some of them.

First, the initial cost of the proposal would be more than £1 billion, as my hon. Friend the Minister said. That is a similar investment to the one that the Government are making in the intermediate care package, which will provide 5,000 places by 2003. The first hard question to answer is whether we should provide existing services more cheaply for some, mainly better-off, people or fund new and extended provision for all. As has been said, we cannot spend the same money twice.

Secondly, the £1 billion cost would not remain at that level. The royal commission made it clear that by 2050, the figure would have risen to at least £6 billion. The second question is, therefore, whether such costs would be sustainable. Reference has been made to the negative impact of having a funding regime that would not be sustainable in the long run. That would be totally disruptive to the care of elderly people, and we should shun such an option.

Thirdly, expectations change. That powerful point was made by the authors of the note of dissent to the royal commission's report. Older people will not now accept the care packages that were on offer in the 1960s. Equally, older people in 2050 will not accept the kind of care packages that are available now. The third question, therefore, is whether we should risk putting a cap on quality and variety by enshrining into our system a principle that would never provide enough of the right kind of care in the long run.

The issue is controversial. Difficult choices have to be made, and there will undoubtedly be all kinds of teething problems with the provisions. I acknowledge and accept that there is now a new settlement between the individual and the state in relation to pensions and other matters. It is a settlement that protects the poorest as a first priority, which is just. It asks the better-off to make a bigger contribution, which is fair, and it guarantees quality for everyone, which we all expect. Those principles are reflected in the new arrangements for personal care, and I fully support them.

Photo of Nick Harvey Nick Harvey Shadow Spokesperson (Health) 9:29 pm, 5th February 2001

It is a pleasure to participate in the debate, which has been useful to explore the issues involved and to identify where the political parties will position themselves in the run-in to the general election.

As my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) said, the Liberal Democrats do not control the timetable for when we get the chance to raise matters on Opposition Supply days. Nevertheless, events in Scotland are, for Liberal Democrats, a cause for celebration. We celebrate the success of devolution, because those events represent devolution working, and working well, and the fact that people in Scotland will be able to use the long-term free personal care that the Scottish Executive and, in the end, all parties in the Scottish Parliament recognised that it was right to offer. That does not mean that we have to offer free personal care in England, but it does mean that those of us who believe in that have a duty to argue for it in England. That is what we are doing.

It is wrong for people such as the hon. Member for Woodspring (Dr. Fox), who is the Conservatives' key spokesman on these matters, to appear on television to say that it is an absolute scandal that different things will happen in Scotland and in England, only for it to creep out that that is their position as well. The Conservatives in Scotland believe in free personal care, but it has emerged in today's debate, as it has before, that the Conservatives at Westminster do not support it. Small wonder that the hon. Member for Buckingham (Mr. Bercow), who was bouncing up and down enthusiastically at the beginning of the debate, left the Chamber on hearing what his Front-Bench spokesman had to say. I am not surprised by his attitude because he would have been gravely disappointed to discover that that was the position.

Photo of Nick Harvey Nick Harvey Shadow Spokesperson (Health)

Where indeed is the hon. Member for Meriden (Mrs. Spelman)? She could have returned to listen to the conclusion of the debate.

The task for those of us in England who believe in free personal care is to campaign and argue for it, and that is what we are doing tonight. I shall address a few remarks to the Minister, who defended the Government's position and said that our proposals are not the right way forward in England.

On the demographic time bomb, my hon. Friend the Member for Isle of Wight (Dr. Brand) made a stout defence. As the Minister said, as time goes on there will be more people of retirement age and in their eighties, but it is equally true, as my hon. Friend pointed out, that the greater part of the expenditure on such care services occurs in the last six weeks of life. Unless the population is bound to expand in some unrecognisable way, the basic costs involved will remain broadly the same.

The hon. Member for Wythenshawe and Sale, East (Mr. Goggins) said that, over time, the original estimate would, in cash terms, reach a sum six times that estimated by the royal commission. Of course it would. Sums increase as time goes on and inflation makes figures rise, but the estimate will remain broadly stable as a proportion of gross domestic product. The idea that there is a demographic time bomb and that we will not be able to afford our proposals was comprehensively dismissed by the royal commission, which went into those matters in great detail.

The Government say that they have introduced a comprehensive package of intermediate care and that, somehow, it is an alternative because in this world it is possible to do only one thing or the other—it is not possible to do both, nor should one have the ambition to do so. Let me make it perfectly clear that the Liberal Democrats support the new priority that the Government want to give to intermediate care. We welcomed that on the day that it was announced and we have welcomed it in the House since.

The hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Health Committee, was right to say that we do not want hon. Members to get into the cul-de-sac of thinking that all care has to be residential. The more intermediate, short-term care and longer-term care that we can offer to enable people to be cared for in their own homes, the better that will be for everybody concerned and for society as a whole. We welcome the Government's intermediate care package. We recognise, however, that free personal care involves expenditure over and above that. It certainly does not involve the original £1 billion that the royal commission estimated.

If one was to proceed on that basis, one would be assuming that the free nursing care that the Government are introducing would achieve nothing and that the intermediate care package itself would achieve nothing. Yet the Government's own brief about intermediate care specifies that one of their objectives is to reduce the number of people going into long-term residential care. The Government are clearly confident that that will succeed, and so are we. The cost of introducing a policy of free personal care falls as a result.

Photo of Dan Norris Dan Norris Labour, Wansdyke

Exactly how much will it cost for the additional strategy that the Liberal Democrats propose? How will they raise the money, given that one of their proposals is to have a higher rate of income tax for people earning more than £100,000 a year? I calculate that that has been spent 11 times over, given what the hon. Member for Sutton and Cheam (Mr. Burstow) has said. Putting that to one side, how much will the proposal cost the taxpayer?

Photo of Nick Harvey Nick Harvey Shadow Spokesperson (Health)

If one starts with the original royal commission estimate and nets out of that what will be spent on nursing care, taking account of the extent to which intermediate care will relieve some of the pressure on that, the cost will be about £750 million a year. The hon. Gentleman refers to our separate policy of putting a 50p tax rate on incomes above £100,000. Let me point out that that would raise £3.5 billion in a year. He may have counted the money as being spent 11 times over, but even at that rate it can be spent almost five times over and it will pay for a great deal more than that. Nevertheless, I thank the hon. Gentleman for his question.

Both the Minister and the hon. Member for Stockport (Ms Coffey) made some spurious arguments to the effect that it is impossible to draw up a definition of personal care. That is simply not true. The royal commission report had a good stab at doing so. As the hon. Member for Wakefield said, it used as its basic principle the fact that the person being cared for had to be touched. If hon. Members think that that sounds vague, they should look at the report, which lists exactly what would be provided.

I am not saying that a trouble-free list can be drawn up, but it is nonsense to say that a definition cannot be made. Equally, it is nonsense to say that a distinction between nursing care and personal care cannot be made. That does not mean that no difficulties arise. In practice, it will prove very difficult. As my hon. Friend the Member for Sutton and Cheam stressed in his speech, where the Government choose to draw the lines in establishing that definition is not what the royal commission had in mind in its report.

All those involved in this sector, including the Royal College of Nursing and the British Medical Association, in an announcement that it made yesterday, have arrived at the same conclusion: that the Government have opted for a mean and narrow definition. It is based not on the tasks that will be carried out or on the condition of the patient but, bizarrely, on who will carry out the care. It is a most unsatisfactory definition, which will cause many difficulties in practice. However, it is a definition, which proves that a definition can be made.

The Minister made a completely ludicrous point about the activities of the London borough of Sutton in the middle of the Thatcher regime. For goodness sake, a council trying to run its services in the middle of the Thatcher regime when some 85 per cent. of its budget was determined for it by the Government—[Interruption.] As if problems were not bad enough, Lady Olga Maitland was the local Member of Parliament. The Minister cannot suggest that the Liberal Democrats, in proposing an election manifesto, would try to do exactly the same as we did in the 1980s in the London borough of Sutton when Mrs. Thatcher was controlling the budget. The two are not remotely comparable. In any sane country, an organisation as big as a London borough would determine its own policies and raise its own taxes to pay for them. However, Britain does not work like that; everything has to be spoon fed from above. Matters have improved slightly over the years, but not an awful lot.

While we are on the subject of local government finance, the Minister was right to ask the Conservative party whether it would match Government spending on social services. It is worth taking a moment to look at what the Government are doing with social services funding. This year, all. social services departments have budgets above the standard spending assessment. Despite that, as of last week they were collectively overspent by £205 million. The settlement for next year will be insufficient to cover repayment of the debt and to cope with the increased demand on social services.

The Government have estimated that their new four-year plan to end bed blocking will cost £900,000. Much of that will have to be paid for out of social services budgets, and no extra is provided for it in this year's budget. Therefore, there is a great gap, so the Conservatives should be able at least to match the Government's proposals. The hon. Member for Meriden (Mrs. Spelman) said that the whole thing comes down to funding. She was right when she said that there is a big hole, but she contrived to dig an even bigger hole and jumped into it. She said that the solution to the funding hole was not provided by the Government's proposals or by the Liberal Democrats' suggestion, because that would "disincentivise" people from making provision on their own account. When we sat on the edge of our seats waiting to hear her solution, there came absolutely nothing. We were told that the Conservative proposal would appear in due course, and we would have to contain ourselves.

It was all too much—or rather too little—for the hon. Member for Buckingham, who fled into the night. The hon. Member for Teignbridge (Mr. Nicholls) is made of stouter stuff. He told us what he thinks the policy should be. It was remarkably similar to the Liberal Democrat policy that we have enunciated this evening. It will be interesting to see whether, come the election, he stands on the Conservative or the Liberal Democrat policy.

Photo of Mr Patrick Nicholls Mr Patrick Nicholls Conservative, Teignbridge

I would not want the hon. Gentleman to go round the west country claiming that he and I are allies. If I came to a similar conclusion, it was because mine was based on principle.

Photo of Nick Harvey Nick Harvey Shadow Spokesperson (Health)

I thought that the bulk of the hon. Gentleman's rather intemperate remarks about the Liberal Democrats were based on the fact that his majority over the Liberal Democrat candidate at the last election was all of 281.

The hon. Member for Stockport irresponsibly set alarms bells ringing by suggesting that Liberal Democrats were arguing for the removal of existing attendance allowances. That is certainly not part of our policy, and it is not how we would propose to pay for these provisions.

The hon. Member for Teignbridge said that his argument was born out of principle. The royal commission went into this matter in great detail, and explored the principles involved. It considered the practical implications and the costings, and plotted those forward over a period of time. It made a recommendation, which we have supported consistently, and I welcome the fact that the hon. Gentleman does so, too. I listened to a couple of interventions from the hon. Member for Macclesfield (Mr. Winterton), and I got the impression that he also supported that recommendation as an issue of principle.

Liberal Democrats have argued this case in England and in Scotland because it is right in principle. It is completely unjust for someone suffering from a long-term, chronic condition, such as dementia or Parkinson's disease, who is in need of personal help with bathing, dressing, their toilet and other necessities, to have to pay for those services. By any common-sense, layman's definition such chronic conditions would ordinarily be viewed as a health problem. All those who have paid national insurance contributions have believed that they have been buying care from the cradle to the grave. It is an injustice and it is wrong in principle that they should be penalised and asked to pay for personal care.

I welcome the commitments made by the British Medical Association. It believes that the Government's definition of nursing care is too limited. Dr. Dearden, the chairman of its community care committee, said: We are pressing politicians to make changes to the Bill so that free care includes personal care as well as nursing care. If someone is unable to wash themselves, use the bathroom or get dressed on their own because of their medical condition, we believe help with these basic things should be free of charge. If individuals have to pay for this increased level of personal care it is akin to a tax on being sick. This goes against the ethos of the NHS. That is right, and that is why Liberal Democrats believe that personal care should, in principle, be free. We will argue that proudly and strongly at the forthcoming election.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health) 9:45 pm, 5th February 2001

This has been, mostly, a thoughtful and well-informed debate, and I congratulate those who have taken part. It has been a debate about the challenges we face, and the choices we have to make.

It is clear that we live in an ageing society. Many more people live longer: that is to be welcomed, but the challenge we face is to ensure that our health and social services meet the needs of older people. Older people want to lead healthy and independent lives; they do not want to be in institutions. As a Government, we need to find a fair way of funding long-term care that strikes the right balance—between what the state should provide and fund and what should be the responsibility of the individual, and ensuring that the money, when it is spent, provides better care.

The status quo was clearly unacceptable. We needed to expand services for the care of older people, we needed to make major new investment in those services and we needed to redesign services. We are doing just that. We are providing extra funds—an additional £900 million by 2003–04—for intermediate care and new services, and a further £360 million year on year to finance nursing care costs. We are thinking about expansion and redesign. That is why we have developed national service frameworks for older people, that is why we established the National Care Standards Commission and that is why we are developing intermediate care.

The hon. Member for Sutton and Cheam (Mr. Burstow) rightly described the previous system as discredited and unfair, but I could not agree with much that he said subsequently, other than his expressed desire for a fair and sustainable system. I certainly do not agree with his analysis of the solution. Essentially, he said that he supported everything the Government were doing but wanted more. In a sense I would have been surprised if he had not said that, but it would have been helpful had he recognised that some considerable advances are being made.

I am still deeply puzzled by the contribution of the hon. Member for Meriden (Mrs. Spelman). She described the problem as a big black hole around which we were trying to navigate, and I sense that many of us are trying to navigate around a big black hole following her speech. In fact, she probably fell into the black hole, and we all know what happens when someone disappears into one: it is difficult to get out.

Not the least of the hon. Lady's problems is her continued refusal to clarify the Opposition's policy. She said that she wanted to clarify what her colleague the hon. Member for Woodspring (Dr. Fox) had said about personal care. The hon. Gentleman, however, gave no such confirmation. He said: I welcome the Government's decision to make all nursing care free".—[Official Report, 10 January 2001; Vol. 360, c. 1100.] It appears that the hon. Lady herself is not terribly clear about what the policy is.

The hon. Lady offered no solution, other than saying, "We support what the Government are doing, until we come up with our own comprehensive policy." That is a policy that we were promised as long ago as December 1999, but we still have not heard anything. We wait with bated breath, but, given that social services are such a vital component, it would be helpful if, for a start, we could hear whether the Opposition will match NHS and social services funding.

Photo of Caroline Spelman Caroline Spelman Shadow Spokesperson (Health)

I am sure that, as a professional politician, the Minister understands that tactically it was worth waiting to see whether the Government would have a knee-jerk reaction, as they did in Scotland.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

Unlike the Liberals, who are now jumping on every bandwagon that comes their way, the Conservatives will sit on the fence to see which way the wind blows, and will then decide in which direction to jump. We all look forward to that.

I congratulate my hon. Friend the Member for Stockport (Ms Coffey) on her thoughtful speech. She gave strong support to what the Government are doing. I particularly appreciate her support, which she gave not because of political allegiances but because of her experience of working on the ground. She acknowledged the difficulties with definition and that it was not straightforward, but she made it clear that no alternative was offered—someone who has worked on the ground recognised that that was the right way forward.

I was fascinated by the contribution of the hon. Member for Teignbridge (Mr. Nicholls), who told us that his was a principled statement. If I understood the principled statement correctly, he was arguing along the lines not of justice but of the right of inheritance for the wealthier, and, if that did not work, insurance would be a way forward. In many ways, it did not add up.

I welcome what my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said. He has tremendous experience and is a highly respected Chairman of the Select Committee on Health. He made a powerful point about the failure to invest in alternative provisions for care. He acknowledges the difficulties. We know that we have some differences, but he is broadly in support. Just because it is difficult to make that distinction does not mean that it is impossible.

My hon. Friend specifically requested that we move away from institutional settings and look radically at the matter, recognising people's human rights and supporting their right to live independently. I hope that, when he looks at what we have done, he will realise that we have taken that on board. I am grateful for his contribution.

The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood)—as a former member of the Select Committee on Social Security, which he chairs, I almost called him my hon. Friend—suggests that what is happening in Scotland indicates a two-tier system. That is a fundamental misunderstanding of the driving force behind what we are doing. We decided to take that route in England because it delivers better care and addresses some of the inequalities of the previous arrangement.

Photo of Mr Archy Kirkwood Mr Archy Kirkwood Chair, Social Security Committee

I was not making myself clear. I was talking about the two tiers between personal and nursing care, not between north and south. I apologise.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

I am grateful for that intervention.

The hon. Gentleman welcomed the royal commission, but we rejected the proposal on personal care not because of cost, but to deliver better care. May I briefly come back to Scotland? Different solutions for funding will not provide one extra nurse, one extra doctor or one extra provision north of the border, so it is not logical to conclude that there will be better care.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat, Edinburgh West

Does the Minister accept that all the six parties represented in the Scottish Parliament support the proposition and that all the people who gave evidence, who really know about the subject, to the Scottish Parliament's Committee all favoured the policy? Therefore, the policy is not as insane as she makes out.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

I was not for one moment suggesting that. I am simply saying that that is a logical conclusion of devolution: different choices are made. The debate is about making choices, but I am still somewhat puzzled about why the Liberal Democrats support the proposal in Scotland, but have different views in Wales and are not sure about England. There may be some inconsistency there. [Interruption.] Hon. Members may not like it, but may I make a little progress?

My hon. Friend the Member for Wythenshawe and Sale, East (Mr. Goggins) described powerfully the changes that he has seen on the ground and the benefits to his constituents as a result of bringing in the new models of service, which deal with such things as delayed discharges. He has seen what home care packages are doing for people on the ground.

The hon. Member for North Devon (Mr. Harvey) made an interesting observation about what the debate was really all about: it was about political positioning. He made that clear. I am grateful for that honesty. I am delighted that he has put on the record his support for the royal commission because, in 1999, when we had the previous debate, the Liberal Democrat spokesperson would not be drawn on whether the Liberal Democrats supported it. Again, it was a case of sitting on the fence, seeing how it played and suddenly saying, "We fully support it."

The hon. Gentleman questioned the arguments about the demographic time bomb. There is a whole line of arguments to be made, but what he does not deal with is the fact that what we are putting forward is based not on cost, but on better services that provide a better response.

Extraordinarily, the hon. Gentleman questioned the £1 billion cost figure. Underlying his assertion that the change would not cost that sum was the good old Liberal Democrat approach of accepting everything that the Government are doing and our extra investment and asking for more. He said that the change would not cost £1 billion, but would be much cheaper, because of all the Government's action in intermediate care. That is the bottom line.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

I am glad that we have put that on record.

Nothing that we have heard today has shed any light on the Opposition's policies or on how they would fund them. It is very easy to make proposals without saying where the money will come from. Liberal Democrat Members say that extra tax on those making more than £100,000 would fund both their care proposals and their education proposals, but I would like to see the calculations. Liberal Democrat Members want more money, but they do not say where they will find it.

Conservative Members broadly agree with the Government and will probably do so until they have developed their own comprehensive policies. However, they have still not said whether they will match our vital social services funding. The Opposition might therefore find it helpful—I always try to be helpful—if I outline the real action that the Government have taken using real money, not sweet aspirations and empty words.

The NHS plan outlines a vision of health and well-being for older people and for those who care for them. I do not think that we have said enough today about carers. That vision is backed by real investment of an extra £1.4 billion by 2003–04. With that investment, we will promote better health, encourage faster recovery from illness, support independence, avoid the increasing institutionalisation of the elderly and deal with hospital admissions. We offer not only new choices and new opportunities, but the money necessary to realise those opportunities.

By 2004, the new investment will help an extra 130,000 people annually. By 2004, the number of people benefiting from community equipment services will increase by 50 per cent., helping people to stay at home safely for longer. Although all hon. Members want that outcome, we are actually achieving it. Not only will 50,000 people be able to live more independently at home, but we will support the carers.

Opposition Members asked the interesting question what will happen when we are 90 and our children have to look after us. I remind them that, by then, our children themselves may well be 70 and require support. We are therefore supporting carers by doubling the carers' special grant from £50 million to £100 million. My right hon. Friend the Secretary of State for Social Security has also announced a package worth £500 million to back up our words. That money will benefit 300,000 carers in the next three years. The national service framework will back up those investments and support older people with mental health problems and dementia sufferers.

Those measures were created to deal with the individual concerns of people whom we need to support. It is also essential that those services are reconfigured. As my hon. Friend the Member for Wakefield said, simply doing more of the same is not a long-term strategy. We are therefore providing money to reconfigure services and to provide essential independence. We are extending free nursing care to all settings to promote independence.

It would have been gracious of the hon. Member for North Devon to acknowledge that some progress is being made, and that the Government will be preventing people from having to sell their homes against their wishes. As the Prime Minister said, such a situation is disgraceful. I wish that Opposition Members would even partly recognise that we are moving in the right direction. We are tackling unacceptable variations in charges for home care. We are also providing guidance on the NHS continued care responsibilities.

The Government are taking action to provide a fair and sustainable way forward. Opposition Members have a long way to go to convince anyone that they have any credible policy and funding options that anyone could accept. What we have heard today will convince no one, either in the Chamber or outside it. It has been an entirely missed opportunity.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 41, Noes 271.

Division No. 104][9.59 pm
AYES
Allan, RichardJones, Nigel (Cheltenham)
Baker, NormanKeetch, Paul
Ballard, JackieKennedy, Rt Hon Charles
Berth, Rt Hon A J(Ross Stye & Inverness W)
Bell, Martin (Tatton)Kirkwood, Archy
Brake, TomLivsey, Richard
Brand, Dr PeterLlwyd, Elfyn
Breed, ColinMichie, Mrs Ray (Argyll & Bute)
Burnett, JohnMoore, Michael
Burstow, PaulOaten, Mark
Campbell, Rt Hon MenziesÖpik, Lembit
(NE Fife)Rendel, David
Russell, Bob (Colchester)
Cotter, BrianSanders, Adrian
Davey, Edward (Kingston)Taylor, Matthew (Truro)
Fearn, RonnieThomas, Simon (Ceredigion)
Foster, Don (Bath)Tonge, Dr Jenny
George, Andrew (St Ives)Tyler, Paul
Gidley, SandraWebb, Steve
Hancock, MikeWillis, Phil
Harris, Dr Evan
Harvey, NickTellers for the Ayes:
Heath, David (Somerton & Frome)Mr. Andrew Stunell and
Hughes, Simon (Southwark N)Mr. Donald Gorrie.
NOES
Abbott, Ms DianeClapham, Michael
Adams, Mrs Irene (Paisley N)Clark, Dr Lynda
Ainger, Nick(Edinburgh Pentlands)
Ainsworth, Robert (Cov'try NE)Clark, Paul (Gillingham)
Armstrong, Rt Hon Ms HilaryClarke, Rt Hon Tom (Coatbridge)
Ashton, JoeClelland, David
Atherton, Ms CandyCoffey, Ms Ann
Austin, JohnColeman, Iain
Colman Tony
Bailey, AdrianConnarty, Michael
Banks, TonyCooper, Yvette
Barnes, HarryCorbett, Robin
Barron, KevinCorbyn, Jeremy
Battle, JohnCorston, Jean
Bayley, HughCox, Tom
Bell, Stuart (Middlesbrough)Crausby, David
Benn, Rt Hon Tony (Chesterfield)Cryer, Mrs Ann (Keighley)
Bennett, Andrew FCummings, John
Benton, JoeDarling, Rt Hon Alistair
Bermingham, GeraldDavey, Valerie (Bristol W)
Best, HaroldDavidson, Ian
Betts, CliveDavies, Rt Hon Denzil (Llanelli)
Blears, Ms HazelDavies, Geraint (Croydon C)
Boateng, Rt Hon PaulDavis, Rt Hon Terry
Borrow, David(B'ham Hodge H)
Bradley, Keith (Withington)Dawson, Hilton
Bradshaw, BenDean, Mrs Janet
Brinton, Mrs HelenDenham, John
Browne, DesmondDismore, Andrew
Burden, RichardDobbin, Jim
Dobson, Rt Hon Frank
Butler, Mrs ChristineDoran, Frank
Byers, Rt Hon StephenDowd, Jim
Campbell, Alan (Tynemouth)Eagle, Angela (Wallasey)
Campbell-Savours, DaleEagle, Maria (L'pool Garston)
Cann, JamieEdwards, Huw
Caton, MartinEfford, Clive
Cawsey, IanEllman, Mrs Louise
Chapman, Ben (Wirral S)Ennis, Jeff
Chaytor, DavidEtherington, Bill
Field, Rt Hon FrankLloyd, Tony (Manchester C)
Fisher, MarkLove, Andrew
Fitzpatrick, JimMcAvoy, Thomas
Fitzsimons, Mrs LornaMcCabe, Steve
Flint, CarolineMcCafferty, Ms Chris
Flynn, PaulMcCartney, Rt Hon Ian
Follett, Barbara(Makerfield)
Foster, Rt Hon DerekMacdonald, Calum
Foster, Michael J (Worcester)McDonnell, John
Foulkes, GeorgeMcFall, John
Galloway, GeorgeMcGuire, Mrs Anne
Gapes, MikeMcKenna, Mrs Rosemary
George, Rt Hon Bruce (Walsall S)McNulty, Tony
Gerard, NeilMactaggart, Fiona
Gibson, Dr IanMcWalter, Tony
Gilroy, Mrs LindaMcWilliam, John
Godsiff, RogerMahon, Mrs Alice
Goggins, PaulMallaber, Judy
Golding, Mrs LlinMandelson, Rt Hon Peter
Gordon, Mrs EileenMarshall, Jim (Leicester S)
Griffiths, Jane (Reading E)Maxton, John
Griffiths, Nigel (Edinburgh S)Meacher, Rt Hon Michael
Griffiths, Win (Bridgend)Meale, Alan
Grocott, BruceMichael, Rt Hon Alun
Grogan, JohnMichie, Bill (Shef'ld Heeley)
Hain, PeterMilburn, Rt Hon Alan
Hall, Mike (Weaver Vale)Miller, Andrew
Hamilton, Fabian (Leeds NE)Mitchell, Austin
Hanson, DavidMoffatt, Laura
Harman, Rt Hon Ms HarrietMoonie, Dr Lewis
Healey, JohnMorgan, Ms Julie (Cardiff N)
Henderson, Doug (Newcastle N)Morley, Elliot
Hendrick, MarkMorris, Rt Hon Ms Estelle
Hepburn, Stephen(B'ham Yardley)
Heppell, JohnMorris, Rt Hon Sir John
Hewitt, Ms Patricia(Aberavon)
Hill, KeithMountford, Kali
Hinchliffe, DavidMullin, Chris
Hodge, Ms MargaretMurphy, Rt Hon Paul (Torfaen)
Hoey, KateNaysmith, Dr Doug
Hoon, Rt Hon GeoffreyNorris, Dan
Hope, PhilO'Brien, Bill (Normanton)
Hopkins, KelvinO'Brien, Mike (N Warks)
Howarth, Rt Hon Alan (Newport E)O'Hara, Eddie
Howells, Dr KimPickthall, Colin
Hughes, Ms Beverley (Stretford)Pike, Peter L
Hughes, Kevin (Doncaster N)Pond, Chris
Hurst, AlanPope, Greg
Hutton, JohnPound, Stephen
Iddon, Dr BrianPowell, Sir Raymond
Jackson, Helen (Hillsborough)Prentice, Ms Bridget (Lewisham E)
Jamieson, DavidPrentice, Gordon (Pendle)
Jenkins, BrianPrescott, Rt Hon John
Johnson, Alan (Hull W& Hessle)Primarolo, Dawn
Johnson, Miss MelanieProsser, Gwyn
(Welwyn Hatfield)Purchase, Ken
Jones, Rt Hon Barry (Alyn)Quinn, Lawrie
Jones, Helen (Warrington N)Rapson, Syd
Jones, Dr Lynne (Selly Oak)Reed, Andrew (Loughborough)
Jones, Martyn (Clwyd S)Robertson, John
Jowell, Rt Hon Ms Tessa(Glasgow Anniesland)
Joyce, EricRobinson, Geoffrey (Cov'try NW)
Kaufman, Rt Hon GeraldRoche, Mrs Barbara
Keeble, Ms SallyRogers, Allan
Keen, Alan (Feltham & Heston)Rooker, Rt Hon Jeff
Keen, Ann (Brentford & Isleworth)Rooney, Terry
Kemp, FraserRoss, Ernie (Dundee W)
Kennedy, Jane (Wavertree)Roy, Frank
Kidney, DavidRuane, Chris
Kilfoyle, PeterRuddock, Joan
King, Andy (Rugby & Kenilworth)Russell, Ms Christine (Chester)
Ladyman, Dr StephenSalter, Martin
Lammy, DavidSarwar, Mohammad
Lawrence, Mrs JackieSavidge, Malcolm
Leslie, ChristopherSedgemore, Brian
Lewis, Ivan (Bury S)Sheldon, Rt Hon Robert
Short, Rt Hon ClareTipping, Paddy
Simpson, Alan (Nottingham S)Todd, Mark
Skinner, DennisTrickett Jon
Smith, Rt Hon Andrew (Oxford E)Truswell, Paul
Smith, Angela (Basildon)Turner, Dennis (Wolverh'ton SE)
Smith, Miss GeraldineTurner, Dr Desmond (Kemptown)
(Morecambe & Lunesdale)Turner, Neil (Wigan)
Smith, Jacqui (Redditch)Twigg, Derek (Halton)
Smith, Llew (Blaenau Gwent)Vis, Dr Rudi
Snape, PeterWard, Ms Claire
Soley, CliveWareing, Robert N
Spellar, JohnWatts, David
Squire, Ms RachelWhitehead, Dr Alan
Stevenson, GeorgeWilliams, Alan W (E Carmarthen)
Stewart, David (Inverness E)Williams, Mrs Betty (Conwy)
Stewart, Ian (Eccles)Wilson, Brian
Stoate, Dr HowardWinntek, David
Stringer, GrahamWinterton, Ms Rosie (Doncaster C)
Stuart, Ms GiselaWood, Mike
Sutcliffe, GerryWoodward, Shaun
Taylor, Rt Hon Mrs AnnWray, James
(Dewsbury)Wright, Tony (Cannock)
Taylor, Ms Dari (Stockton S)Wyatt, Derek
Temple—Morris, Peter
Thomas, Gareth (Clwyd W)Tellers for the Noes:
Thomas, Gareth R (Harrow W)Mr. Graham Allen and
Timms, StephenMr. Ian Pearson.

Question accordingly nagatived.

Question, that the proposed words be there added, put forthwith, pursuant to Standing Order NO. 31 (Questions on amendments):

The House divided: Ayes 270,Noes 41.

Division No. 105][10.13 pm
AYES
Abbott, Ms DianeClapham, Michael
Adams, Mrs Irene (Paisley N)Clark, Dr Lynda
Ainger, Nick(Edinburgh Pentlands)
Ainsworth, Robert (Cov'try NE)Clark, Paul (Gillingham)
Armstrong, Rt Hon Ms HilaryClarke, Rt Hon Tom (Coatbridge)
Ashton, JoeClelland, David
Atherton, Ms CandyCoffey, Ms Ann
Austin, JohnColeman, Iain
Bailey, AdrianColman, Tony
Banks, TonyConnarty, Michael
Barnes, HarryCooper, Yvette
Barron, KevinCorbett, Robin
Battle, JohnCorston, Jean
Bayley, HughCox, Tom
Benn, Rt Hon Tony (Chesterfield)Crausby, David
Bennett, Andrew FCryer, Mrs Ann (Keighley)
Benton, JoeCummings, John
Bermingham, GeraldDarling, Rt Hon Alistair
Best, HaroldDavey, Valerie (Bristol W)
Betts, CliveDavidson, Ian
Blears, Ms HazelDavies, Rt Hon Denzil (Llanelli)
Boateng, Rt Hon PaulDavies, Geraint (Croydon C)
Borrow, DavidDavis, Rt Hon Terry
Bradley, Keith (Withington)(B'ham Hodge H)
Bradshaw, BenDawson, Hilton
Brinton, Mrs HelenDean, Mrs Janet
Browne, DesmondDenham, John
Burden, RichardDismore, Andrew
Butler, Mrs ChristineDobbin, Jim
Byers, Rt Hon StephenDobson, Rt Hon Frank
Campbell, Alan (Tynemouth)Doran, Frank
Campbell-Savours, DaleDowd, Jim
Cann, JamieEagle, Angela (Wallasey)
Caton, MartinEagle, Maria (L 'pool Garston)
Cawsey, IanEdwards, Huw
Chapman, Ben (Wirral S)Efford, Clive
Chaytor, DavidEllman, Mrs Louise
Ennis, JeffLeslie, Christopher
Etherington, BillLewis, Ivan (Bury S)
Field, Rt Hon FrankUoyd, Tony (Manchester C)
Fisher, MarkLove, Andrew
Fitzpatrick, JimMcAvoy, Thomas
Fitzsimons, Mrs LornaMcCabe, Steve
Flint, CarolineMcCafferty, Ms Chris
Flynn, PaulMcCartney, Rt Hon Ian
Follett, Barbara(Makerfield)
Foster, Rt Hon DerekMacdonald, Calum
Foster, Michael J (Worcester)McDonnell, John
Foulkes, GeorgeMcFall, John
Galloway, GeorgeMcGuire, Mrs Anne
Gapes, MikeMcKenna, Mrs Rosemary
George, Rt Hon Bruce (Walsall S)McNulty, Tony
Gerrard, NeilMactaggart, Fiona
Gibson, Dr IanMcWalter, Tony
Gilroy, Mrs LindaMcWilliam, John
Godsiff, RogerMahon, Mrs Alice
Goggins, PaulMallaber, Judy
Golding, Mrs LlinMandelson, Rt Hon Peter
Gordon, Mrs EileenMarshall, Jim (Leicester S)
Griffiths, Jane (Reading E)Marshall-Andrews, Robert
Griffiths, Nigel (Edinburgh S)Maxton, John
Griffiths, Win (Bridgend)Meacher, Rt Hon Michael
Grocott, BruceMeale, Alan
Grogan, JohnMichael, Rt Hon Alun
Hain, PeterMichie, Bill (Shef'ld Heeley)
Hall, Mike (Weaver Vale)Milburn, Rt Hon Alan
Hamilton, Fabian (Leeds NE)Miller, Andrew
Hanson, DavidMitchell, Austin
Harman, Rt Hon Ms HarrietMoffatt, Laura
Healey, JohnMoonie, Dr Lewis
Henderson, Doug (Newcastle N)Morgan, Ms Julie (Cardiff N)
Hendrick, MarkMorley, Elliot
Hepburn, StephenMorris, Rt Hon Ms Estelle
Heppell, John(B'ham Yardley)
Hewitt, Ms PatriciaMorris, Rt Hon Sir John
Hill, Keith(Aberavon)
Hinchliffe, DavidMountford, Kali
Hodge, Ms MargaretMullin, Chris
Hoey, KateMurphy, Rt Hon Paul (Torfaen)
Hoon, Rt Hon GeoffreyNaysmith, Dr Doug
Hope, PhilNorris, Dan
Hopkins, KelvinO'Brien, Bill (Normanton)
Howarth, Rt Hon Alan (Newport E)O'Brien, Mike (N Warks)
Howells, Dr KimO'Hara, Eddie
Hughes, Ms Beverley (Stretford)Pickthall, Colin
Hughes, Kevin (Doncaster N)Pike, Peter L
Hurst AlanPond, Chris
Hutton, JohnPope, Greg
Iddon, Dr BrianPound, Stephen
Jackson, Helen (Hillsborough)Powell, Sir Raymond
Jamieson, DavidPrentice, Ms Bridget (Lewisham E)
Jenkins, BrianPrentice, Gordon (Pendle)
Johnson, Alan (Hull W& Hessle)Prescott, Rt Hon John
Johnson, Miss MelaniePrimarob, Dawn
(Welwyn Hatfield)Prosser, Gwyn
Jones, Rt Hon Barry (Alyn)Purchase, Ken
Jones, Helen (Warrington N)Quinn, Lawrie
Jones, Dr Lynne (Selly Oak)Rapson, Syd
Jones, Martyn (Clwyd S)Reed, Andrew (Loughborough)
Jowell, Fit Hon Ms TessaRobertson, John
Joyce, Eric(Glasgow Anniesland)
Kaufman, Rt Hon GeraldRobinson, Geoffrey (Cov'try NW)
Keeble, Ms SallyRoche, Mrs Barbara
Keen, Alan (Feltham & Heston)Rogers, Allan
Keen, Ann (Brentford & Isleworth)Rooker, Rt Hon Jeff
Kemp, FraserRooney, Terry
Kennedy, Jane (Wavertree)Ross, Ernie (Dundee W)
Kidney, DavidRoy, Frank
Kilfoyle, PeterRuane, Chris
King, Andy (Rugby & Kenilworth)Ruddock, Joan
Ladyman, Dr StephenRussell, Ms Christine (Chester)
Lammy, DavidSalter, Martin
Lawrence, Mrs JackieSarwar, Mohammad
Savidge, MalcolmThomas, Gareth R (Harrow W)
Sedgemore, BrianTimms, Stephen
Sheldon, Rt Hon RobertTipping, Paddy
Short, Rt Hon ClareTodd, Mark
Simpson, Alan (Nottingham S)Trickett, Jon
Skinner, DennisTruswell, Paul
Smith, Rt Hon Andrew (Oxford E)Turner, Dennis (Wolverh'ton SE)
Smith, Angela (Basildon)Turner, Dr Desmond (Kemptown)
Smith, Miss GeraldineTurner, Neil (Wigan)
(Morecambe & Lunesdale)Twigg, Derek (Halton)
Smith, Jacqui (Redditch)Vis, Dr Rudi
Smith, Llew (Blaenau Gwent)Ward, Ms Claire
Snape, PeterWareing, Robert N
Soley, CliveWatts, David
Spellar, JohnWhitehead, Dr Alan
Squire, Ms RachelWilliams, Alan W (E Carmarthen)
Williams, Mrs Betty (Conwy)
Stevenson, GeorgeWilson, Brian
Stewart, David (Inverness E)Winnick, David
Stewart, Ian (Eccles)Winterton, Ms Rosie (Doncaster C)
Stoate, Dr HowardWood, Mike
Stringer, GrahamWoodward, Shaun
Stuart, Ms GiselaWray, James
Sutclitfe, GerryWright, Tony (Cannock)
Taylor, Rt Hon Mrs AnnWyatt, Derek
(Dewsbury)
Taylor, Ms Dari (Stockton S)Tellers for the Ayes:
Temple-Morris, PeterMr. Ian Pearson and
Thomas, Gareth (Clwyd W)Mr. Graham Allen.
NOES
Allan, RichardJones, Nigel (Cheltenham)
Baker, NormanKeetch, Paul
Ballard, JackieKennedy, Rt Hon Charles
Berth, Rt Hon A J(Ross Skye & Inverness W)
Bell, Martin (Tatton)Kirkwood, Archy
Brake, TomLivsey, Richard
Brand, Dr PeterUwyd, Elfyn
Breed, ColinMichie, Mrs Ray (Argyll & Bute)
Burnett, JohnMoore, Michael
Burstow, PaulOaten, Mark
Campbell, Rt Hon MenziesÖpik, Lembit
(NE Fife)Rendel, David
Russell, Bob (Colchester)
Cotter, BrianSanders, Adrian
Davey, Edward (Kingston)Taylor, Matthew (Truro)
Fearn, RonnieThomas, Simon (Ceredigion)
George, Andrew (St Ives)Tonge, Dr Jenny
Gidley, SandraTyler, Paul
Gorrie, DonaldWebb, Steve
Hancock, MikeWillis, Phil
Harris, Dr Evan
Harvey, NickTellers for the Noes:
Heath, David (Somerton & Frome)Mr. Andrew Stunell and
Hughes, Simon (Southwark N)Mr. Don Foster.

Question accordingly agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,

That this House welcomes the NHS Plan's commitments to a care system founded on the principles of equity and fairness; welcomes the measures the Government has announced to reform the funding of long term care and to invest in new health and social care services for older people; notes that this matches the extra spending on long term care recommended by the Royal Commission; believes that the implementation of free nursing care on the basis of need and not ability to pay will bring an end to a major injustice affecting tens of thousands of older people in nursing homes; welcomes the new investment announced in the NHS Plan of £900 million annually by 2003–04 in new intermediate care services for older people; supports the priority the Government has rightly attached to improving front line services for older people; and calls on the Liberal Democrats to set out what services they would cut in order to fund their proposals.